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Population for Digital Heart Failure Coaching App May Need Rethinking

Article

AHA Scientific Sessions 2021

AHA Scientific Sessions 2021: New research provides a note of caution for the use of digital heart failure coaching apps in severely ill and elderly patients with unstable heart failure.

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.


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