A nurse-coordinated, mobile health-supported collaborative care model for patients with heart failure with reduced ejection fraction (HFrEF) is associated with an increased number of days alive and out of hospital (DAOH) and decreased all-cause mortality, according to study findings published in Circulation.

The results are from the parallel-group, cluster-randomized controlled TIME-HF (Team-Based M-Health Enabled Care Model in Heart Failure) trial conducted at 22 HF centers in India.

The study enrolled patients aged 18 years and older with echocardiographically confirmed HFrEF before hospital discharge. The centers were randomized 1:1 to the nurse-coordinated mobile health-assisted collaborative care model or usual care.

The incorporation of nurse-coordinated collaborative care into national heart failure management programs is supported as a practical strategy to improve clinical outcomes and strengthen chronic disease care in resource-limited settings.

The intervention group received care from trained nurses and physicians working closely together to deliver integrated HF care tailored to patients’ needs, as well as lifestyle and pharmacologic optimization, risk stratification, and a nurse-coordinated, mobile health-supported disease management program with active follow-up, self-care education, and continuous outpatient monitoring. Usual care group patients continued to receive routine medical management from their physicians.

Follow-up visits were scheduled for every 3 months for 2 years. DAOH was the primary endpoint, and all-cause mortality was a secondary endpoint.

The cohort included 1507 participants from 11 usual care centers (n=752) and 11 intervention centers (n=755). Mean (SD) age was 61.9 (12.1) years, and 77.6% were men. A majority lived in rural areas (57.3%), they had a median of 10 years of education, and 77.4% had ischemic heart disease. The median time between HF diagnosis and enrollment was 15 days in the usual care group and 20 days in the intervention group.

The mean (SD) DAOH was 610.4 (222.4) days, and the mean %DAOH (DAOH/730 days) was 0.84 (0.30). Compared with usual care, the intervention resulted in a 7.95% increase in %DAOH (95% CI, 0.29%-15.6%; P =.042).

The probability of surviving up to 730 days without hospitalization was 84.0% (95% CI, 82.2%-85.8%) for the intervention group, compared with 79.4% (95% CI, 77.7%-81.2%) for the usual care group, according to the 1-inflated β model. The probability of being alive and out of the hospital at 730 days increased by 4.5 percentage points in the intervention group (95% CI, 2.3-6.8; P <.001). There were 78% greater odds for having a %DAOH of 1 (730/730 days) in the intervention group, compared with the usual care group (odds ratio, 1.78; 95% CI, 1.42-2.23).

The overall follow-up was 933,915 person-days, and 201 deaths (26.73%) occurred in the usual care group compared with 163 (21.59%) in the intervention group (risk ratio, 0.80; 95% CI, 0.67-0.97). In the intervention group, the mortality rates per 100 person-years were 12.6 (95% CI, 10.8-14.7) vs 15.9 (95% CI, 13.9-18.3) in the usual care group. The annual HF hospitalization rates in the 2 groups were 15.6% in the intervention group and 18.5% in the usual care group.

The intervention group had a 22% lower risk of mortality compared with the usual care group (hazard ratio, 0.78; 95% CI, 0.63-0.95; P =.028) in the multivariable Cox proportional hazards model.

Limitations of the study include a residual imbalance between groups and the unblinded design. In addition, the follow-up duration may be inadequate to assess long-term sustainability and durability of adherence, and generalizability may be limited to settings with similar infrastructure, staffing, and access to mobile technology.

“The incorporation of nurse-coordinated collaborative care into national heart failure management programs is supported as a practical strategy to improve clinical outcomes and strengthen chronic disease care in resource-limited settings,” the study authors wrote.