Tele-Intensive Care Unit-associated Early Recognition of In-hospital Hemodynamic Events and Clinical Outcomes: A Multicenter Observational Study

Background and aims:In-hospital cardiac arrest (IHCA) remains a major cause of mortality among hospitalized patients globally.This prospective, multicenter, observational study assessed the associations of a tele-intensive care unit (Tele-ICU) hemodynamic surveillance program and clinical outcomes in adult inpatients monitored across three tertiary-care hospitals in India.Patients and methods: From September 2024 to August 2025, 5,253 adult inpatients in ICUs, general wards, and Emergency Departments (EDs) were continuously monitored by a centralized Tele-ICU hub.Pre-specified thresholds for hemodynamic parameters generated real-time alerts, which were verified and adjudicated by Tele-ICU intensivists according to a standardized protocol.Outcomes, interventions, and mortality were analyzed using full multivariable logistic regression, with clearly defined denominators and clustering by site to account for within-site addressed.Results: A total of 2,278 patients (43.3%) experienced clinically significant hemodynamic alerts.The system's alerting and verification protocol demonstrated a sensitivity of 79.2% and specificity of 80.1%, with consistent performance across sites and locations.Median acute physiology and chronic health evaluation (APACHE) II score was 16 [interquartile range (IQR) = 12-22].Patients experiencing verified alerts had a mortality rate of 12% (n = 273), which is lower than the APACHE-predicted rate of 24.5% (risk-adjusted mortality ratio = 0.69; calibration plot provided).Multivariable logistic regression, including age, sex, APACHE II, diagnosis group, comorbidities, admission location, and time to intervention, showed that early intervention 15 minutes after alert was associated with lower odds of in-hospital mortality [adjusted odds ratio (aOR) 0.65, 95% CI: 0.52-0.81,p < 0.001; C-statistic 0.83]. Conclusion and clinical significance:The early recognition and verification of hemodynamic alerts in Tele-ICU were associated with improved clinical outcomes and a lower risk-adjusted mortality.