Despite proven benefits in reducing morbidity and mortality, many heart failure (HF) patients do not receive optimal guideline-directed medical therapy (GDMT). The 2021 European Society of Cardiology guidelines recommend guideline-directed medical therapy (GDMT) for patients with HF with reduced ejection fraction (HFrEF). This includes beta-blockers, ACE inhibitors, ARBs, ARNIs, MRAs, and SGLT2 inhibitors. The greatest benefit is seen with a combination of beta-blocker, ARNI, MRA, and SGLT2. Rapid sequencing and avoidance of delays in GDMT setup are crucial, yet substantial underuse persists, with slow optimization and low target dose achievement. Factors like race, gender, and socio-economic status further influence GDMT utilization.
Digital consults (DCs) offer a promising solution to enhance GDMT optimization for the growing HF population. Digital consults (DCs), involving remote measurements, tailored clinical summaries, and e-learning, hold promise for improving GDMT prescriptions. The COVID-19 pandemic highlighted the potential of video consults (VCs), even among older patients, to support self-care, improve disease management, and facilitate collaboration with caregivers.
A new trial, ADMINISTER (Assessment of Digital Consults on Clinical Impact and Efficiency using an RCT), aims to evaluate the efficacy and safety of a multifaceted digital intervention for GDMT optimization in HFrEF patients. This trial adopts a remote strategy for GDMT optimization.
The investigator-initiated ADMINISTER trial is a pragmatic multicenter randomized controlled open-label study designed to evaluate the efficacy and safety of DCs for patients undergoing HF treatment.
The trial will randomize 150 patients with HF and reduced ejection fraction to either DC or standard care (1:1). The intervention group will receive comprehensive DCs, including:
1. Digital data sharing (e.g., pharmacotherapy use and home-measured vital signs).
2. Patient education through e-learning.
3. Digital guideline recommendations for treating clinicians.
Consults will be performed remotely unless a physical consult is indicated. The primary outcome is the GDMT prescription rate score, with secondary outcomes covering the time to full GDMT optimization, patient and clinician satisfaction, time spent on healthcare, and the Kansas City Cardiomyopathy Questionnaire.
The ADMINISTER trial aims to provide the first randomized controlled data on the impact of DCs on GDMT prescription rates, optimization time, healthcare efficiency, quality of life, and satisfaction for both patients and clinicians. The results of this trial are eagerly anticipated.
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Original article: Man JP et al. ESC Heart Failure 2024; 11: 560–569.
