Abstract
BACKGROUND: Medically underserved areas (MUAs) are associated with higher rates of hospitalizations and mortality. Although structured remote management (RM) programs demonstrated clinical benefits, their effectiveness in MUAs in Europe remains scarcely investigated. OBJECTIVES: The objective of the study was to assess whether heart failure (HF) patients derive similar outcomes from a structured, multiparametric, RM program irrespective of MUA designation. METHODS: Consecutive patients enrolled in a standardized, multiparametric, HF RM program between April 2020 and December 2022 in 2 French regions (Auvergne Rhône-Alpes and Nouvelle-Aquitaine) at 2 French university hospitals were included in the study. Inclusion criteria were chronic HF with ≥1 episode of HF hospitalization within the last year or NYHA functional class ≥II associated with an elevated B-type natriuretic peptide. Patient assessments were performed remotely with body weight, blood pressure, heart rate, symptoms, biology, and data from cardiac implantable electronic devices. The primary outcome was the composite of unplanned HF hospitalization or all-cause mortality. RESULTS: Among 1,040 patients (mean age 72 ± 12 years, 70% male), 32% lived in MUAs. The median follow-up was 20 (IQR: 10-24) months. The annualized rate of the primary outcome was 13.7% (95% CI: 11.9-15.9) in the overall population, with no significant difference between MUAs and no MUAs patients (13.5% [95% CI: 10.3-17.4] vs 13.9% [95% CI: 11.6-16.5]; P = 0.876). MUAs were not associated with the primary outcome (adjusted HR: 0.93; 95% CI: 0.68-1.27; P = 0.84). Using Kaplan-Meier analysis, survival curves showed no difference between MUA and non-MUA patients (P = 0.83). CONCLUSIONS: Our study showed no difference in primary outcome among HF patients enrolled in a structured, multiparametric RM program, irrespective of MUAs.