Despite the growing adoption of the mobile health (mHealth) applications (apps), few studies address concerns with low retention rates. This study aimed to investigate how the usage patterns of mHealth app functions affect user retention. We collected individual usage logs for 1,439 users of single tethered personal health record app, which spanned an 18-months period from August 2011 to January 2013. The user logs contained timestamps whenever an individual uses each function, which enables us to identify the usage patterns based on the intensity of using a particular function in the app. We then estimated how these patterns were related to 1) the app usage over time (using the random effect model) and 2) the probability of stopping the use of the application (using the Cox proportional hazard model). The analyses suggested that the users utilize the app most at the time of the adoption and gradually reduce their usage over time. The average duration of use after starting the app was 25.62 weeks (SD: 18.41). The degree of the usage reduction, however, decreases as the self-monitoring function is more frequently used (coefficient = 0.002, P = 0.013); none of the other functions has this effect. Moreover, engaging with the self-monitoring function frequently (coefficient = −0.18, P = 0.003) and regularly (coefficient = 0.10, P = 0.001) significantly also reduces the probability of abandoning the application. Specifically, the estimated survival rate indicates that, after 40 weeks since the adoption, the probability of the regular users of self-monitoring to stay in use was about 80% while that of non-user was about 60%. This study provides the empirical evidence that sustained use of mHealth app is closely linked to the regular usage on self-monitoring function. The implications can be extended to the education of users and physicians to produce better outcomes as well as application development for effective user interfaces.

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BackgroundMechanical thrombectomy (MT) is a primary endovascular modality for acute intracranial large vessel occlusion. However, further treatment, such as rescue stenting, is occasionally necessary for refractory cases. We aimed to investigate the efficacy and safety of rescue stenting in first-line MT failure and to identify the clinical factors affecting its clinical outcome.MethodsA multicenter prospective registry was designed for this study. We enrolled consecutive patients who underwent rescue stenting for first-line MT failure. Endovascular details and outcomes, follow-up patency of the stented artery, and clinical outcomes were summarized and compared between the favorable and unfavorable outcome groups.ResultsA total of 78 patients were included. Intracranial atherosclerotic stenosis was the most common etiology for rescue stenting (97.4%). Seventy-seven patients (98.7%) were successfully recanalized by rescue stenting. A favorable outcome was observed in 66.7% of patients. Symptomatic intracranial hemorrhage and mortality were observed in 5.1% and 4.0% of patients, respectively. The stented artery was patent in 82.1% of patients on follow-up angiography. In a multivariable analysis, a patent stent on follow-up angiography was an independent factor for a favorable outcome (OR 87.6; 95% CI 4.77 to 1608.9; p=0.003). Postprocedural intravenous maintenance of glycoprotein IIb/IIIa inhibitor was significantly associated with the follow-up patency of the stented artery (OR 5.72; 95% CI 1.45 to 22.6; p=0.013).ConclusionsIn this multicenter prospective registry, rescue stenting for first-line MT failure was effective and safe. For a favorable outcome, follow-up patency of the stented artery was important, which was significantly associated with postprocedural maintenance of glycoprotein IIb/IIIa inhibitors.