Assisted therapy optimizing module to improve physician adhErence with guideLine-directed medical heart failure therapy rationale and design of the AMPEL trial

Luca Brunelli; Luiza Hoch; Bernhard Erich Pfeifer; Sabrina Neururer; Elisabeth Kleinheinz; Bettina Fetz; Aaron Lauschensky; Günter Schreier; Robert Modre-Osprian; Marc-Michael Zaruba; Moritz Messner; Maria Ungericht; Markus Wallner; Cosima Stark; Stefan Pötz; Bernadette Taucher; Almut Frank; Gerhard Pölzl

doi:10.1016/j.ijcha.2025.101797

Assisted therapy optimizing module to improve physician adhErence with guideLine-directed medical heart failure therapy rationale and design of the AMPEL trial

Luca Brunelli
, Luiza Hoch
, Bernhard Erich Pfeifer
, Sabrina Neururer
, Elisabeth Kleinheinz
, Bettina Fetz
, Aaron Lauschensky
, Günter Schreier
, Robert Modre-Osprian
, Marc-Michael Zaruba
, Moritz Messner
, Maria Ungericht
, Markus Wallner
, Cosima Stark
, Stefan Pötz
, Bernadette Taucher
, Almut Frank
, Gerhard Pölzl

Digital Health Information Systems

University Hospital for Internal Medicine III, Medical University Innsbruck
Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck
Institut für klinische Epidemiologie (IET), Tirol Kliniken GmbH
Division for Digital Health and Telemedicine, UMIT TIROL - Private University for Health Sciences and Technology
Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH
telbiomed
Division of Cardiology, Department of Internal Medicine, MedUni Graz
Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz
Steiermärkische Krankenanstaltengesellschaft m.b.H. (KAGes)
Medical Directorate, Styrian Hospitals Association

Research output: Contribution to journal › Article › peer-review

Abstract

Background
Guideline-directed medical therapy (GDMT) is very effective in the early, vulnerable phase after discharge following an acute heart failure (HF) event, but its widespread implementation in everyday clinical practice is limited.
AMPEL is a guideline-based decision support software service for physicians to improve adherence with GDMT. The four drug classes that make up the GDMT and the percentage of each prescribed dose in relation to the target dose according to the current ESC guidelines are displayed graphically. A daily update considers the current therapy as well as absolute or relative contraindications.

Methods and results
We present the rationale and protocol of the AMPEL trial, a multicenter randomized trial with a parallel-group design to investigate the effectiveness of the AMPEL service on GDMT implementation and patient clinical outcomes in a total of 260 patients. Salient features of the AMPEL study are that it is being conducted as part of the established disease management program (DMP) for HF, HerzMobil, and that participating physicians are given randomised access to the AMPEL service compared to the standard of care in the control group. The primary endpoint includes an implementation endpoint for assessment of the quality of indication- and dose-adjusted GDMT at 90 days and a clinical endpoint assessed with a stratified win ratio.

Conclusions
The AMPEL trial is a prospective, randomized trial investigating the effectiveness of a guideline-based decision support software service for physicians to improve adherence with GDMT in a telemedicine-assisted disease management program for patients with heart failure.

Graphical abstract
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Original language	English
Article number	101797
Number of pages	7
Journal	IJC Heart and Vasculature
Volume	61
Early online date	11 Sept 2025
DOIs	https://doi.org/10.1016/j.ijcha.2025.101797
Publication status	Published - Dec 2025

Research Field

Exploration of Digital Health

Keywords

HEART failure
GDMT (guideline-directed medical therapy)
Guideline-based decision support for physicians
Disease management program
Randomized controlled trial

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10.1016/j.ijcha.2025.101797Licence: CC BY-NC-ND

Cite this

Brunelli, L., Hoch, L., Pfeifer, B. E., Neururer, S., Kleinheinz, E., Fetz, B., Lauschensky, A., Schreier, G., Modre-Osprian, R., Zaruba, M.-M., Messner, M., Ungericht, M., Wallner, M., Stark , C., Pötz, S., Taucher , B., Frank , A., & Pölzl, G. (2025). Assisted therapy optimizing module to improve physician adhErence with guideLine-directed medical heart failure therapy rationale and design of the AMPEL trial. IJC Heart and Vasculature, 61, Article 101797. https://doi.org/10.1016/j.ijcha.2025.101797

