Heart failure tool reduces length of hospital stay, improves self-care behaviour
OPTILOGG, an mHealth tool for heart failure (HF) that provides education, symptom monitoring and diuretic titration guide, effectively cuts in-hospital days and improves self-care behaviour in the general HF population, according to data from two clinical controlled trials.
“New technical solutions often fail to leave the test bed-environment to be implemented in clinical practice and oftentimes the reason can be that the generalizability, or external validity of the [trial]-findings, is questioned,” the authors said.
The results of the present analysis add to the external validity of previous findings and should provide healthcare professionals and healthcare organizations a stronger foundation for assessing the potential use of the mHealth tool as part of clinical practice, they added.
For the analysis, the authors used data from PACEMAN-HF (n=72) and Hemse trials (n=100). The two trials were similar in terms of the population and OPTILOGG intervention duration (180 days). The most important difference was that PACEMAN-HF participants (intervention, n=32; control, n=40) were recruited at hospitals in the Sweden capital Stockholm (randomized controlled trial), whereas those of Hemse (intervention, n=50; control, n=50) were treated in primary care and in a rural part of Sweden (clinical controlled trial).
Poisson log-linear regression revealed that relative to the control intervention, use of OPTILOGG significantly reduced the primary outcome of in-hospital days in both PACEMAN-HF (risk ratio [RR], 0.72; 0.61–0.84; p<0.05) and Hemse cohorts (RR, 0.67, 0.45–0.99; p<0.05). The result was consistent in the pooled dataset (RR, 0.71, 0.61–0.82, p<0.05). [Open Heart 2019;6:e000954]
Additionally, self-care behaviour improved by 27 percent with the mHealth device in the Hemse cohort (median European Heart Failure Self-care Behaviour Scale score, 30 at baseline vs 22 at 180 days; p<0.05). System adherence was also high at a median of 94 percent in the pooled cohort.
OPTILOGG consists of a preprogrammed tablet connected wirelessly to a weight scale installed in the patient’s home. It provides an education module to better the patient’s understanding of HF, as well as to enhance their self-care behaviour. The system registers body weight and symptoms and uses these data to instruct the patient to increase diuretic dose in the event of sudden weight changes. Another interesting feature is the ability to detect deterioration in HF status, triggering an alert for an imminent exacerbation.
“The tool was designed for elderly patients and patients with multiple comorbidities and has the advantage of being accessible whenever the patient is ready to seek information, as well as being part of everyday routines,” the authors noted.
They pointed out that the favourable results for in-hospital days might be explained by the very high adherence to OPTILOGG, with the rate believed to be the highest reported system adherence to a home-based system after 180 days for HF patients.
“The fact that neither age nor gender predicted the level of adherence is a positive trait of the mHealth-tool, as patient involvement is important in behavioural change. Furthermore, the means by which the patient is engaged should be tailored, and the mHealth-tool adjusts what educational material is being shown, based on how the patient interacts with the system,” the authors continued.