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: Of 127 randomized patients (TMI, n=70; usual care, n=57), mean +/- SD age was 64 +/- 11 years, 48% were women, 71% were Black race, 33% had <4 years of education, 65% were New York Heart Association class III/IV, and 68% had reduced ejection fraction (<= 50%). At 180 days, 26% of the TMI group had HF-related rehospitalizations versus 46% in usual care (relative risk [RR]=0.56, P<0.02). All-cause death or rehospitalizations occurred in 30% of the TMI group versus 47% in usual care (RR=0.63, P=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.