The Cardio-share Telemedicine Cross-sector Collaboration Model for Managing Vulnerable Patients With Heart Failure

The goal of this observational study is to explore the potential of implementing a telemedicine-based cross-sector collaboration model to manage patients with frequent admissions with decompensated heart failure. The main question(s) it aims to answer are: * Characterization of conditions that make these patients vulnerable * Description of key-elements that makes possible to manage the patients with the cardio-share model Participants are: * Patients - will be helped to use the available telemedicine tools * General Practitioners - will be offered teleconferences with cardiologists (chat and video) on demand * Community health workers (caregivers at the patient home or in elderly home) - will be guided to assist the patients to use the available telemedicine tools Researchers will compare readmission rates (primary outcome) and quality of life of patients where the cardio-share management model is successfully implemented one year before and after the implementation.

NCT Number	NCT06176131
Lead Sponsor	University Hospital Bispebjerg and Frederiksberg
Conditions	Heart Failure，Congestive, Atrial Fibrillation
Enrollment	300 participants
Start Date	2024-01-01
Primary Completion	2026-06-30 (estimated)
Study Completion	2026-12-31 (estimated)
Updated on ClinicalTrials.gov	2026-01-16