Digital Versus Hospital Follow-Up for Heart Failure Management After Hospital Discharge A Study Comparing Home-Based Telehealth and Outpatient Clinic Care Using the STRONG-HF Strategy

What this Trial Is About

Researchers are evaluating if patients with acute heart failure can achieve the same level of heart failure medication management through digital follow-up at home compared to traditional hospital visits, based on the STRONG-HF strategy. This study addresses the challenge of low use of recommended heart failure therapies despite evidence showing they reduce mortality, aiming to improve care delivery by testing remote medication up-titration and follow-up. The trial builds on the STRONG-HF trials success, which showed better outcomes with early medication adjustment and follow-up in specialized clinics but faced barriers due to frequent hospital visits. Participants will be randomly assigned to one of two groups one receiving follow-up and heart failure medication management at home via telecommunication led by specialized nurses, including home visits at 1, 2, 3, and 6 weeks plus a primary care physician visit around week 2 the other group receiving follow-up and medication management at hospital outpatient clinics on the same schedule. Both groups follow the STRONG-HF intensive care strategy with early and rapid medication up-titration to at least half the maximum tolerated doses at discharge and then to maximum tolerated doses after 2 weeks, with safety visits at weeks 1, 3, and 6. During the 90-day study period, participants will be monitored for medication doses, heart function via echocardiography, blood tests including NT-proBNP, quality of life assessments, self-care, and patient satisfaction. Readmissions and survival will be tracked for up to 24 months. Follow-up visits occur weekly during the first 6 weeks, and researchers will assess treatment adherence, adverse events, and healthcare costs. This approach aims to reduce the burden on patients and healthcare systems while maintaining effective heart failure care.

Management of Patients With Heart Failure at Home After Hospital Discharge