Effectiveness of a nurse-led telemedicine-based program for pharmacological and prognostic optimization of patients with heart failure and reduced ejection fraction: the MAR-HF-Titration study

Guidelines emphasize the importance of quadruple therapy in heart failure with reduced ejection fraction (HFrEF), and of achieving target doses quickly. The aim of the MAR-HF-Titration study was to assess the effectiveness of a nurse-led, telemedicine programme for this purpose.

Prospective study including 210 HFrEF patients between September 2021 and December 2023. The 6-month follow-up used a telemedicine programme involving daily telemonitoring of vital signs, weight and symptoms, routine laboratory test monitoring, videoconferences and the use of algorithms for drug titration. Mean age was 70 years, 35% women. Mean left ventricle ejection fraction (LVEF) was 31%, 60% had a non-ischaemic aetiology, and 61% newly diagnosed HF. After the intervention, significant increases were achieved in the use of quadruple therapy at any dose (63 vs. 75%; P = 0.001), at ≥50% of the target doses of each drug (10 vs. 44%, P < 0.001), and at target doses of all drugs (0 vs. 19%, P < 0.001). Median titration time was 45 days for beta-blockers, 65 for MRA, and 69 for ARNI. Older age, chronic kidney disease, hypotension, and higher NTproBNP were associated with lower odds of effective titration. The LVEF increased (31–45%, P < 0.001) and the NTproBNP values were significantly reduced (1960–806 pg/mL, P < 0.001). Increases in the use of prognostic medications were also observed in a sub-analysis restricted to participants aged ≥75 years.

Our intensive, nurse-led, telemedicine-based programme attained a fast optimization of prognostic therapies in HFrEF and resulted in significant improvements in parameters with prognostic relevance.