AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Guideline-Directed Medical Therapy in Heart Failure: Comparison of a Real-World Telemonitoring Cohort and Matched Registry Controls
By Sjoland H, Sakalaki M, Fu M et al.
Background: Telemonitoring programs may facilitate more efficient up-titration of guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF), potentially reducing the need for in-person visits and accelerating the attainment of target doses. Research Question: To evaluate whether patients with HFrEF enrolled in a real-world telemonitoring program during the GDMT up-titration phase achieved more complete and rapid results compared with a matched control group from the Swedish Heart Failure registry. Methods: Consecutive patients with new or worsening HFrEF were recruited for telemonitoring (June 2020-July 2023) for 6 months (cases, n=222). Controls (n=2,136) were identified from the national Swedish HF registry, matched for age, sex, LVEF, HF duration, calendar time, and hospital admission <1 year prior to baseline. Patients provided daily self-measurements of weight, blood pressure, and pulse rate by wireless transmission, integrated into the HF team workflow and equipped with a chat-function for asynchronous communication, clinically evaluated by an HF nurse. HF-nurses were instructed to follow regular up-titration protocols for GDMT, but to perform up-titration steps without physical appointments, if remote reports permitted. Follow-up data were collected from medical records and national registers. The primary endpoint was attainment of GDMT target doses at 90 and 180 days. The secondary endpoint was number of in-person visits during telemonitoring. Results: Baseline characteristics are summarized in Table 1. Age, sex and comorbidities were similarly distributed between groups, while differences were observed in renal function, NT-proBNP levels, and NYHA class. The number of in-person physician visits was similar between cases and controls during telemonitoring (rate ratio 1.01, p=NS). Compared with controls, telemonitored patients had higher odds of achieving higher doses, closer to target doses, of mineralocorticoid receptor antagonists (MRA) at 90 days (OR 1.31, 95% CI 1.02—1.68, p=0.032) and 180 days (OR 1.78, 95% CI 1.40—2.25, p<.0001). Similarly, higher odds of achieving doses of SGLT inhibitors closer to target, were observed at 90 days (OR 1.51, 95% CI 1.15—1.98, p=0.0028) and 180 days (OR 1.48, 95% CI 1.12—1.95, p=0.0051) (Figure 1). Conclusions: In a real-world cohort of patients with new or worsening HFrEF, telemonitoring was associated with higher odds of achieving higher doses, achieving doses, closer to guideline-recommended targets for MRA and SGLT2 inhibitors.