Table 1.

Notable recent trials in heart failure quality improvement

	Trial	Format	N	Primary findings	Strengths	Limitations	Implications
Multidisciplinary	STRONG-HF [11••]	Multinational, randomized, parallel group implementation trial	1078	Rapid up-titration of GDMT after HF admission significant reduced all-cause death or HF readmission at 180 days	Specific targets and timeline of intervention; similar rates of serious adverse events with usual care	Unblinded; causes of readmission were not adjudicated; SGLT2i not included	4 clinic visits within 2 weeks post-discharge in the intensive treatment arm requires significant patient, provider, and system commitment. Follow-up performed by HF experts
	CONNECT-HF [10]	Cluster-randomized, multicenter, implementation, post-discharge QI	5647	No difference in composite of mortality or HF readmission; Hospitals randomized to receive extensive HF-related education	Large, multicenter	Did not provide recommendations or automate orders/referrals	No difference in outcomes detected with hospitals who were provided HF education and quality initiative information; Limits buy-in from health systems
	PACT-HF [26]	Stepped-wedge cluster randomized; single-center	2494	No difference in all-cause readmission, ED visit, or death at 3 months; Patient-centered transitional care model vs usual care	Significant resource commitment with transitional care; patients, providers, and policy-makers involved	Single healthcare system; did not assess adherence to discharge (DC) recommendations	No difference in primary outcome(s) with transitional care model which included nurse-led self-care education, DC summary, close follow-up, ± home-care visits
	Remote Optimization. Desai et al. [32]	Case–control study for algorithmic, multidisciplinary GDMT optimization	1028 (19% in optimization group)	Significant increase in dose or use of BB and RAAS antagonists (but not MRA) with navigator driven remote medication optimization vs usual care	Clinical navigator driven algorithmic intervention; remote-care; multidisciplinary approach	Non-randomized; short-term follow-up; single-center	Potentially scalable; would require dedicated navigator, pharmacist, and HF cardiologist efforts
EHR-based	PROMPT-HF [22•]	Single-center, randomized, pragmatic, EHR-based; outpatient	100 providers; 1310 patients	Increase in GDMT prescriptions (primarily with BB) at 30 days. Providers randomized to receive targeted prompts vs usual care	Provides framework for rapid, lower cost EHR-based, pragmatic randomized trials	Single-system; Detected changes quite modest (mostly beta-blocker)	Relatively low-cost and scalable; requires integrated EHR; Average of 14 prompts per provider to prescribe 1 additional class of GDMT
	REVEAL-HF [25]	Single-center, randomized, pragmatic, EHR-based	3124	No difference in composite of all-cause mortality at 1 yr and HFH within 30 days; Providers randomized to receive prognostic information vs usual care	Easy to integrate within existing EHR	Did not provide recommendations or automate orders/referrals	No benefit detected to providing 1 year mortality estimates
	IMPLEMENT-HF pilot study [44]	Prospective pilot study; EHR-based	118	Increase in prescriptions at time of discharge for BB, ARNI, and MRA; Primary team provided with algorithmic recommendations from pharmacist–physician GDMT Team	Increase in GDMT score in the intervention arm; proof-of-concept	Small, single-center pilot quality study	Requires dedicated HF Cardiologist and Pharmacist effort
	EPIC-HF [9]	Single-center; randomized; patient-centered	306	Increase in GDMT intensification at 30 days; 3-min video and 1 page checklist provided electronically to patients prior to clinic visit	Patient-engagement, readily scalable at centers with integrated EHR and patient messaging capability	Single system. Patients already scheduled with Cardiology were enrolled	Relatively low cost and scalable for patients with technology literacy
Virtual RCT	CHIEF-HF [62]	Completely remote, patient-centered	476	Canagliflozin use improved KCCQ symptom score at 12 weeks	Similar QOL improvement with both HFrEF and HFpEF; all-remote trial with no in-person interaction	Subjective symptom assessment and QOL measures	Virtual implementation of GDMT shown to be safe and effective, trial design efficient/cost-effective. Fitbit devices to monitor activity level
Remote monitoring	CHAMPION [42]	Single-blind, randomized trial with CardioMEMS device	550	Reduction in HF hospitalization at 6 months with the addition of ambulatory PA pressure monitoring	Success with remote monitoring device	Single-blinded; industry-funded	Scalability has some limitations given invasive procedure that requires dedicated resources to receive and act on hemodynamic data but likely underutilized for eligible patients