Medication Titration in Heart Failure: How DigiBeat Can Transform Care

Heart failure (HF) remains a leading cause of hospitalization and death globally, affecting over 6 million adults in the United States alone (Virani et al., 2023). Guideline-directed medical therapy (GDMT), including beta-blockers, angiotensin receptor-neprilysin inhibitors (ARNIs), mineralocorticoid receptor antagonists (MRAs), and SGLT2 inhibitors, has been shown to significantly reduce morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF) (Heidenreich et al., 2022). However, achieving optimal dosing of these medications requires careful titration based on clinical status, hemodynamics, and tolerance—a process often hampered by delays, suboptimal monitoring, and frequent clinical inertia.

The Challenge of Medication Titration in Heart Failure

Titration of HF medications involves gradually adjusting doses to reach target levels proven to confer survival benefits, while closely monitoring for adverse effects such as hypotension, bradycardia, renal dysfunction, and hyperkalemia (Yancy et al., 2017). Guidelines recommend dose adjustments every 2 to 4 weeks (Heidenreich et al., 2022). However, studies show that less than 25% of eligible patients are on target doses of GDMT at 6 months, largely due to:

• Limited clinic capacity for close follow-up.

• Patient access barriers, particularly in rural or underserved areas.

• Reliance on in-clinic assessments of blood pressure, heart rate, and symptoms, often missing early decompensation signs.

• Delays in recognizing suboptimal responses or adverse events.

This fragmented model contributes to avoidable hospitalizations, delayed therapy optimization, and worse outcomes (Greene et al., 2018).

DigiBeat: Closing the Gap with Home-Based Precision Monitoring

DigiBeat introduces a disruptive approach to patient management by enabling home-based cardiography that captures and analyzes real-time heart function using its Cartometric Cardiography (CCG) system. Unlike traditional remote monitoring tools that focus only on weight, heart rate, or single-lead ECG, DigiBeat provides:

• Dynamic, spatially modeled cardiac assessments, offering a richer view of cardiac function changes.

• Objective trending of key markers from extra heart sounds and changes in rhythm to cardiac acoustic biomarkers associated with filling pressures.

• Patient-guided exams using the DigiBeat app, facilitating frequent checks without clinic visits.

By integrating DigiBeat into medication titration protocols, clinicians can:

1. Detect early physiologic changes indicating intolerance or progression, enabling proactive dose adjustments.

2. Monitor therapy response remotely with precision, avoiding over-reliance on subjective symptom reports.

3. Accelerate titration timelines by replacing some in-clinic visits with validated home exams.

4. Empower patients with feedback loops, enhancing adherence and engagement in their care.

Potential Impact on Heart Failure Outcomes

Incorporating home-based precision monitoring into titration strategies supports faster achievement of target doses, potentially improving survival and reducing hospitalizations. The TIM-HF2 trial demonstrated that structured remote monitoring reduced all-cause mortality and hospital days in HF patients (Koehler et al., 2018). DigiBeat's unique spatial cardiography could further enhance this by offering more sensitive detection of changes in cardiac function compared to standard telemonitoring tools.

Conclusion

Medication titration in heart failure is a time-sensitive, precision-driven process that too often falls short in current care models. DigiBeat's innovative cartometric cardiography provides clinicians with a game-changing tool to accelerate and personalize titration, transforming the way medications are optimized, particularly for patients facing barriers to frequent in-person care.

References

• Greene, S. J., Butler, J., Albert, N. M., et al. (2018). Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry. Journal of the American College of Cardiology, 72(4), 351–366. https://doi.org/10.1016/j.jacc.2018.04.070

• Heidenreich, P. A., Bozkurt, B., Aguilar, D., et al. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Journal of the American College of Cardiology, 79(17), e263–e421. https://doi.org/10.1016/j.jacc.2021.12.012

• Koehler, F., Koehler, K., Deckwart, O., et al. (2018). Efficacy of Telemedical Interventional Management in Patients With Heart Failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. The Lancet, 392(10152), 1047-1057. https://doi.org/10.1016/S0140-6736(18)31880-4

• Virani, S. S., et al. (2023). Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association. Circulation, 147(8), e93–e621. https://doi.org/10.1161/CIR.0000000000001123

• Yancy, C. W., Jessup, M., Bozkurt, B., et al. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 Guideline for the Management of Heart Failure. Journal of the American College of Cardiology, 70(6), 776–803. https://doi.org/10.1016/j.jacc.2017.04.025