Days alive and out of hospital were significantly increased in patients with heart failure when a nurse-coordinated collaborative care model was introduced, according to Indian researchers.
The TIME-HF trial assessed whether a nurse-led intervention integrating ‘mobile health’ could improve uptake of guideline-directed therapies and clinical outcomes in patients with heart failure in India.
“We believe this model is not only relevant to low- and middle-income countries but also to other settings around the world”
Jeemon Panniyammakal
There was an increased probability of surviving without hospitalisation and a 22% reduction in deaths at two years with the nurse-led intervention versus usual care, said the study authors.
This collaborative care model may serve as a blueprint for other settings where life-saving therapies are currently underused, they said at the European Society of Cardiology’s (ESC) annual conference.
They noted that, affecting more than 64 million individuals worldwide, heart failure was an escalating global public health challenge marked by a huge burden of mortality, morbidity and healthcare costs.
But they said that, while several therapies were proven to reduce deaths and admissions, and were recommended in ESC guidelines, their use in real-world practice was far from optimal.
Researcher Dr Jeemon Panniyammakal, from Sree Chitra Tirunal Institute for Medical Sciences and Technology in Thiruvananthapuram, presented the findings at the ESC event in Munich.
“Gaps between guideline recommendations and routine practice substantially limit the real-world impact of proven therapies for patients with heart failure,” he said.
“Under-use of guideline-directed medical therapies remains a key driver of the persistent global disparities seen in heart failure outcomes, particularly in low- and middle-income settings.”
He added: “We designed the TIME-HF trial on the premise that a combination of early intensive optimisation and sustained, low-cost nurse-led follow-up with education on self-care may help to increase the long-term uptake of evidence-based therapies and therefore improve outcomes.”
The TIME-HF (Team-Based M-Health Enabled Care Model in Heart Failure) trial involved 1,507 adults with heart failure with reduced ejection fraction – less than or equal to 40% – across 22 centres in India.
In an intervention group, a nurse-coordinated collaborative model was implemented with trained nurses working closely with physicians to deliver integrated care tailored to patients’ needs.
A mobile health application helped nurses coordinate care, enabling real-time patient communication and data collection, and allowing patients to log warning signs and symptoms to allow timely follow-up and monitoring.
The researchers stressed that the mobile health application, which was smartphone based, served as an “implementation and communication tool, not a complex clinical decision system”.
Nurses also provided structured counselling on lifestyle changes, strategies to improve medication adherence and educational materials to support behaviour change and self-care.
Meanwhile, patients randomised to a usual-care group continued to receive routine medical management from their treating physicians.
The mean age of the study population was 62 years, 32% were women and 57% lived in rural areas, said the researchers who have also published their findings in the journal Circulation.
The use of guideline-directed medical therapy was consistently higher in the intervention group than in the usual-care group, they said.
For example, adherence to all four guideline-directed medical therapies was only 22.1% in the usual-care group and 37.3% in the intervention group at two years.
The probability of surviving up to two years without hospitalisation was significantly higher with the intervention than with usual care – 84% versus 79.4%.
Importantly, there was also a 22% reduction in deaths in the intervention group at two years, the researchers highlighted.
Dr Panniyammakal said: “Taken together, the data suggest that a structured, nurse-coordinated, technology-enabled delivery model may offer a practical strategy to improve heart failure outcomes in routine care.
“We believe this model is not only relevant to low- and middle-income countries but also to other settings around the world where adherence to guideline-directed medical therapies is suboptimal.”