Designing and Implementing a Telemedicine Program for Patients With Heart Failure at Rajaie Cardiovascular Medical and Research Institute: A Mixed Methods Study

Document Type : Original Article


1 Rajaie Cardiovascular Medical and Research Institute, Iran University of Medical Sciences, Tehran, IR Iran.

2 Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Institute, Iran University of Medical Sciences, Tehran, IR Iran.

3 Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Institute, Iran University of Medical Sciences, Tehran, IR Iran.

4 Department of Computer Science, California State University San Marcos, California, USA.


Background: The COVID-19 pandemic has rapidly expanded telemedicine in healthcare. We designed and implemented a telemedicine program at Rajaie Cardiovascular Medical and Research Institute.
Methods: This sequential mixed-methods study was conducted at Rajaie Cardiovascular Medical and Research Institute from April through December 2021 in 3 stages: 1) Findings obtained from a literature review were discussed in expert panel sessions, and a telemedicine program was designed. 2) based on a quasi-experimental method, patients were non-randomly assigned to the experimental and control groups, with the former receiving the telemedicine program for 3 months. 3) The groups were compared concerning the number of hospitalizations, the length of hospital stay, and emergency department visits 3 months after the implementation of the program. Data analysis was performed using SPSS, version 24. The χ2 test was used for qualitative data analysis, and the t and paired samples t tests were employed for quantitative data analysis. ‎
Results: The results showed no statistically significant differences between the experimental and control groups regarding the number of hospitalizations, the length of hospital stay, and the number of emergency visits after the implementation of the telemedicine program (P > 0.05).
Conclusions: The number of hospitalizations, the number of emergency visits, and the length of hospital stay did not significantly differ between the experimental and control groups after the telemedicine program. (Iranian Heart Journal 2024; 25(1): 74-81)


  1. Gadzinski AJ, Andino JJ, Odisho AY, Watts KL, Gore JL, Ellimoottil C. Telemedicine and eConsults for hospitalized patients during COVID-19. Urology. 2020.
  2. Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen J, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). Journal of telemedicine and telecare. 2020:1357633X20916567.
  3. Wright JH, Caudill R. Remote treatment delivery in response to the COVID-19 pandemic. Psychotherapy and Psychosomatics. 2020; 89(3):1.
  4. Rabuñal R, Suarez-Gil R, Golpe R, Martínez-García M, Gómez-Méndez R, Romay-Lema E, et al. Usefulness of a Telemedicine Tool TELEA in the Management of the COVID-19 Pandemic. Telemedicine and e-Health. 2020.
  5. Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: evidence from the field. Journal of the American Medical Informatics Association. 2020.
  6. Leite H, Hodgkinson IR, Gruber T. New development:‘Healing at a distance’—telemedicine and COVID-19. Public Money & Management. 2020:1-3.
  7. Eccleston C, Blyth FM, Dear BF, Fisher EA, Keefe FJ, Lynch ME, et al. Managing patients with chronic pain during the COVID-19 outbreak: considerations for the rapid introduction of remotely supported (eHealth) pain management services. Pain. 2020; 161(5):889.
  8. Klein BC, Busis NA. COVID-19 is catalyzing the adoption of teleneurology. AAN Enterprises; 2020.
  9. Smith WR, Atala AJ, Terlecki RP, Kelly EE, Matthews CA. Implementation guide for rapid integration of an outpatient telemedicine program during the COVID-19 pandemic. Journal of the American College of Surgeons. 2020.
  10. Rockwell KL, Gilroy AS. Incorporating telemedicine as part of COVID-19 outbreak response systems. Am J Manag Care. 2020; 26(4):147-8.
  11. Molinari G, Molinari M, Di Biase M, Brunetti ND. Telecardiology and its settings of application: An update. Journal of telemedicine and telecare. 2018; 24(5):373-81.
  12. Zhu Y, Gu X, Xu C. Effectiveness of telemedicine systems for adults with heart failure: a meta-analysis of randomized controlled trials. Heart failure reviews. 2020; 25(2):231-43.
  13. Moazzami B, Razavi-Khorasani N, Moghadam AD, Farokhi E, Rezaei N. COVID-19 and telemedicine: Immediate action required for maintaining healthcare providers well-being. Journal of Clinical Virology. 2020:104345.
  14. Ohannessian R, Duong TA, Odone A. Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic: a call to action. JMIR public health and surveillance. 2020; 6(2):e18810.
  15. Tersalvi G, Winterton D, Cioffi GM, Ghidini S, Roberto M, Biasco L, et al. Telemedicine in heart failure during COVID-19: a step into the future. Frontiers in Cardiovascular Medicine. 2020; 7:612818.
  16. Serper M, Cubell AW, Deleener ME, Casher TK, Rosenberg DJ, Whitebloom D, et al. Telemedicine in Liver Disease and Beyond: Can the COVID‐19 Crisis Lead to Action? Hepatology. 2020.
  17. Silva-Cardoso J, Juanatey JRG, Comin-Colet J, Sousa JM, Cavalheiro A, Moreira E. The future of telemedicine in the management of heart failure patients. Cardiac failure review. 2021; 7.
  18. Portnoy J, Waller M, Elliott T. Telemedicine in the Era of COVID-19. The Journal of Allergy and Clinical Immunology: In Practice. 2020; 8(5):1489-91.
  19. Dorsey ER, Topol EJ. Telemedicine 2020 and the next decade. The Lancet. 2020; 395(10227):859.
  20. Omboni S. Telemedicine during the COVID-19 in Italy: a missed opportunity? Telemedicine and e-Health. 2020.