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.