Two presentations at AHA 2026 simultaneously published in JACC: Heart Failure evaluated two novel technologies: a voice-based heart failure (HF) monitoring system, and an EHR-embedded mineralocorticoid receptor antagonists (MRA) prescription prompt.

DETECT-HF

According to results of the DETECT-HF study, the voice-based Cordio HearO System detected impending HF events weeks before clinical presentation in patients with symptomatic chronic HF – demonstrating reasonable sensitivity with low-alert burden, high adherence and an excellent safety profile.

The prospective, international, multicenter, single-arm, blinded noninterventional study prompted 563 patients (mean age, 68 years; 29% women) to create daily voice recordings of six prespecified sentences in their native languages on their smartphones, which were then analyzed with the HearO system, although the analysis did not influence care.

“The HearO platform represents a fundamentally different approach to remote monitoring,” write trial investigators William T. Abraham, MD, FACC, and colleagues. “The underlying biological rationale is that pulmonary congestion, changes in respiratory mechanics and alterations in vocal tract function may influence acoustic speech characteristics. Because speech production integrates respiratory, laryngeal and neuromuscular function, subtle physiologic changes may be detectable before the onset of overt symptoms.”

Results showed that the system detected 52 of 76 first HF events, reaching a sensitivity of 68.4% (95% confidence interval, 58.0% to 78.9%; p=0.0573), with the lower confidence interval bound being slightly below the pre-specified performance target of 60%. When recurrent events were included, the system detected 80 of 112 HF events (71.4%; model-adjusted sensitivity, 70.5%), and detected first HF events on average 24.1 days before clinical presentation.

Additionally, 1,981 unexplained priority notification events were recorded, at a rate of 2.65 notifications/patient-year for first HF events, meeting prespecified performance criterion, and 2.59 notifications/patient-year for all HF events. Both sensitivity and unexplained priority notification rate estimates were consistent across prespecified subgroups.

Daily recording adherence was 85%, and on a five-point patient questionnaire on usability, patients gave the system a mean score ranging from 4.7 to 4.9. No device-related adverse events occurred.

BETTER CARE-HF

The BETTER CARE-HF trial found that an automated, EHR-embedded alert for providers improved MRA prescription rate for HF with reduced ejection fraction (HFrEF) across multiple health systems.

The pragmatic, two-arm, cluster-assigned trial included 1,136 U.S. patients (median age, 73 years; 29% women) with ejection fraction ≤40% across 272 cardiology providers in three large health systems, assigned to either the EHR-embedded alert or usual care based on provider-level cluster assignment. The alert was displayed to cardiology providers at the time of eligible patient visit and included real-time, patient-specific information needed to make a decision about prescribing MRAs, including a pre-selected order set with orders for MRAs, advanced HF referral, laboratory tests or other guideline-recommended therapies.

Results showed that 9.2% of patients in the usual care arm vs. 17.9% in the alert arm were prescribed MRAs within 30 days of the alert, corresponding to an 89% increase in MRA prescribing (relative risk, 1.89; p<0.001). Number of patients needed to alert to result in one new MRA prescription was 14, and in the alert arm, 31 of 108 new MRA orders were placed using the pre-selected order set. There were no significant differences in prescriptions for other therapies, or in the prespecified hyperkalemia safety endpoints (p>0.05 for all).

“Despite class 1 guideline recommendations and randomized controlled trials demonstrating mortality benefit, along with being a generic, affordable medication, MRA continues to be markedly underutilized in HFrEF,” write authors Amrita Mukhopadhyay, MD, FACC, et al. “Our findings demonstrated the potential for a relatively low cost, scalable solution to broadly improve prescribing of MRA across multiple institutions.”

Explore more simultaneously published research through the JACC Journals at AHA event page, and visit ACC’s AHA 2026 Meeting Coverage page for additional studies, clinical insights and news from the meeting.

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: AHA Annual Scientific Sessions, AHA26, Heart Failure, Hyperkalemia, Mineralocorticoid Receptor Antagonists, Stroke Volume