Nurse-led care reduced deaths by 22% in Indian heart-failure trial

When a patient with heart failure logs a warning sign in a mobile health application, a trained nurse can see it, collect the information and coordinate follow-up with a physician. That model was tested across 22 centers in India, where 1,507 adults with heart failure and an ejection fraction of less than or equal to 40% were assigned to nurse-led collaborative care or usual care.

The nurses did more than monitor symptoms. They worked with doctors to tailor treatment, explained lifestyle changes, supported medication adherence and gave patients material for self-care. The intervention was designed to address a familiar gap: therapies recommended in clinical guidelines are proven to reduce deaths and hospitalizations, but their use in routine practice remains uneven, especially where specialist access and treatment costs are obstacles.

The difference in treatment uptake persisted over two years. The share of patients receiving all four guideline-directed medical therapies was 37.3% with the nurse-coordinated model, against 22.1% under usual care. The trial’s main measure focused on time patients could spend alive and outside hospital: the probability of surviving two years without hospitalization was 84.0%, compared with 79.4% in the usual-care group.

The mortality result was also significant. The intervention group recorded a 22% reduction in deaths after two years, with a reported p-value of 0.028. The findings were presented at ESC Congress 2026 and published simultaneously in Circulation.

So what changes in practice? For patients, the model links treatment, symptom reporting and education through a team that can maintain contact after the consultation. For health systems, it offers a way to extend specialist-led care through trained nurses and a low-cost digital coordination layer. The evidence currently comes from a randomized trial in India; it does not establish that the model has already been deployed broadly or that the same results will occur in every health system.