Impact of remote titration combined with telemonitoring on the optimization of guideline-directed medical therapy for patients with heart failure: internal pilot of a randomized controlled trial
Author(s)
Type
Journal Article
Abstract
Background:
To improve health outcomes in patients with heart failure, guideline-directed medical therapy (GDMT) should be optimized to target doses. However, GDMT remains underutilized, with less than 25% of patients receiving target doses in clinical practice. Telemonitoring could provide reliable and real-time physiological data for clinical decision support to facilitate remote GDMT titration.
Objective:
This paper aims to present findings from an internal pilot study regarding the effectiveness of remote titration facilitated by telemonitoring.
Methods:
A 2-arm randomized controlled pilot trial comparing remote titration versus standard care in a heart function clinic was conducted. Patients were randomized to undergo remote medication titration facilitated by data from a smartphone-based telemonitoring system or standard titration performed during clinic visits.
Results:
A total of 42 patients with new-onset (10/42, 24%) and existing (32/42, 76%) heart failure and a mean age of 55.29 (SD 11.28) years were randomized between January and June 2019. Within 6 months of enrollment, 86% (18/21) of patients in the intervention group achieved optimal doses versus 48% (10/21) of patients in the control group. The median time to dose optimization was 11.0 weeks for the intervention group versus 18.8 weeks for the control group. The number of in-person visits in the intervention group was 54.5% lower than in the control group.
Conclusions:
The results of this pilot study suggest that remote titration facilitated by telemonitoring has the potential to increase the proportion of patients who achieve optimal GDMT doses, decrease time to dose optimization, and reduce the number of clinic visits. Remote titration may facilitate optimal and efficient titration of patients with heart failure while reducing the burden for patients to attend in-person clinic visits.
Trial Registration:
ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513
To improve health outcomes in patients with heart failure, guideline-directed medical therapy (GDMT) should be optimized to target doses. However, GDMT remains underutilized, with less than 25% of patients receiving target doses in clinical practice. Telemonitoring could provide reliable and real-time physiological data for clinical decision support to facilitate remote GDMT titration.
Objective:
This paper aims to present findings from an internal pilot study regarding the effectiveness of remote titration facilitated by telemonitoring.
Methods:
A 2-arm randomized controlled pilot trial comparing remote titration versus standard care in a heart function clinic was conducted. Patients were randomized to undergo remote medication titration facilitated by data from a smartphone-based telemonitoring system or standard titration performed during clinic visits.
Results:
A total of 42 patients with new-onset (10/42, 24%) and existing (32/42, 76%) heart failure and a mean age of 55.29 (SD 11.28) years were randomized between January and June 2019. Within 6 months of enrollment, 86% (18/21) of patients in the intervention group achieved optimal doses versus 48% (10/21) of patients in the control group. The median time to dose optimization was 11.0 weeks for the intervention group versus 18.8 weeks for the control group. The number of in-person visits in the intervention group was 54.5% lower than in the control group.
Conclusions:
The results of this pilot study suggest that remote titration facilitated by telemonitoring has the potential to increase the proportion of patients who achieve optimal GDMT doses, decrease time to dose optimization, and reduce the number of clinic visits. Remote titration may facilitate optimal and efficient titration of patients with heart failure while reducing the burden for patients to attend in-person clinic visits.
Trial Registration:
ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513
Date Issued
2020-11-03
Date Acceptance
2020-09-30
Citation
Journal of Medical Internet Research, 2020, 22 (11), pp.1-14
ISSN
1438-8871
Publisher
JMIR Publications
Start Page
1
End Page
14
Journal / Book Title
Journal of Medical Internet Research
Volume
22
Issue
11
Copyright Statement
© Veronica Artanian, Heather J Ross, Valeria E Rac, Mary O'Sullivan, Darshan H Brahmbhatt, Emily Seto. Originally published
in JMIR Cardio (http://cardio.jmir.org), 03.11.2020. This is an open-access article distributed under the terms of the Creative
Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work, first published in JMIR Cardio, is properly cited. The complete
bibliographic information, a link to the original publication on http://cardio.jmir.org, as well as this copyright and license
information must be included.
in JMIR Cardio (http://cardio.jmir.org), 03.11.2020. This is an open-access article distributed under the terms of the Creative
Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work, first published in JMIR Cardio, is properly cited. The complete
bibliographic information, a link to the original publication on http://cardio.jmir.org, as well as this copyright and license
information must be included.
License URL
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000585384500017&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Medical Informatics
telemonitoring
remote
titration
monitoring
mHealth
heart failure
PRESERVED EJECTION FRACTION
MANAGEMENT PROGRAM
UP-TITRATION
TASK-FORCE
RISK
CARVEDILOL
MORTALITY
SOCIETY
PATHWAY
CARE
Publication Status
Published
Article Number
ARTN e21962
Date Publish Online
2020-11-03