Abstract 15079: Equitable Access to MHealth Through a Smartphone Loaner Program in Patients With Acute Myocardial Infarction

Abstract

Introduction: Mobile health (mHealth) is expanding as a healthcare delivery tool but depends on patients’ existing ownership of technology, which could create inequity. We faced this challenge in developing and implementing the “Corrie” mHealth program for Apple iOS and watchOS to aid patients in post-myocardial infarction recovery. Considering that cardiologists commonly loan equipment to patients (e.g. Holter monitors), we created an iPhone loaner program to expand access to Corrie. Here, we explore sociodemographics and readmission outcomes associated with loaner use. Methods: In the Myocardial infarction COmbined-device Recovery Enhancement (MiCORE) study, we prospectively enrolled acute myocardial infarction patients at four hospitals. Patients who owned a compatible iPhone used Corrie on their own phone (“non-iShare”) while others used a loaner iPhone (“iShare”). Loaned phones were returned 30 days after discharge. We used logistic regression models to evaluate sociodemographic differences in iShare versus non-iShare patients. We also explored readmission outcomes in the two groups. Results: Of the 200 patients in MiCORE, 46% (n=92) were in the iShare group. Compared to non-iShare patients, iShare patients were younger (mean age 57.4±11 years [range 30-81] vs 60.8±11 [32-89]; p=0.04). After adjusting for age, iShare patients were more likely to be women (36% vs 23%, p=0.03), insured by Medicaid (20% vs 4%, p<0.01), and less likely to have commercial insurance (47% vs 61%, p<0.01). More iShare patients were black (25% vs 14%), unmarried (49% vs. 35%) and unemployed/disabled (29% vs 16%) relative to non-iShare patients, albeit not reaching statistical significance (p>0.05). Among patients asked about income (53%, n=106), iShare patients had a lower mean annual income ($56,000 vs. $97,000, p<0.01) and a higher percentage of annual income <$30,000 (35% vs 11%, p<0.01). Readmissions were infrequent and similar in iShare and non-iShare patients, including 30-day all-cause readmission (10% vs 4%, p=0.09) and cardiac readmission (4% vs 2%, p=0.66). Conclusions: These results suggest the potential for a smartphone loaning program to facilitate equitable mHealth access for underserved patients including those with a lower income.