Effects on Adherence to a Mobile App-Based Self-management Digital Therapeutics Among Patients With Coronary Heart Disease: Pilot Randomized Controlled Trial

Yuxi Li, Yanjun Gong, Bo Zheng, Fangfang Fan, Tieci Yi, Yimei Zheng, Pengkang He, Jin Fang, Jia Jia, Qin Zhu, Jie Jiang, Yong Huo, Yuxi Li, Yanjun Gong, Bo Zheng, Fangfang Fan, Tieci Yi, Yimei Zheng, Pengkang He, Jin Fang, Jia Jia, Qin Zhu, Jie Jiang, Yong Huo

Abstract

Background: The adherence to secondary prevention treatment in patients with coronary heart disease (CHD) is low. Digital therapeutics (DTx) refers to an emerging branch of medicine that delivers medical interventions directly to patients using evidence-based, clinically evaluated, technology-based software algorithms or apps to facilitate disease management, which may be an efficient tool to optimize adherence.

Objective: This paper aims to investigate the effect of mobile app-based self-management DTx on long-term use of secondary prevention medications in patients with CHD in China.

Methods: This pilot study was a parallel-designed, open-labeled, single-center, randomized controlled trial. Hospitalized patients with CHD admitted to Peking University First Hospital between April 2016 and June 2017 were randomized before discharge on a 1:1 ratio. The intervention group received regular follow-up combined with DTx, which is a self-management mobile app already installed on an Android 5 (Mi Pad 1, Xiaomi Corporation) tablet. Structured data from the hospital informatics system were integrated automatically, and medication, lifestyle intervention plan, follow-up protocol, and patient education materials were also provided according to the diagnosis. Participants could use DTx for self-management at home. The control group was under conventional hospital-based follow-up care. Patients were followed up for 1 year, and the primary end point was the percentage of all guideline-recommended medications at 12 months. The secondary end points included the percentage adhered to standard secondary prevention medications at 6 months, the control rate of lipid profile, and blood pressure at 6 months and 1 year.

Results: Among 300 randomized patients with CHD, 290 (96.7%) were included in the final analysis, including 49.3% (143/290) and 50.7% (147/290) of patients from the intervention and control groups, respectively. Baseline characteristics were similar between the 2 groups. There was a statistically significant improvement in the percentage of all guideline-recommended medications at 12 months in the intervention group compared with the control group (relative risk [RR] 1.34, 95% CI 1.12-1.61; P=.001), and there was no interaction with baseline characteristics. The intervention group had a significantly higher proportion of patients achieving blood pressure under control (systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) and low-density lipoprotein cholesterol <1.8 mmol/L (RR 1.45, 95% CI 1.22-1.72; P<.001 and RR 1.40, 95% CI 1.11-1.75; P=.004, respectively) at 12 months. Furthermore, on logistic regression, the intervention group had a lower risk of withdrawing from guideline-recommended medications (odds ratio 0.46, 95% CI 0.27-0.78; P=.004).

Conclusions: Among patients with CHD, using a mobile app-based self-management DTx in addition to traditional care resulted in a significant improvement in guideline-recommended medication adherence at 12 months. The results of the trial will be applicable to primary care centers, especially in rural areas with less medical resources.

Trial registration: ClinicalTrials.gov NCT03565978; https://ichgcp.net/clinical-trials-registry/NCT03565978.

Keywords: adherence; coronary heart disease; digital therapeutics; mobile app; mobile phone; secondary prevention; self-management.

Conflict of interest statement

Conflicts of Interest: QZ is an employee of Philips Research.

©Yuxi Li, Yanjun Gong, Bo Zheng, Fangfang Fan, Tieci Yi, Yimei Zheng, Pengkang He, Jin Fang, Jia Jia, Qin Zhu, Jie Jiang, Yong Huo. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 15.02.2022.

Figures

Figure 1
Figure 1
Flowchart of the study participants. CHD: coronary heart disease; FAS: full analysis set.
Figure 2
Figure 2
Proportion of patients taking the standard secondary prevention medications. OR: odds ratio.
Figure 3
Figure 3
Blood pressure and low-density lipoprotein cholesterol (LDL-C) level changes between the 2 groups. bpm: beats per minute.

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