Nurse-Coordinated Care Model Improves Heart Failure Outcomes

This inadequate uptake contributes to preventable hospitalizations and deaths, particularly in settings where access to specialist care is limited. Closing this implementation gap requires scalable models that can support ongoing medication optimization, patient monitoring, and self-care. A new study now shows that a nurse-coordinated collaborative care model can significantly improve outcomes for adults with heart failure.

The nurse-coordinated collaborative care model was evaluated by investigators associated with Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST; Thiruvananthapuram, India) and presented at a Hot Line session at ESC Congress 2026, with simultaneous publication in Circulation. The approach positions trained nurses to work alongside physicians to deliver integrated, patient-centered management focused on guideline-directed therapy and longitudinal follow-up.

In the intervention arm, nurses coordinated care through a mobile health application that supported real-time communication and data capture. Patients used the platform to log symptoms and warning signs, allowing nurses to identify concerns and initiate timely outreach. Nurses also delivered structured counseling on lifestyle modification, reinforced medication adherence, and provided educational materials to support behavior change and self-care.

The TIME-HF study was a cluster-randomized trial that enrolled 1,507 adults with heart failure with reduced ejection fraction, defined as an ejection fraction of 40% or lower, across 22 centers in India. Centers were randomized 1:1 to implement the nurse-led model or continue usual care under treating physicians. Participants had a mean age of 62 years; 32% were women, and 57% lived in rural areas.

Outcomes favored the nurse-led strategy. Days alive and out of hospital increased, and the probability of surviving up to two years without hospitalization was higher with the intervention than with usual care (84.0% versus 79.4%; p<0.001). All-cause mortality was reduced by 22% at two years (p=0.028). Use of guideline-directed medical therapy was consistently higher in the intervention group, including adherence to all four recommended drug classes at two years (37.3% versus 22.1%).

“Taken together, the data suggest that a structured, nurse-coordinated, technology-enabled delivery model may offer a practical strategy to improve heart failure outcomes in routine care. We believe this model is not only relevant to low- and middle-income countries but also to other settings around the world where adherence to guideline-directed medical therapies is suboptimal,” said Dr. Panniyammakal Jeemon, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, India.

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