The SAATHI-HF project will be implemented across 10 tertiary care cardiology centres in India through a structured, technology-enabled, multicentre randomized clinical trial involving patients with heart failure with reduced ejection fraction (HFrEF) following hospital discharge. A total of 2260 participants will be enrolled and will be followed for six months, with the total study duration of 48 months.

A standardized training model will be used to prepare healthcare professionals and study teams involved in patient management. Training will cover the study protocol, data collection, patient communication, use of the digital platform and wearable device, telemedicine consultations, electronic clinical decision support, GDMT optimization, alert management, and defined escalation pathways.

The intervention will use an integrated digital platform and wearable-based monitoring system to support home management. Data collected through the wearable device will be used for non-invasive, AI-based prediction of NT-proBNP spikes and potential clinical deterioration. Relevant alerts and decision-support information will be reviewed by treating cardiologists, who will assess the patient remotely and provide appropriate guidance or intervention through assisted home-based telemedicine consultations.

The study will also support guideline-directed medical therapy (GDMT) where the focus would be on achieving optimal dose at two months, supported through biomarker-guided treatment optimization with ongoing assessment of treatment response, adherence and patient status. Patients will receive appropriate education and support to encourage medication adherence, monitoring and active participation in their heart failure care.

Research activities will include participant recruitment and follow-up, clinical and outcome assessments, monitoring of mortality and hospital readmissions, assessment of medication adherence, quality of life and mental health, and evaluation of the feasibility of implementing biomarker led GDMT, and cost-effectiveness of the intervention.

Implementation will be supported through standardized SOPs, defined roles and responsibilities, regular training and monitoring, centralized coordination, data-quality checks, technical support and predefined clinical escalation pathways across participating sites. Regular communication, meetings and knowledge-sharing activities will help identify implementation challenges and facilitate timely resolution. Findings from the trial will be used to assess the feasibility of integrating this model into routine healthcare settings and its potential for wider scale-up.