Digital solutions to optimize guideline-directed medical therapy prescription rates in patients with heart failure: a clinical consensus statement from the ESC Working Group on e-Cardiology, the Heart Failure Association of the European Society of Cardiology, the Association of Cardiovascular Nursing & Allied Professions of the European Society of Cardiology, the ESC Digital Health Committee, the ESC Council of Cardio-Oncology, and the ESC Patient Forum
European Heart Journal - Digital Health,
Год журнала:
2024,
Номер
5(6), С. 670 - 682
Опубликована: Авг. 30, 2024
Abstract
The
2021
European
Society
of
Cardiology
guideline
on
diagnosis
and
treatment
acute
chronic
heart
failure
(HF)
the
2023
Focused
Update
include
recommendations
pharmacotherapy
for
patients
with
New
York
Heart
Association
(NYHA)
class
II–IV
HF
reduced
ejection
fraction.
However,
multinational
data
from
EVOLUTION
study
found
substantial
prescribing
inertia
guideline-directed
medical
therapy
(GDMT)
in
clinical
practice.
cause
was
multifactorial
included
limitations
organizational
resources.
Digital
solutions
like
digital
consultation,
remote
monitoring,
interrogation
cardiac
implantable
electronic
devices,
decision
support
systems,
multifaceted
interventions
are
increasingly
available
worldwide.
objectives
this
Clinical
Consensus
Statement
to
provide
(i)
examples
that
can
aid
optimization
prescription
GDMT,
(ii)
evidence-based
insights
GDMT
using
solutions,
(iii)
current
evidence
gaps
implementation
barriers
limit
adoption
practice,
(iv)
critically
discuss
strategies
achieve
equality
access,
reference
patient
subgroups.
Embracing
through
use
consults
monitoring
will
future-proof,
example
alerts
clinicians,
informing
them
suboptimal
GDMT.
Researchers
should
consider
employing
optimize
effectiveness
designs
fit
unique
sociotechnical
aspects
solutions.
Artificial
intelligence
handle
larger
sets
relieve
professionals’
workloads,
but
as
artificial
limited,
further
investigation
is
warranted.
Язык: Английский
Digital consults in heart failure care: a randomized controlled trial
Nature Medicine,
Год журнала:
2024,
Номер
unknown
Опубликована: Авг. 31, 2024
Abstract
Guideline-directed
medical
therapy
(GDMT)
has
clear
benefits
on
morbidity
and
mortality
in
patients
with
heart
failure;
however,
GDMT
use
remains
low.
In
the
multicenter,
open-label,
investigator-initiated
ADMINISTER
trial,
(
n
=
150)
diagnosed
failure
reduced
ejection
fraction
(HFrEF)
were
randomized
(1:1)
to
receive
usual
care
or
a
strategy
using
digital
consults
(DCs).
DCs
contained
(1)
data
sharing
from
patient
clinician
(pharmacotherapy
use,
home-measured
vital
signs
Kansas
City
Cardiomyopathy
Questionnaires);
(2)
education
via
text-based
e-learning;
(3)
guideline
recommendations
all
treating
clinicians.
All
remotely
gathered
information
was
processed
into
summary
that
available
clinicians
electronic
health
record
before
every
consult.
interactions
standardly
conducted
remotely.
The
primary
endpoint
change
score
over
12
weeks
(ΔGDMT);
this
directly
incorporated
non-conditional
class
1
indications
for
HFrEF
equal
weights.
trial
met
its
outcome
of
achieving
higher
DC
group
after
follow-up
(ΔGDMT
group:
median
1.19,
interquartile
range
(0.25,
2.3)
arbitrary
units
versus
0.08
(0.00,
1.00)
care;
P
<
0.001).
To
our
knowledge,
is
first
multicenter
controlled
proves
effective
achieve
optimization.
ClinicalTrials.gov
registration:
NCT05413447
.
Язык: Английский
Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions
Current Heart Failure Reports,
Год журнала:
2024,
Номер
21(2), С. 147 - 161
Опубликована: Фев. 16, 2024
Abstract
Purposeof
Review
Guideline-directed
medical
therapy
(GDMT)
underuse
is
common
in
heart
failure
(HF)
patients.
Digital
solutions
have
the
potential
to
support
professionals
optimize
GDMT
prescriptions
a
growing
HF
population.
We
aimed
review
current
literature
on
effectiveness
of
digital
optimization
patients
with
HF.
Recent
Findings
report
efficacy,
characteristics
study,
and
population
published
for
optimization.
The
following
are
discussed:
teleconsultation,
telemonitoring,
cardiac
implantable
electronic
devices,
clinical
decision
embedded
within
health
records,
multifaceted
interventions.
Effect
reported
dedicated
studies,
retrospective
or
larger
studies
another
focus
that
also
commented
use.
Overall,
we
see
more
significant
increase
However,
there
large
heterogeneity
study
design,
outcomes
used,
populations
studied,
which
hampers
comparison
different
solutions.
Barriers,
facilitators,
designs,
future
directions
discussed.
Summary
There
remains
need
well-designed
evaluation
determine
safety
Based
this
review,
measuring
controlling
vital
signs
telemedicine
should
be
encouraged,
actively
alerted
about
suboptimal
GDMT,
researchers
consider
employing
effectiveness,
use
designs
fit
unique
sociotechnical
aspects
Future
expected
include
artificial
intelligence
handle
datasets
relieve
professional’s
workload.
Язык: Английский
Digital consults to optimize guideline‐directed therapy: design of a pragmatic multicenter randomized controlled trial
ESC Heart Failure,
Год журнала:
2023,
Номер
11(1), С. 560 - 569
Опубликована: Дек. 26, 2023
Many
heart
failure
(HF)
patients
do
not
receive
optimal
guideline-directed
medical
therapy
(GDMT)
despite
clear
benefit
on
morbidity
and
mortality
outcomes.
Digital
consults
(DCs)
have
the
potential
to
improve
efficiency
GDMT
optimization
serve
growing
HF
population.
The
investigator-initiated
ADMINISTER
trial
was
designed
as
a
pragmatic
multicenter
randomized
controlled
open-label
evaluate
efficacy
safety
of
DC
in
treatment.
Язык: Английский