Telemedicine: an effective tool for up-titration of prognosis-modifying HFrEF therapy

Abstract

Introduction and Objectives: Heart Failure with reduced ejection fraction (HFrEF) management requires the rapid implementation of prognosis-modifying therapy (HFrEF-PMT) to target doses, within a 12-week recommended period. This may represent a significant challenge, however, the use of telemedicine may be a valuable tool for this purpose while reducing healthcare services' strain. We aimed at analyzing the role of telephone consultations for HFrEF-PMT rapid initiation and up-titration. Methods: All HFrEF patients attending a University Hospital HF Outpatient Clinic between March 2020 and February 2021 were screened. Patients who had, at least, one telephone consultation during the process of HFrEF PMT initiation/up-titration were included and were prospectively followed until December 2022. Results: Seventy-seven patients were included. A total of 105 HFrEF initiation/up-titration processes (IUPs) occurred, involving 150 telephone consultations. In 89 (85%) IUPs, we were able to increase the PMT dose with no adverse events. Target doses of angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, beta-blockers, and sodium-glucose co-transporter-2 inhibitors were achieved in 27%, 58%, 60%, and 50% of patients, respectively. Conclusion: Telephone consultations are a safe and effective tool in HF-PMT initiation/up-titration.