Schuuring Mark Johan, Treskes Roderick Willem, Castiello Teresa, Jensen Magnus Thorsten, Casado-Arroyo Ruben, Neubeck Lis, Lyon Alexander R, Keser Nurgul, Rucinski Marcin, Marketou Maria, Lambrinou Ekaterini, Volterrani Maurizio, Hill Loreena
Department of Biomedical Signals and Systems, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands.
Department of Cardiology, Medical Spectrum Twente, 7512 KZ Enschede, The Netherlands.
Eur Heart J Digit Health. 2024 Aug 30;5(6):670-682. doi: 10.1093/ehjdh/ztae064. eCollection 2024 Nov.
The 2021 European Society of Cardiology guideline on diagnosis and treatment of acute and chronic heart failure (HF) and the 2023 Focused Update include recommendations on the pharmacotherapy for patients with New York Heart Association (NYHA) class II-IV HF with reduced ejection fraction. However, multinational data from the EVOLUTION HF study found substantial prescribing inertia of guideline-directed medical therapy (GDMT) in clinical practice. The cause was multifactorial and included limitations in organizational resources. Digital solutions like digital consultation, digital remote monitoring, digital interrogation of cardiac implantable electronic devices, clinical decision support systems, and multifaceted interventions are increasingly available worldwide. The objectives of this Clinical Consensus Statement are to provide (i) examples of digital solutions that can aid the optimization of prescription of GDMT, (ii) evidence-based insights on the optimization of prescription of GDMT using digital solutions, (iii) current evidence gaps and implementation barriers that limit the adoption of digital solutions in clinical practice, and (iv) critically discuss strategies to achieve equality of access, with reference to patient subgroups. Embracing digital solutions through the use of digital consults and digital remote monitoring will future-proof, for example alerts to clinicians, informing them of patients on suboptimal GDMT. Researchers should consider employing multifaceted digital solutions to optimize effectiveness and use study designs that fit the unique sociotechnical aspects of digital solutions. Artificial intelligence solutions can handle larger data sets and relieve medical professionals' workloads, but as the data on the use of artificial intelligence in HF are limited, further investigation is warranted.
2021年欧洲心脏病学会急性和慢性心力衰竭（HF）诊断与治疗指南以及2023年聚焦更新版包括了对射血分数降低的纽约心脏协会（NYHA）II-IV级HF患者药物治疗的建议。然而，来自EVOLUTION HF研究的多国数据发现，在临床实践中，指南指导的药物治疗（GDMT）存在严重的处方惰性。原因是多方面的，包括组织资源的限制。数字解决方案，如数字会诊、数字远程监测、心脏植入式电子设备的数字问询、临床决策支持系统和多方面干预措施，在全球范围内越来越普及。本临床共识声明的目的是提供：（i）有助于优化GDMT处方的数字解决方案示例；（ii）关于使用数字解决方案优化GDMT处方的循证见解；（iii）限制数字解决方案在临床实践中应用的当前证据空白和实施障碍；（iv）参照患者亚组，批判性地讨论实现平等获取的策略。通过使用数字会诊和数字远程监测来接受数字解决方案将为未来做好准备，例如向临床医生发出警报，告知他们GDMT未达最佳状态的患者。研究人员应考虑采用多方面的数字解决方案来优化有效性，并使用适合数字解决方案独特社会技术方面的研究设计。人工智能解决方案可以处理更大的数据集并减轻医疗专业人员的工作量，但由于HF中使用人工智能的数据有限，有必要进行进一步调查。
