EFFECTIVENESS OF TELEPHONE MONITORING OF PATIENTS WITH CHRONIC HEART FAILURE BY NURSES

Highlights

The management of patients with chronic heart failure (CHF), with its high mortality and hospitalization rates, is a pressing issue. Active patient monitoring through telephone visits conducted by medical personnel has proven effective in managing the risk of adverse events in this patient population.

Aim. To evaluate the effectiveness of remote patronage by nurses (brothers) of patients with CHF using telephone “visits”.

Methods. 108 patients were included: group 1 – active control using telephone “visits”, group 2 – traditional follow-up. Telephone “visits” were conducted weekly for 1 month after inclusion in the study, then once a month for the next 5 months. After 1 year, the patient's status was assessed: “alive/dead”, the number of requests for medical help due to decompensation of heart failure.

Results. During the 6 months of follow–up, the following were registered: in the active control group – 10 emergency medical team calls, 5 hospitalizations, 25 outpatient visits to a cardiologist, there were no deaths; in the traditional follow-up group – 18 NSR team calls, 16 hospitalizations, 29 outpatient visits to a cardiologist. The proportion of patients taking 4-component therapy increased: in the active control group – up to 74.1%, in the traditional follow–up group – up to 22.2% (p < 0.0001). The proportion of patients taking 3 or more drugs in the active control group was more than 90%, in the traditional follow–up group – 46.3% (p < 0.0001). After 1 year, there were 3 deaths in the active control group and 5 deaths in the traditional follow–up group. Calls to the NSR team were 12 and 17, episodes of hospitalization were 10 and 19, outpatient visits to a cardiologist were 13 and 19 (in the active control and traditional follow–up group, respectively). A decrease in the proportion of patients taking 4-component therapy: in the active control group – from 74.1% to 27.8%, in the traditional follow-up group – from 29.6% to 16.7%.

Conclusion. Telephone “visits” have a high potential in managing the risks of adverse events in patients with CHF.

1. Shlyahto E.V., Zvartau N.E., Villivalde S.V., Yakovlev A.N., Solovyeva A.E., Fedorenko A.A., et al. Znachimost ocenki rasprostranennosti i monitoring ishodov u pacientov s serdechnoi nedostatochnostyu v Rossii. Rossiiskii kardiologicheskii jyrnal. 2020; 12: 146-154 (In Russ) doi:10.15829/1560-4071-2019-11-69-82

2. Bell C.M., Schnipper J.L., Auerbach A.D., Kaboli P.J., Wetterneck T.B., Gonzales D.V., et al. Association of communication between hospital-based physicians and primary care providers with patient outcomes J Gen Intern Med.2009; 24: 381-386. doi: 10.1007/s11606-008-0882-8

3. Larina V.N., Zamyatin K.A., Sheregova E.N., Kydinova M.A. Privergennost lecheniu kak neotemlemii component taktiki vedeniya pecientov s hronicheskoi serdechnoi nedostatochnostyu. Rossiiskii kardiologocheskii jyrnal. 2024; 29 (1): 56-90. (In Russ). doi: 10.15829/1560-4071-2024-5690

4. Berardinelli D., Conti A., Hasnaoui A., Casabona, E., Martin, B., Campagna, S. et al. Nurse-Led Interventions for Improving Medication Adherence in Chronic Diseases: A Systematic Review. Healthcare 2024; 12: 23-37. doi:10.3390/healthcare12232337

5. Nilsson T., Mokhtari A., Sandgren J., Lundager Forberg J., Olsson de Capretz P., Ekelund U.. Complications in Emergency Department Patients with Acute Coronary Syndrome with Contemporary Care. Cardiology 2024; 149 (6): 523-532. doi: 10.1159/000538637

6. Blankova Z.N., Svirida O.N., Vinogradova N.G., Reitblat O.M., Shestova I.I., Annenkova J.E., еt al. Telefonii monitoring bolnih hronicheskoi serdechnoi ntdostatochnostiu. Rezyltati oprosa srednego medicinskogo personala rossiiskih klinik. Kardiologicheskii vestnik. 2025; 20 (2): 54-60. (In Russ). doi:10.17116/Cardiobulletin20252002154

