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Publications

Journal Article Epublish 2 citations

PubMed: 42859420 DOI: 10.12688/wellcomeopenres.26369.1

Enhancing Guideline-Directed Medical Therapy at Discharge Through Collaborative Care: Evidence from the TIME-HF Cluster Randomized Controlled Trial.

Wellcome Open Res 11:293

Authors: Panniyammakal Jeemon, Athira Thottathan, Mariyam Alex, Sunaib Ismail, Reshmy Mohan, Safvan Karkuzhiyil, Bahuleyan Charantharalyil Gopalan, Chandgalu Javaregowda Devaraju, Eapen Punnoose, Gopalan Rajendiran, Govindan Unni, Jabir Abdullakutty, Jayakumar Balakrishnan, Joyal J Kandathil, Johny Joseph, Justin Paul Gnanaraj, Madhu Sreedharan, Meera R Pillai, Mahesh Nalin Kumar, Paul Thomas, Placid Sebastian, Rachel Daniel, Rajeev Edakutty, Sajan Ahmad, Salman Salahuddin, Shafeeq Mattummal, Stigi Joseph, Sunil Pisharody, Natesan Syam, Tiny Nair, Veena Nanjappa, Vijayan Ganesan, Vijo George, Anu Mary Chacko, Sanjay Ganapathi, Sivadasanpillai Harikrishnan

Affiliations

  • Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
  • Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India.
  • Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
  • Malankara Orthodox Syrian Church Medical College and Hospital, Kolenchery, Kerala, India.
  • PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
  • Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India.
  • Lisie Hospital, Kochi, Kerala, India.
  • Thangam Hospital of PMRC, Palakkad, Kerala, India.
  • St. Gregorios Memorial Mission Hospital, Parumala, Kerala, India.
  • Caritas Hospital, Kottayam, Kerala, India.
  • Madras Medical College and Government General Hospital, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.
  • NIMS Hospital, Thiruvananthapuram, Kerala, India.
  • KIMSHEALTH, Thiruvananthapuram, Kerala, India.
  • General Hospital, Ernakulam, Kerala, India.
  • Aster MIMS Hospital, Kannur, Kerala, India.
  • NS Memorial Institute of Medical Sciences, Kollam, Kerala, India.
  • District Cooperative Hospital, Calicut, Kerala, India.
  • Aster MIMS Hospital, Calicut, Kerala, India.
  • Little Flower Hospital and Research Centre, Angamaly, Kerala, India.
  • EMS Memorial Cooperative Hospital and Research Centre Ltd, Malappuram, Kerala, India.
  • Government District Hospital, Kollam, Kerala, India.
  • PRS Hospital, Thiruvananthapuram, Kerala, India.
  • National Institute of Technology Calicut, Kozhikode, Kerala, India.

Abstract

BACKGROUND

Nurse-led care supported by mobile health (mHealth) technologies offers a feasible strategy to strengthen heart failure (HF) management in resource-constrained settings. This study evaluated the impact of an mHealth-enabled, nurse-led collaborative care model on prescription of guideline-directed medical therapy (GDMT) at discharge among patients with heart failure with reduced ejection fraction (HFrEF) in India.

METHODS

The TIME-HF study was a multicenter, open-label, cluster-randomized controlled trial conducted across 22 centers enrolling patients with HFrEF. Centers were randomized 1:1 to an intervention arm (11 centers; 755 patients) or enhanced usual care (11 centers; 752 patients). In the intervention arm, nurses used an mHealth application to review GDMT prescriptions and recommend treatment modifications to physicians. GDMT at discharge was assessed individually and using a composite score. Intervention effects were evaluated using multivariable mixed-effects logistic regression models.

RESULTS

Participants were predominantly male (77.6%) with a mean age of 61.9 years (SD 12.1). Hypertension (56.1%), diabetes (62%), and chronic kidney disease (18.4%) were common comorbidities. Ischemic heart disease was the leading etiology (77.4%), and 48.8% were in NYHA class III/IV. Baseline characteristics were similar between groups. At discharge, 20% received all four GDMT components, with higher use in the intervention group than usual care (27% vs 13%, p < 0.001; adjusted OR 1.61, 95% CI 1.48-1.75). Intervention participants were also more likely to achieve a high GDMT score (OR 1.13, 95% CI 1.04-1.22).

CONCLUSION

An mHealth-supported nurse-led discharge medication review improved GDMT use in HFrEF and may help reduce preventable HF mortality in India. Trial registration: Clinical Trial Registry of India (CTRI/2021/11/037797), Registered on 03/11/2021; the study is ongoing.

MeSH

Nurses, Heart Failure, Heart, Prescriptions, Heart Failure, Systolic, Therapeutics