Team based collaborative care model, facilitated by mHealth enabled and trained nurses, for management of heart failure with reduced ejection fraction in India (TIME-HF)

doi:10.1161/circulationaha.126.082490

TIME-HF

Patient / Population Intervention / Exposure Comparison Outcome

In 1,507 patients with HFrEF at 22 hospitals in India, nurse-led, app-supported collaborative care increased days alive and out of hospital over 2 years compared with usual care.

N

1,507patients

Design

parallel-group, open-label, multicentre cluster-randomised controlled trial; 22 hospital units in India randomised 1:1 by computer-generated sequence (no blocking or matching) to intervention or usual care; about 70 patients per centre (≈770 per arm); rolling recruitment over 6–12 months; 2-year follow-up per patient

Endpoint

Days alive and out of hospital (DAOH) during 2 years of follow-up (total follow-up time minus days in hospital and days from death to end of follow-up)

Relevance

2Important — one of several pillars.

ResultProbability of surviving 730 days without hospitalisation 84.0% (95% CI 82.2–85.8) with the collaborative-care intervention vs 79.4% (95% CI 77.7–81.2) with usual care (absolute +4.5 percentage points); odds of DAOH = 730/730 days OR 1.78 (95% CI 1.42–2.23). All-cause death 163/755 (21.59%) vs 201/752 (26.73%); RR 0.80 (95% CI 0.67–0.97); adjusted Cox HR 0.78 (95% CI 0.63–0.95), P=0.028.

Jeemon P, Ganapathi S, et al. Circulation. 2026; published online 30 August. 10.1161/circulationaha.126.082490

Discussion & critique

Nothing new was prescribed here: a trained nurse, a phone app and structured counselling raised four-pillar therapy from 22% to 37% and bought days out of hospital and fewer deaths — the gap between what the guidelines say and what patients receive is itself treatable. Cluster-randomised and open-label, so the difference includes the attention the intervention arm received, and 22 units mean the unit of randomisation is small. Read as a health-services finding for a setting where 57% of patients live rurally; whether the same nurse-and-app package moves anything where baseline adherence is already high is a different trial.