Chronic Heart Failure Care Research Articles

Evaluation of ivabradine plus beta-blocker versus beta-blocker alone in addition to standard care in reducing hospitalization and major adverse cardiovascular event in patients with chronic heart failure: a prospective observational study in tertiary care hospital in central India

BackgroundIn recent years, there has been an increase in cases of heart failure, ultimately leading to an increase in hospitalization for heart failure (HF) and cardiovascular mortality. The aim of our study was to evaluate ivabradine combined with beta-blocker versus beta-blocker alone in addition to standard care for chronic heart failure, followed for a period of 6 months for the rate of hospitalization and major adverse cardiovascular event (MACE) in patients with reduced left ventricular ejection fraction (LVEF < 35%).ResultsA total of 64 patients were included in this observational study with 30 patients in the ivabradine + beta-blocker (IVA + BB) group and 34 in the beta-blocker (BB) group. The median (IQR) age of the study sample was 57 (50–62) and 58.5 (55–67) in IVA + BB and BB groups, respectively, with LVEF < 35%. The incidence of the primary endpoint of composite MACE (MI, stroke, death, worsening of HF) was 5 in both groups. The mean heart rate was significantly decreased (p < 0.001) at 3-month and 6-month follow-up from baseline in the ivabradine + beta-blocker group as compared to the beta-blocker group alone, while it significantly increased in the beta-blocker group at 3 months (p < 0.01) and also at sixth months (p < 0.05). Parameters such as the New York Heart Association (NYHA) class and the Minnesota Living with Heart Failure questionnaire (MLWHFQ) were also assessed but did not show significant change.ConclusionOverall, observations from the study results show that IVA + BB seems to be overall well tolerated in the study sample, with a somewhat smaller decrease in hospitalization and a delay in MACE events in the sample population enrolled in a tertiary care hospital in India. Further exploration in a larger sample is required concerning the Indian population.

Palliative care for chronic heart failure: non-pharmacological methods of relieving the main symptoms

Chronic heart failure is one of the main causes of the increase in mortality and disability of the population around the world. In the final stages of chronic heart failure, when the debilitating symptoms of patients no longer respond to treatment, the issue of palliative care arises. To date, current clinical recommendations and guidelines do not contain data on palliative measures for this category of patients – in such conditions, doctors often do not understand what tactics of patient management they need to choose. Therefore, the importance of integrating palliative care into the treatment of chronic heart failure is increasing. Many symptoms associated with the terminal stages of chronic heart failure have a negative impact on the general condition and quality of life of patients. The main ones are shortness of breath, pain, manifestations of asthenia, as well as anxiety-depressive disorders. In order to maximize the possible improvement in the quality of life of such patients, palliative care should be comprehensive: regular pharmacotherapy prescribed in accordance with current clinical recommendations, combined with various non-drug methods for relieving the main symptoms. As such methods, the main cardiac rehabilitation measures can be considered, including regular physical training, training in compliance with the treatment regimen, stress management techniques, and psychological support. The relationship of patients and caregivers with medical professionals is important in the organization of palliative care. Adequate and timely communication is necessary to improve self-control and compliance with medication, prevent unplanned hospitalization, inform decision-making and, ultimately, ensure a safe death. The article discusses the basic concepts of organizing and providing palliative care to patients with chronic heart failure, as well as non-pharmacological palliative measures proposed by European, American, and Russian specialists.

Cost Effectiveness of Dapagliflozin for Heart Failure Across the Spectrum of Ejection Fraction: An Economic Evaluation Based on Pooled, Individual Participant Data From the DELIVER and DAPA-HF Trials.

