Registry-Driven Digital Outreach Boosts Use of Heart Failure Medicines

Although sodium-glucose cotransporter 2 inhibitors are proven to benefit patients, many eligible individuals do not receive them in routine care. Uptake can be especially difficult when patients with longstanding disease are no longer followed in specialist clinics. To close this care gap, researchers have developed and tested a registry-driven digital outreach strategy to increase initiation of evidence-based therapy.

The EMAIL-HF trial, led from Herlev and Gentofte University Hospital in Copenhagen, evaluated a population-level digital strategy and was presented at the European Society of Cardiology (ESC) Congress 2026. Investigators identified adults with heart failure who were not using sodium–glucose cotransporter 2 (SGLT2) inhibitors in the Capital Region of Denmark and the municipality of Roskilde. Participants were randomly assigned to the digital strategy or to usual care.

The digital strategy used the governmental Digital Post system to send letters that explained SGLT2 therapy and offered a telephone consultation with a heart failure specialist. During the call, the specialist reviewed the patient’s electronic health record and assessed eligibility for initiation according to current ESC guidelines. Usual care patients did not receive outreach and continued routine management.

A total of 5,996 patients were randomized. Participants had a mean age of 71 years, 33% were women, mean heart failure duration was about five years, and 40% had a prior heart failure hospitalization. Among those offered the digital intervention, 60% responded and registered on the platform. The primary outcome, initiation of dapagliflozin or empagliflozin within six months, occurred in 18.6% of patients in the digital group compared with 8.2% receiving usual care (p<0.001), with the difference maintained at 24 months. Safety events were infrequent, with no excess observed in the digital group.

Hospitalization for heart failure or death from any cause occurred in 13.0% of digital-strategy patients and 14.0% of usual-care patients (p=0.276). Investigators noted that because only a proportion of invitees initiated therapy, the between-group difference in SGLT2 use was modest, and a larger study would be needed to reliably detect clinical-outcome effects.

“SGLT2 inhibitors have proven benefits in the treatment of heart failure and yet, as with many evidence-based therapies, adoption in routine clinical practice is limited,” said Mariam Elmegaard, trial lead, Herlev and Gentofte University Hospital, Copenhagen, Denmark.

“Our findings show that digital systems can be developed that proactively identify and contact patients who are missing out, helping more patients to receive guideline-recommended treatment in a timely manner, without relying on their next hospital visit or hospitalization. If adopted more widely, this type of digital strategy could help narrow the gap between medical evidence and the care patients actually receive,” added Elmegaard.

Related Links
European Society of Cardiology
Herlev and Gentofte University Hospital