Digital Apps Could Improve Outcomes, Adherence Among Patients With Heart Failure

Adam DeVore, MD

Data from an ancillary study of the CONNECT-HF trial provide support for use of digital tools in an effort to improve management and outcomes among adult patients with heart failure.

Presented at the Heart Failure Society of America 2021 Annual Scientific Meeting, results of the study demonstrate patients using the had greater improvements in optimizing medication adherence and had a lower risk of heart failure rehospitalization or all-cause mortality, but investigators noted this reduction did not reach statistical significance.

“CONNECT-HF was the first large multicenter trial to implement mobile health technology in longitudinal care following hospitalizations for heart failure,” said Adam DeVore, MD, MHS, assistant professor of medicine at Duke University School of Medicine, in a statement. “As digital health technologies evolve, future work must also understand how best to engage different groups of patients while reducing risks of expanding health disparities through digital technology use.”

CONNECT-HF was a cluster-randomized clinical trial was conducted from 2017-2020 at 161 US hospitals and included 5647 patients. With primary composite end point of heart failure hospitalization or all-cause mortality, the trial compared the effects of a quality improvement intervention versus usual care among patients hospitalized with heart failure with reduced ejection fraction (HFrEF). Upon conclusion of the trial, results suggested there were no significant difference in the primary end point based on whether a patient received the intervention or were randomized to usual care.

As part of the original CONNECT-HF trial, hospitals randomized to the digital intervention early were able to enroll in an optional ancillary study assessing the effects of using a mobile health application from HealthStar. Of the 5647 patients enrolled in the study, 2431 were offered digital tools at discharge from the hospital. The digital intervention included a self-guided program designed to track and improve adherence to medication, activity recommendations, diet, and weight measurements over a 12-month period. During his presentation Vishal Rao, MD, MPH, of Duke University School of Medicine, pointed out some versions of the app included features testing loss aversion, accountability, and negatively framed incentives.

Using data from the 1276 patients offered digital tools, investigators identified matched cohorts of 310 digital tool users to 310 nonusers from the usual care group according to age, sex, site, and number of eligible quality metrics at baseline. Although matched cohorts were used, Rao pointed out there were no significant differences in baseline characteristics or medication use between those who used the digital tool and those who declined the digital tool among those in the intervention arm of the trial.

Rao also made note of declines in use of the digital tools among users—pointing out use declined to 68% by 4 weeks and below 30% by week 52. However, Rao noted the industry standard for commercial health application use around 14% at 1 year.

Upon analysis, results indicated digital users experienced greater increases in the composite heart failure quality score compared to nonusers, with a between-group difference of 4.3%, which increased to 4.9% (3.32-6.57; p=.0025) after adjustment for baseline composite score. The primary composite outcome occurred among 41.4% of nonusers and 36.7% among digital users, which correlated to a 16% reduction in relative risk (HR, 0.84 [95% CI, 0.65-1.07]; P=.16).

“This study shows promise that a digital tool such as a mobile app could help patients improve the care they administer at home and out of the hospital,” Rao said. “This warrants further study, but digital tools could be a key to improved personalized care as we partner with patients and empower them to help improve their quality of life.”

This study, “The Association Of Digital Tool Use And Heart Failure Care: Insights From The Connect-hf Trial,” was presented at HFSA 2021.