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.