Mobile Health Self-management Interventions for Patients With Heart Failure: A Pilot Study.
Myra S Schmaderer, Leeza Struwe, Courtney Loecker and 5 others
PMID 34369914WHAT IT FOUND
Heart failure patients receiving a post-discharge bundle with app weight and medication monitoring, reminders, education, and nurse/community health worker contacts on top of usual care had fewer hospitalizations than enhanced usual care in a pilot trial, but quality of life did not differ.
Key findings
01The mHealth+ group had significantly fewer rehospitalizations than enhanced usual care: 4 of 25 patients had 8 hospitalizations, while 13 of 26 patients had 21 hospitalizations (P = .02).
02Shortness of breath had reported effect sizes of 0.60 to 0.55 for both intervention groups, and lower extremity edema had reported effect sizes of 0.32 to 0.51.
03There were no significant between-group differences in EuroQol-5 Dimension quality of life at 3 months, although visual analog scale scores trended toward improvement in the mobile health groups.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a pilot feasibility study with 74 patients, so it was not powered to prove benefit. The study reported several outcomes, and the findings are hypothesis-generating rather than definitive. Hospitalization and emergency department counts were only from the study hospital, so patients who used other facilities may have been missed. Symptom and quality of life analyses included only patients who responded at each time point, so the number analysed varied. The app plus visits arm included many components, including app reminders, educational tips, weight and medication recording, nurse practitioner visits, community health worker visits, and standard heart failure education, so the contribution of any one component cannot be separated. The app did not allow daily symptom monitoring, so changes in symptom severity/frequency were assessed only at baseline and three months.
Declared interests
The authors reported no conflicts of interest to disclose. The article is listed as supported by non-U.S. government research support.
The easy way to misread this
Do not conclude that a mobile health app plus virtual nurse practitioner and community health worker visits prevents heart failure rehospitalization. This was a small pilot, the hospitalization result was one of several outcomes, the app and visits were delivered together with standard education and follow-up, and care received at other hospitals was not counted.