Days alive and out of hospital were significantly increased in patients with heart failure when a nurse-coordinated collaborative care model was introduced, according to results presented in a Hot Line session today at ESC Congress 2026 and published simultaneously in Circulation.
Affecting more than 64 million individuals worldwide, heart failure is an escalating global public health challenge marked by a huge burden of mortality, morbidity and healthcare costs. Several medical therapies are proven to reduce deaths and hospitalisations and these are recommended in ESC Guidelines, but their use in real-world practice is far from optimal.
Gaps between guideline recommendations and routine practice substantially limit the real-world impact of proven therapies for patients with heart failure. Underuse of guideline-directed medical therapies remains a key driver of the persistent global disparities seen in heart failure outcomes, particularly in low- and middle-income settings.”
Doctor Panniyammakal Jeemon from Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, India
Limited specialist access, healthcare and drug costs, subtherapeutic dosing and delayed intensification of treatment are just some of the reasons proposed to account for the gaps in care.
Doctor Jeemon commented: “We designed the TIME-HF trial on the premise that a combination of early intensive optimisation and sustained, low-cost nurse-led follow-up with education on self-care may help to increase the long-term uptake of evidence-based therapies and therefore improve outcomes.”
This cluster-randomized trial involved 1,507 adults with heart failure with reduced ejection fraction (less than or equal to 40%) across 22 centres in India. Centres were randomized (1:1) to the nurse-led intervention or usual care. In the intervention group, a nurse-coordinated collaborative model was implemented with trained nurses working closely with physicians to deliver integrated care tailored to patients’ needs. A mobile health application helped nurses coordinate care, enabling real-time patient communication and data collection, and allowing patients to log warning signs and symptoms to facilitate timely follow-up and monitoring. Nurses provided structured counselling on lifestyle changes, strategies to improve medication adherence and educational materials to support behaviour change and self-care. Patients allocated to the usual-care group continued to receive routine medical management from their treating physicians.
The mean age of the study population was 62 years, 32% were women and 57% lived in rural areas.
The use of guideline-directed medical therapy was consistently higher in the intervention group than in the usual-care group. For example, adherence to all four guideline-directed medical therapies was only 22.1% in the usual-care group and 37.3% in the intervention group at two years.
Doctor Jeemon noted that the primary endpoint of days alive and out of hospital was chosen to represent a broad and patient-centred measure of benefit. The probability of surviving up to two years without hospitalisation was significantly higher with the intervention than with usual care (84.0% vs. 79.4%; p<0.001). Importantly, there was also a 22% reduction in deaths in the intervention group (p=0.028) at two years.
“Taken together, the data suggest that a structured, nurse-coordinated, technology-enabled delivery model may offer a practical strategy to improve heart failure outcomes in routine care. We believe this model is not only relevant to low- and middle-income countries but also to other settings around the world where adherence to guideline-directed medical therapies is suboptimal,” concluded Doctor Jeemon.
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