Population for Digital Heart Failure Coaching App May Need Rethinking

New research being presented at the American Heart Association’s (AHA) Scientific Sessions 2021, held virtually from November 13-15, 2021, provides a note of caution for using mobile health (m-health) devices and apps in severely ill and elderly patients with unstable heart failure (HF).

The findings come from the Risk-HF clinical trial, which examined a multifactorial disease management program aimed at reducing HF readmissions. The current abstract reports on the intensive self-care intervention and evaluates whether an avatar-based digital HF app could improve HF knowledge and self-care management among patients with acute decompensated HF (ADHF) who were at high risk for hospital readmission and/or death.

Participants were randomized to receive usual care or intervention which included use of the digital app. The app consisted of a digital coach that provided training on appropriate self-care and included interactive components for daily evaluation, such as self-monitoring of HF symptoms, goal setting, homework tasks, and questionnaires for HF.

Over 16 months (August 2019 to December 2020), 36 of the 74 high-risk participants were randomized to the intervention arm, of whom 26 (72%) had restricted access to the HF app (unable to use a tablet device and/or unwilling to be taught how to use it) and 10 (28%) were enrolled to use the HF app (median age, 71.5 years; mean years of education, 11.6).

Researchers found that younger patients (odds ratio [OR], 0.89; 95% CI, 0.82-0.97; p<.01) and those with a higher education level (OR, 1.58; 95% CI, 1.09-2.28; p=.03) were more likely to enroll in the disease management program.

Among enrolled participants, 2 engaged and completed ≥70% of the program; and 6 of the remaining 8 participants who did not engaged were readmitted.

“Future research should consider how to use such technology-based interventions with elderly patients as well as to target younger ADHF patients, which may provide stronger evidence of benefits in patient self-care and outcomes,” concluded study authors led by Georgios Zisis, MSc, PhD student, Baker Heart and Diabetes Institute, Melbourne, Australia.

Reference: Zisis G, Carrington MJ, Whitmore K, et al. A digital heart failure coach intervention for improving education, self-management and outcomes in patients admitted for acute decompensated heart failure: Barriers to effective implementation. Poster (1506) presented at: AHA Scientific Sessions 2021, held online November 13-15, 2021.