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

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.

To evaluate the effectiveness of rapid titration of GDMT using remote monitoring.

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).

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<0.001; beta-blockers: 50% [25; 50] vs 100% [50; 100], p<0.001; MRA: 50 [50; 100] vs 100 [100; 100], p=0.003). There was no change in the UC group (RAASi: 25% [12.5;25] vs 25% [12.5;25], p=0.37; beta-blockers: 50% [25; 50] vs 50% [25; 50], p=0.59; MRA: 100% [50;100] vs 50% [50;100], p=0.03). Diuretic doses were reduced in the RM group and unchanged in the UC group. The intervention was safe with no reported complications. Two patients were hospitalized in the RM group. Two patients died and 14 were hospitalized in the UC group. After 6 months, the doses of GDMT were not changed in the RM group and there was an increase in the doses of RAASi in the UC group (25% [12.5; 25] vs 25% [25; 50], p<0.001). There was 1 death and 3 hospitalizations in the RM group and 5 deaths and 28 hospitalizations in the UC group after 6 months follow-up.

The BOT-IMPROVE-HF achieved a higher dose of GDMT in the RM group than in UC group during the first 6 weeks after discharge. This resulted in a significant reduction in the combined endpoint (mortality and HF hospitalizations). The data demonstrated the effectiveness and safety of remote GDMT rapid optimization.