@article{b3f88c58df524f918e46c8ceab600e36,

title = "Assisted therapy optimizing module to improve physician adhErence with guideLine-directed medical heart failure therapy rationale and design of the AMPEL trial",

abstract = "Background Guideline-directed medical therapy (GDMT) is very effective in the early, vulnerable phase after discharge following an acute heart failure (HF) event, but its widespread implementation in everyday clinical practice is limited. AMPEL is a guideline-based decision support software service for physicians to improve adherence with GDMT. The four drug classes that make up the GDMT and the percentage of each prescribed dose in relation to the target dose according to the current ESC guidelines are displayed graphically. A daily update considers the current therapy as well as absolute or relative contraindications. Methods and results We present the rationale and protocol of the AMPEL trial, a multicenter randomized trial with a parallel-group design to investigate the effectiveness of the AMPEL service on GDMT implementation and patient clinical outcomes in a total of 260 patients. Salient features of the AMPEL study are that it is being conducted as part of the established disease management program (DMP) for HF, HerzMobil, and that participating physicians are given randomised access to the AMPEL service compared to the standard of care in the control group. The primary endpoint includes an implementation endpoint for assessment of the quality of indication- and dose-adjusted GDMT at 90 days and a clinical endpoint assessed with a stratified win ratio. Conclusions The AMPEL trial is a prospective, randomized trial investigating the effectiveness of a guideline-based decision support software service for physicians to improve adherence with GDMT in a telemedicine-assisted disease management program for patients with heart failure. Graphical abstract Download high-res image (162KB) URL: https://ars.els-cdn.com/content/image/1-s2.0-S2352906725002003-ga1\_lrg.jpg Download full-size image URL: https://ars.els-cdn.com/content/image/1-s2.0-S2352906725002003-ga1.jpg",

keywords = "HEART failure, GDMT (guideline-directed medical therapy), Guideline-based decision support for physicians, Disease management program, Randomized controlled trial",

author = "Luca Brunelli and Luiza Hoch and Pfeifer, \{Bernhard Erich\} and Sabrina Neururer and Elisabeth Kleinheinz and Bettina Fetz and Aaron Lauschensky and G{\"u}nter Schreier and Robert Modre-Osprian and Marc-Michael Zaruba and Moritz Messner and Maria Ungericht and Markus Wallner and Cosima Stark and Stefan P{\"o}tz and Bernadette Taucher and Almut Frank and Gerhard P{\"o}lzl",

note = "{\textcopyright} 2025 The Authors. Published by Elsevier B.V.",

year = "2025",

month = dec,

doi = "10.1016/j.ijcha.2025.101797",

language = "English",

volume = "61",

journal = "IJC Heart and Vasculature",

issn = "2352-9067",

publisher = "Elsevier Ireland Ltd",

}

Brunelli, L, Hoch, L, Pfeifer, BE, Neururer, S, Kleinheinz, E, Fetz, B, Lauschensky, A , Schreier, G, Modre-Osprian, R, Zaruba, M-M, Messner, M, Ungericht, M, Wallner, M, Stark , C, Pötz, S, Taucher , B, Frank , A & Pölzl, G 2025, 'Assisted therapy optimizing module to improve physician adhErence with guideLine-directed medical heart failure therapy rationale and design of the AMPEL trial', IJC Heart and Vasculature, vol. 61, 101797. https://doi.org/10.1016/j.ijcha.2025.101797

TY - JOUR

T1 - Assisted therapy optimizing module to improve physician adhErence with guideLine-directed medical heart failure therapy rationale and design of the AMPEL trial

