A Low-Cost Telemedicine + Nurse-Led Decision-Support Program for Heart Failure in the Middle East: A Prospective Cohort Study with Clinical and Economic Outcomes

Abstract

Background: Heart failure is a leading cause of morbidity, mortality, and healthcare costs in the Middle East. Frequent rehospitalizations remain a significant challenge. Recent studies, including the AHA 2023 and ESC 2021 guidelines, show that telemedicine interventions can reduce rehospitalization and improve quality of life in HF patients. However, data from low-resource settings in the Middle East remain limited. This study aims to evaluate the effectiveness of a low-cost telemedicine model with nurse-led decision support in reducing 90-day rehospitalization rates, improving functional status, and assessing patient satisfaction and cost-effectiveness.

Methods: This prospective cohort study included 60 consecutive patients with HFrEF or HFpEF, recently discharged from the hospital. The intervention comprised: (1) individualized discharge education, (2) daily self-reporting of weight, blood pressure, and symptoms via a messaging app, (3) nurse-driven monitoring using an algorithm-based approach, (4) rapid physician intervention within 24 hours in case of clinical alerts. A historical control group of 60 matched patients was used for comparison. The primary endpoint was HF rehospitalization or all-cause death within 90 days. Secondary endpoints included changes in NYHA class, quality of life (MLHFQ), patient satisfaction (VAS 1–10), and an economic cost analysis.

Results: The intervention group showed a significant reduction in rehospitalization or death (HR = 0.50; 95% CI, 0.28–0.89; p = 0.03). Rehospitalization rates decreased from ~30% to ~14% (relative risk reduction ≈ 53%). Functional improvement (≥1 NYHA class) was observed in 65% of the intervention group vs. 35% in controls (p = 0.01). Patient satisfaction increased from 6.2 to 8.7 (p < 0.001).Cost savings: approximately $800 per patient over 90 days.

Conclusions: A low-cost telemedicine model with nurse-led decision support can substantially reduce rehospitalization and improve outcomes in heart failure patients in the Middle East. This scalable, cost-effective model offers significant potential for integration into healthcare policies in resource-limited settings.