ENGAGE-HF App Improves Guideline-Directed Therapy Optimization After Hospitalization

In a multicenter, open-label randomized trial of 134 recently hospitalized patients with heart failure and LVEF below 50%, a digital health intervention improved a medication-optimization score at 90 days compared with usual care. The trial found no significant between-group difference in Kansas City Cardiomyopathy Questionnaire clinical summary scores.

Randomized 134 recently hospitalized patients with LVEF below 50%.
Medication Optimization Score was higher with the app at 90 days.
No significant between-group difference in KCCQ-23 score.
Small trial with short follow-up and an intermediate primary outcome.

Suboptimal use of guideline-directed medical therapy (GDMT) remains common in heart failure with reduced or mildly reduced ejection fraction. ENGAGE-HF randomized 134 recently hospitalized patients with LVEF below 50% and suboptimal GDMT at three academic centers to usual care or a 90-day intervention comprising a patient-facing app and clinician dashboard overseen by study coordinators. The primary outcome was the Medication Optimization Score (MOS; 0–100%); secondary outcomes included individual therapies and the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-23 CSS).

At 90 days, adjusted MOS was 83.7% with ENGAGE-HF and 74.0% with usual care (p=0.010). Prescribing increased more in the intervention group for mineralocorticoid receptor antagonists (+15.9 vs +2.5 percentage points) and SGLT2 inhibitors (+10.9 vs +2.5 points). More participants also achieved target doses of ARNI (+18.8% vs +6.3%) and beta-blockers (+8.5% vs +0.6%). KCCQ-23 CSS was 75.2 versus 72.2, with no significant between-group difference (p=0.40).

The findings suggest the intervention can improve short-term GDMT optimization after hospitalization, but the trial was small and followed participants for only 90 days. The medication score is an intermediate outcome; the study did not demonstrate improved symptoms or clinical events. Funding was from the AHA Strategically Focused Research Network.

In practice

For patients recently hospitalized with heart failure and LVEF below 50% who are receiving suboptimal GDMT, the ENGAGE-HF app-and-dashboard intervention improved a medication-optimization score over 90 days compared with usual care. This is promising evidence for a care-process intervention, not evidence that the approach reduces hospitalization or mortality: the trial included 134 participants, follow-up was short, and KCCQ-23 clinical summary scores did not differ significantly between groups. The findings do not establish long-term benefit or applicability beyond the studied setting.

AI-generated clinical interpretation · Not editor-reviewed

AI summary · Not yet editor-reviewed

Is this summary clinically accurate?

Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.

Source

Circulation: Heart Failure: A Multicenter Randomized Controlled Trial of a Digital Health Intervention for Medication Optimization in Heart Failure: The ENGAGE-HF Trial Outcomes ↗

This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.