AU - Brunelli, Luca

AU - Hoch, Luiza

AU - Pfeifer, Bernhard Erich

AU - Neururer, Sabrina

AU - Kleinheinz, Elisabeth

AU - Fetz, Bettina

AU - Lauschensky, Aaron

AU - Schreier, Günter

AU - Modre-Osprian, Robert

AU - Zaruba, Marc-Michael

AU - Messner, Moritz

AU - Ungericht, Maria

AU - Wallner, Markus

AU - Stark , Cosima

AU - Pötz, Stefan

AU - Taucher , Bernadette

AU - Frank , Almut

AU - Pölzl, Gerhard

PY - 2025/12

Y1 - 2025/12

N2 - Background Guideline-directed medical therapy (GDMT) is very effective in the early, vulnerable phase after discharge following an acute heart failure (HF) event, but its widespread implementation in everyday clinical practice is limited. AMPEL is a guideline-based decision support software service for physicians to improve adherence with GDMT. The four drug classes that make up the GDMT and the percentage of each prescribed dose in relation to the target dose according to the current ESC guidelines are displayed graphically. A daily update considers the current therapy as well as absolute or relative contraindications. Methods and results We present the rationale and protocol of the AMPEL trial, a multicenter randomized trial with a parallel-group design to investigate the effectiveness of the AMPEL service on GDMT implementation and patient clinical outcomes in a total of 260 patients. Salient features of the AMPEL study are that it is being conducted as part of the established disease management program (DMP) for HF, HerzMobil, and that participating physicians are given randomised access to the AMPEL service compared to the standard of care in the control group. The primary endpoint includes an implementation endpoint for assessment of the quality of indication- and dose-adjusted GDMT at 90 days and a clinical endpoint assessed with a stratified win ratio. Conclusions The AMPEL trial is a prospective, randomized trial investigating the effectiveness of a guideline-based decision support software service for physicians to improve adherence with GDMT in a telemedicine-assisted disease management program for patients with heart failure. Graphical abstract Download high-res image (162KB) URL: https://ars.els-cdn.com/content/image/1-s2.0-S2352906725002003-ga1_lrg.jpg Download full-size image URL: https://ars.els-cdn.com/content/image/1-s2.0-S2352906725002003-ga1.jpg

AB - Background Guideline-directed medical therapy (GDMT) is very effective in the early, vulnerable phase after discharge following an acute heart failure (HF) event, but its widespread implementation in everyday clinical practice is limited. AMPEL is a guideline-based decision support software service for physicians to improve adherence with GDMT. The four drug classes that make up the GDMT and the percentage of each prescribed dose in relation to the target dose according to the current ESC guidelines are displayed graphically. A daily update considers the current therapy as well as absolute or relative contraindications. Methods and results We present the rationale and protocol of the AMPEL trial, a multicenter randomized trial with a parallel-group design to investigate the effectiveness of the AMPEL service on GDMT implementation and patient clinical outcomes in a total of 260 patients. Salient features of the AMPEL study are that it is being conducted as part of the established disease management program (DMP) for HF, HerzMobil, and that participating physicians are given randomised access to the AMPEL service compared to the standard of care in the control group. The primary endpoint includes an implementation endpoint for assessment of the quality of indication- and dose-adjusted GDMT at 90 days and a clinical endpoint assessed with a stratified win ratio. Conclusions The AMPEL trial is a prospective, randomized trial investigating the effectiveness of a guideline-based decision support software service for physicians to improve adherence with GDMT in a telemedicine-assisted disease management program for patients with heart failure. Graphical abstract Download high-res image (162KB) URL: https://ars.els-cdn.com/content/image/1-s2.0-S2352906725002003-ga1_lrg.jpg Download full-size image URL: https://ars.els-cdn.com/content/image/1-s2.0-S2352906725002003-ga1.jpg

KW - HEART failure

KW - GDMT (guideline-directed medical therapy)

KW - Guideline-based decision support for physicians

KW - Disease management program

KW - Randomized controlled trial

U2 - 10.1016/j.ijcha.2025.101797

DO - 10.1016/j.ijcha.2025.101797

M3 - Article

SN - 2352-9067

VL - 61

JO - IJC Heart and Vasculature

JF - IJC Heart and Vasculature

M1 - 101797

ER -

Assisted therapy optimizing module to improve physician adhErence with guideLine-directed medical heart failure therapy rationale and design of the AMPEL trial

Abstract

Research Field

Keywords

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