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Effectiveness of Nurse-Coordinated, Digital-Supported Collaborative Care Model in Reducing Hospital Stay and Mortality Among Patients With Heart Failure: TIME-HF Cluster RCT India
Key result
Nurse-coordinated mHealth collaborative care increases two-year hospitalization-free survival odds by ~78% in HFrEF.
- OR 1.78
- 95% CI 1.42-2.23
- n=1,507
Why the trial?
Guideline-directed heart failure therapy is persistently under-implemented in routine practice. TIME-HF asked whether a team-based collaborative care model improves treatment optimisation and outcomes compared with usual management.
Does a nurse-coordinated, mobile health-supported collaborative care model improve days alive and out of the hospital in adults with HFrEF?
Population
1,507 adults with HFrEF at 22 centres in India (mean age 61.9; 77.6% men)
Comparison
Nurse-coordinated, mHealth-supported collaborative care vs usual care
Design
Parallel-group, cluster-randomized controlled trial (centres 1:1)
Follow-up
2 years (24 months)
Authors
Discussion
Key questions
No takes yet. Share an insight, caveat, or question.
Where experts stand
Experts read TIME-HF as a clear positive signal that nurse-led, digitally supported heart failure care can meaningfully reduce mortality and hospitalizations, with several noting the breakthrough here is not a new drug but better delivery of proven care.
The reaction to TIME-HF is uniformly positive, with clinicians highlighting that structured nurse-led follow-up, not just technology alone, drove the survival and hospitalization benefits. Commentators contrast this result with telemonitoring-only trials that failed, crediting the combination of digital tools and nursing agency. The open question is whether this collaborative care model can be replicated and scaled outside the Indian health system where it was tested.
Agreement
Multiple clinicians emphasized that the key lesson of TIME-HF is that better care delivery, not a new drug, produced these outcomes. They frame the nurse-led digital model as the active ingredient behind the mortality and hospitalization reductions.
2 clinicians say this directly
1 take classified by contention axis so far — the map appears as more land.
Still unclear
Whether this nurse-led, mobile-health model can be exported to health systems with different staffing structures and resources remains unaddressed. Experts have not yet weighed in on which components of the intervention were most essential or whether guideline bodies will act on these findings.
Key expert perspectives
Sometimes the breakthrough is not a new drug but delivering proven care better
Alania highlights the survival-without-hospitalization benefit (84.0% vs 79.4%) and the 22% mortality reduction, framing nurse-led mobile-health-supported HF care as the real innovation. He emphasizes that better delivery of existing therapies, rather than a novel molecule, drove these results.
AWAnna WitowiczHeart failure specialist, National Institute of Cardiology, WarsawPractice takeSep 13
The real heart failure advance at ESC was about who conducts follow-up, not AI
At a congress dominated by AI, Witowicz argues that TIME-HF delivered the most instructive heart failure result by showing that an app in a nurse's hands cut deaths by 22%. She contrasts it with EMAIL-HF, where passive detection without continuity failed, concluding that detection is getting easier but continuity is not.
Distilled from their postOriginal post
Ahmed Bennis · Heart Failure / Cardiomyopathy · Centre Hospitalier Universitaire Hassan II · Aug 30 Live reporting Flagged the TIME-HF cluster RCT results on nurse-coordinated, digital-supported collaborative care for heart failure in India. X post
Implication
Nurse-coordinated collaborative care improved 2-year survival without hospitalization (84.0% vs 79.4%) and cut all-cause death (HR 0.78) in Indian HFrEF care.
Key Points
- To assess whether a nurse-coordinated, mobile health-supported collaborative care model improves days alive and out of the hospital and reduces all-cause mortality in patients with heart failure with reduced ejection fraction.
- Parallel-group, cluster-randomized controlled trial across 22 centers in India randomized 1:1 to the collaborative care intervention or usual care (CTRI/2021/11/037797).
- Enrolled 1507 adults with heart failure with reduced ejection fraction followed for 2 years.
- The intervention provided risk stratification, medication and lifestyle optimization, and a nurse-coordinated mobile health management program with continuous outpatient monitoring.
- The probability of surviving 730 days without hospitalization was 84.0% (95% CI, 82.2%–85.8%) in the intervention group versus 79.4% (95% CI, 77.7%–81.2%) in usual care, with 78% higher odds of remaining out of the hospital for all 730 days (OR, 1.78 [95% CI, 1.42–2.23]).
- All-cause mortality occurred in 21.59% (163/755) of the intervention group compared with 26.73% (201/752) of the usual care group (RR, 0.80 [95% CI, 0.67–0.97]; adjusted HR, 0.78 [95% CI, 0.63–0.95]; P=0.028).
Evidence details
What drove the result?
| Outcome | Collab care | Usual care |
|---|---|---|
| Alive and out of hospital for all 730 days | 84.0% | 79.4% |
| Primary outcome · OR 1.78 (95% CI 1.42–2.23) favoring collaborative care | ||
| All-cause death | 163/755 (21.6%) | 201/752 (26.7%) |
| Secondary outcome · adjusted HR 0.78 (95% CI 0.63–0.95); p=0.028 | ||
Limitations & tradeoffs
Representation
Single-country trial in India in which 70% of participants had low educational attainment, 57% were rural, and 77.6% were men.
Subgroup caution
The mortality benefit was a secondary outcome, not the primary endpoint.
Design limitations
No blinding is described in the record for this care-model intervention.
Structured PICO
Does a nurse-coordinated, mobile health-supported collaborative care model improve days alive and out of the hospital in adults with HFrEF?
P
Population
1507 adults with heart failure with reduced ejection fraction across 22 centers in India, followed for 2 years.
I
Intervention
Nurse-coordinated, mobile health-supported collaborative care model including risk stratification, lifestyle and pharmacological optimization, self-care education, active follow-up, and continuous outpatient monitoring over 2 years.
C
Comparator
Usual care.
O
Outcome
Days alive and out of the hospital over 2 years.composite
Main Result
Odds Ratio: 1.78 (95% CI 1.42–2.23)
Absolute Event Rate: 84% vs 79.4%
Absolute Risk Reduction: 4.5%
A nurse-coordinated, digital-supported collaborative care model significantly increased days alive and out of hospital and reduced all-cause mortality in patients with HFrEF in India.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Cite This Study
Jeemon et al. (2026) conducted an RCT in Heart failure with reduced ejection fraction (n=1,507). Nurse-coordinated, mobile health-supported collaborative care model vs. Usual care was evaluated on Days alive and out of the hospital (OR 1.78, 95% CI 1.42-2.23). A nurse-coordinated collaborative care model for HFrEF increased the probability of surviving 2 years without hospitalization (84.0% vs 79.4%; OR 1.78) and reduced mortality (HR 0.78).