ETD

• Heart Failure

Background: Suboptimal adherence to guideline-directed medical therapy (GDMT) remains a major barrier to effective heart failure (HF) management. We investigated whether digitally supported medication adherence and remote monitoring were associated with greater GDMT optimization and favorable changes in biomarkers, cardiac remodeling, and treatment burden.
Methods: We evaluated 113 HF outpatients: 50 used a digital tool providing medication reminders, active confirmation of medication intake, weekly remote adherence monitoring, and targeted clinician contact for persistent suboptimal adherence (digital-tool group), while 63 received standard follow-up (standard-care group). Clinical, laboratory, echocardiographic, and therapeutic changes were assessed over 9.0±3.6 months. Multi-class GDMT optimization was defined as optimization of ≥2 GDMT classes.
Results: Multi-class GDMT optimization was more frequent with digital support (24.0% vs 6.3%; OR 4.66, 95% CI 1.27–21.00; p=0.013). A ≥30% NT-proBNP reduction occurred in 59.1% versus 23.1% (p=0.002), with the association persisting after adjustment for baseline NT-proBNP (adjusted OR 7.94, 95% CI 2.58–24.45; p<0.001). Digital support was also associated with more frequent LVEF improvement (38.6% vs 17.5%; p=0.014), reductions in left ventricular mass index (70.3% vs 45.0%; p=0.015), end-diastolic volume (78.0% vs 57.1%; p=0.029), and end-diastolic diameter (70.0% vs 41.9%; p=0.006), and improvement in left atrial dilation class (50.0% vs 20.3%; p=0.003). Diuretic dose reduction was more frequent with digital support (30.0% vs 4.8%; p<0.001).
Conclusions: Digitally supported adherence and remote monitoring were associated with greater GDMT optimization, favorable biomarker response and cardiac reverse remodeling, and reduced diuretic requirements. These findings support prospective evaluation of digitally supported adherence strategies in longitudinal HF management.