Artificial Voice Analysis and Telemonitoring for Heart Failure. A Feasibility Study (AVATAR-HF)

June 17, 2026 updated by: Niguarda Hospital

AVATAR-HF (Artificial Voice Analysis and Telemonitoring for Heart Failure): Studio di fattibilità Sull'Uso Dell'Analisi Vocale Basata su Intelligenza Artificiale Per il Telemonitoraggio Dei Pazienti Con Insufficienza Cardiaca.

Heart failure is a serious condition and a major reason why older adults are admitted to the hospital. Even after going home, many patients struggle to get the follow-up care they need, leading to high rates of return to the hospital.

While remote monitoring technology exists, it is often difficult to use, expensive, or hard for doctors to interpret.

Recent research suggests that changes in a person's voice and speech can be early warning signs of worsening heart failure, but we need to test if this can work reliably in a home setting.This study tests a new, user-friendly platform called AVATAR-SC.

This system uses a a computer-generated character to interact with patients. By analyzing short voice clips and simple health questionnaires provided by the patient, the system aims to make home monitoring easier and more effective.

The study will involve 60 participants divided into two groups:half of the patients who have recently been discharged from the hospital following a heart failure episode; the other 30 patients who visit the hospital monthly for a specific heart failure treatment (Levosimendan).

Participants will interact with the digital avatar twice a week. During these sessions, they will provide brief voice recordings and answer a few questions about how they feel. It is important to note that the AI in this study is not making medical decisions or changing the patient's current treatment; it is strictly being tested to see how well the technology functions.

As a feasibility study, the primary goal is to evaluate the practical implementation of the technology rather than clinical outcomes.

The research focuses on: Determining if patients can navigate the system easily and independently, Assessing how consistently participants engage with the scheduled sessions, Verifying the technical reliability of the platform in a home environment,identifying the strengths and challenges of the system to prepare for future, larger-scale trials.

Benefits: Participants may feel more supported and more aware of their symptoms through regular check-ins.

Risks: The risks are very low. They mostly involve getting used to new technology and ensuring that personal data is kept private and secure.

Impact If successful, AVATAR-SC could lead to a new way for doctors to keep an eye on heart failure patients at home, catching problems early through the sound of their voice and preventing unnecessary hospital visits.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Heart Failure (HF) is a leading cause of hospitalization and mortality among the elderly, characterized by high readmission rates and a significant impact on the National Health Service. Despite guideline recommendations, only a minority of patients receive timely post-discharge follow-up, contributing to clinical deterioration and rising healthcare costs. Existing remote monitoring systems have shown mixed results, primarily due to poor patient adherence, data interpretation challenges, and high costs. While vocal and linguistic analysis supported by Artificial Intelligence (AI) algorithms has shown promise for the early identification of heart failure, its practical application in home monitoring has yet to be systematically evaluated.

AVATAR-SC proposes an accessible, non-invasive platform based on advanced AI technologies. It integrates vocal biomarkers, clinical data, and Patient-Reported Outcome Measures (PROMs) to enhance home monitoring and support a more proactive management of heart failure patients.

Study Population: 60 patients with Heart Failure (HF), including 30 patients discharged following hospitalization for acute heart failure and 30 patients receiving monthly Levosimendan therapy in a Day Hospital setting.

Study Objectives: Although AI-supported vocal and linguistic analysis shows significant potential for the early detection of clinical deterioration in HF patients, there is a lack of data regarding feasibility, acceptability, adherence, integration into care pathways, and data quality within a real-world home monitoring context. A feasibility study is therefore necessary to:i) evaluate patients' ability to use AVATAR-SC independently;ii) estimate adherence to daily vocal data collection;iii) verify the technical performance of the platform;iv) define operational metrics (time, resources, completion rates);v) identify barriers and facilitators in preparation for a large-scale clinical trial.The study does not involve the use of AI systems as clinical tools, nor their application for the automated assessment of an individual patient's health status.Nature and extent of benefits and risks associated with study participation: Potential benefits include more regular symptom monitoring and increased support in disease management. Risks are minimal and primarily concern the use of technology and the processing of personal data.

