Telemedicine-supported medication titration in heart failure: evaluation of HerzMobil Tirol, Austria

Abstract Background Heart failure is a leading cause of morbidity and mortality across Europe. Although guideline-directed medical therapy (GDMT) improves outcomes, its real-world implementation - especially dose titration to recommended target levels - remains suboptimal. This study evaluates GDMT uptake in HerzMobil Tirol (HMT), a telemedicine-supported disease management programme in Austria and explores opportunities for therapeutic optimization. Methods This retrospective analysis included 1,492 patients enrolled in HMT between 2016 and 2024. Titration success for beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), renin-angiotensin-aldosterone system inhibitors (RAASi) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) was assessed at the end of the three-month care phase. Descriptive statistics were calculated for achieved doses and time trends in titration rates over the study period. Results Overall titration success improved from 28.1% in 2016 to 40.1% in 2024. A marked improvement was observed following the introduction of SGLT2i in 2021, with a titration success rate of 75.6% by 2024. In contrast, titration success rates for BB (46.8% in 2024), MRA (38.3% in 2024) and RAASi (53.5% in 2024) showed stagnation or slight decline compared to 2016 levels. Only 4.5% of patients achieved full target doses for quadruple therapy in 2024. Conclusions While HMT supports GDMT implementation, particularly for newer agents like SGLT2i, substantial potential for optimization remains for established drug classes (BB, MRA and RAASi). The low proportion of patients reaching target doses for quadruple therapy underscores the urgent need for improved titration strategies and enhanced physician adherence to guideline recommendations. Key messages • Overall medication titration rates improved over time in the telemedicine-supported HerzMobil Tirol programme, mainly driven by substantial titration success with SGLT2i. • Stagnation in BB, MRA, and RAASi titration indicates a need for better implementation strategies.