The sodium glucose cotransporter-2 inhibitors are guideline-recommended to treat heart failure across the spectrum of left ventricular ejection fraction; however, economic evaluations of adding sodium glucose cotransporter-2 inhibitors to standard of care in chronic heart failure across a broad left ventricular ejection fraction range are lacking. We conducted a US-based cost-effectiveness analysis of dapagliflozin added to standard of care in a chronic heart failure population using pooled, participant data from the DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) and DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure) trials. The 3-state Markov model used estimates of transitional probabilities, effectiveness of dapagliflozin, and utilities from the pooled trials. Costs estimates were obtained from published sources, including published rebates in dapagliflozin cost. Adding dapagliflozin to standard of care was estimated to produce an additional 0.53 quality-adjusted life years (QALYs) compared with standard of care alone. Incremental cost effectiveness ratios were $85 554/QALY when using the publicly reported full (undiscounted) Medicare cost ($515/month) and $40 081/QALY, at a published nearly 50% rebate ($263/month). The addition of dapagliflozin to standard of care would be of at least intermediate value (<$150 000/QALY) at a cost of <$872.58/month, of high value (<$50 000/QALY) at <$317.66/month, and cost saving at <$40.25/month. Dapagliflozin was of at least intermediate value in 92% of simulations when using the full (undiscounted) Medicare list cost in probabilistic sensitivity analyses. Cost effectiveness was most sensitive to the dapagliflozin cost and the effect on cardiovascular death. The addition of dapagliflozin to standard of care in patients with heart failure across the spectrum of ejection fraction was at least of intermediate value at the undiscounted Medicare cost and may be potentially of higher value on the basis of the level of discount, rebates, and price negotiations offered. URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01035255 & NCT01920711.

Heart failure and the cost of dying: must the ferryman always be paid?

Provision of palliative care in chronic heart failure (CHF) can support complex decision-making, significantly improve quality of life and may lower healthcare costs. To examine whether healthcare costs differed in terminal admissions according to the adoption of a palliative approach. Retrospective review of medical records and costing data for all admissions resulting in death from CHF (July 2011 to December 2019),analysed as two groups (2011-2016 and 2016-2019) because of background changes in costings. Admissions with CHF resulting in death in an Australian tertiary referral centre. The cohort (n = 439) were elderly (median age 83.7 years, interquartile range (IQR) = 77.6-88.7 years) and mostly men (54.9%). Half (230, 52.4%) were referred to a specialist palliative care team, whereas over a third (172, 39.2%) received a palliative approach. Receiving a palliative approach was associated with a nonstatistically significant lower admission cost (AU$12 710 vs AU$15 978; P = 0.19) between 2011 and 2016 (n = 101, 38.8%) and a significantly lower cost (AU$11 319 vs AU$15 978; P < 0.01) between 2016 and 2019 (n = 71, 39.7%). Intensive care admission resulted in the single greatest additional cost at AU$14 624 (IQR = AU$4130-AU$44 197) (n = 48, 2011-2016). Median terminal admission cost was lower for patients with comfort goals of care (P < 0.01), without life-sustaining interventions (P < 0.01) or who received a palliative approach (P < 0.01). Referral to inpatient specialist palliative care or receiving a palliative approach resulted in comparable admission costings (AU$11 621 [IQR = AU$4705-AU$32 457] and AU$11 466 [IQR = AU$4973-AU$25 614]). A palliative approach in terminal CHF admission may improve quality at the end of life and decrease costs associated with care.

Хроническая сердечная недостаточность: лекарственное обеспечение, диспансерное наблюдение и перспективы использования цифровых технологий

This article is aimed at analyzing and discussing the quality of drug provision for patients with chronic heart failure (CHF), the organization of follow-up and the application potential of digital technologies in the treatment of patients with CHF, the prevalence of which continues to grow in the modern population. Optimal and timely adjusted drug therapy is the basis for effective treatment of patients with CHF. The lack of unified medical information systems and registers of such patients with the possibility of analytical work in most regions of the Russian Federation does not allow to fully assess the drug therapy quality in CHF. Evaluation of drug therapy in patients with CHF on an outpatient basis shows incomplete compliance of CHF treatment with current clinical recommendations. Follow-up conducted within the framework of current regulatory legal acts requires regular monitoring concerning not only the visit frequency, but also of the compliance of laboratory and instrumental study extent with current clinical recommendations. The inclusion of patients with CHF in the intensive outpatient follow-up program will improve the life prognosis of this patient cohort. The development and implementation in practical healthcare of methods for analyzing the digital data arrays, machine learning based on AI will contribute to improving the medical care quality. To improve the quality of medical care in CHF, it is necessary to provide patients with optimal drug therapy (including within the preferential drug provision) in order to conduct high-quality follow-up using modern digital technologies. All this will help to significantly reduce the risk of adverse outcome and hospitalization in this patient cohort. KEYWORDS: heart failure, drug therapy, drug provision, follow-up, AI. FOR CITATION: Dolgusheva Yu.A., Efremova Yu.E., Gornyakova N.B., Kudrina V.G., Ayrapetyan A.A., Mironov N.Yu., Bogdanova V.O., Sorokin E.V. Chronic heart failure: drug provision, follow-up and application potential of digital technologies. Russian Medical Inquiry. 2024;8(7):375–385 (in Russ.). DOI: 10.32364/2587-6821-2024-8-7-3.