Intervention: Interactions via digital avatar ≥ 2 times/week, collection of short voice clips, and essential PROMs (Patient-Reported Outcome Measures). No alerts will be generated, and there will be no influence on the patient's clinical pathway.

Study Type

Interventional

Enrollment (Estimated)

60

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria

  • Age ≥ 18 years
  • Diagnosis of heart failure (NYHA Class II-IV), according to the Diagnosis Related Group (DRG) classification.
  • Recent discharge following acute heart failure (AHF) or ongoing treatment with Levosimendan in a Day Hospital setting.
  • Provision of signed informed consent in Italian.
  • Currently receiving Guideline-Directed Medical Therapy (GDMT) for heart failure

Exclusion Criteria:

  • Inability or incapacity to provide informed consent.
  • Cognitive impairment severe enough to prevent interaction with the avatar and compromise the reliability of the collected data.
  • Significant phonation disorders (e.g., results of previous otorhinolaryngological surgery or post-traumatic outcomes).
  • Inability to manage a compatible device or the device provided by the study for interaction with the AVATAR-SC platform.
  • Life expectancy of less than 6 months due to concurrent comorbidities.
  • Technological or language barriers.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: AVATAR_SC Post-AHF Follow-up
Patients discharged following hospitalization for acute heart failure will be enrolled in this study arm and will utilize AVATAR_SC for periodic monitoring
Other: AVATAR-SC
Patients discharged following hospitalization for acute heart failure will be enrolled in this study arm and will utilize AVATAR_SC for periodic monitoring
Other: Standard Care + AVATAR-SC Monitoring
Patients receiving monthly therapy in accordance with standard clinical practice will undergo remote monitoring via the AVATAR-SC platform.
Other: AVATAR-SC
Patients discharged following hospitalization for acute heart failure will be enrolled in this study arm and will utilize AVATAR_SC for periodic monitoring
Drug: Levosimendan

Patients receiving monthly Levosimendan therapy at the ASST GOM Niguarda (Cardiology 2 - Heart Failure and Transplants) will be enrolled for longitudinal voice data collection. This approach captures data across all preclinical stages of the deterioration-compensation cycle, supported by periodic monitoring via the AVATAR-SC platform.

Levosimendan will be prescribed as per clinical practice. .

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Feasability of the AVATAR-SC System in Heart Failure patients
Time Frame: Through study completion, an average of 3 months per patients
≥80% of patients compleating 75% of scheduled interaction
Through study completion, an average of 3 months per patients

