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Effectiveness of Nurse-Coordinated, Digital-Supported Collaborative Care Model in Reducing Hospital Stay and Mortality Among Patients With Heart Failure: TIME-HF Cluster RCT India
Key result
Nurse-coordinated mHealth collaborative care increases two-year hospitalization-free survival odds by ~78% in HFrEF.
- OR 1.78
- 95% CI 1.42-2.23
- n=1,507
Why the trial?
Guideline-directed heart failure therapy is persistently under-implemented in routine practice. TIME-HF asked whether a team-based collaborative care model improves treatment optimisation and outcomes compared with usual management.
Does a nurse-coordinated, mobile health-supported collaborative care model improve days alive and out of the hospital in adults with HFrEF?
Population
1,507 adults with HFrEF at 22 centres in India (mean age 61.9; 77.6% men)
Comparison
Nurse-coordinated, mHealth-supported collaborative care vs usual care
Design
Parallel-group, cluster-randomized controlled trial (centres 1:1)
Follow-up
2 years (24 months)
Authors
JPJeemon PanniyammakalPresenting author
Panniyammakal JeemonGeneral / Preventive / LipidsSGSanjay GanapathiInterventional / Structural CardiologyNANavya AnikkadyHeart Failure / Cardiomyopathy
Panniyammakal JeemonGeneral / Preventive / LipidsSGSanjay GanapathiInterventional / Structural CardiologyNANavya AnikkadyHeart Failure / CardiomyopathyDiscussion
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Implication
Nurse-coordinated collaborative care improved 2-year survival without hospitalization (84.0% vs 79.4%) and cut all-cause death (HR 0.78) in Indian HFrEF care.
Key Points
- To assess whether a nurse-coordinated, mobile health-supported collaborative care model improves days alive and out of the hospital and reduces all-cause mortality in patients with heart failure with reduced ejection fraction.
- Parallel-group, cluster-randomized controlled trial across 22 centers in India randomized 1:1 to the collaborative care intervention or usual care (CTRI/2021/11/037797).
- Enrolled 1507 adults with heart failure with reduced ejection fraction followed for 2 years.
- The intervention provided risk stratification, medication and lifestyle optimization, and a nurse-coordinated mobile health management program with continuous outpatient monitoring.
- The probability of surviving 730 days without hospitalization was 84.0% (95% CI, 82.2%–85.8%) in the intervention group versus 79.4% (95% CI, 77.7%–81.2%) in usual care, with 78% higher odds of remaining out of the hospital for all 730 days (OR, 1.78 [95% CI, 1.42–2.23]).
- All-cause mortality occurred in 21.59% (163/755) of the intervention group compared with 26.73% (201/752) of the usual care group (RR, 0.80 [95% CI, 0.67–0.97]; adjusted HR, 0.78 [95% CI, 0.63–0.95]; P=0.028).
Evidence details
What drove the result?
| Outcome | Collab care | Usual care |
|---|---|---|
| Alive and out of hospital for all 730 days | 84.0% | 79.4% |
| Primary outcome · OR 1.78 (95% CI 1.42–2.23) favoring collaborative care | ||
| All-cause death | 163/755 (21.6%) | 201/752 (26.7%) |
| Secondary outcome · adjusted HR 0.78 (95% CI 0.63–0.95); p=0.028 | ||
Limitations & tradeoffs
Representation
Single-country trial in India in which 70% of participants had low educational attainment, 57% were rural, and 77.6% were men.
Subgroup caution
The mortality benefit was a secondary outcome, not the primary endpoint.
Design limitations
No blinding is described in the record for this care-model intervention.
Structured PICO
Does a nurse-coordinated, mobile health-supported collaborative care model improve days alive and out of the hospital in adults with HFrEF?
P
Population
1507 adults with heart failure with reduced ejection fraction across 22 centers in India, followed for 2 years.
I
Intervention
Nurse-coordinated, mobile health-supported collaborative care model including risk stratification, lifestyle and pharmacological optimization, self-care education, active follow-up, and continuous outpatient monitoring over 2 years.
C
Comparator
Usual care.
O
Outcome
Days alive and out of the hospital over 2 years.composite
Main Result
Odds Ratio: 1.78 (95% CI 1.42–2.23)
Absolute Event Rate: 84% vs 79.4%
Absolute Risk Reduction: 4.5%
A nurse-coordinated, digital-supported collaborative care model significantly increased days alive and out of hospital and reduced all-cause mortality in patients with HFrEF in India.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Cite This Study
Jeemon et al. (2026) conducted an RCT in Heart failure with reduced ejection fraction (n=1,507). Nurse-coordinated, mobile health-supported collaborative care model vs. Usual care was evaluated on Days alive and out of the hospital (OR 1.78, 95% CI 1.42-2.23). A nurse-coordinated collaborative care model for HFrEF increased the probability of surviving 2 years without hospitalization (84.0% vs 79.4%; OR 1.78) and reduced mortality (HR 0.78).