@Article{info:doi/10.2196/cardio.9153,
author="Smeets, Christophe JP
and Storms, Valerie
and Vandervoort, Pieter M
and Dreesen, Pauline
and Vranken, Julie
and Houbrechts, Marita
and Goris, Hanne
and Grieten, Lars
and Dendale, Paul",
title="A Novel Intelligent Two-Way Communication System for Remote Heart Failure Medication Uptitration (the CardioCoach Study): Randomized Controlled Feasibility Trial",
journal="JMIR Cardio",
year="2018",
month="Apr",
day="04",
volume="2",
number="1",
pages="e8",
keywords="heart failure; telemedicine; clinical decision support; drug monitoring; drug utilization; call centers",
abstract="Background: European Society of Cardiology guidelines for the treatment of heart failure (HF) prescribe uptitration of angiotensin-converting enzyme inhibitors (ACE-I) and $\beta$-blockers to the maximum-tolerated, evidence-based dose. Although HF prognosis can drastically improve when correctly implementing these guidelines, studies have shown that they are insufficiently implemented in clinical practice. Objective: The aim of this study was to verify whether supplementing the usual care with the CardioCoach follow-up tool is feasible and safe, and whether the tool is more efficient in implementing the guideline recommendations for $\beta$-blocker and ACE-I. Methods: A total of 25 HF patients were randomly assigned to either the usual care control group (n=10) or CardioCoach intervention group (n=15), and observed for 6 months. The CardioCoach follow-up tool is a two-way communication platform with decision support algorithms for semiautomatic remote medication uptitration. Remote monitoring sensors automatically transmit patient's blood pressure, heart rate, and weight on a daily basis. Results: Patients' satisfaction and adherence for medication intake (10,018/10,825, 92.55{\%}) and vital sign measurements (4504/4758, 94.66{\%}) were excellent. However, the number of technical issues that arose was large, with 831 phone contacts (median 41, IQR 32-65) in total. The semiautomatic remote uptitration was safe, as there were no adverse events and no false positive uptitration proposals. Although no significant differences were found between both groups, a higher number of patients were on guideline-recommended medication dose in both groups compared with previous reports. Conclusions: The CardioCoach follow-up tool for remote uptitration is feasible and safe and was found to be efficient in facilitating information exchange between care providers, with high patient satisfaction and adherence. Trial Registration: ClinicalTrials.gov NCT03294811; https://clinicaltrials.gov/ct2/show/NCT03294811 (Archived by WebCite at http://www.webcitation.org/6xLiWVsgM) ",
issn="2561-1011",
doi="10.2196/cardio.9153",
url="http://cardio.jmir.org/2018/1/e8/",
url="https://doi.org/10.2196/cardio.9153",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758773"
}