Modelling clinicians' decisions to adjust loop diuretic dose based on patient-reported symptoms to inform decision-aids in daily care of chronic heart failure

Abstract Background To relieve congestion and prevent decompensation in chronic heart failure patients with reduced ejection fraction, the guidelines by the European Society of Cardiology recommend the use of loop diuretics.[1] The patient is encouraged to take an active role by tracking their symptoms and adjusting their dose accordingly.[1] Purpose To develop an exploratory prediction model of clinicians’ decisions to titrate loop diuretics based on patient-reported symptoms to create decision-aids. Methods We conducted a post hoc analysis of TIME-CHF.[2] Of the randomised participants at baseline, we selected those who did not withdraw consent during follow-up, had a furosemide-equivalent diuretic dose ≤600 mg at baseline and the first follow-up moment approximately 1 month after baseline, and had a recommendation registered on diuretic titration at the first follow-up. We developed logistic regression models for two outcomes at the first follow-up: up-titration versus no change, and down-titration versus no change. Predictors considered were: age, gender, furosemide-equivalent loop diuretic dose, NYHA class, angina, orthopnoea, paroxysmal nocturnal dyspnoea, nocturia, dry cough, dizziness, orthostasis, syncope, oedema, body mass index, systolic, diastolic, and systolic minus diastolic blood pressure, heart rate, jugular veins assessment, rales, hepatomegaly, third heart sound, serum-creatinine. These predictors separately and the intervention allocation (NT-proBNP versus symptom-guided therapy) were used to predict the outcomes. We explored symptoms occurring simultaneously with the outcome and change in symptoms between baseline and first follow-up. Ordinal predictors were modelled at the nominal and scale measurement level. We then selected a group of predictors deemed suitable in a daily care context per outcome. Analyses were performed based on complete cases and after multiple imputation. Performance metrics were R²Nagelkerke and C-statistics (apparent values and 95% confidence intervals via bootstrap). Results Of the 622 patients randomised at baseline, 500 fulfilled the selection criteria. There were 101 recommendations to up-titrate, 338 to keep the dose unchanged, and 61 to down-titrate. The complete case analysis did not differ substantively from analysis after multiple imputation due to the low number of missing values, therefore only the complete case analysis is reported here. Table 1 presents the results of the patient-reported symptoms modelled separately, collected simultaneously with the outcomes. For ordinal predictors, the scale measurement level is reported. Table 2 presents the results of the analysis using the groups of predictors. Conclusions This analysis may shape decision-aids by suggesting symptom importance in clinicians’ decisions. Oedema, NYHA class, and orthopnoea are tentatively the most important patient-reported symptoms in recommending up-titration, and orthostasis in recommending down-titration.

Chronic heart failure following hemorrhagic myocardial infarction: mechanism, treatment and outlook.

Myocardial infarction (MI), the blockage of arterial blood supply of the heart, is among the most common causes of death worldwide. Even when patients receive immediate treatment by re-opening blocked arteries, they often develop chronic heart failure (CHF) in the aftermath of MI events. Yet, the factors that contribute to the development of MI-associated CHF are poorly understood. In our recent study (Nat Commun 13:6394), we link intramyocardial hemorrhage, an injury which can occur during reperfusion of areas affected by MI, to an increased risk of CHF. Mechanistically, our data suggest that an iron-induced adverse cascade of events after hemorrhagic MI drives fatty degeneration of infarcted tissue, which ultimately contributes to negative cardiac remodeling. In this Microreview, we discuss the implications of our findings regarding the molecular mechanism, more targeted treatment options as well as perspectives in the clinical care of CHF after hemorrhagic MI.

Trisomy 18: Anti-Congestive Drug Treatment Combined with Transcatheter Occlusion of an Arterial Duct and Misaligned Perimembranous VSD

