Nurse-led coordinated care can reduce heart failure mortality, finds study from Kerala

The model put a trained nurse at the centre of the care pathway, who would closely monitor heart failure patients after discharge, educate the patient and family about heart-failure self-care, lifestyle modification and encourage medication adherence. Image used for representational purposes only | Photo Credit: Getty Images/iStockphoto

A large randomised controlled trial among heart failure patients in India led by the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) in Kerala, has found that hospitalisation episodes and all-cause mortality among heart failure patients can be significantly reduced if patients are systematically followed-up by a nurse, with the help of a mobile health application.

The two-year Telemonitoring and Integrated Multidisciplinary care for Heart Failure (TIME-HF) trial found that heart failure patients with reduced ejection fraction (HFrEF) who received nurse-led collaborative care had a 22% lower risk of death than those receiving usual care. They were also more likely to remain alive without hospitalisation during the two-year follow-up.

The trial results were published in the American Heart Association’s Journal, Circulation, on August 30, 2026.

What makes the trial relevant is that it addresses critical gaps in heart failure care: in Keralam, heart failure registries have reported high mortality post-discharge — 82.7% mortality over 10 years, alongside the fact fact that only 25.4% of the patients with heart failure receive guideline-based therapies. It also holds lessons for the rest of the country: with nearly 27% of all deaths in India being due to heart disease, and 62% of all deaths due to cardiovascular disease occurring between the ages of 40 and 69 years, there is an urgent need for quality, post-discharge care.

The TIME-HF trial involved 1,507 adults at 22 government and private hospitals in Keralam and neighbouring States, with 755 patients assigned to the intervention and 752 to usual care. The mean age was 61.9 years; 77.6% were men, 57.3% lived in rural areas and 70% had relatively low educational attainment. Ischaemic heart disease was the predominant cause of heart failure, accounting for 77.4% of cases.

Results indicated that nurse-led intervention substantially improved prescription of the four major components of guideline-directed medical therapy for heart failure — renin-angiotensin system inhibition/ARNI, beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors.

“Our heart failure patients receive sub-optimal care, as most of them do not adhere to therapies or follow up with the doctor on time. There is also the issue of physician inertia. HF Registry evidence indicates that the median survival after diagnosis of heart failure is just 3.7 years. This collaborative care model is proof that survival and quality of life of these patients can be improved if we systematically address the gaps in care so that proven therapies for heart failure become part of routine care,” said lead researcher and additional professor at SCTIMST P. Jeemon.

The model put a trained nurse at the centre of the care pathway, who would closely monitor heart failure patients after discharge, educate the patient and family about heart-failure self-care, lifestyle modification and encourage medication adherence.

Nurses reviewed the patients’ medication regimen at discharge to ensure that there was no deviation from the guideline-mediated therapies. This was again reviewed at every follow-up visit with the help of a mobile-health app. The m-health app helped the nurses monitor all physical parameters of the patient real time and to identify warning signs of worsening disease, communicate and connect with patients and physicians so that timely hospitalisation was possible.

All participants underwent scheduled follow-up visits every three months for two years. Adherence to all four guideline-directed medical therapies was only 22.1% in the usual-care group, while it was 37.3% in the intervention group at two years.

“The health system engaging with the patient regularly was the key here. The m-health app gave the patient updates in real time to the nurse. Oxygen saturation levels, weight gain, weight loss, drop in blood pressure or respiratory rate comes as alerts, and then were escalated to the physician,” Dr. Jeemon points out.

The TIME-HF trial thus helped address one of the health system’s persistent weaknesses: that of proper follow-up care of patients with chronic diseases. The model is suited for strengthening chronic disease management and reducing the burden of hospitalisation and mortality in resource-limited settings across the country, experts said.