Nurse-coordinated care improves heart failure survival
Using nurses to coordinate heart failure care using a mobile phone app significantly increased survival, according to new data presented at ESC Congress 2006 and published simultaneously in Circulation.[1]
The TIME-HF trial in India evaluated whether a nurse-led intervention could improve the uptake of guideline-directed medical therapies and clinical outcomes in patients with heart failure compared to the standard of care. The use of guideline-directed medical therapy was consistently higher in the nurse-coordination group than in the usual-care group. Adherence to all four guideline-directed medical therapies was only 22.1% in the usual-care group, but rose to 37.3% in the intervention group at two years.
“Gaps between guideline recommendations and routine practice substantially limit the real-world impact of proven therapies for patients with heart failure,” Panniyammakal Jeemon, PhD, a researcher with the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) in Thiruvananthapuram, India, said in a statement. “Underuse 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.”
Heath failure is a key driver of healthcare costs. Patients are frequently rehospitalized and utilize a lot of healthcare resources. Mortality and morbidity are also very high in this population. While several drug therapies are very successful in reducing deaths and hospitalizations, and are a part of society guidelines, real-world adherence to those therapies is low. Part of the issue is the lack of care access, and the often intensive nature of needing to monitor these patients to proactively adjust medications or encourage medication adherence.
The TIME-HF trial was designed to initiate drug therapies quickly and create a sustained, low-cost, nurse-led follow-up program. Patient education was one focus of the team's efforts.
The trial randomized 1,507 patients with heart failure with reduced ejection fraction (less than or equal to 40%) across 22 centers in India. They were evenly split between a nurse-led intervention or usual care. The mean patient age was 62, and 32% were women. Approximately 57% of patients lived in rural areas with limited health resources.
In the intervention group, trained nurses working closely with physicians to deliver integrated care tailored to patients' needs. They used a mobile health application to help coordinate care and enable real-time patient communication and data collection. This included patients logging warning signs and symptoms to initiate timely follow-up and monitoring. The nurses also provided structured patient counseling on lifestyle changes, strategies to improve medication adherence and educational materials to support better self-care. Patients allocated to the usual-care group continued to receive routine medical management from their treating physicians.
The probability of surviving up to two years without hospitalization was significantly higher in the nurse intervention group than in the usual care group (84% vs. 79.4%).
“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,” Jeemon said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]