Digital Health Intervention to Optimize Heart Failure Management After Hospital Discharge in Brazil (OPT-HF): A Randomized Clinical Trial

Why clinicians should know about it

• Picked for Cardiology and Cardiovascular Medicine (paper of the day, 7 November 2026): Randomized trial improves GDMT optimization after HFrEF hospitalization
• Picked for Family Practice (paper of the day, 7 November 2026): Randomized trial improves heart-failure therapy optimization after discharge

Abstract

BACKGROUND: Barriers to optimizing guideline-directed medical therapy (GDMT) for heart failure include infrequent clinical visits, clinician inertia, and poor patient knowledge. Digital health interventions (DHIs) may mitigate these barriers, but evidence from low- and middle-income countries is limited. We evaluated whether a DHI would improve GDMT use and other outcomes in Brazil. METHODS: We enrolled adults admitted for heart failure with ejection fraction <50% and GDMT gaps (≥1 GDMT class not started or ≥2 classes ≤50% target dose) across 5 Brazilian public hospitals from November 2023 to August 2025. Participants were randomized to usual care or the DHI comprising a patient-facing app linked to a provider dashboard, supporting nurse-led remote monitoring, cardiologist teleconsultations, and self-care education. The primary outcome was the between-group difference in mean heart failure GDMT score (0-12) at 90 days. Secondary outcomes included differences in health status, self-care, hospitalization rates, and all-cause mortality. Intention-to-treat analyses used baseline-adjusted linear regression and estimated risk ratios. RESULTS: Among 154 randomized patients (DHI: 87; usual care: 67), mean age was 65±14 years; 62% were male, 66% were Black, 44% had ≤4 years of education, and 68% were New York Heart Association class III/IV. Primary outcome data were available for 141 participants (91.6%; DHI: 81; usual care: 60). Mean GDMT scores increased from 7.2 in both groups to 10.5 with DHI versus 7.5 with usual care at 90 days (changes: +3.3 versus +0.3 points; adjusted difference, 3.01 [95% CI, 2.30-3.73]; P<0.001). A borderline difference was observed in health status (7.89; P=0.052). Improvements were observed in self-care (β=14.79 [95% CI, 9.78-19.81]; P<0.001). Fewer participants were hospitalized with DHI than usual care (9/87 [10.3%] versus 15/67 [22.4%]; risk ratio, 0.46 [95% CI, 0.21-0.99]; P=0.048), with no statistically significant difference for deaths. CONCLUSIONS: In patients hospitalized for heart failure in Brazil, a context-adapted DHI improved GDMT use, self-care, and reduced hospitalizations. These findings provide early randomized evidence supporting DHI for GDMT optimization in low-resource settings. REGISTRATION: URL: https://ensaiosclinicos.gov.br/rg/RBR-10vpf9bm; Unique identifier: U1111-1295-1864.

Abstract as published, via PubMed.