ArticleAnnals of medicine and surgery (2012)2026
Digital and algorithmic strategies for guideline-directed medical therapy initiation and up-titration in adults with heart failure with reduced ejection fraction: a systematic review.
Article in Annals of medicine and surgery (2012), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Guideline-directed medical therapy (GDMT) reduces morbidity and mortality in heart failure with a reduced ejection fraction (HFrEF), yet underuse and suboptimal up-titration remain common. Digital and algorithmic strategies are increasingly being used to address these gaps, but their comparative effectiveness remains uncertain. Methods: This systematic review followed the PRISMA 2020 guidance and was prospectively registered with PROSPERO (CRD420251268580). PubMed, Embase, and Scopus were searched from inception through 26 December 2025. Randomized and comparative studies enrolling adults with HFrEF were eligible if they evaluated digital, algorithm-based, or telemonitoring strategies designed to facilitate GDMT initiation, titration, or optimization versus usual care. Results: Six randomized comparative trials involving 3706 participants were included. Interventions comprised provider-facing electronic health record alerts and digitally enabled remote titration or telemonitoring pathways. Five of the six trials showed improvements in medication-optimization outcomes; the single neutral trial was a provider-facing alert intervention that showed no difference in GDMT prescribing at hospital discharge. Remote pathway-based strategies demonstrated the largest effects, including higher titration completion (82.1% vs 53.8% at 6 months; an absolute difference of approximately 28 percentage points) and greater improvements in therapy scores. Alert-based interventions showed mixed findings, including no difference in overall GDMT class prescribing at discharge in one inpatient trial (34% vs 34%). Meta-analysis was not performed because of substantial heterogeneity in interventions, outcomes, and reporting formats. Conclusion: Digital strategies appear to improve GDMT optimization in HFrEF, particularly when embedded within structured care pathways that enable repeated reassessment and protocol-driven titration. Passive alerts alone appear less effective. Standardized outcome measures and trials evaluating clinical endpoints are needed.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.