Digital health app linked to better outcomes in heart failure

A study of a mobile health app used to support patients hospitalised with heart failure has concluded that it provided a modest improvement in quality-of-life scores, as well as better clinical outcomes.

The finding comes from the large-scale CONNECT-HF cluster study, which looked at various patient engagement and education interventions to see if they could help patients with heart failure do better after discharge from hospital.

The overall study was a disappointment, finding no significant difference in time to first heart failure rehospitalisation or death, or in change in a composite heart failure quality-of-care score, the primary endpoints.

The new finding comes from a prospective, ancillary study of Pattern Health Technologies' HealthStar app – which provides a personalised, self-guided programme to help patients better manage their condition– in a subgroup of 2,431 patients in the study.

The app is designed to increase patients' motivation and follow-through on medication adherence, physical activity, eating a healthy diet, and controlling their weight.

It can be bewildering for heart failure patients to implement the advice of their doctors, says Pattern Health.

That can include recommendations to lose weight, decrease stress, monitor fluid intake, avoid or limit alcohol and caffeine, adjust their diet, become physically active, track blood pressure, and more – all while typically being prescribed up to eight heart failure medicines.

Among patients with the capability to use digital applications, digital users compared to matched nonusers receiving usual medical care had higher overall quality-of-care scores for heart failure and rates of rehospitalisation or death at one year.

HealthStar users saw a 3.6% increase in quality of life scores, compared to a decline of 1.5% in the nonuser group, which was a statistically significant result with a p value of 0.001. The benefit seemed to accrue from greater adherence to guideline-directed medical therapy (GDMT) and fewer discontinuations in drug therapy.

The rate of rehospitalisation for heart failure or death was 33% among digital users and 39.6% in the control group, which just made it statistically significant (p=0.027).

However, only around a fifth of patients offered the app downloaded and used the application within a week of leaving hospital, according to the CONNECT-HF researchers, who have just published their findings in the Journal of Cardiac Failure.

"Most patient-facing medical mobile applications include limited functionality to engage users," they write.

Their results "indicate the potential for more motivating interventions that go beyond self-monitoring and progress tracking alone", they continue.

"Innovative strategies that leverage behavioural economic concepts in digital health tools may improve long-term engagement with patient users."

Earlier this year, an analysis of ten clinical trials of digital health interventions targeted at patients recently hospitalised for acute heart failure also found improved outcomes compared to standard care.