Digital Strategy Doubles Heart Failure Treatment Rates, EMAIL-HF Trial Shows

Presented at the ESC Congress 2026, the EMAIL-HF trial revealed that a registry-based digital strategy identifying untreated heart failure patients and proactively offering telephone consultations more than doubled the initiation of SGLT2 inhibitor therapy. Led by Dr. Mariam Elmegaard, the trial tackled treatment gaps affecting millions worldwide.

In Plain English: The Clinical Takeaway

• The Gap: Many patients diagnosed with heart failure fail to receive guideline-recommended medications like SGLT2 inhibitors because they stop seeing heart failure specialists over time.
• The Strategy: Public health registries were scanned to find untreated patients, who then received secure digital messages inviting them to a phone consultation with a specialist.
• The Result: This simple digital outreach more than doubled the number of patients starting treatments within six months, maintaining the difference at 24 months.

Closing the Gap in Chronic Disease Management

Affecting more than 64 million individuals worldwide, heart failure remains a public health issue. It carries high mortality rates, frequent hospitalizations, and a poor quality of life. Yet, despite robust clinical trial data confirming their benefits, medications often sit underutilized in routine clinical practice.

According to trial lead Dr. Mariam Elmegaard from Herlev and Gentofte University Hospital in Copenhagen, Denmark, implementation hurdles peak among patients with longstanding conditions. “Many of these patients are no longer followed in specialist heart failure clinics, but receive care in general cardiology, primary care or other nonspecialist settings,” she noted during her presentation at the ESC Congress 2026.

Inside the EMAIL-HF Trial Design

To address this systemic oversight, researchers tested a novel population-level implementation framework. Using nationwide health registries in the Capital Region of Denmark and the municipality of Roskilde, investigators pinpointed every heart failure patient not currently prescribed an SGLT2 inhibitor. A total of 5,996 patients with a mean age of 71 years—33% of whom were women—were randomized into either a digital strategy cohort or a usual care control group.

Patients assigned to the digital strategy received a formal letter via the governmental Digital Post system. This communication detailed information about sodium-glucose cotransporter 2 inhibitors and offered a direct telephone consultation with a heart failure specialist. During these calls, clinicians reviewed electronic health records to ensure safe prescription tailoring.

EMAIL-HF Trial Outcomes at 6 Months

Clinical Parameter	Digital Strategy Group	Usual Care Group
Primary Outcome (SGLT2 Inhibitor Initiation)	18.6%	8.2% (p<0.001)
Secondary Outcome (HF Hospitalization or All-Cause Death)	13.0%	14.0% (p=0.276)
Patient Engagement (Responded to Digital Invitation)	60%	N/A

The primary outcome measured the initiation of dapagliflozin or empagliflozin within six months. Results showed that 18.6% of patients in the digital-strategy group commenced therapy, compared to just 8.2% in the usual-care arm. This margin remained consistent at the 24-month mark. However, secondary endpoints evaluating heart failure hospitalization or all-cause mortality showed no statistically significant divergence, occurring in 13.0% of the digital group versus 14.0% of the usual-care group.

As Dr. Elmegaard explained, “Because only a proportion of patients responded to the invitation and initiated treatment, the difference in SGLT2 inhibitor use between the groups was limited.”

Contraindications & When to Consult a Doctor

While SGLT2 inhibitors represent a cornerstone of modern guideline-directed medical therapy for heart failure, they are not appropriate for every patient.

References

• European Society of Cardiology (ESC). “A digital strategy helped patients with heart failure to receive proven medication.” ESC Congress 2026 Press Releases.