Multifaceted Strategy Based on Automated Text Messaging After a Recent Heart Failure Admission
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Published:2023-12-06
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ISSN:2380-6583
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Container-title:JAMA Cardiology
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language:en
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Short-container-title:JAMA Cardiol
Author:
Rohde Luis E.1, Rover Marciane M.2, Hoffmann Filho Conrado R.3, Rabelo-Silva Eneida Rejane4, Silvestre Odilson M.5, Martins Silvia M.6, Passos Luiz C. S.7, de Figueiredo Neto José A.8, Danzmann Luiz C.9, Silveira Fábio S.10, Mesas Cezar Eumann11, Hernandes Mauro E.12, Moura Lidia Z.13, Simões Marcus V.14, Ritt Luiz E. F.15, Nishijuka Fábio Akio16, Bertoldi Eduardo G.17, Dall Orto Frederico T. C.18, Magedanz Ellen Hettwer19, Mourilhe-Rocha Ricardo20, Fernandes-Silva Miguel M.21, Ferraz Almir Sergio22, Schwartzmann Pedro23, de Castilho Fábio M.24, Pereira Barretto Antonio Carlos25, dos Santos Júnior Edval Gomes26, Nogueira Paulo Roberto27, Canesin Manoel11, Beck-da-Silva Luis1, de Carvalho Silva Maísa28, Adolfi Júnior Mario Sergio28, Santos Renato H. N.29, Ferreira Amanda1, Pereira Danielle1, Lopes Leticia1, Kojima Flávia C. S.29, Campos Viviane29, de Barros e Silva Pedro G. M.29, Blacher Mariana1, Cavalcanti Alexandre B.29, Ramires Felix29, Machado Bruna B.30, Hoscheidt Lais M.30, Poletti Silvia Z.30, Savaris Simone L.30, Meerholz Drieli A.S.30, Bernardes Daniela S.30, Scherer Mariana30, Prates Janaína S.30, Freitas Dhayn C.A.30, Barbosa Wilson R.30, Santana Francisco M.30, Medeiros Carolina A.30, Lemos Tayne30, Cunha Rossana G.30, Santana Maria I.S.30, Dorta Daniela C.30, Santos Viviane30, Grimaldi Aline30, Santos Naiara C.30, Carvalho William N.30, Silva Maria V. B.30, Vieira Naiara J. S.30, Muricy Daniel P.30, Figueiredo Clara S.30, Santos Helen M.30, Santana Itana L.30, Silva Alana R.30, Fernandes Julia D.30, Gomes Luane L. C.30, Assis Renata M.30, Moraes Maria J. D.30, Santos Josete C.30, Rocha Maria F. C.30, Tobias Joilma S.P.30, Albrecht Ana L.C.30, Tscheika Ana P.30, Rohrig Sheila30, Silveira Marcos S.30, Silveira Maelyn G.O.30, Seixas Aline C.M.30, Oliveira Ellen D.R.S.30, Galvão Tamyres M.O.30, Anjos Daniela O.30, Rieki Gustavo A.30, Marques Maria C.S.30, Perini Thaisa P.30, Morelli Hugo H.30, Fabri Felipe O.30, Rezende Catia30, Garcia Bruna M.B.30, Bandeira Milena V.30, Negri Kamila M.S.30, Pantano Gracielly S.30, Dallagassa Cibelle B.30, Miyasaki Dayane M.30, Woehl Juliane30, Pereira Monika B.30, Cruz Julia C.P.30, Rodrigues Izabela C.30, Menges Antonio C.30, Coutinho Barbara M.30, Litcanov Debora C.30, Lima Ana F.V.30, Nascimento João P.R.30, Marques Pedro H.30, Murari Michelle S.30, Hermann Sheila C.30, Calletti Julia C.30, Oliveira Queila B.30, Mascarenhas Sara N.30, Teixeira Bianca S.30, Cordeiro Karina C.30, Pereira Marcus V.B.30, Baptista Andresa30, Barbosa Ingrid30, Marinho Leonardo O.30, Silva Paulo A.30, Miranda Maria G.30, Medeiros Brunna M.30, Drogemoller Guilherme30, Barbosa Pablo R.M.30, Bonato Jonas F.30, Dantas Luan M.30, Soares Felipe G.30, Moro Manuelle R.30, Decker Sergio R.R.30, Bergo Ricardo R.30, Ribeiro Gislayne R.30, Andrade Luciana A.30, Melo Graziela P.30, Corsini Claire