Habits Heart App for Patient Engagement in Heart Failure Management: Pilot Feasibility Randomized Trial

Kevin S Wei, Nasrien E Ibrahim, Ashok A Kumar, Sidhant Jena, Veronica Chew, Michal Depa, Namrata Mayanil, Joseph C Kvedar, Hanna K Gaggin, Kevin S Wei, Nasrien E Ibrahim, Ashok A Kumar, Sidhant Jena, Veronica Chew, Michal Depa, Namrata Mayanil, Joseph C Kvedar, Hanna K Gaggin

Abstract

Background: Due to the complexity and chronicity of heart failure, engaging yet simple patient self-management tools are needed.

Objective: This study aimed to assess the feasibility and patient engagement with a smartphone app designed for heart failure.

Methods: Patients with heart failure were randomized to intervention (smartphone with the Habits Heart App installed and Bluetooth-linked scale) or control (paper education material) groups. All intervention group patients were interviewed and monitored closely for app feasibility while receiving standard of care heart failure management by cardiologists. The Atlanta Heart Failure Knowledge Test, a quality of life survey (Kansas City Cardiomyopathy Questionnaire), and weight were assessed at baseline and final visits.

Results: Patients (N=28 patients; intervention: n=15; control: n=13) with heart failure (with reduced ejection fraction: 15/28, 54%; male: 20/28, 71%, female: 8/28, 29%; median age 63 years) were enrolled, and 82% of patients (N=23; intervention: 12/15, 80%; control: 11/13, 85%) completed both baseline and final visits (median follow up 60 days). In the intervention group, 2 out of the 12 patients who completed the study did not use the app after study onboarding due to illnesses and hospitalizations. Of the remaining 10 patients who used the app, 5 patients logged ≥1 interaction with the app per day on average, and 2 patients logged an interaction with the app every other day on average. The intervention group averaged 403 screen views (per patient) in 56 distinct sessions, 5-minute session durations, and 22 weight entries per patient. There was a direct correlation between duration of app use and improvement in heart failure knowledge (Atlanta Heart Failure Knowledge Test score; ρ=0.59, P=.04) and quality of life (Kansas City Cardiomyopathy Questionnaire score; ρ=0.63, P=.03). The correlation between app use and weight change was ρ=-0.40 (P=.19). Only 1 out of 11 patients in the control group retained education material by the follow-up visit.

Conclusions: The Habits Heart App with a Bluetooth-linked scale is a feasible way to engage patients in heart failure management, and barriers to app engagement were identified. A larger multicenter study may be warranted to evaluate the effectiveness of the app.

Trial registration: ClinicalTrials.gov NCT03238729; https://ichgcp.net/clinical-trials-registry/NCT03238729.

Keywords: heart failure; heart failure management; smartphone application.

Conflict of interest statement

Conflicts of Interest: The authors report the following relationships with industry: NEI—Jana Care research grant recipient; AAK, SJ, VC, MD, and NM are Jana Care employees; JCK—advisor for MD Revolution, Medtronic, Mint Health, Res App, and LuminDx, board member for b.well Connected Health and shareholder of b.well, Res app, MD Revolution, and LuminDx; HKG—recipient of research grant support from Roche Diagnostics, Jana Care, Ortho Clinical, Novartis, Pfizer, Alnylam, and Akcea and consulting income from Amgen, Eko, Merck, Roche Diagnostics, Radiometer, and Pfizer, ownership of Eko stocks; recipient of research payments for clinical endpoint committees from Radiometer and Baim Institute for Clinical Research (for Abbott, Siemens, and Beckman Coulter). All other authors have no conflicts to declare.

©Kevin S Wei, Nasrien E Ibrahim, Ashok A Kumar, Sidhant Jena, Veronica Chew, Michal Depa, Namrata Mayanil, Joseph C Kvedar, Hanna K Gaggin. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 20.01.2021.

Figures

Figure 1
Figure 1
Study flow diagram. AHFKT-V2: Atlanta HF Knowledge Test, Version 2; HF: heart failure; KCCQ-12: Kansas City Cardiomyopathy Questionnaire.
Figure 2
Figure 2
Layout of the Habits Heart App: To-Do List, Track, Learn, Coach.
Figure 3
Figure 3
App feasibility and patient rating.

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Source: PubMed

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