Automated, Telemonitoring-Guided Optimization of Guideline-Directed Medical Therapy (GDMT) in Patients with Reduced Ejection Fraction Heart Failure

Abstract

Background: Despite robust evidence confirming their survival benefit, Guideline-Directed Medical Therapy (GDMT) regimens are systematically under-titrated in patients with Heart Failure with Reduced Ejection Fraction (HFrEF), limiting clinical gains. Effective and rapid up-titration is a complex logistical challenge often hindered by conventional follow-up schedules. We hypothesized that a novel, artificial intelligence enabled telemonitoring platform could safely accelerate and measurably enhance GDMT optimization rates.

Methods: This prospective, single-blind, randomized controlled trial (RCT) enrolled 320 chronic HFrEF patients across two regional specialized HF clinics. Participants were randomized 1:1 to either Standard of Care (SOC) follow-up or a Telemonitoring Intervention Group (TIG). The TIG received daily automated symptom/vital sign monitoring; an iterative AI-powered algorithm instantly alerted the medical team to parameters supporting safe up-titration of angiotensin receptor-neprilysin inhibitors or beta-blockers. The primary endpoint was the percentage of patients achieving 50% or greater target GDMT dose at 90 days. Statistical analysis utilized independent t-tests, Chi-square tests, and Kaplan-Meier survival analysis for clinical outcomes.  

Results: The Telemonitoring Intervention Group achieved the primary endpoint significantly faster than the Standard of Care group (78% vs. 49%, p<0.001). The median time required to achieve the 50% GDMT target dose was reduced by 34 days in the TIG (TIG median: 56 days; SOC median: 90 days; p<0.001). Furthermore, the TIG demonstrated a measurable and clinically significant reduction in the secondary endpoint of all-cause readmissions at 90 days (TIG: 12.5% vs. SOC: 21.9%; p=0.018). No differences in adverse event rates were observed between the two groups (p=0.45).

Conclusion: AI-enabled telemonitoring significantly accelerates the critical up-titration of GDMT in HFrEF, proving safe and highly effective in reducing readmissions. This rapid optimization strategy is essential for enhancing patient outcomes. Deploying such advanced digital platforms supports the regional goal of establishing an integrated care delivery model of the future, transforming chronic disease management.