RT Journal Article
T1 Multifaceted Strategy Based on Automated Text Messaging After a Recent Heart Failure Admission: The MESSAGE-HF Randomized Clinical Trial
A1 Rohde, Luis E
A1 Rover, Marciane M.
A1 Hoffmann Filho, Conrado R.
A1 Rabelo Silva, Eneida Rejane
A1 Silvestre, Odilson M.
A1 Martins, Silvia M.
A1 Passos, Luiz C. S.
A1 Figueiredo Neto, José A. de
A1 Danzmann, Luiz C.
A1 Silveira, Fábio S.
A1 Mesas, Cezar Eumann
A1 Hernandes, Mauro E.
A1 Moura, Lidia Z.
A1 Simões, Marcus V.
A1 Ritt, Luiz E. F.
A1 Akio Nishijuka, Fábio
A1 Bertoldi, Eduardo G.
A1 Dall Orto, Frederico T. C.
A1 Hettwer Magedanz, Ellen
A1 Mourilhe Rocha, Ricardo
A1 Fernandes Silva, Miguel M.
A1 Ferraz, Almir Sergio
A1 Schwartzmann, Pedro
A1 Castilho, Fábio M. de
A1 Pereira Barretto, Antonio Carlos
A1 Santos Júnior, Edval Gomes dos
A1 Nogueira, Paulo Roberto
A1 Canesin, Manoel
A1 Silva, Luis Beck da
A1 Carvalho Silva, Maísa de
A1 Adolfi Júnior, Mario Sergio
A1 Santos, Renato H. N.
A1 Ferreira, Amanda
A1 Pereira, Danielle
A1 López Pedraza, Leticia
A1 Kojima, Flávia C. S.
A1 Campos, Viviane
A1 Barros E Silva, Pedro G M de
A1 Blacher, Mariana
A1 Cavalcanti, Alexandre B
A1 Felix Ramires, 
AB 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 ParticipantsThis 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.InterventionParticipants 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
PB American Medical Association
SN 2380-6583
YR 2023
FD 2023-12-06
LK https://hdl.handle.net/20.500.14352/133374
UL https://hdl.handle.net/20.500.14352/133374
LA eng
NO Rohde LE, Rover MM, Hoffmann Filho CR, Rabelo-Silva ER, Silvestre OM, Martins SM, Passos LCS, de Figueiredo Neto JA, Danzmann LC, Silveira FS, Mesas CE, Hernandes ME, Moura LZ, Simões MV, Ritt LEF, Nishijuka FA, Bertoldi EG, Dall Orto FTC, Magedanz EH, Mourilhe-Rocha R, Fernandes-Silva MM, Ferraz AS, Schwartzmann P, de Castilho FM, Pereira Barretto AC, Dos Santos Júnior EG, Nogueira PR, Canesin M, Beck-da-Silva L, de Carvalho Silva M, Adolfi Júnior MS, Santos RHN, Ferreira A, Pereira D, López Pedraza L, Kojima FCS, Campos V, de Barros E Silva PGM, Blacher M, Cavalcanti AB, Ramires F; MESSAGE-HF Investigators. Multifaceted Strategy Based on Automated Text Messaging After a Recent Heart Failure Admission: The MESSAGE-HF Randomized Clinical Trial. JAMA Cardiol. 2024 Feb 1;9(2):105-113. doi: 10.1001/jamacardio.2023.4501. Erratum in: doi: 10.1001/jamacardio.2024.0032. PMID: 38055237; PMCID: PMC10701668.
NO Concept and design: Rohde, Rabelo-Silva, Passos, Silveira, Mesas, Bertoldi, Ferraz, Schwartzmann,Adolfi Júnior, Pereira, López Pedraza, Blacher, Cavalcanti, Ramires
NO The MESSAGE-HF initiative was funded by the Brazilian Ministry of Health
DS Docta Complutense
RD 20 mar 2026