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MiCORE: Smartphone app with Apple Watch decreases readmissions after MI
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Patients who used an intervention with a smartphone app and an Apple Watch to manage their care after STEMI or non-STEMI had lower risk for being readmitted compared with those treated with usual care, according to preliminary results from the MiCORE study presented at the American Heart Association Quality of Care and Outcomes Research Scientific Sessions.
“It is exciting that you have new technologies that are brought together to the Corrie application and delivering it to patients who are some of the sickest patients that we have and that we take care of in cardiology after a heart attack within the intensive care unit,” Francoise A. Marvel, MD, cardiology fellow at Johns Hopkins Hospital, told Cardiology Today.
This application also gives an alternative to the traditional paper-based standard of care for this patient population.
“We are in the beginning now of showing this new digitally enhanced model for empowering patients to take an active role in their health care,” Cardiology Today Editorial Board Member Seth S. Martin, MD, MHS, FACC, FAHA, FASPC, assistant professor of medicine and cardiologist at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, said in an interview. “There is so much more to like about this than handing someone a static piece of paper, here are your instructions. Here, it is not just giving instructions, but actually connecting them with what they need to implement those instructions to follow the ABCs of prevention.”
Study design
In this study, researchers analyzed data from 859 patients with STEMI or non-STEMI from four sites. Patients were either in the Corrie Health group (n = 164; mean age, 57 years; 31% women) or in the historical comparison group (n = 695; mean age, 64 years; 39% women).
“A lot of people think about heart attack patients as older patients who are unlikely to engage with technology,” Martin told Cardiology Today. “We asked a simple question: Can you reach older heart attack patients? ... The answer is yes. This is now in 2019. In the years to come, it is going to become more and more of a prevalent platform to reach patients.”
Patients in the Corrie Health group received the Corrie app, an Apple Watch loaner if they did not own one and a Bluetooth BP cuff (iHealth). The application was installed onto their smartphone, which was used during inpatient admission, at discharge and at 30 days after discharge. Standard of care discharge instructions were also given to the patient. Researchers then assessed administrative and electronic medical record data for readmissions at 30 days, which was the primary endpoint. Patients also completed a survey at 30 days.
The Corrie app contains a section for patients to track medication adherence and learn more about side effects and indications. It also has the capability to collect information on BP and heart rate, and track weight, steps and mood. Patients can learn more about evidence-based preventive cardiology through animated videos and articles, in addition to animations to learn about the causes of MI and what to expect during CV procedures. Notifications are also available for follow-up with primary care providers, cardiologists and cardiac rehabilitation.
“Our hope is that by spending more and more time with patients, with family members, with getting feedback from people who are using Corrie — and this has literally been our process from the beginning,” Marvel said in an interview. “It starts with the patient, it continues with the patient and it gets better with the patient and their caregivers. Where we see this blossoming is to continue that mantra alongside our patients to build this into something that will not require a significant infrastructure or training to make health, cardiovascular health and prevention part of life because it is coming from the people who used it.”
Reduction in readmissions
Patients in the Corrie app group had fewer all-cause readmissions at 30 days compared with those in the control group (10% vs. 18%; P = .02). After adjusting for sex, age, type of MI and race, those in the Corrie group were 43% less likely to be readmitted at 30 days compared with the control group (OR = 0.57; 95% CI, 0.33-0.99).
The cost analysis showed that in 99.2% of 10,000 simulations, Corrie was not only cost-effective, but also provided a higher average of quality-adjusted life-years. Use of this intervention was associated with a savings of $6,027 per patient and 0.8 additional QALYs. The incremental cost-effectiveness ratio was $15,588 per additional QALY.
The survey conducted at the end of the study found that more than 80% of patients in the Corrie group agreed that they understood when to follow up with their providers, what medications they were prescribed and their care plan at home at 3 days after discharge and 30 days after discharge.
“These are three huge things that we know can impact readmission,” Marvel said in an interview. “This is all happening as they are using Corrie within the hospital, at discharge and heading home. It is exciting because these are the kinds of impacts that we were hopeful to make when we registered Corrie at clinicaltrials.gov. We anticipated, hopefully, this is where we are going to make an impact.”
During the 30-day period, there were 2.6 million app interactions with a median of 252 interactions per patient.
“Next steps include finishing MiCORE, fully digesting and disseminating the data and meanwhile, we are exploring expansion to other conditions like AF or heart failure,” Martin told Cardiology Today. – by Darlene Dobkowski
Reference:
Marvel FA. Young Investigator Award Semi-Finalists. Presented at: AHA Quality of Care and Outcomes Research Scientific Sessions; April 5-6, 2019; Arlington, Va.
Disclosures: Materials used in this study were donated by Apple and iHealth. Marvel and Martin report they developed the Corrie Health Digital Platform and are co-founders of and hold equity in Corrie Health.
Perspective
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Carl J. Pepine, MD, MACC
This a very interesting project and clearly the future. I am, however, disappointed to see that less than a third are women. I would strongly encourage a major effort to better enroll women, particularly younger women, in such studies.
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