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Review
. 2024 Apr;21(2):147-161.
doi: 10.1007/s11897-024-00649-x. Epub 2024 Feb 16.

Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions

Jelle P Man  1   2 , Joanna Klopotowska  3   4 , Folkert W Asselbergs  5   6   7 , M Louis Handoko  1   7 , Steven A J Chamuleau  1   2 , Mark J Schuuring  8   9
Affiliations
Review

Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions

Jelle P Man et al. Curr Heart Fail Rep. 2024 Apr.

Abstract

Purposeof review: Guideline-directed medical therapy (GDMT) underuse is common in heart failure (HF) patients. Digital solutions have the potential to support medical professionals to optimize GDMT prescriptions in a growing HF population. We aimed to review current literature on the effectiveness of digital solutions on optimization of GDMT prescriptions in patients with HF.

Recent findings: We report on the efficacy, characteristics of the study, and population of published digital solutions for GDMT optimization. The following digital solutions are discussed: teleconsultation, telemonitoring, cardiac implantable electronic devices, clinical decision support embedded within electronic health records, and multifaceted interventions. Effect of digital solutions is reported in dedicated studies, retrospective studies, or larger studies with another focus that also commented on GDMT use. Overall, we see more studies on digital solutions that report a significant increase in GDMT use. However, there is a large heterogeneity in study design, outcomes used, and populations studied, which hampers comparison of the different digital solutions. Barriers, facilitators, study designs, and future directions are discussed. There remains a need for well-designed evaluation studies to determine safety and effectiveness of digital solutions for GDMT optimization in patients with HF. Based on this review, measuring and controlling vital signs in telemedicine studies should be encouraged, professionals should be actively alerted about suboptimal GDMT, the researchers should consider employing multifaceted digital solutions to optimize effectiveness, and use study designs that fit the unique sociotechnical aspects of digital solutions. Future directions are expected to include artificial intelligence solutions to handle larger datasets and relieve medical professional's workload.

Keywords: Digital health; Digital solutions; GDMT; Guideline recommendations; Heart failure; eHealth.

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Conflict of interest statement

M.L. Handoko is supported by the Dutch Heart Foundation (2020T058) and Netherlands CardioVascular Research Initiative (CVON): the Dutch Heart Foundation, Dutch Federation of University Medical Centres, the Netherlands Organisation for Health Research and Development, and the Royal Netherlands Academy of Sciences (CVON; 2020B008). M.L. Handoko received an educational grant from Novartis and Boehringer Ingelheim, and speaker/consultancy fees from Novartis, Boehringer Ingelheim, Daiichi Sankyo, Vifor Pharma, AstraZeneca, Bayer, MSD, Abbott and Quin

Figures

Fig. 1
Fig. 1
Major types of digital solutions for GDMT optimization discussed in this review
Fig. 2
Fig. 2
Necessities for a successful implementation of digital solutions for GDMT optimization in multiple hospitals
See this image and copyright information in PMC

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