<i>Background </i>Trisomy 18 syndrome, the second most common autosomal numerical chromosomal disorder, is associated with multiple-organ abnormalities. Cardiovascular malformations are just one of those affecting prenatal and postnatal life expectancy. In general, the type and scope of treatment are still controversial and are handled very differently. Palliative care usually focuses on improving quality of life or life-threatening conditions. <i>Objective</i> Based on parental treatment preferences for their child, we report the anticongestive drug treatment and consecutive transcatheter therapy of cardiac shunt lesions in a girl with trisomy 18 who was born small-for-date. <i>Methods </i>Anticongestive drug treatment was switched form diuretic-directed drug treatment to our standard care for chronic heart failure in infants, which consists of a ß1-specific beta-blocker (bisoprolol) in combination with an ACE-inhibitor (lisinopril) and a low-dose mineralocorticoid-blocker (spironolactone). In addition, the strategy and technique of semi-invasive transcatheter treatment of significant cardiovascular shunt lesions is reported. At 3 months of age and weighing 2.4kg, a significant arterial duct was first occluded percutaneously with an MVP-5Q device, followed by transcatheter closure of a slightly misaligned perimembranous VSD six weeks later. Both interventions were performed on a spontaneously breathing only sedated baby. <i>Results </i>The device strategy for treating the hemodynamically significant cardiovascular shunt lesions was technically feasible and effective in combination with medication. However, the medium- or long-term outcome cannot be defined due to the limitations caused by the syndrome. <i>Conclusion</i> As part of a medical risk-benefit assessment, the parents should make the decision as to whether their child should be treated or not; the responsible physicians have individually to offer the best treatment option.

The first results of advanced medical care for chronic heart failure in different regions of the Russian Federation. Part I. Organization of care for chronic heart failure and prevalence of disease with reduced and preserved left ventricular ejection fraction

The first results of advanced medical care for chronic heart failure in different regions of the Russian Federation. Part I. Organization of care for chronic heart failure and prevalence of disease with reduced and preserved left ventricular ejection fraction

The first results of advanced medical care for chronic heart failure in different regions of the Russian Federation

The first results of advanced medical care for chronic heart failure in different regions of the Russian Federation

The first results of advanced medical care for chronic heart failure in different regions of the Russian Federation. Part II. Application of the main drugs for chronic heart failure and dynamics of hospitalizations

The first results of advanced medical care for chronic heart failure in different regions of the Russian Federation. Part II. Application of the main drugs for chronic heart failure and dynamics of hospitalizations

Efficacy of different telemonitoring strategies on chronic heart failure care: A protocol for systematic review and meta-analysis.

Background:Growing interest on the effects of telemonitoring on patients with chronic heart failure (CHF) has led to a rise in the number of trials addressing the same or very similar research questions with a concomitant increase in discordant findings. Therefore, we conducted a protocol for systematic review and meta-analysis to compare the effects of different telemonitoring strategies on clinical outcomes in patients with CHF.Methods:Two individual researchers conducted the platform searches on the PubMed, Cochrane Library, and Embase databases from inception to February 2022. Literature retrieving was carried out through a combined searching of subject terms (“MeSH” on PubMed and “Emtree” on “Embase”) and free terms on the platforms of PubMed and Embase, and through keywords searching on platform of Cochrane Library. Systematic review and meta-analysis of the data will be performed in STATA13.0 software according to the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Two authors independently performed the literature searching, data extraction, and quality evaluation. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials (RCTs).Results:The results will be submitted to a peer-reviewed journal.Conclusion:This meta-analysis will provide a comprehensive analysis and synthesis that can be used as an evidence map to inform practitioners and policy makers about the effectiveness of telemonitoring interventions for patients with CHF.

The GENICA project - a prospective cohort of heart failure patients with a comprehensive ambulatory approach aiming better outcomes: study protocol.

Heart failure (HF) is a syndrome increasing worldwide, and literature shows that the hospitalizations are associated with greater mortality rates. A patient-centered method combined with optimized medical treatment and palliative care may improve HF outcomes, and some advocate a multifaceted approach to achieve a perfect management of chronic HF (CHF). The objective of this study was to present the study protocol of GENICA project which aims to optimize the ambulatory approach of CHF patients, and reduce their re-hospitalization, emergency readmission, and global death rate. Prospective cohort including patients referred to HF consultation and collecting sociodemographic, clinical, and analytical variables among others. The outcomes will be mortality, re-hospitalization, and emergency readmission rates. The association between the independent variables and outcomes will be assessed by logistic regression. Comparison between GENICA patients and controls will be made by χ2 test. Significance at p level of less than 0.05. GENICA will offer a wide range of longitudinal data with evidence that will influence future healthcare of CHF patients at an ambulatory basis. GENICA will provide practical evidence of real HF patient's profile and develop workable decision algorithms, which will influence future ambulatory care of CHF. HF patients will be safer at home and will keep stability for longer periods, consuming less health resources and slow the progression of the disease. Being a matched cohort, GENICA benefits from an accuracy similar to that of randomized controlled trials, without the need to perform a rigorous allocation of the intervention. Being prospective there's no problem about response bias. CHF should be approached with a multidisciplinary and multifaceted strategy privileging the outpatient setting, including home monitoring, and GENICA is the paramount protocol enabling this. GENICA may come to show health policy makers that the asset is not to divide and rule, but to converge strategies, therapies, and knowledge.

