Patient Engagement With a Mobile Web-Based Telemonitoring System for Heart Failure Self-Management: A Pilot Study

Abstract

BackgroundIntensive remote monitoring programs for congestive heart failure have been successful in reducing costly readmissions, but may not be appropriate for all patients. There is an opportunity to leverage the increasing accessibility of mobile technologies and consumer-facing digital devices to empower patients in monitoring their own health outside of the hospital setting. The iGetBetter system, a secure Web- and telephone-based heart failure remote monitoring program, which leverages mobile technology and portable digital devices, offers a creative solution at lower cost.ObjectiveThe objective of this pilot study was to evaluate the feasibility of using the iGetBetter system for disease self-management in patients with heart failure.MethodsThis was a single-arm prospective study in which 21 ambulatory, adult heart failure patients used the intervention for heart failure self-management over a 90-day study period. Patients were instructed to take their weight, blood pressure, and heart rate measurements each morning using a WS-30 bluetooth weight scale, a self-inflating blood pressure cuff (Withings LLC, Issy les Moulineaux, France), and an iPad Mini tablet computer (Apple Inc, Cupertino, CA, USA) equipped with cellular Internet connectivity to view their measurements on the Internet. Outcomes assessed included usability and satisfaction, engagement with the intervention, hospital resource utilization, and heart failure-related quality of life. Descriptive statistics were used to summarize data, and matched controls identified from the electronic medical record were used as comparison for evaluating hospitalizations.ResultsThere were 20 participants (mean age 53 years) that completed the study. Almost all participants (19/20, 95%) reported feeling more connected to their health care team and more confident in performing care plan activities, and 18/20 (90%) felt better prepared to start discussions about their health with their doctor. Although heart failure-related quality of life improved from baseline, it was not statistically significant (P=.55). Over half of the participants had greater than 80% (72/90 days) weekly and overall engagement with the program, and 15% (3/20) used the interactive voice response telephone system exclusively for managing their care plan. Hospital utilization did not differ in the intervention group compared to the control group (planned hospitalizations P=.23, and unplanned hospitalizations P=.99). Intervention participants recorded shorter average length of hospital stay, but no significant differences were observed between intervention and control groups (P=.30).ConclusionsThis pilot study demonstrated the feasibility of a low-intensive remote monitoring program leveraging commonly used mobile and portable consumer devices in augmenting care for a fairly young population of ambulatory patients with heart failure. Further prospective studies with a larger sample size and within more diverse patient populations is necessary to determine the effect of mobile-based remote monit...

A Systematic Review of mHealth-Based Heart Failure Interventions

“…Only three of the studies reported the racial composition of their study sample (overall, 68% White, 18% Black, 14% other race) and all were conducted in North America. 22–24 The remaining 6 studies were conducted in Europe and Australia. Study duration ranged from 4 weeks to 24 months.…”

Gerontechnologies for Older Patients with Heart Failure: What is the Role of Smartphones, Tablets, and Remote Monitoring Devices in Improving Symptom Monitoring and Self-Care Management?

“…This study included taking daily weight and blood pressure readings, weekly single-lead ECGs, and daily symptom questions on a mobile phone over 6 months with feedback both to the patient and the cardiology provider (Table 1). A more recent example is the remote monitoring system called iGetBetter [15] (Partners, Boston), which enables patients to self-monitor by being able to take their weight using a Bluetooth scale, blood pressure, and heart rate measurements. Patients can view their results on an iPad mini tablet computer (Apple Inc, Cupertino, CA, USA) equipped with cellular internet connectivity [15].…”

“…This can be challenging because symptom changes can be so insidious that patients have difficulty recognizing and responding to them, as well as differentiating them from symptoms of other chronic conditions including, depression [11], atrial fibrillation, diabetes, and chronic kidney disease [12]. Despite these difficulties, active participation in self-care management is crucial in heart failure because patients who are involved in their own care are more likely to have improved survival, decreased readmission rates, and better quality of life [13–15]. …”

The Digital Outcome Measure

“…All clinical stakeholders can benefit. Early work has highlighted potential uses, such as low-resource remote monitoring of congestive heart failure patients obtaining weight, blood pressure, and heart rate [24]. Pharmaceutical companies have already begun integrating the use of technology to incorporate PROMs into clinical trials.…”