Bot-improve-hf: the potential of remote monitoring for rapid therapy optimization

Abstract Objectives Patients with heart failure with reduced ejection fraction (HFrEF) require rapid up-titration of guideline-directed medical therapies (GDMT) and monitoring after hospital discharge. Using a smartphone and a personal messenger app can help solve these problems. Purpose To evaluate the effectiveness of rapid titration of GDMT using remote monitoring. Materials and Methods The study involved 66 patients with HFrEF, who were randomized into a remote monitoring (RM) group and a usual care (UC) group. A remote monitoring strategy was implemented, which included sharing vital signs data through a mobile messaging app (chatbot) and providing weekly guidance to optimize treatment over six weeks. The patients in the UC group were observed by outpatient doctors. The combined endpoint was: all-cause mortality and HF hospitalizations. The study design was published in Clinical Trials Registry (NCT06304753). Results Twenty-six patients in the RM group and thirty-three patients in the UC group completed the six-month follow-up. The mean age was 61.5±12.1 years in the RM group and 63.6±11.8 years in UC group. There were no significant differences of sex, comorbidity or HF severity between groups. After 6 weeks, the percent of goal dose of GDMT increased significantly in the RM group (RAASi: 25% [25;25] vs 87.5% [50;100], p