DOI: 10.1161/circ.148.suppl_1.13191 ISSN: 0009-7322

Abstract 13191: Effectiveness of a Telemedicine Intervention in Reducing Heart Failure Hospitalizations in Brazil: A Randomized Clinical Trial

EDMAR G RIBEIRO, Luisa C Brant, Regina T Bernal, Lilian C Rezende, Graziela Chequer, Barbara V Temponi, Daniel B Vilela, Julia B Buback, Tulio B Franco, Antonio L Ribeiro, Deborah Malta
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Telemedicine interventions (TMI) for heart failure (HF) can reduce hospitalizations and deaths. It is unknown if lower literacy and access to technology in low- and middle-income countries could hamper these positive results. We evaluated if a TMI could reduce HF-related rehospitalizations in HF patients discharged from public hospitals in Brazil compared to usual care.

Methods: In a randomized clinical trial (UTN: U1111-1263-9802), patients >30 years, hospitalized due to HF in 6 public hospitals (09/2021 to 06/2022) were randomized before discharge to usual care (n=57) or to a multi-component TMI (n=70). The TMI included a weekly structured telephone support from a nurse to evaluate the daily monitoring of weight, blood pressure and heart rate collected by the patient, assess decompensation signs and treatment adherence barriers, and promote self-care education - including flexible diuretics dosing. The nurse was linked to a cardiologist for teleconsultations, according to pre-defined clinical decision trees. An educational program was also available, including unidirectional messages and two-way messaging in working hours. The primary outcome was HF-related rehospitalizations after 180 days, analyzed by intention-to-treat.

Results: Of 127 patients, mean age was 64±11 years, 48% were female, 71% were black/“pardo”, 33% had <4 years of education, and 68% had reduced ejection fraction. At 180 days, HF-related hospitalizations occurred in 18 (26%) patients from the TMI vs. 26 (46%) from the usual care group (RR=0.56, 95%CI 0.34-0.91, p<0.01). Kaplan-Meier curves for the primary outcome are shown in Figure 1 . All-cause death or rehospitalizations (secondary outcome) occurred in 30% of patients in the TMI vs 47% in the usual care group (RR=0.63, CI95% 0.40-0.99, p=0.04).

Conclusions: In HF patients discharged from hospitals in Brazil, a TMI reduced HF-related rehospitalizations compared to usual care.

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