Implementation of Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Heart Failure Through a New Digital Strategy

doi:10.1016/j.jchf.2026.103176

EMAIL-HF

Paciente / Población Intervención / Exposición Comparación Desenlace

In 5,996 patients with heart failure not on an SGLT2 inhibitor, a digital letter inviting specialist review increased initiation of an SGLT2 inhibitor within 6 months compared with usual care.

N

5996pacientes

Diseño

nationwide registry-based, randomised 1:1 (simple randomisation in monthly batches, May 2023–June 2024), parallel-group; letter does not disclose the trial and controls are unaware of participation; prescribing heart failure specialists blinded to prescription redemption; primary endpoint at 6 months, registry follow-up to 2 years

Desenlace

Proportion of patients initiating an SGLT2 inhibitor (dapagliflozin or empagliflozin) within 6 months of randomisation

Relevancia

2Importante — uno de varios pilares.

ResultadoSGLT2 inhibitor started within 6 months in 18.6% vs 8.2% (P < 0.001), and the gap persisted at 24 months. Heart failure hospitalisation or death from any cause 13.0% vs 14.0% (P = 0.28).

Elmegaard M, Køber L, Ersbøll MK, et al. A Randomized Clinical Implementation Trial Testing a Digital Strategy to Increase SGLT2 Inhibitor Initiation in Heart Failure. JACC Heart Fail. 2026 Jun 10:103176. doi:10.1016/j.jchf.2026.103176 10.1016/j.jchf.2026.103176

Discusión y crítica

A letter through the national digital post, plus the offer of a telephone consultation with a specialist who had read the record, more than doubled uptake of a Class I drug. It doubled it from 8% to 19%: four in five eligible patients still ended the trial untreated, which says more about how implementation trials should be judged than the relative figure does. No difference in hospitalisation or death at 24 months, and the trial was not powered to find one. It also runs on a complete national registry and a state digital letterbox — the intervention is Danish infrastructure as much as it is an idea.