Effect of Telemedicine Interventions on Heart Failure Hospitalizations: A Randomized Trial

BACKGROUND: Telemedicine interventions (TMIs) for heart failure (HF) can reduce hospitalizations and deaths. It is unclear if low literacy and limited access to technology in low- and middle-income countries affect these benefits. We evaluated whether TMIs added to usual care could reduce HF-related rehospitalizations in patients discharged from hospitals in Brazil. METHODS: A randomized clinical trial was conducted in 6 public hospitals from September 2021 to June 2022. Patients hospitalized because of HF were randomized to usual care or a multicomponent TMIs. The TMI included weekly nurse-led structured telephone support to monitor weight, blood pressure, heart rate, decompensation signs, and treatment adherence, while promoting self-care education, including diuretic dose adjustments. The nurse was linked to a cardiologist for teleconsultations, according to predefined decision trees. An educational program via text messages was also provided. The primary outcome was HF-related rehospitalizations at 180 days, analyzed by intention-to-treat analysis. RESULTS: =0.04). Results were consistent in "per-protocol" and subgroup analyses. Enrollment was lower than expected because of COVID-19 disruptions. CONCLUSIONS: TMI reduced HF-related rehospitalizations, demonstrating its potential to improve clinical outcomes in this population. REGISTRATION: URL: https://www.ensaiosclinicos.gov.br/rg/RBR-10znr9xn; Unique Identifier: UTN U1111-1263-9802.