Abstract
Background: Optimal heart failure (HF) management after hospitalization requires ongoing care coordination. Digital approaches with a unified disease management platform (DMP) experience may improve patient care. Objective: A single-arm single-institution pilot study to assess feasibility of implementation and engagement with a DMP among HF patients for 60 days post-hospitalization. Methods: The DMP included a clinician electronic medical record-integrated dashboard and patient-facing smartphone app that provided patient-reported data entry, educational materials, and secure messaging. Eligible patients admitted to a cardiology service were onboarded with a smartphone DMP app at discharge. Clinical outcomes were compared between the intervention group and propensity-matched historical controls at the same institution and matched contemporary and historical controls at a nearby institution. Results: 70 of 167 eligible patients (41.9%) enrolled over the 6-month recruitment period and 51 (71.4%) completed the study. Mean age of completed participants was 65.8 (SD 12.9) years; 36 (70.6%) were male and 22 (43.1%) had HF with reduced ejection fraction. Daily DMP engagement (patient-reported data entry or in-app messaging) ranged from 35%-78% and participants engaged a median 44 (IQR 14-53) days during the 60-day study period. There was no correlation between age, sex, or clinical comorbidities and daily engagement. Compared to matched historical controls at the same institution, the study cohort had significantly fewer all-cause readmissions (HR 0.39, 95% CI 0.19 - 0.80, p=0.009). Matched contemporary and historical controls over the same time period on a cardiology service at a nearby institution had no reduction in readmission rates. Conclusions: Implementation of a post-hospitalization HF-specific DMP is feasible and may yield improvements in readmission rates, supporting the role for future randomized controlled trials (NCT04782973).
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