Randomised trial of telephone intervention in chronic heart failure: DIAL trial.

Objective: To determine whether a centralised telephone intervention reduces the incidence of death or admission for worsening heart failure in outpatients with chronic heart failure.
Design: Multicentre randomised controlled trial.
Setting: 51 centres in Argentina (public and private hospitals and ambulatory settings).
Participants: 1518 outpatients with stable chronic heart failure and optimal drug treatment randomised, stratified by attending cardiologist, to telephone intervention or usual care.
Intervention: Education, counselling, and monitoring by nurses through frequent telephone follow-up in addition to usual care, delivered from a single centre.
Main Outcome Measure: All cause mortality or admission to hospital for worsening heart failure.
Results: Complete follow-up was available in 99.5% of patients. The 758 patients in the usual care group were more likely to be admitted for worsening heart failure or to die (235 events, 31%) than the 760 patients who received the telephone intervention (200 events, 26.3%) (relative risk reduction = 20%, 95% confidence interval 3 to 34, P = 0.026). This benefit was mostly due to a significant reduction in admissions for heart failure (relative risk reduction = 29%, P = 0.005). Mortality was similar in both groups. At the end of the study the intervention group had a better quality of life than the usual care group (mean total score on Minnesota living with heart failure questionnaire 30.6 v 35, P = 0.001).
Conclusions: This simple, centralised heart failure programme was effective in reducing the primary end point through a significant reduction in admissions to hospital for heart failure.