Multifaceted Strategy Based on Automated Text Messaging After a Recent Heart Failure Admission
Authors: Rohde Luis E. , Rover Marciane M. , Hoffmann Filho Conrado R. , Rabelo-Silva Eneida Rejane , Silvestre Odilson M. , Martins Silvia M. , Passos Luiz C. S. , de Figueiredo Neto José A. , Danzmann Luiz C. , Silveira Fábio S. , Mesas Cezar Eumann , Hernandes Mauro E. , Moura Lidia Z. , Simões Marcus V. , Ritt Luiz E. F. , Nishijuka Fábio Akio , Bertoldi Eduardo G. , Dall Orto Frederico T. C. , Magedanz Ellen Hettwer , Mourilhe-Rocha Ricardo , Fernandes-Silva Miguel M. , Ferraz Almir Sergio , Schwartzmann Pedro , de Castilho Fábio M. , Pereira Barretto Antonio Carlos , dos Santos Júnior Edval Gomes , Nogueira Paulo Roberto , Canesin Manoel , Beck-da-Silva Luis , de Carvalho Silva Maísa , Adolfi Júnior Mario Sergio , Santos Renato H. N. , Ferreira Amanda , Pereira Danielle , López Pedraza Leticia , Kojima Flávia C. S. , Campos Viviane , de Barros e Silva Pedro G. M. , Blacher Mariana , Cavalcanti Alexandre B. , Ramires Felix ,   MESSAGE-HF Investigators, Machado Bruna B. , Hoscheidt Lais M. , Poletti Silvia Z. , Savaris Simone L. , Meerholz Drieli A.S. , Bernardes Daniela S. , Scherer Mariana , Prates Janaína S. , Freitas Dhayn C.A. , Barbosa Wilson R. , Santana Francisco M. , Medeiros Carolina A. , Lemos Tayne , Cunha Rossana G. , Santana Maria I.S. , Dorta Daniela C. , Santos Viviane , Grimaldi Aline , Santos Naiara C. , Carvalho William N. , Silva Maria V. B. , Vieira Naiara J. S. , Muricy Daniel P. , Figueiredo Clara S. , Santos Helen M. , Santana Itana L. , Silva Alana R. , Fernandes Julia D. , Gomes Luane L. C. , Assis Renata M. , Moraes Maria J. D. , Santos Josete C. , Rocha Maria F. C. , Tobias Joilma S.P. , Albrecht Ana L.C. , Tscheika Ana P. , Rohrig Sheila , Silveira Marcos S. , Silveira Maelyn G.O. , Seixas Aline C.M. , Oliveira Ellen D.R.S. , Galvão Tamyres M.O. , Anjos Daniela O. , Rieki Gustavo A. , Marques Maria C.S. , Perini Thaisa P. , Morelli Hugo H. , Fabri Felipe O. , Rezende Catia , Garcia Bruna M.B. , Bandeira Milena V. , Negri Kamila M.S. , Pantano Gracielly S. , Dallagassa Cibelle B. , Miyasaki Dayane M. , Woehl Juliane , Pereira Monika B. , Cruz Julia C.P. , Rodrigues Izabela C. , Menges Antonio C. , Coutinho Barbara M. , Litcanov Debora C. , Lima Ana F.V. , Nascimento João P.R. , Marques Pedro H. , Murari Michelle S. , Hermann Sheila C. , Calletti Julia C. , Oliveira Queila B. , Mascarenhas Sara N. , Teixeira Bianca S. , Cordeiro Karina C. , Pereira Marcus V.B. , Baptista Andresa , Barbosa Ingrid , Marinho Leonardo O. , Silva Paulo A. , Miranda Maria G. , Medeiros Brunna M. , Drogemoller Guilherme , Barbosa Pablo R.M. , Bonato Jonas F. , Dantas Luan M. , Soares Felipe G. , Moro Manuelle R. , Decker Sergio R.R. , Bergo Ricardo R. , Ribeiro Gislayne R. , Andrade Luciana A. , Melo Graziela P. , Corsini Claire M.D. , Ferreira Kelimys M. , Silva Ana R.D. , Rogante Rosana M.C. , Lopes Nádia A. , Homem Rosa M. V. , Pinheiro Andrielle D. , Santos Aline C. , Bueno Natalia L. , Battisti Vanessa , Grings Vanessa , Stefano Nicolas B. , Grecco Clarissa , Alves Brenda D. , Rêgo Simone O. , Bittencourt Marcelo I. , Abrahão Fabio M. , Santos Luciana R.B. , Sales Ana L.F. , Albuquerque Felipe N. , Spineti Pedro P.M. , Pereira Regiani R. , Paula Estela , Maiole Soraima C. , Cerci Rodrigo J. , Silva Mayara C. , Souza Juliana M. , Mota Diandro , Silva Aline O. , Silva João A. , Rocha Jefferson S. , Faustino Gabriela G. , Leite Priscilla C. , Guimarães Hanna C. , Rosario Adailza B. , Falcone Rossana , Prado Leticia N. , Villela Silvia C.C. , Alves Matheus P. , Salgado Isabela A. , Done Stefania C. , Borges Vanilda , Maciel Hannelore T.R. , Magalhães Bruna I. , Oliveira Ludgero A.B. , Lacerda Henrique C. , Santos Gabrielle F. , Lima Josyene S. , Cardoso Juliano M. , Curiatti Milena N.C. , Clemente Luciane S. , Guedez Mria R.M.P. , Oliveira Aline S. , Opozo Carlos E. , Matte Pedro C. , Santos Larissa K.S. , Oliveira Paloma F. , Casaes Deise F. , Martins Danielo F. , Franco Beatriz L. , Pedro Mayra R. , Bonfim Natasha C. , Politi Samuel F. , Lima Tiago A.M. , Torres Debora M. , Padarese Vinicius , Menezes Gabriela B , Silva Alana M. , Navarro Mariá G.D. , Butinhão Cristiani F. , Santos Carolina C. , Tamburim Barbara R. , Santana Carolina D. , Lopes Renata , Silva Erlon O. A , Tramujas Lucas , Zanateli Alessandra , Vianna Cibele O. , Sbardelini Bethina C. , Sousa Arielly S.R. , Mustafá Eliana M. , Ferreira Victor R.R. , Araujo Daniela F. , Leão Debora A. , Rodrigues Ruanna M. , Sena Kaytiussia R. , Lacourt Rayane , Fernandes Kenzo , Matioli Klicia , Mesquita Diego M. , Oliveira Jacqueline P. , Costa Vanessa 
Published: December 2023

Importance

Readmissions after an index heart failure (HF) hospitalization are a major contemporary health care problem.

Objective

To evaluate the feasibility and efficacy of an intensive telemonitoring strategy in the vulnerable period after an HF hospitalization.

Design, Setting, and Participants

This 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.

Intervention

Participants 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 Measures

The 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.

Results

Of 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 Relevance

An 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 Registration

ClinicalTrials.gov Identifier: NCT04062461