# Rationale and Design of the Cooperative Program for ImpLementation of Optimal Therapy in Heart Failure

## TL;DR

This study aims to improve heart failure treatment by testing a remote pharmacist-led strategy to optimize medication use compared to education alone.

## Contribution

The study introduces a pragmatic, remote, navigator-led intervention to improve guideline-directed medical therapy implementation in heart failure patients across all ejection fraction levels.

## Key findings

- The trial will assess if a pharmacist-led strategy improves optimal treatment rates at 3 months.
- Outcomes will include treatment adherence at 6 and 12 months, as well as health resource utilization.
- The study focuses on heart failure patients across the full ejection fraction spectrum.

## Abstract

Despite overwhelming evidence of clinical benefit for patients with heart failure (HF), the uptake of guideline‐directed medical therapies (GDMT) has been slow. Collaborative approaches are critically needed to improve alignment between evidence and clinical practice. Many strategies proposed to improve GDMT implementation have been either ineffective or too resource‐intensive to implement at scale across different practice contexts. Furthermore, most existing approaches focus primarily on patients with HF and reduced EF, despite growing evidence for effective pharmacologic therapy in those with HF and mildly reduced or preserved ejection fraction (HFpEF).

Based on this experience, we designed the Cooperative Program for ImpLementation of Optimal Therapy in Heart Failure (COPILOT‐HF) study (NCT05734690).

This is a pragmatic, randomized, open‐label intervention trial to compare a comprehensive, remote, navigator‐led, algorithm‐driven strategy for optimization of GDMT prescribing in patients with HF across the full spectrum of ejection fraction with a control intervention focused on patient and provider education regarding the importance of GDMT optimization.

The primary efficacy endpoint of the study is the proportion of patients receiving optimal HF treatment at 3 months. Additional outcomes of interest include the proportion of patients with optimal HF therapy at 6 months and 12 months as well as health resource utilization, including hospitalizations and deaths.

COPILOT‐HF will evaluate the effectiveness of an early implementation of a remote pharmacist‐led medication titration strategy across the HF spectrum.

The COPILOT‐HF trial is a pragmatic, randomized study designed to determine if a remote, pharmacist‐led navigator‐driven intervention with patient and provider education is more effective than patient and provider education alone at improving the implementation of guideline‐directed medical therapy for patients across the full spectrum of heart failure.