Digital Outreach More Than Doubles Heart Failure Patients Getting Proven Drug, Trial Finds

A digital strategy that used national health registries to find heart failure patients missing out on an effective drug, and invited them for a phone consultation, more than doubled how many started the treatment, according to results from the EMAIL-HF trial presented at ESC Congress 2026. Heart failure affects more than 64 million people worldwide and carries high rates of death, poor quality of life and high healthcare costs.

SGLT2 inhibitors, a class of drug with proven benefits for heart failure, are often underused partly because many long-term patients are followed in general cardiology or primary care rather than specialist clinics, said trial lead Dr Mariam Elmegaard of Herlev and Gentofte University Hospital, Copenhagen, Denmark. Her team identified all heart failure patients in Denmark's Capital Region and the municipality of Roskilde who were not on SGLT2 inhibitor therapy, then randomly assigned them to a digital strategy or usual care.

Patients in the digital-strategy group were sent a letter through Denmark's governmental Digital Post system and offered a phone consultation with a heart failure specialist, who reviewed their health record and decided whether to start the drug. A total of 5,996 patients were randomised; their average age was 71, a third were women, and 40% had previously been hospitalised for heart failure. Of those offered the digital strategy, 60% responded and signed up. Within six months, 18.6% of the digital-strategy group had started an SGLT2 inhibitor compared with 8.2% of the usual-care group, a difference that held at 24 months. Hospitalisation for heart failure or death from any cause occurred in 13.0% of the digital-strategy group versus 14.0% of usual care, a difference too small to be statistically reliable given how many patients ultimately started treatment.

Safety outcomes were infrequent, with no excess events in the digital-strategy group. Elmegaard said cardiovascular medicine's biggest challenge is often not discovering new treatments but ensuring patients actually receive them, adding that such digital systems could help close that gap "without relying on their next hospital visit or hospitalization."