The Effects of the ManageHF4Life Mobile App on Patients With Chronic Heart Failure: Randomized Controlled Trial

Michael P Dorsch, Karen B Farris, Brigid E Rowell, Scott L Hummel, Todd M Koelling, Michael P Dorsch, Karen B Farris, Brigid E Rowell, Scott L Hummel, Todd M Koelling

Abstract

Background: The successful management of heart failure (HF) involves guideline-based medical therapy as well as self-management behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management.

Objective: The aim of this paper was to evaluate the efficacy of enhanced self-management via a mobile app intervention on health-related quality of life, self-management, and HF readmissions.

Methods: A single-center randomized controlled trial was performed. Participants older than 45 years and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group ("app group") used a mobile app, and the intervention prompted daily self-monitoring and promoted self-management. The control group ("no-app group") received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire score and recurrent HF admissions.

Results: A total of 83 participants were enrolled and completed all baseline assessments. Baseline characteristics were similar between the groups except for the prevalence of ischemic HF. The app group had a reduced MLHFQ at 6 weeks (mean 37.5, SD 3.5 vs mean 48.2, SD 3.7; P=.04) but not at 12 weeks (mean 44.2, SD 4 vs mean 45.9, SD 4; P=.78), compared to the no-app group. There was no effect of the app on the SCHFI at 6 or 12 weeks. The time to first HF readmission was not statistically different between the app group and the no-app group (app group 11/42, 26% vs no-app group 12/41, 29%; hazard ratio 0.89, 95% CI 0.39-2.02; P=.78) over 12 weeks.

Conclusions: The adaptive mobile app intervention, which focused on promoting self-monitoring and self-management, improved the MLHFQ at 6 weeks but did not sustain its effects at 12 weeks. No effect was seen on HF self-management measured by self-report. Further research is needed to enhance engagement in the app for a longer period and to determine if the app can reduce HF readmissions in a larger study.

Trial registration: ClinicalTrials.gov NCT03149510; https://ichgcp.net/clinical-trials-registry/NCT03149510.

Keywords: heart failure; mHealth; medical therapy; mobile app; remote monitoring; self-care; self-management.

Conflict of interest statement

Conflicts of Interest: KBF serves as the site principal investigator for an investigator-initiated grant from AstraZeneca that is focused on implementation of a collaborative model between oncology and primary care pharmacists to improve medication adherence to oral anti-cancer agents and chronic disease medications.

©Michael P Dorsch, Karen B Farris, Brigid E Rowell, Scott L Hummel, Todd M Koelling. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 07.12.2021.

Figures

Figure 1
Figure 1
Example of a health status indicator in the ManageHF4Life mobile app.
Figure 2
Figure 2
CONSORT (Consolidated Standards of Reporting Trials) flow diagram.
Figure 3
Figure 3
The change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score over time by group.
Figure 4
Figure 4
Time to first heart failure readmission by group; HR: heart rate.

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