Research ArticleResearchMedication SafetyPatient Education

Nurse-led warfarin telehealth improved early INR measures and medication adherence, but complication and readmission rates did not differ significantly

Frontiers in cardiovascular medicine (PubMed)Jun 30, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In a single-center randomized trial of 122 adults with atrial fibrillation, a nurse-led WeChat and cloud follow-up program improved early INR compliance, INR monitoring, medication adherence, and knowledge, but detected no difference in complications or readmissions.

What NurseJet pulled from the source

This randomized trial enrolled 122 cardiology patients taking long-term warfarin and assigned 61 to routine discharge education or 61 to the same education plus an Internet Plus Nursing telehealth program using WeChat and cloud-based education and monitoring. At 10 days, INR compliance was 98.3% with telehealth and 86.5% with usual care; at 1 month it was 86.7% and 57.7%. INR monitoring rates were also higher at both time points. Medication adherence was 88.3% with telehealth and 48.1% with usual care, and knowledge and satisfaction scores were higher. No significant differences were detected in complications or readmissions during six months of follow-up, so the trial supports process and adherence benefits rather than improved clinical outcomes.

Why this matters for nurses

Cardiology and medication-safety nurses reinforce warfarin teaching, coordinate INR follow-up, and identify barriers after discharge. This trial matters because it tested a nurse-led digital pathway and measured both care-process outcomes and clinical outcomes instead of treating improved engagement as proof of fewer complications.

Bedside takeaway

Be aware that nurse-led warfarin telehealth improved INR follow-up and adherence, but the small trial detected no reduction in complications or readmissions.

How This Applies in Practice

Use this when: Your service is implementing an approved nurse-led follow-up pathway for patients discharged on long-term warfarin.

On your shift

Confirm that the patient knows when and where the next INR will be checked and how results will be communicated.
Use the approved follow-up channel to reinforce medication education and escalate missed INR checks or reported concerns.

Keep in mind: This trial did not show fewer complications or readmissions. Follow facility policy, the anticoagulation protocol, and patient-specific provider orders.

Explain this for my unit

Key takeaways

The single-center trial randomized 122 adults taking long-term warfarin for atrial fibrillation.
The intervention combined routine education with WeChat and cloud-based nurse follow-up for six months.
INR compliance and monitoring were higher at 10 days and 1 month, and medication adherence was higher with telehealth.
The trial detected no significant difference in complications or readmissions.

Practice implications

A structured, approved telehealth pathway may help reinforce INR follow-up and medication adherence after discharge. Teams should still monitor bleeding, thromboembolic events, complications, and readmissions because better process measures did not translate into detected clinical-outcome differences in this small trial.

Limitations & cautions

This was a single-center study of 122 patients in one Chinese cardiology department with six months of follow-up. The intervention combined education, WeChat contact, and cloud monitoring, and the study did not detect differences in complications or readmissions.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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Frontiers in cardiovascular medicine (PubMed)

Frontiers in cardiovascular medicine (PubMed). Effect of internet plus nursing mode telehealth intervention on warfarin management in atrial fibrillation patients.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42453658/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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IJTLD open (PubMed)Jul 13, 2026Research Article

In a 10-hospital cluster-randomized trial with 2,134 analyzed patients, nurse case management did not significantly improve multidrug-resistant tuberculosis treatment success, although a secondary analysis found lower adjusted odds of treatment failure.

Med-SurgAI summaryReview source

Research ArticleResearchWorkflowAI summary · original source linked below

This pragmatic cluster-randomized trial evaluated nurse case management for multidrug-resistant tuberculosis at 10 district hospitals in South Africa. Of 2,844 people enrolled between 2014 and 2019, 2,134 were analyzed: 1,093 in nurse case management and 1,041 in usual care. Treatment success was 64.5% with nurse case management and 61.9% with usual care, a nonsignificant difference; the adjusted primary analysis also showed no improvement. Treatment failure occurred in 2.6% and 4.5%, respectively, and a secondary adjusted analysis found 44% lower odds of treatment failure (aOR 0.56, 95% CI 0.31 to 0.99). Other outcomes did not differ significantly, and the intervention alone did not overcome loss to follow-up or delayed presentation.

Key takeaways

The pragmatic trial was conducted at 10 South African district hospitals and analyzed 2,134 patients.
Treatment success was 64.5% with nurse case management and 61.9% with usual care, with no significant improvement.
A secondary analysis found lower adjusted odds of treatment failure with nurse case management.
The intervention did not overcome barriers related to loss to follow-up or delayed presentation.

Why this matters on shift

Nurses often coordinate prolonged tuberculosis treatment, follow-up, education, and communication across care settings. This trial matters because it tests a nurse-centered delivery model at scale while showing that case management alone may not be enough to improve overall treatment success.

Bedside takeaway

Worth knowing that nurse case management alone did not improve overall MDR-TB treatment success, despite lower treatment-failure odds in a secondary analysis.

Nursing implications

Programs using nurse case management for multidrug-resistant tuberculosis should track treatment success, failure, loss to follow-up, and delayed presentation separately. The null primary result argues for evaluating additional system and access supports rather than relying on case management alone.

Limitations & cautions

The trial involved 10 district hospitals in two South African provinces, enrollment occurred from 2014 to 2019, and 2,134 of 2,844 enrolled patients were analyzed. The primary outcome was not improved, while the lower treatment-failure estimate came from a secondary analysis with a confidence interval close to no difference.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

IJTLD open (PubMed). Nurse case management to improve multidrug-resistant TB: a cluster-randomised trial.

