{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:41:49Z","timestamp":1793396509315,"version":"4.5.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Guidelines emphasize the importance of quadruple therapy in heart failure with reduced ejection fraction (HFrEF), and of achieving target doses quickly. The aim of the MAR-HF-Titration study was to assess the effectiveness of a nurse-led, telemedicine programme for this purpose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Prospective study including 210 HFrEF patients between September 2021 and December 2023. The 6-month follow-up used a telemedicine programme involving daily telemonitoring of vital signs, weight and symptoms, routine laboratory test monitoring, videoconferences and the use of algorithms for drug titration. Mean age was 70\u2005years, 35% women. Mean left ventricle ejection fraction (LVEF) was 31%, 60% had a non-ischaemic aetiology, and 61% newly diagnosed HF. After the intervention, significant increases were achieved in the use of quadruple therapy at any dose (63 vs. 75%; P = 0.001), at \u226550% of the target doses of each drug (10 vs. 44%, P &amp;lt; 0.001), and at target doses of all drugs (0 vs. 19%, P &amp;lt; 0.001). Median titration time was 45\u2005days for beta-blockers, 65 for MRA, and 69 for ARNI. Older age, chronic kidney disease, hypotension, and higher NTproBNP were associated with lower odds of effective titration. The LVEF increased (31\u201345%, P &amp;lt; 0.001) and the NTproBNP values were significantly reduced (1960\u2013806\u2005pg\/mL, P &amp;lt; 0.001). Increases in the use of prognostic medications were also observed in a sub-analysis restricted to participants aged \u226575\u2005years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our intensive, nurse-led, telemedicine-based programme attained a fast optimization of prognostic therapies in HFrEF and resulted in significant improvements in parameters with prognostic relevance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjcn\/zvaf161","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T11:44:58Z","timestamp":1754567098000},"page":"1365-1374","source":"Crossref","is-referenced-by-count":7,"title":["Effectiveness of a nurse-led telemedicine-based program for pharmacological and prognostic optimization of patients with heart failure and reduced ejection fraction: the MAR-HF-Titration study"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6074-914X","authenticated-orcid":false,"given":"Sonia","family":"Ruiz-Bustillo","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hospital del Mar , Passeig Maritim de la Barceloneta 25-29, Barcelona 08003 ,","place":["Spain"]},{"name":"Hospital del Mar Research Institute , Carrer del Doctor Aiguader, 88, 08003 Barcelona ,","place":["Spain"]},{"name":"Department of Medicine, School of Medicine, Universitat Pompeu Fabra , Carrer de Ramon Trias Fargas, 25, 27, 08005 Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0051-918X","authenticated-orcid":false,"given":"Miren","family":"Vicente","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital del Mar , Passeig Maritim de la Barceloneta 25-29, Barcelona 08003 ,","place":["Spain"]},{"name":"Hospital del Mar Research Institute , Carrer del Doctor Aiguader, 88, 08003 Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0424-5597","authenticated-orcid":false,"given":"Pilar","family":"Ruiz-Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital del Mar , Passeig Maritim de la Barceloneta 25-29, Barcelona 08003 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8337-2848","authenticated-orcid":false,"given":"Ana Mar\u00eda","family":"Lin\u00e1s-Alonso","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital del Mar , Passeig Maritim de la Barceloneta 25-29, Barcelona 08003 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0400-3247","authenticated-orcid":false,"given":"Sandra","family":"Valdivielso-Mor\u00e9","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital del Mar , Passeig Maritim de la Barceloneta 25-29, Barcelona 08003 ,","place":["Spain"]},{"name":"Hospital del Mar Research Institute , Carrer del Doctor Aiguader, 88, 08003 Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3110-6572","authenticated-orcid":false,"given":"N\u00faria","family":"Farr\u00e9","sequence":"additional","affiliation":[{"name":"Portiuncula University Hospital and East Galway and Roscommon Integrated Care Hub , Garbally Demesne, Ballinasloe Co. Galway, H53 T971 ,","place":["Ireland"]},{"name":"School of Medicine, University of Galway , University Road, H91 TK33 Galway ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2774-1290","authenticated-orcid":false,"given":"Laia","family":"Belarte-Tornero","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital del Mar , Passeig Maritim de la Barceloneta 25-29, Barcelona 08003 ,","place":["Spain"]},{"name":"Hospital del Mar Research Institute , Carrer del Doctor Aiguader, 88, 08003 Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0518-8092","authenticated-orcid":false,"given":"Ronald","family":"Morales-Murillo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital del Mar , Passeig Maritim de la Barceloneta 25-29, Barcelona 08003 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