Abstract 10078: Facilitators and Barriers to Chronic Care Among Patients with Heart Failure in Rural Haiti: A Qualitative Study

Introduction: Heart failure (HF) is a leading cause of hospitalizations in rural Haiti. However, few patients hospitalized for HF return for outpatient care. The factors that contribute to chronic HF care access are poorly understood. Objective: To investigate the facilitators and barriers to accessing care for chronic HF from the patients’ perspectives. Methods: We conducted three group interviews and one individual interview with thirteen patients with HF. We recruited patients after discharge from a non-governmental organization-supported academic hospital in rural Haiti. We employed thematic analysis using emergent coding and categorized themes using the socioecological model. Results: Facilitators of chronic care included participants’ knowledge about the importance of HF treatment and engagement with health systems to manage symptoms. Strong social support networks helped participants access clinic visits. Participants reported low cost of care at this subsidized hospital, good medication accessibility, and trust in the healthcare system. Participants expressed the strong spiritual belief that the healthcare system is an extension of God’s influence. Barriers to chronic care included participants' misconceptions about adherence to medications and the need to take HF medications with food. Lack of social support prevented clinic access, and non-healthcare costs associated with clinic visits were prohibitive. Participants expressed low satisfaction regarding the clinic experience. Another barrier to healthcare was the belief that heart disease caused by supernatural spirits is incurable. Conclusions: We identified several facilitators and barriers to chronic HF care with implications for HF management in rural Haiti. Future interventions to improve chronic HF care should address misconceptions and foster patient support systems for visit and medication adherence. Leveraging local spiritual beliefs may promote care engagement.

Efficacy of remote physiological monitoring-guided care for chronic heart failure: an updated meta-analysis.

Previous studies have reported contradictory findings on the utility of remote physiological monitoring (RPM)-guided management of patients with chronic heart failure (HF). Multiple databases were searched for studies that evaluated the clinical efficacy of RPM-guided management versus standard of care (SOC) for HF patients. The primary outcome was HF-related hospitalization (HFH). The secondary outcomes were all-cause mortality, cardiovascular-related (CV) mortality, and emergency department (ED) visits. Pooled relative risk (RR) and corresponding 95% confidence intervals (CIs) were calculated and combined using a random-effects model. A total of 16 randomized controlled trials, including 8679 HF patients (4574 managed with RPM-guided therapy vs. 4105 managed with SOC), were included in the final analysis. The average follow-up period was 15.2months. There was no significant difference in HFH rate between the two groups (RR: 0.94; 95% CI: 0.84-1.07; P = 0.36). Similarly, there were no significant differences in CV mortality (RR 0.86, 95% CI 0.73-1.02, P = 0.08) or in ED visits (RR 0.80, 95% CI 0.59-1.08, P = 0.14). However, RPM-guided therapy was associated with a borderline statistically significant reduction in all-cause mortality (RR: 0.88; 95% CI: 0.78-1.00; P = 0.05). Subgroup analysis based on the strategy of RPM showed that both hemodynamic and arrhythmia telemonitoring-guided management can reduce the risk of HFH (RR: 0.79; 95% CI: 0.64-0.97; P = 0.02) and (RR: 0.79; 95% CI: 0.67-0.94; P = 0.008) respectively. Our study demonstrated that RPM-guided diuretic therapy of HF patients did not reduce the risk of HFH but can improve survival. Hemodynamic and arrhythmia telemonitoring-guided management could reduce the risk of HF-related hospitalizations.

