The TIME-HF trial, presented at the European Society of Cardiology (ESC) Congress 2026, demonstrated that a nurse-coordinated, technology-enabled care model significantly improved outcomes for patients with heart failure with reduced ejection fraction (HFrEF) in India. The study, published in Circulation, followed 1,507 adults across 22 centers, finding that the intervention group had an 84.0% probability of surviving two years without hospitalization, compared to 79.4% in the usual care group. Deaths were reduced by 22% in the nurse-led group, with researchers calling the model a practical strategy
for low- and middle-income countries and other settings with suboptimal adherence to guideline-directed therapies.
Nurse-Led Care Model Demonstrates Significant Outcomes
The TIME-HF trial, led by Panniyammakal Jeemon, MD, at the Sree Chitra Tirunal Institute for Medical Sciences & Technology, randomized 1,507 adults with HFrEF to either a nurse-led intervention or usual care. The intervention included mobile health tools, self-care education, and structured follow-up. Patients in the intervention group showed consistently higher adherence to guideline-directed medical therapies, with 37.3% adhering to all four therapies at two years, compared to 22.1% in the usual care group. Gaps between guideline recommendations and routine practice substantially limit the real-world impact of proven therapies,
Jeemon said, emphasizing that the model could bridge this divide.
The trial’s primary endpoint—days alive and out of hospital—highlighted the model’s effectiveness. Participants in the nurse-led group spent 84.0% of the two-year period without hospitalization, a 4.6 percentage point increase over the usual care group. Researchers noted that the model’s success stemmed from its combination of early intensive optimization and sustained, low-cost follow-up. 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,
Jeemon added.
Global Implications and Expert Reactions
Experts highlighted the trial’s broader significance for heart failure management. Rajeev Gupta, MD, PhD, noted that improving medication adherence and lifestyle changes is a critical area of investigation, while Lisa A. Kitko, PhD, RN, emphasized the trial’s contribution to team-based care. TIME-HF advances the science of heart failure implementation by connecting a nurse-coordinated collaborative care intervention with changes in evidence-based prescribing and subsequent clinical outcomes,
Kitko wrote. The study’s focus on transitional care for HFrEF is one of the largest with the longest follow-up from South Asia, according to Gupta.
The findings align with growing evidence that nurse-led models can address care gaps in resource-limited settings. We designed the TIME-HF trial on the premise that a combination of early intensive optimization and sustained, low-cost nurse-led follow-up with education on self-care may help to increase the long-term uptake of evidence-based therapies,
Jeemon said. The trial’s results could influence global guidelines, particularly in regions with limited specialist access.
What Comes Next: Scaling the Model and Policy Considerations
The success of the TIME-HF model has prompted discussions about expanding nurse-led care in public health systems. In India, where 57% of participants lived in rural areas, the integration of mobile health tools could address geographic disparities. Meanwhile, policymakers are evaluating how to replicate the model in other low-resource settings.
While the TIME-HF trial focuses on India, its implications extend globally. Researchers stress the need for further studies to assess the model’s long-term sustainability and cost-effectiveness. For now, the study stands as a landmark in heart failure care, offering a replicable framework for improving outcomes through structured, technology-enabled nursing interventions.
