Quick Dive: Digital solutions to optimize heart failure therapy

What is the reason for and aim of the publication?

We have written this paper because digital solutions for the optimisation of guideline-directed medical therapy (GDMT) are quite new. What is particularly positive is that many different groups and organisations were involved in finding this consensus. The first goal was to classify the different types of digital solutions that can perform this optimisation. Then the different types of digital solutions that are currently available were critically evaluated. The overall goal is to optimise therapy and close the gap between what is prescribed in clinical practice and what the guidelines recommend.

What are the most important take-home messages?

We classified 5 types of digital solutions – digital consults, digital remote monitoring, multifaceted intervention, implantable devices and CDSS (clinical decision support system):

For each type, we have summarised the key features, interpretation of the literature, best practices and knowledge gaps.

Furthermore, the following aspects are important:

• We should embrace the different types of digital solutions more fully and there is still a lot to explore and implement in this area.
• Raising awareness: Clinicians need to be better informed about sub-optimal prescribing of GDMT to improve compliance with guidelines. They should also be informed about digital solutions that can support them.
• Although artificial intelligence is widely discussed, there is limited data on optimising heart failure and more research is needed.
• The use of multifaceted interventions is a promising approach, combining multiple digital solutions to achieve better outcomes. This is also underlined by a recent randomised controlled trial of multifaceted digital consults in heart failure care which I published with a research team in Nature Medicine.

What are challenges in practical implementation – and possible solutions?

Many people have ideas for digital solutions but don't know where to start because the field is too broad and too vague. We have listed best practices in the consensus paper, such as the integration of electronic health records or the use of secure and reliable platforms. These definitions in the consensus statement with steps for implementation and best practices can help people get started.

Which issues still need to be tackled, that are not yet addressed by the paper?

Larger outcome studies are necessary. At the moment, we mostly have smaller pilot studies that demonstrate the concept. The next step is larger studies, similar to drug trials, in which a large number of patients participate. The same applies to artificial intelligence, where we are generating plenty of results on workflow improvements, but still too few on clinical outcomes.

What further developments on the topic are emerging?

We are gaining more and more insight into the field of digital health. It is becoming clear that simply monitoring data is not enough – real action needs to be taken based on that data. We need "nudging tools" that put clinicians in an active role for the next step: For example, in the study published in Nature Medicine, clinicians were given a summary of telemonitoring data, heart rate, blood pressure, previous medication, patient wellbeing, a comparison with guidelines and then very specific next steps. This information was available to the clinicians in the electronic health record before each consultation. This works better than alerts or notifications that are clicked away. The focus needs to be on actively engaging clinicians rather than passively watching the data. This kind of smart active approach is key to the future of digital interventions.

Clinical consensus statement: "Digital solutions to optimize guideline-directed medical therapy prescription rates in patients with heart failure"

Reference: Schuuring MJ, Treskes RW, Castiello T, et al, Digital solutions to optimize guideline-directed medical therapy prescription rates in patients with heart failure: a clinical consensus statement from the ESC Working Group on e-Cardiology, the Heart Failure Association of the European Society of Cardiology, the Association of Cardiovascular Nursing & Allied Professions of the European Society of Cardiology, the ESC Digital Health Committee, the ESC Council of Cardio-Oncology, and the ESC Patient Forum, European Heart Journal - Digital Health, 2024. https://doi.org/10.1093/ehjdh/ztae064