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Perceived Quality of Life (QoL)
Time Frame: Through study completion, an average of 3 months per patients
Outcome Measures. A clinical improvement defined as at least a 10% increase in perceived quality of life scores, as measured by standardized Patient-Reported Outcome Measures (KCCQ, EQ-5D).
Through study completion, an average of 3 months per patients
Change in Vocal Biomarkers Score
Time Frame: Through study completion, an average of 3 months per patients
Exploratory offline analysis to evaluate the statistical consistency between vocal patterns and clinical parameters. Quantitative metrics including accuracy, precision, recall, and F1-score will be used for descriptive purposes only. This analysis is purely exploratory, without the definition of clinical thresholds, individual classification, or operational use of the results
Through study completion, an average of 3 months per patients
New York Heart Association (NYHA) Functional Class of Heart Failure
Time Frame: Through study completion, an average of 3 months per patients
Clinical assessment performed by the physician to evaluate the patient's overall heart failure severity and functional limitations based on cardiac symptoms. The evaluation is performed using the New York Heart Association (NYHA) classification, which categorizes patients into one of four classes based on their limitations during physical activit (class I to IV) . Higher classes indicate greater severity of heart failure and worse functional status.
Through study completion, an average of 3 months per patients
Change in Montreal Cognitive Assessment (MoCA) Score
Time Frame: Through study completion, an average of 3 months per patients ]
The MoCA is a screening instrument for cognitive impairment. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. The total score is the sum of all item scores. The scale ranges from 0 to 30, where a score higher than 26 .
Through study completion, an average of 3 months per patients ]
Change in Frontal Assessment Battery (FAB) Score
Time Frame: Through study completion, an average of 3 months per patients
The FAB is a brief tool to assess executive functions. It consists of six subtests (similarities, lexical fluency, motor series, conflicting instructions, go-no-go, and grasping behavior). Total scores range from 0 to 18, where higher scores indicate better executive function.
Through study completion, an average of 3 months per patients
Change in Patient Health Questionnaire-9 (PHQ-9) Score
Time Frame: Through study completion, an average of 3 months per patients
The PHQ-9 is a self-report tool used to screen for and monitor the severity of depression. It consists of 9 items based on the DSM-IV criteria for depression. Each item is scored on a scale from 0 (not at all) to 3 (nearly every day). The total score ranges from 0 to 27, where higher scores indicate greater severity of depressive symptoms (e.g., 5-9: mild; 10-14: moderate; 15-19: moderately severe; 20-27: severe).
Through study completion, an average of 3 months per patients
Change in Trail Making Test (TMT)
Time Frame: Through study completion, an average of 3 months per patients
Psychological Well-being as Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms and Generalized Anxiety Disorder-7 (GAD-7) for anxiety levels.
Through study completion, an average of 3 months per patients
Change in Generalized Anxiety Disorder-7 (GAD-7) Score
Time Frame: Through study completion, an average of 3 months per patients
The GAD-7 is a self-report scale for screening and severity measuring of generalized anxiety disorder. It consists of 7 items, each scored from 0 (not at all) to 3 (nearly every day). The total score ranges from 0 to 21, where higher scores indicate a higher level of anxiety (e.g., 5-9: mild; 10-14: moderate; 15-21: severe).The SDMT is used to assess psychomotor speed and attention. Patients are given a key matching symbols to numbers and must fill in the correct numbers for a series of symbols within 90 seconds. The score is the number of correct substitutions. Scores typically range from 0 to 110. A higher score indicates better cognitive processing speed and attention.
Through study completion, an average of 3 months per patients
Change in Symbol Digit Modalities Test (SDMT) Score
Time Frame: Through study completion, an average of 3 months per patients
The SDMT is used to assess psychomotor speed and attention. Patients are given a key matching symbols to numbers and must fill in the correct numbers for a series of symbols within 90 seconds. The score is the number of correct substitutions. Scores typically range from 0 to 110. A higher score indicates better cognitive processing speed and attention.
Through study completion, an average of 3 months per patients

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Niguarda Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

June 30, 2026

Primary Completion (Estimated)

May 15, 2027

Study Completion (Estimated)

May 15, 2028

Study Registration Dates

First Submitted

April 14, 2026

First Submitted That Met QC Criteria

June 17, 2026

First Posted (Actual)

June 24, 2026

Study Record Updates

Last Update Posted (Actual)

June 24, 2026

Last Update Submitted That Met QC Criteria

June 17, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 7005
  • InnovaWalfare 2025-0158 (Other Grant/Funding Number: InnovaWalfare 2025-0158)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual Participant Data (IPD) will not be made publicly available to ensure strict compliance with EU Regulation 2016/679 (GDPR) and to protect patient privacy regarding sensitive vocal recordings. All collected data, including audio tracks and clinical features, are processed in a pseudo-anonymous form using non-reversible alphanumeric codes. The link log connecting these codes to patients' identities is stored exclusively at the coordinating center (ASST GOM Niguarda) and is not accessible to other partners or third parties.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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