M.D.30, Ferreira Kelimys M.30, Silva Ana R.D.30, Rogante Rosana M.C.30, Lopes Nádia A.30, Homem Rosa M. V.30, Pinheiro Andrielle D.30, Santos Aline C.30, Bueno Natalia L.30, Battisti Vanessa30, Grings Vanessa30, Stefano Nicolas B.30, Grecco Clarissa30, Alves Brenda D.30, Rêgo Simone O.30, Bittencourt Marcelo I.30, Abrahão Fabio M.30, Santos Luciana R.B.30, Sales Ana L.F.30, Albuquerque Felipe N.30, Spineti Pedro P.M.30, Pereira Regiani R.30, Paula Estela30, Maiole Soraima C.30, Cerci Rodrigo J.30, Silva Mayara C.30, Souza Juliana M.30, Mota Diandro30, Silva Aline O.30, Silva João A.30, Rocha Jefferson S.30, Faustino Gabriela G.30, Leite Priscilla C.30, Guimarães Hanna C.30, Rosario Adailza B.30, Falcone Rossana30, Prado Leticia N.30, Villela Silvia C.C.30, Alves Matheus P.30, Salgado Isabela A.30, Done Stefania C.30, Borges Vanilda30, Maciel Hannelore T.R.30, Magalhães Bruna I.30, Oliveira Ludgero A.B.30, Lacerda Henrique C.30, Santos Gabrielle F.30, Lima Josyene S.30, Cardoso Juliano M.30, Curiatti Milena N.C.30, Clemente Luciane S.30, Guedez Mria R.M.P.30, Oliveira Aline S.30, Opozo Carlos E.30, Matte Pedro C.30, Santos Larissa K.S.30, Oliveira Paloma F.30, Casaes Deise F.30, Martins Danielo F.30, Franco Beatriz L.30, Pedro Mayra R.30, Bonfim Natasha C.30, Politi Samuel F.30, Lima Tiago A.M.30, Torres Debora M.30, Padarese Vinicius30, Menezes Gabriela B30, Silva Alana M.30, Navarro Mariá G.D.30, Butinhão Cristiani F.30, Santos Carolina C.30, Tamburim Barbara R.30, Santana Carolina D.30, Lopes Renata30, Silva Erlon O. A30, Tramujas Lucas30, Zanateli Alessandra30, Vianna Cibele O.30, Sbardelini Bethina C.30, Sousa Arielly S.R.30, Mustafá Eliana M.30, Ferreira Victor R.R.30, Araujo Daniela F.30, Leão Debora A.30, Rodrigues Ruanna M.30, Sena Kaytiussia R.30, Lacourt Rayane30, Fernandes Kenzo30, Matioli Klicia30, Mesquita Diego M.30, Oliveira Jacqueline P.30, Costa Vanessa30,
Affiliation:
1. Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil 2. Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil 3. Hospital Regional Hans Dieter Schmidt, Joinville, Brazil 4. Hospital de Clinicas de Porto Alegre e Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil 5. Hospital Silvestre Santé, Rio Branco, Brazil 6. Pronto Socorro Cardiológico de Pernambuco, Recife, Brazil 7. Hospital Ana Nery, Salvador, Brazil 8. Hospital Universitário da Universidade Federal do Maranhão, São Luiz, Brazil 9. Hospital Universitário de Canoas e Universidade Luterana do Brasil, Canoas, Brazil 10. Clínica do Coração de Aracaju, Aracaju, Brazil 11. Hospital Universitário Regional do Norte do Paraná, Londrina, Brazil 12. Santa Casa de Votuporanga, Votuporanga, Brazil 13. Hospital Universitário do Cajuru, Curitiba, Brazil 14. Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil 15. Instituto D’Or de Pesquisa e Ensino, Hospital Cárdio Pulmonar, Salvador, Brazil 16. Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil 17. Hospital Escola Universidade Federal de Pelotas, Pelotas, Brazil 18. Hospital Maternidade e Pronto Socorro Santa Lúcia, Poços de Caldas, Brazil 19. Hospital São Lucas da PUCRS, Porto Alegre, Brazil 20. Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil 21. Quanta Diagnóstico por Imagem, Curitiba, Brazil 22. Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil 23. Centro Avançado de Pesquisa e Ensino e Hospital Unimed de Ribeirão Preto, Ribeirão Preto, Brazil 24. Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil 25. Casa de Saúde Santa Marcelina, São Paulo, Brazil 26. Instituto Cárdio-Pulmonar, Feira de Santana, Brazil 27. Hospital de Base, São José do Rio Preto, Brazil 28. Kidopi–Soluções em Informática Médica, Ribeirão Preto, Brazil 29. Hcor Research Institute, São Paulo, Brazil 30. for the MESSAGE-HF Investigators