Improving outpatient care in chronic heart failure

Despite advances in pharma and high-technology medicine, the rate of burdensome hospital admissions and mortality in patients with chronic heart failure (CHF) remains high. Over half of all admission-entailing decompensations have been repeatedly shown to emerge from non-compliance with outpatient prescriptions. Poor adherence to medication and non-medication treatment can only be broken by improving the patient’s awareness of the disease and his closer monitoring by healthcare professionals. The power of clinical and laboratory illness monitoring in line with the recommended quality criteria of medical aid in heart failure (HF) is strongly limited today by time resources available in outpatient and midwifery clinics. Meanwhile, an international and certain domestic experience has been built up to run CHF outpatient centres with involvement of specially-trained nursing and senior medical staff. Analytic evidence on such centres suggests a reduction in mortality and hospitalisation rate among the visiting patients. To combat existing drawbacks of CHF outpatient care, the National Medical Research Center of Cardiology in alliance with the Specialist Society of Heart Failure have developed the nurses’ guidelines for CHF rooms and are launching a medical staff training programme to manage CHF rooms, registry and data analysis. Furthermore, a procedure has been developed for patient routing to regional CHF outpatient cabinets that is being actively deployed in the Tyumen Region.

Attitudes and practices towards palliative care in chronic heart failure: a survey of cardiovascular nurses and physicians

Background Heart failure is a chronic condition with various implications for individuals and families. Although the importance of implementing palliative care is recommended in best practice guidelines, implementation strategies are less clear. Aims This study sought to; (1) determine Australian and New Zealand cardiovascular nurses and physicians’ end of life care attitudes and specialist palliative care referral in heart failure and; (2) determine self-reported delivery of supportive care and attitudes towards service names. Methods An electronic survey was emailed to members of four peak bodies and professional networks. Participants were also recruited through social media. Paper-based versions of the survey were completed by attendees of the 66th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, August 2018. Findings There were 113 completed responses included in the analyses. Participants were nurses (n = 75), physicians (n = 32) and allied health professionals (n = 4). Most (67%) reported they were comfortable with providing end of life care; however, fewer respondents agreed they received support for their dying patients and one-third experienced a sense of failure when heart failure progressed. Most (84–100%) participants agreed they would refer a heart failure patient later in the illness trajectory. There was a more favourable attitude towards the service name ‘supportive care’ than to ‘palliative care’. Conclusion Comfort with end of life discussions is encouraging as it may lead to a greater likelihood of planning future care and identifying palliative care needs. Peer support and supervision may be useful for addressing feelings of failure. The use of needs-based assessment tools, adopting the service name ‘supportive care’ and further research focusing on primary palliative team-based approach is required to improve palliative care access. Impact statement Cardiovascular nurses and physicians are comfortable providing end of life care, but referrals to palliative care in the later stages of heart failure persists.

Understanding and Defining Palliative Care in Chronic Heart Failure: A Survey of Cardiovascular Health Professionals

Individuals with chronic heart failure experience high symptom burden, and poor quality of life. Palliative care is recommended in best practice guidelines; however, barriers currently exist, including health professionals’ understanding of palliative care.

Professionals guidance about palliative medicine in chronic heart failure: a mixed-method study

IntroductionHealthcare professionals (HCPs) experience difficulties in timely recognising and directing palliative care (PC) needs of their patients with chronic heart failure (CHF). The aim of this study was to develop...

Telemonitoring in patients with chronic heart failure and moderate depressed symptoms: results of the Telemedical Interventional Monitoring in Heart Failure (TIM-HF) study.

Depression is a frequent comorbidity in patients with chronic heart failure (CHF). Telemonitoring has emerged as a novel option in CHF care. However, patients with depression have been excluded in most telemedicine studies. This pre-specified subgroup analysis of the Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial investigates the effect of telemonitoring on depressive symptoms over a period of 12 months. The TIM-HF study randomly assigned 710 patients with CHF to either usual care (UC) or a telemedical intervention (TM) using non-invasive devices for daily monitoring electrocardiogram, blood pressure and body weight. Depression was evaluated by the 9-item Patient Health Questionnaire (PHQ-9) with scores ≥10 defining clinically relevant depressive symptoms. Mixed model repeated measures were performed to calculate changes in PHQ-9 score. Quality of life was measured by the Short Form-36. At baseline, 156 patients had a PHQ-9 score ≥10 points (TM: 79, UC: 77) with a mean of 13.2 points indicating moderate depressiveness. Patients randomized to telemedicine showed an improvement of their PHQ-9 scores, whereas UC patients remained constant (P=0.004). Quality of life parameters were improved in the TM group compared to UC. Adjustment was performed for follow-up, New York Heart Association class, medication, age, current living status, number of hospitalizations within the last 12 months and serum creatinine. In the study population without depression, the PHQ-9 score was similar at baseline and follow-up. Telemedical care improved depressive symptoms and had a positive influence on quality of life in patients with CHF and moderate depression.