DeVore Adam D, Walsh Mary Norine, Vardeny Orly, Albert Nancy M, Desai Akshay S
Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Ascension St Vincent Heart Center, Indianapolis, Indiana, USA.
JACC Heart Fail. 2025 May;13(5):675-684. doi: 10.1016/j.jchf.2024.10.014. Epub 2025 Jan 8.
Data from large-scale, randomized, controlled trials demonstrate that contemporary treatments for heart failure (HF) can substantially improve morbidity and mortality. Despite this, observed outcomes for patients living with HF are poor, and they have not improved over time. The are many potential reasons for this important problem, but inadequate use of optimal medical therapy for patients with HF, an important component of guideline-directed medical therapy, in routine practice is a principal and modifiable contributor. In this state-of-the-art review, we focus on digital interventions that specifically target the rapid initiation and titration of medical therapy for HF, typically not involving face-to-face encounters. Early data suggest that digital interventions that use data collected outside of structured episodes of care can facilitate initiation and titration of guideline-directed medical therapy for patients with HF. More data are necessary, however, to understand the safety and efficacy of these interventions compared with current care models. In addition, specific efforts by key constituents are necessary to generate sufficient data on the effectiveness and sustainability of digital interventions in routine practice and to ensure that they do not exacerbate existing disparities in care.
大规模随机对照试验的数据表明，当代心力衰竭（HF）治疗可显著改善发病率和死亡率。尽管如此，HF患者的实际治疗效果不佳，且长期以来并无改善。造成这一重要问题的潜在原因众多，但在常规实践中，HF患者未充分使用最佳药物治疗（这是指南指导药物治疗的重要组成部分）是一个主要且可改变的因素。在这篇前沿综述中，我们聚焦于数字干预措施，这些措施专门针对HF药物治疗的快速启动和滴定，通常不涉及面对面接触。早期数据表明，利用在结构化护理环节之外收集的数据进行数字干预，可促进HF患者启动和滴定指南指导的药物治疗。然而，与当前护理模式相比，还需要更多数据来了解这些干预措施的安全性和有效性。此外，关键参与者需做出具体努力，以生成关于数字干预在常规实践中的有效性和可持续性的充分数据，并确保这些干预措施不会加剧现有的护理差距。
