Abstract / Summary
The HEARTLAND Protocol (Heart failure Evidence-based Access in Rural Treatment, Linking Advanced Network Delivery) is a proposed clinical implementation toolkit for primary care-led heart failure management in rural and resource-limited settings. Version 3.4 updates the narrative evidence synthesis and operational framework; it is not a clinical validation study or a report of patient outcomes. The toolkit covers resource-based implementation tiers; clinician-directed pharmacotherapy and monitoring; discharge and follow-up; digital and analog monitoring; affordability navigation; workforce responsibilities; supplementary rural risk assessment; and a proposed examination and communication cycle. The cycle distinguishes ordering and access, collection, result versioning and correction, professional review, action, patient contact, and documented closure or transfer. This revision corrects trial populations, comparators and endpoints; distinguishes ARTS from FINEARTS-HF; clarifies phenotype-specific evidence and finerenone monitoring; expands source traceability to 58 references; and makes uncertainty, implementation assumptions and local verification requirements explicit. Printed implementation materials have been revised for readability and consistency. Historical publications remain unchanged. Research and implementation boundary: HEARTLAND remains a proposed framework pending prospective validation. Its supplementary risk score and implementation assumptions are not established measures of clinical effectiveness. Publication is not authorization for patient use, autonomous medication changes, institutional adoption, or a claim of regulatory clearance or privacy/security certification. Local clinical governance, responsible professionals, individual care plans and applicable institutional requirements remain necessary. Candidate emergency/oxygen policies, ambulatory-entry scope and social-support instrument interpretation retain the limitations stated in the toolkit. Companion software and public demonstrations are separately versioned. Demonstrations use synthetic data. Deployed code, an alert, a saved acknowledgment, a quiz response or a provider HTTP receipt does not establish delivered care, successful contact, clinical teach-back or continuous monitoring. Audio-script review is distinct from approval and activation of exact recordings; notification and audio release states must be verified in their own release records. No patient study or real-patient data are included in this deposit.