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Healthcare (Basel, Switzerland) (PubMed)Jun 23, 2026Research ArticlePractice applicable

In an eight-ward cluster-randomized crossover trial of 1,324 adults, replacing peripheral IV catheters only when clinically indicated was noninferior to routine 96-hour replacement for phlebitis and required fewer insertions with longer dwell times.

Med-SurgAI summaryReview source

Research ArticleResearchWorkflowPractice applicableAI summary · original source linked below

This noninferiority cluster-randomized crossover trial enrolled 1,324 adults who required peripheral IV therapy for at least 96 hours across eight wards of one South Korean hospital. Phlebitis occurred in 12.6% with clinically indicated replacement and 11.7% with routine 96-hour replacement. The absolute risk difference was 1.44 percentage points (95% CI -1.47 to 4.35), remaining within the prespecified 5-point noninferiority margin. Clinically indicated replacement required fewer catheter insertions per patient (mean 1.77 versus 2.16) and produced longer mean dwell times (112.0 versus 89.6 hours). No catheter-related bloodstream infections occurred in either group, but zero rare events do not establish comparative bloodstream-infection safety.

Key takeaways

The trial included 1,324 adults across eight wards in a cluster-randomized crossover design.
Clinically indicated replacement was noninferior to routine 96-hour replacement for phlebitis.
Patients in the clinically indicated group had fewer insertions and longer catheter dwell times.
No catheter-related bloodstream infections occurred, but the trial cannot establish noninferiority for this rare outcome.

Why this matters on shift

Med-Surg nurses assess peripheral IV sites, decide when findings need escalation, and perform or coordinate replacement. This trial matters because it tested whether an assessment-driven approach can avoid routine reinsertion without exceeding the prespecified phlebitis margin.

Bedside takeaway

Worth knowing that clinically indicated PIVC replacement was noninferior for phlebitis and reduced repeat insertions in an eight-ward trial.

Nursing implications

Facilities considering clinically indicated replacement can use these findings alongside a standardized catheter-assessment, documentation, and escalation pathway. Individual nurses should not extend dwell time outside an approved protocol, and bloodstream-infection surveillance remains necessary despite zero events in this study.

Limitations & cautions

The study was conducted in 2021 at one South Korean tertiary hospital across eight wards and included adults expected to need peripheral IV therapy for at least 96 hours. Zero catheter-related bloodstream infections in both groups cannot establish comparative safety for that rare outcome.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Healthcare (Basel, Switzerland) (PubMed). Routine Versus Clinically Indicated Replacement of Peripheral Intravenous Catheters in Adults: A Non-Inferiority Cluster-Randomised Crossover Trial.

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AI-summarized from the linked source. Review the original article before applying to practice.

Heart (PubMed)Nov 23, 2025Research ArticlePractice applicable

Across 12 hospitals in five Asian countries, an ESC 0/1-hour high-sensitivity troponin T pathway produced noninferior 30-day major adverse cardiac events compared with usual care and increased emergency-department discharge from 35% to 60%.

Emergency TelemetryAI summaryReview source

Research ArticleResearchWorkflowPractice applicableAI summary · original source linked below

This prospective stepped-wedge cluster-randomized trial enrolled 3,869 patients with suspected non-ST-elevation acute coronary syndrome at 12 hospitals in five Asian countries. Usual care used troponin testing without standardized timing; the intervention used high-sensitivity cardiac troponin T at baseline and 1 hour according to the ESC pathway. Thirty-day major adverse cardiac events occurred in 1.7% with usual care and 1.4% with the 0/1-hour pathway, meeting the prespecified 1.5% noninferiority margin. Emergency-department discharge increased from 35% to 60%. Among 941 patients classified as low risk, three had a 30-day event: one cardiovascular death and two unplanned revascularizations, with no nonfatal myocardial infarctions. The results support this specific assay-based protocol in the settings studied, not unsupervised use of an isolated troponin value.

Key takeaways

The trial included 3,869 patients with suspected non-ST-elevation acute coronary syndrome across 12 hospitals and five countries.
The intervention standardized high-sensitivity troponin T testing at baseline and 1 hour.
Thirty-day major adverse cardiac events were 1.4% with the pathway and 1.7% with usual care, meeting the trial's noninferiority criterion.
Emergency-department discharge increased from 35% to 60%, although three 30-day events occurred among 941 patients classified as low risk.

Why this matters on shift

Emergency nurses coordinate time-sensitive chest-pain assessment, specimen collection, reassessment, and disposition communication. This study matters because it tested a standardized rapid pathway across diverse hospitals and measured both safety and patient flow rather than speed alone.

Bedside takeaway

Be aware that a standardized ESC 0/1-hour troponin T pathway increased ED discharge from 35% to 60% while meeting noninferiority for 30-day cardiac events across 12 Asian hospitals.

Nursing implications

ED teams can use the findings when evaluating a locally approved 0/1-hour high-sensitivity troponin T pathway with clear eligibility, timing, interpretation, and escalation rules. The study does not support substituting a single result for the full protocol or applying its cutoffs to a different assay without validation.

Limitations & cautions

This was a stepped-wedge cluster trial rather than individual randomization and used high-sensitivity troponin T in Asian emergency departments. Transfer to other populations, assays, cutoffs, and workflows requires local validation, and a small number of 30-day events still occurred among patients classified as low risk.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Heart (PubMed). Validation of the European Society of Cardiology 0/1-hour algorithm for chest pain triage in Asian emergency departments: a multinational stepped-wedge cluster-randomised trial.

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Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Nurse case management did not improve MDR-TB treatment success, though treatment-failure odds were lower in secondary analysis

Clinically indicated PIVC replacement was noninferior for phlebitis and required fewer insertions than 96-hour replacement

The ESC 0/1-hour chest-pain pathway raised ED discharge from 35% to 60% with noninferior 30-day cardiac events