Digital health app may improve self-care after acute HF hospitalization
Compared with the usual care alone, a mobile app intervention plus the usual care may improve HF quality of care by improving patients’ own self-care after hospitalization for acute HF, a speaker reported.
However, the mobile intervention failed to significantly improve HF readmission or all-cause mortality at 1 year compared with the usual care.
“The CONNECT-HF digital ancillary study demonstrated that a self-guided, personalized digital program offered to patients following hospitalization for acute heart failure was associated with higher heart failure quality of care scores, compared to matched nonusers; yet the risks for heart failure rehospitalization and all-cause mortality were similar between both groups,” Vishal N. Rao, MD, MPH, fellow in the advanced training in cardiology program at Duke University School of Medicine, said during a presentation at the Heart Failure Society of America Annual Scientific Meeting. “While promising, digital tools should have evidence from randomized clinical trials before widespread adoption.”
According to the presentation, more than 3 million patients in the U.S. have HF with reduced ejection fraction and the use of guideline-directed medical therapy to treat these patients is low, resulting in suboptimal outcomes.
The CONNECT-HF trial sought to address this issue by utilizing the CONNECT-HF hospital and post-discharge quality improvement intervention; an intervention focused on audit and feedback to hospitals on HF care and outcomes, and education and mentorship to hospitals by the CONNECT-HF Academy.
As Healio previously reported, the hospital and post-discharge quality improvement intervention did not improve rehospitalization or survival in patients with HFrEF beyond existing quality improvement programs.
For this post hoc analysis of the CONNECT-HF trial, researchers evaluated associations between use of a digital health app (HealthStar) compared with usual care after HF hospitalization on the use of guideline-directed therapies for HFrEF and outcomes during 12 months of follow-up.
The digital health app was designed to aid in medication adherence and routinely track activity, diet and weight.
At hospital discharge, eligible patients were given the option to receive usual care plus the digital health app intervention (n = 310; mean age, 58 years; 33% women) or to receive usual care (n = 310; mean age, 57 years; 33% women).
Baseline characteristics such as age, sex, race and pre-hospitalization treatment were similar between patients who elected to use the digital health app compared with those who declined.
The co-primary endpoints were time to first HF readmission or death and improvement in an opportunity-based composite score for adherence to quality metrics for HF.
At 4 weeks after discharge, approximately 68% of the intervention group was still using the app. At 12 months, the proportion of users dropped to 29%; a percentage that, at 1 year, was greater than the 14% industry standard for commercial health app user retention, Rao said.
At 12-month follow-up, patients in the digital intervention arm experienced a 2.8% increase in the composite HF quality score compared with a 1.4% decrease among nonusers (between-group difference, 4.3%; adjusted effect = 4.95; 95% CI, 3.32-6.57; P = .0025).
Moreover, participants in the digital intervention arm exhibited a nonsignificant trend toward lower risk for HF rehospitalization or death compared with nonusers (HR = 0.84; 95% CI, 0.65-1.07; P = .16).
“Mobile applications may show promise in improving heart failure quality of care. Usage rates exceeded that of the industry standard in this analysis and, amazingly, persisted amid the COVID-19 pandemic, which overlapped during the follow-up period,” Rao said. “Additionally, a digital divide may exist among patients who can use digital tools, but either choose to use them or not to use them for heart failure self-care. In CONNECT-HF, the differences we observed in these two populations were not largely due to age, race or even insurance status. Future studies must investigate how best to engage different populations of patients with mobile capabilities while not only focusing on improving quality of care and clinical outcomes, but also understanding how best to prevent or mitigate the potential for expanding health disparities through technology use.”
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Rao VN, et al. Late Breaking Clinical Trials II. Presented at: Heart Failure Society of America Annual Scientific Meeting; Sept. 10-13, 2021; Denver (hybrid meeting).
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