Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Mar 18;14(6):e036241.
doi: 10.1161/JAHA.124.036241. Epub 2025 Mar 7.

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

Edmar G Ribeiro  1 , Luisa C C Brant  2 , Lilian C Rezende  1 , Regina Bernal  1 , Graziela Chequer  2 , Barbara V Temponi  2 , Daniel B Vilela  2 , Julia B Buback  2 , Renato D Lopes  3 , Tulio B Franco  4 , Antonio L P Ribeiro  2 , Deborah C Malta  1
Affiliations
Randomized Controlled Trial

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

Edmar G Ribeiro et al. J Am Heart Assoc. .

Abstract

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.

Keywords: Brazil; digital health; heart failure; treatment.

PubMed Disclaimer

Conflict of interest statement

Dr Lopes reports research grants or contracts from Amgen, Bristol‐Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi‐Aventis; funding for educational activities or lectures from Pfizer, Bristol‐Myers Squibb, Novo Nordisk, and AstraZeneca; and funding for consulting from Bayer, Boehringer Ingelheim, Bristol‐Myers Squibb, Novo Nordisk, and AstraZeneca. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Participant flowchart.
Figure 2
Figure 2. Probability of event‐free survival during study follow‐up.
A, Primary outcome: HF‐related hospitalizations. B, Secondary outcome: all‐cause deaths or hospitalizations. HF indicates heart failure.
Figure 3
Figure 3. Prespecified subgroup analysis (n=127).
LVEF indicates left ventricular ejection fraction; NYHA, New York Heart Association; and RR, relative risk.
See this image and copyright information in PMC

References

    1. Oliveira GMM, Brant LCC, Polanczyk CA, Malta DC, Biolo A, Nascimento BR, Souza MFM, Lorenzo AR, Júnior AAPF, Schaan BD, et al. Cardiovascular Statistics—Brazil 2021. Arq Bras Cardiol. 2022;118:115–373. doi: 10.36660/abc.20211012 - DOI - PMC - PubMed
    1. Khan MS, Sreenivasan J, Lateef N, Abougergi MS, Greene SJ, Ahmad T, Anker S, Fonarow G, Butler J. Trends in 30‐ and 90‐day readmission rates for heart failure. Circ Heart Fail. 2021;14:e008335. doi: 10.1161/CIRCHEARTFAILURE.121.008335 - DOI - PubMed
    1. Chun S, Tu JV, Wijeysundera HC, Austin PC, Wang X, Levy D, Lee DS. Lifetime analysis of hospitalizations and survival of patients newly admitted with heart failure. Circ Heart Fail. 2012;5:414–421. doi: 10.1161/CIRCHEARTFAILURE.111.964791 - DOI - PMC - PubMed
    1. de Albuquerque DC, de Barros ESPGM, Lopes RD, Hoffmann‐Filho CR, Nogueira PR, Reis H, Nishijuka FA, Martins SM, Neto JAF, Pavanello R, et al. In‐hospital management and long‐term clinical outcomes and adherence in patients with acute decompensated heart failure: primary results of the first Brazilian registry of heart failure (BREATHE). J Card Fail. 2023;30:639–650. doi: 10.1016/j.cardfail.2023.08.014 - DOI - PubMed
    1. Desai AS, Stevenson LW. Rehospitalization for heart failure: predict or prevent? Circulation. 2012;126:501–506. doi: 10.1161/CIRCULATIONAHA.112.125435 - DOI - PubMed

Publication types