Heart Failure and Digital Health Intervention Following Hospital Discharge

Health services delivered electronically through health applications following hospitalization for heart failure (HF) significantly improve outcomes and decrease risk for mortality, according to study findings published in the International Journal of Cardiology.

Researchers sought to investigate the efficacy of digital health interventions (DHI) vs standard care in patients previously hospitalized with HF. To accomplish this, they conducted a retrospective observational study of 10 randomized controlled trials in MEDLINE, Cochrane, OVID, CINHAL and ERIC databases that examined the outcomes with DHI in patients with HF. The study included 7204 patients (weighted mean 65.7 years of age; predominantly men) with follow-up of almost 16 months. The primary endpoint was all-cause death.

Comparing the DHI group with the reference group, researchers found lower all-cause mortality (8.5% vs. 10.2%; risk ratio [RR], 0.80; 95% CI, 0.66-0.96; P =.02), and lower cardiovascular mortality (7.3% vs. 9.6%; RR, 0.76; 95% CI, 0.62-0.94; P =.01). There was no significant difference in hospitalizations for HF (23.4% vs. 26.2%; RR, 0.82; 95% CI, 0.66-1.02; P =.07) and all-cause hospitalizations (48.3% vs. 49.9%; RR, 0.89; 95% CI, 0.77-1.03; P =.11).

Compared with the reference group, there were fewer days lost due to HF-related hospitalizations in the DHI group (mean difference [MD], -1.77; 95% CI, -3.06 to -0.48; P =.01; I² = 51), but similar days lost to all-cause hospitalizations (MD, -0.76; 95% CI, -3.07 to -1.55; P =.52; I² = 69).

Study limitations included using study-level data instead of patient-level data, the meta-analysis design, the degree of heterogeneity in some of the study endpoints, and the under-representation of women.

“This meta-analysis of [randomized controlled trials] supports a suggested reduction of all-cause mortality and cardiovascular mortality with fewer total days lost to HF hospitalizations when DHI is employed in patients with prior HF hospitalizations,” the study authors wrote. “Further large-scale investigations are warranted to evaluate the role of various methods of DHI and the cost-effectiveness of DHI in HF management.”

Reference

Elbadawi A, Tan BE, Assaf Y, et al. Digital health intervention in patients with recent hospitalization for acute heart failure: A systematic review and meta-analysis of randomized trials. Int J Cardiol. Published online April 15, 2022. doi:10.1016/j.ijcard.2022.04.039