Abstract
ImportanceReadmissions after an index heart failure (HF) hospitalization are a major contemporary health care problem.ObjectiveTo evaluate the feasibility and efficacy of an intensive telemonitoring strategy in the vulnerable period after an HF hospitalization.Design, Setting, and ParticipantsThis randomized clinical trial was conducted in 30 HF clinics in Brazil. Patients with left ventricular ejection fraction less than 40% and access to mobile phones were enrolled up to 30 days after an HF admission. Data were collected from July 2019 to July 2022.InterventionParticipants were randomly assigned to a telemonitoring strategy or standard care. The telemonitoring group received 4 daily short message service text messages to optimize self-care, active engagement, and early intervention. Red flags based on feedback messages triggered automatic diuretic adjustment and/or a telephone call from the health care team.Main Outcomes and MeasuresThe primary end point was change in N-terminal pro–brain natriuretic peptide (NT-proBNP) from baseline to 180 days. A hierarchical win-ratio analysis incorporating blindly adjudicated clinical events (cardiovascular deaths and HF hospitalization) and variation in NT-proBNP was also performed.ResultsOf 699 included patients, 460 (65.8%) were male, and the mean (SD) age was 61.2 (14.5) years. A total of 352 patients were randomly assigned to the telemonitoring strategy and 347 to standard care. Satisfaction with the telemonitoring strategy was excellent (net promoting score at 180 days, 78.5). HF self-care increased significantly in the telemonitoring group compared with the standard care group (score difference at 30 days, −2.21; 95% CI, −3.67 to −0.74; P = .001; score difference at 180 days, −2.08; 95% CI, −3.59 to −0.57; P = .004). Variation of NT-proBNP was similar in the telemonitoring group compared with the standard care group (telemonitoring: baseline, 2593 pg/mL; 95% CI, 2314-2923; 180 days, 1313 pg/mL; 95% CI, 1117-1543; standard care: baseline, 2396 pg/mL; 95% CI, 2122-2721; 180 days, 1319 pg/mL; 95% CI, 1114-1564; ratio of change, 0.92; 95% CI, 0.77-1.11; P = .39). Hierarchical analysis of the composite outcome demonstrated a similar number of wins in both groups (telemonitoring, 49 883 of 122 144 comparisons [40.8%]; standard care, 48 034 of 122 144 comparisons [39.3%]; win ratio, 1.04; 95% CI, 0.86-1.26).Conclusions and RelevanceAn intensive telemonitoring strategy applied in the vulnerable period after an HF admission was feasible, well-accepted, and increased scores of HF self-care but did not translate to reductions in NT-proBNP levels nor improvement in a composite hierarchical clinical outcome.Trial RegistrationClinicalTrials.gov Identifier: NCT04062461
Publisher
American Medical Association (AMA)
Subject
Cardiology and Cardiovascular Medicine
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