REACT-HF: predictors of 12-month heart-failure rehospitalization in a very elderly cohort under nurse-assisted telemonitoring
R Esser, M Larbaneix, A Mondragon, M Esteban, C Farges, M Harboun, G Akuda, A Hamdi, N Pages, S Nisse-Durgeat, O MaurouAbstract
Background
Older adults with heart failure (HF) frequently experience recurrent hospitalizations, frailty, and loss of autonomy. Although digital health interventions are endorsed by recent ESC guidelines for chronic HF follow-up, evidence remains scarce in very elderly and frail populations. The REACT-HF study evaluated 12-month outcomes of a telemonitoring program implemented in a cardiogeriatric center, combining nurse-led coordination, digital alerts, and multidisciplinary management.
Methods
This retrospective study included consecutive patients aged ≥ 65 years hospitalized for acute decompensated HF in a cardiogeriatric department and subsequently enrolled in a structured telemonitoring pathway, with ≥ 12-month follow-up. The primary endpoint was ≥ 1 unplanned HF rehospitalization within 12 months. Secondary analyses explored the number and duration of HF rehospitalizations and clinical, biological, and geriatric predictors. Comparisons used Mann–Whitney U and χ²/Fisher tests; independent predictors were identified using multivariable logistic regression.
Results
A total of 255 patients were analyzed (median age 87 [81–91] years; 54 % female; ADL 5.5 [5–6]; BMI 25.3 [22.4–29.1] kg/m²; albumin 32 [28.5–35.5] g/L; Charlson 8 [6–9]). At 12 months, 63 patients (24.7 %) experienced ≥ 1 HF rehospitalization. Median length of stay for these events was 8 [6–12] days. Univariate analyses showed associations with higher NT-proBNP at discharge (p = 0.033), lower ferritin (p < 0.001), and higher loop-diuretic dose (p < 0.001). In multivariable analysis, three factors remained independently associated with 12-month HF rehospitalization: chronic obstructive pulmonary disease (COPD, p = 0.043), ≥ moderate mitral regurgitation (p = 0.008), and absolute iron deficiency (p = 0.001). NT-proBNP, ferritin (continuous), and diuretic dose lost significance after adjustment.
Conclusions
In this very elderly HF cohort managed in a cardiogeriatric setting (median age 87 years), the 12-month HF rehospitalization rate was 24.7 %, lower than expected for this age group. A nurse-assisted, algorithm-based telemonitoring model — fully consistent with ESC recommendations — proved feasible, safe, and transferable to other healthcare environments. Independent predictors of rehospitalization (COPD, mitral regurgitation, and absolute iron deficiency) highlight actionable targets for integrated cardio-pulmonary-renal and iron-replacement strategies. REACT-HF supports the scalable implementation of guideline-aligned telemonitoring within multidisciplinary HF care for frail older adults.For image description, please refer to the figure legend and surrounding text.