A registry-based\u00a0digital\u00a0strategy that\u00a0identified\u00a0untreated patients\u00a0and invited them to a telephone consultation\u00a0more than doubled\u00a0implementation of\u00a0an effective type of heart failure treatment.\u00a0These results from the EMAIL-HF trial were presented\u00a0in a Hot Line session today at ESC Congress 2026.<\/p>\n
Affecting\u00a0more than 64 million individuals worldwide, heart failure is a major public health\u00a0issue that is associated with\u00a0high mortality and morbidity,\u00a0poor quality\u00a0of life and\u00a0high healthcare utilization and costs.<\/p>\n
Trial lead,\u00a0Doctor Mariam Elmegaard\u00a0from\u00a0Herlev and Gentofte University Hospital, Copenhagen, Denmark, explained\u00a0why the EMAIL-HF trial was carried out: “Sodium\u2013glucose cotransporter 2 (SGLT2) inhibitors\u00a0have\u00a0proven benefits in the treatment of\u00a0heart failure\u00a0and yet, as with\u00a0many\u00a0evidence-based therapies, adoption in routine clinical practice is limited.”<\/p>\n
She noted that\u00a0the\u00a0implementation of new therapies\u00a0such as\u00a0SGLT2 inhibitors\u00a0can be\u00a0particularly challenging in patients with longstanding heart failure.\u00a0<\/p>\n
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Many of these patients are no longer followed in specialist heart failure clinics, but receive care in general cardiology, primary care or other nonspecialist settings.”<\/p>\n
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Doctor Mariam Elmegaard, Herlev and Gentofte University Hospital, Copenhagen, Denmark<\/p>\n
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Doctor Elmegaard and collaborators tested a novel digital implementation approach, investigating whether SGLT2 inhibitor therapy could be increased by using nationwide health registries to identify untreated patients at the population level and proactively invite them for a specialist consultation.<\/p>\n
In this investigator-initiated, registry-based\u00a0randomized\u00a0trial, all patients with heart failure in the Capital Region of Denmark and the municipality of Roskilde who were not receiving SGLT2 inhibitor therapy were\u00a0identified.\u00a0Eligible patients were assigned to a digital strategy or usual care.\u00a0Patients randomized to the digital strategy were sent a letter\u00a0through\u00a0the\u00a0governmental Digital Post system\u00a0with information about SGLT2 inhibitors\u00a0and\u00a0were\u00a0offered a telephone-based consultation with a heart failure specialist. During the consultation, the specialist reviewed the patient’s electronic\u00a0health record and\u00a0determined\u00a0whether initiation of an SGLT2 inhibitor was\u00a0appropriate according\u00a0to current\u00a0ESC Guidelines.\u00a0Patients assigned to usual care did not receive the digital letter and continued to receive routine care.\u00a0<\/p>\n
A total of\u00a05,996\u00a0patients were randomized who had a\u00a0mean age\u00a0of\u00a071\u00a0years and 33% were women. The mean duration of heart failure\u00a0was around five years and 40%\u00a0of patients had previously been hospitalized for heart failure.\u00a0Among patients assigned to the digital strategy, 60% responded to the invitation and signed\u00a0up on the digital platform.\u00a0<\/p>\n
The\u00a0main finding was that\u00a0initiation of SGLT2 inhibitor\u00a0therapy more than doubled with the\u00a0digital strategy. The primary\u00a0outcome of\u00a0initiation of\u00a0dapagliflozin or empagliflozin within\u00a0six\u00a0months\u00a0occurred in\u00a018.6% of\u00a0patients in the digital-strategy group and 8.2% in the usual-care group\u00a0(p<0.001).\u00a0The difference was\u00a0maintained\u00a0at\u00a024 months.\u00a0<\/p>\n
The secondary outcome\u00a0of\u00a0hospitalization for heart failure or death from any cause\u00a0occurred in\u00a013.0%\u00a0of patients in the\u00a0digital-strategy group\u00a0and 14.0%\u00a0in the usual-care group (p=0.276).\u00a0Doctor Elmegaard said: “Because only a proportion of patients responded to the invitation and\u00a0initiated\u00a0treatment, the difference in SGLT2 inhibitor use between the groups was limited. Based on the observed effect\u00a0on the clinical outcomes, a much larger study would have been needed to reliably detect a difference.”\u00a0<\/p>\n
Safety outcomes were infrequent, with no evidence of excess events in the digital-strategy group.\u00a0<\/p>\n
Doctor\u00a0Elmegaard\u00a0ended\u00a0by saying that the\u00a0biggest challenge in cardiovascular medicine is often not discovering new treatments,\u00a0but\u00a0making sure patients receive\u00a0proven therapies\u00a0in a timely manner.\u00a0“Our findings show that\u00a0digital\u00a0systems can\u00a0be developed that\u00a0proactively identify and contact patients\u00a0who are missing out, helping\u00a0more patients to\u00a0receive guideline-recommended treatment in a timely manner, without relying on their next hospital visit or hospitalization,” she noted, concluding, “If adopted more widely,\u00a0this type of digital strategy\u00a0could help narrow the gap between medical evidence and the care patients actually receive.”\u00a0<\/p>\n
Source:<\/p>\n