Multifaceted Strategy Based on Automated Text Messaging After a Recent Heart Failure Admission: The MESSAGE-HF Randomized Clinical Trial.

Autor:	Rohde LE; Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil., Rover MM; Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil., Hoffmann Filho CR; Hospital Regional Hans Dieter Schmidt, Joinville, Brazil., Rabelo-Silva ER; Hospital de Clinicas de Porto Alegre e Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Silvestre OM; Hospital Silvestre Santé, Rio Branco, Brazil., Martins SM; Pronto Socorro Cardiológico de Pernambuco, Recife, Brazil., Passos LCS; Hospital Ana Nery, Salvador, Brazil., de Figueiredo Neto JA; Hospital Universitário da Universidade Federal do Maranhão, São Luiz, Brazil., Danzmann LC; Hospital Universitário de Canoas e Universidade Luterana do Brasil, Canoas, Brazil., Silveira FS; Clínica do Coração de Aracaju, Aracaju, Brazil., Mesas CE; Hospital Universitário Regional do Norte do Paraná, Londrina, Brazil., Hernandes ME; Santa Casa de Votuporanga, Votuporanga, Brazil., Moura LZ; Hospital Universitário do Cajuru, Curitiba, Brazil., Simões MV; Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil., Ritt LEF; Instituto D'Or de Pesquisa e Ensino, Hospital Cárdio Pulmonar, Salvador, Brazil., Nishijuka FA; Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil., Bertoldi EG; Hospital Escola Universidade Federal de Pelotas, Pelotas, Brazil., Dall Orto FTC; Hospital Maternidade e Pronto Socorro Santa Lúcia, Poços de Caldas, Brazil., Magedanz EH; Hospital São Lucas da PUCRS, Porto Alegre, Brazil., Mourilhe-Rocha R; Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil., Fernandes-Silva MM; Quanta Diagnóstico por Imagem, Curitiba, Brazil., Ferraz AS; Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil., Schwartzmann P; Centro Avançado de Pesquisa e Ensino e Hospital Unimed de Ribeirão Preto, Ribeirão Preto, Brazil., de Castilho FM; Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil., Pereira Barretto AC; Casa de Saúde Santa Marcelina, São Paulo, Brazil., Dos Santos Júnior EG; Instituto Cárdio-Pulmonar, Feira de Santana, Brazil., Nogueira PR; Hospital de Base, São José do Rio Preto, Brazil., Canesin M; Hospital Universitário Regional do Norte do Paraná, Londrina, Brazil., Beck-da-Silva L; Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil., de Carvalho Silva M; Kidopi-Soluções em Informática Médica, Ribeirão Preto, Brazil., Adolfi Júnior MS; Kidopi-Soluções em Informática Médica, Ribeirão Preto, Brazil., Santos RHN; Hcor Research Institute, São Paulo, Brazil., Ferreira A; Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil., Pereira D; Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil., López Pedraza L; Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil., Kojima FCS; Hcor Research Institute, São Paulo, Brazil., Campos V; Hcor Research Institute, São Paulo, Brazil., de Barros E Silva PGM; Hcor Research Institute, São Paulo, Brazil., Blacher M; Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil., Cavalcanti AB; Hcor Research Institute, São Paulo, Brazil., Ramires F; Hcor Research Institute, São Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	JAMA cardiology [JAMA Cardiol] 2024 Feb 01; Vol. 9 (2), pp. 105-113.
DOI:	10.1001/jamacardio.2023.4501
Abstrakt:	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.
Databáze:	MEDLINE
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