The impact of an adaptive patient-centered web application on medication optimization in patients with HFrEF: Rationale and design of the SmartHF trial.
9 affiliations
- 1College of Pharmacy, University of Michigan, Ann Arbor, MI, USA.
- 2Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.
- 3School of Public Health, University of Michigan, Ann Arbor, MI, USA.
- 4Medical School, University of Michigan, Ann Arbor, MI, USA.
- 5Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
- 6Grady Health System, Atlanta, GA, USA.
- 7Washington University School of Medicine, St. Louis, MO, USA.
- 8Henry Ford Health, Detroit, MI, USA.
- 9VA Ann Arbor Health System, Ann Arbor, MI, USA.
Abstract
Introduction
Heart failure (HF) remains a significant public health burden, with frequent readmissions often driven by a lack of guideline-directed medical therapy (GDMT) optimization. While clinical decision support (CDS) can improve healthcare processes, patient-centered tools that empower individuals to participate in their own care are increasingly needed. We developed SmartHF, an adaptive web application that provides patients with tailored HFrEF GDMT recommendations based on their clinical data.Methods
This 12-week, multicenter randomized controlled trial enrolled adults with HFrEF (LVEF </=40%). Participants were randomized 1:1 to either the SmartHF intervention or usual care. The application uses a computable algorithm to integrate electronic health record (EHR) data, including medications, laboratory results, and vitals, via patient portal authorization. The primary endpoint is the change in a GDMT medication optimization score from baseline to Week 12.Results
Enrollment concluded in August 2025 with a total of 225 participants. The study population had a mean age of 61.9 years, with 36% identifying as female and 52% as Black or African American. At baseline, 84% of participants were prescribed an ACEi/ARB/ARNI, 90% were on beta-blockers, 67% were prescribed an SGLT2i, while only 53% were on a mineralocorticoid receptor antagonist (MRA). The mean baseline medication optimization score was 68.5. Final trial results are expected in Winter 2026.Conclusions
SmartHF is an innovative, low-touch digital health intervention that leverages EHR integration to facilitate patient-provider discussions on medication optimization. By providing personalized, guideline-based recommendations, the tool aims to improve GDMT prescribing in patients with HFrEF.Clinical trials registration
ClinicalTrials.gov ID NCT05858320.
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BibTeX
@article{dorsch2026impact,
title = {{The impact of an adaptive patient-centered web application on medication optimization in patients with HFrEF: Rationale and design of the SmartHF trial.}},
author = {Michael P Dorsch and Amy Krambrink and Sabah Ganai and Kaitlyn M Greer and Mohamed S Ali and Rachel Stevens and Uzochi Nwoko and Modele O Ogunniyi and Gregory Ewald and Khaled Abdul-Nour and Scott L Hummel and Todd M Koelling},
journal = {American heart journal plus : cardiology research and practice},
year = {2026},
month = oct,
doi = {10.1016/j.ahjo.2026.100934},
url = {https://europepmc.org/article/MED/42898174},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - The impact of an adaptive patient-centered web application on medication optimization in patients with HFrEF: Rationale and design of the SmartHF trial.
AU - Michael P Dorsch
AU - Amy Krambrink
AU - Sabah Ganai
AU - Kaitlyn M Greer
AU - Mohamed S Ali
AU - Rachel Stevens
AU - Uzochi Nwoko
AU - Modele O Ogunniyi
AU - Gregory Ewald
AU - Khaled Abdul-Nour
AU - Scott L Hummel
AU - Todd M Koelling
PY - 2026
DA - 2026/10/06
JO - American heart journal plus : cardiology research and practice
DO - 10.1016/j.ahjo.2026.100934
UR - https://europepmc.org/article/MED/42898174
AB - Introduction Heart failure (HF) remains a significant public health burden, with frequent readmissions often driven by a lack of guideline-directed medical therapy (GDMT) optimization. While clinical decision support (CDS) can improve healthcare processes, patient-centered tools that empower individuals to participate in their own care are increasingly needed. We developed SmartHF, an adaptive web application that provides patients with tailored HFrEF GDMT recommendations based on their clinical data.Methods This 12-week, multicenter randomized controlled trial enrolled adults with HFrEF (LVEF </=40%). Participants were randomized 1:1 to either the SmartHF intervention or usual care. The application uses a computable algorithm to integrate electronic health record (EHR) data, including medications, laboratory results, and vitals, via patient portal authorization. The primary endpoint is the change in a GDMT medication optimization score from baseline to Week 12.Results Enrollment concluded in August 2025 with a total of 225 participants. The study population had a mean age of 61.9 years, with 36% identifying as female and 52% as Black or African American. At baseline, 84% of participants were prescribed an ACEi/ARB/ARNI, 90% were on beta-blockers, 67% were prescribed an SGLT2i, while only 53% were on a mineralocorticoid receptor antagonist (MRA). The mean baseline medication optimization score was 68.5. Final trial results are expected in Winter 2026.Conclusions SmartHF is an innovative, low-touch digital health intervention that leverages EHR integration to facilitate patient-provider discussions on medication optimization. By providing personalized, guideline-based recommendations, the tool aims to improve GDMT prescribing in patients with HFrEF.Clinical trials registration ClinicalTrials.gov ID NCT05858320.
SN - 2666-6022
ER -