7. Bozkurt B., Ahmad T., Alexander K.M., Baker W.L., Bosak K., Breathett K., еt al. Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America. J Card Fail. 2023; 29(10): 1412-1451. doi: 10.1016/j.cardfail.2023.07.006

8. Schulz M., Griese-Mammen N., Schumacher P.M., Anker S.D., Koehler F., Ruckes C., et al. Impact of Pharmacist Telehealth Comanagement for Heart Failure: A Nonrandomized Controlled Study. JACC Adv. 2025; 4 (7): 241-256. doi: 10.1002/ehf2.12904

9. Boytsov S.A., Ageev F.T., Blankova Z.N., Svirida O.N., Begrambekova Yu.L. Guidelines for nurses and patients with chronic heart failure. Cardiovascular Therapy and Prevention. 2021; 20(1): 27-54. (In Russ.) doi:10.15829/1728-8800-2021-2754

10. Vaisberg A.R., Tarlovskaya E.I., Fomin I.V., Polyakov D.S., Omarova Yu.V. Narysfeniya yglevodnogo obmena y pacientov s hronicheskoi serdechnoi nedostatochnostyu po dannim lokalnogo registra. Rossiiskii kardiologocheskii jyrnal. 2021; 3: 22-28. (In Russ) doi.org/10.15829/1560-4071-2021-4330

11. Galyavich A. S., Tereshchenko S. N., Uskach T. M., Ageev F. T., Aronov D. M., Arutyunov G. P., еt al. 2024 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2024; 11 (29): 251-349 (In Russ.)]. doi: 10.15829/1560-4071-2024-6162. EDN WKIDLJ

12. Greene S.J., Butler J., Albert N.M., DeVore A.D., Sharma P.P., Duffy C.I., et al. Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry. J Am Coll Cardiol. 2018; 72 (4): 351-366. doi: 10.1016/j.jacc.2018.04.070.

13. Bozkurt B., Savarese G., Adamsson Eryd S., Bodegård J., Cleland J.G.F., Khordoc C., et al. Mortality, Outcomes, Costs, and Use of Medicines Following a First Heart Failure Hospitalization: EVOLUTION HF. JACC Heart Fail. 2023; 11(10):1320-1332. doi: 10.1016/j.jchf.2023.04.017.

14. Marques C.R.G, de. Menezes A..F, Ferrari Y.A.C, Oliveira A.S, Tavares A..CM, Barreto A.S., Vieira R.CA., da Fonseca C.D., Santana-Santos E. Educational Nursing Intervention in Reducing Hospital Readmission and the Mortality of Patients with Heart Failure: A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis. 2022; 28;9(12):420. doi: 10.3390/jcdd9120420.

15. Harrison P.L., Hara P.A., Pope J.E., Young M.C., Rula E.Y. The impact of postdischarge telephonic follow-up on hospital readmissions. Popul Health Manag. 2011; 14(1):27-32. doi: 10.1089/pop.2009.0076.

16. Van Spall H.G.C, Rahman T., Mytton O., Ramasundarahettige C., Ibrahim Q., Kabali C., et al. Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis. Eur J Heart Fail. 2017;19(11):1427-1443. doi: 10.1002/ejhf.765.

17. Slyer J.T., Concert C.M., Eusebio A.M., Rogers M.E., Singleton J. A systematic review of the effectiveness of nurse coordinated transitioning of care on readmission rates for patients with heart failure. JBI Libr Syst Rev. 2011; 9(15) :464-490. doi: 10.11124/01938924-201109150-00001.

18. Gheorghiade M, V.aduganathan M., Fonarow G.C., Bonow R.O. Rehospitalization for heart failure: problems and perspectives. J Am Coll Cardiol. 2013 ;61(4): 391-403. doi: 10.1016/j.jacc.2012.09.038.