Mobile Health Intervention Increases Activity Among Adults With HF and Diabetes

A 3-month mobile health (mHealth) intervention improves daily physical activity, health-related quality of life, and metabolomic markers among patients with comorbid heart failure (HF) and diabetes mellitus (DM). These findings were published in the Journal of Cardiac Failure.

The Technologies to improve drug Adherence and Reinforce Guideline based Exercise Targets in patients with Heart Failure and Diabetes Mellitus (ClinicalTrials.gov Identifier: NCT02918175) trial was a multicenter, randomized controlled clinical trial. Patients (N=187) with HF and DM were randomly assigned in a 1:1 ratio to receive mHealth (n=92) or usual care (n=95). All participants were evaluated for normal physical activity (steps) for 1 week at baseline using a commercially available wrist-worn device.

For the next 12 weeks, the mHealth recipients received weekly personalized messages summarizing their physical performance and informing them of their personalized upcoming weekly goals. Physical activity performance was monitored for an additional 12 weeks without targeted messaging. In the next phase of the study, medication adherence was assessed using an electronic pillbox monitor, in which the mHealth arm received an in-person educational session about medication compliance at baseline and 1 month. Plasma was collected from all participants to evaluate metabolic profiles.

The study population comprised 35% women, aged mean 59±11 years, 47% were Black, BMI was 35±8, ejection fraction was 36%±15%, 36% had ischemic HF, N-terminal-pro hormone brain natriuretic peptide (NT-proBNP) was 1309±2271 pg/mL, hemoglobin A_1C (HbA_1C) was 7.7%±1.6%, and 54% used insulin.

Between baseline and 3 months, the mHealth recipients increased their average steps per day by 151 compared with the usual care group that had decreased their steps by 162 per day (P =.044). Significant improvement to Kansas City Cardiomyopathy Questionnaire Overall Summary Score was observed for the intervention cohort (P =.009). No group differences were observed for change in medication adherence (P =.47), HbA_1C (P =.44), or mean NT-proBNP (P =.20).

At 6 months, the mHealth cohort had returned to baseline activity levels and the control cohort had a lower activity level than at baseline.

For metabolic profiles, 13 metabolites significantly changed among the mHealth recipients between baseline and month 3 compared with control patients. The differences were primarily due to decreases in metabolites among the intervention and increases in the control cohorts. The majority of metabolites were medium- and long-chain acylcarnitines which are byproducts of mitochondrial fatty acid oxidation.

This study was limited as recruitment was interrupted by the COVID-19 pandemic.

“In a sedentary population with both heart failure and diabetes, a 3-month mHealth intervention significantly improved daily physical activity and health related quality of life but did not affect medication adherence,” the study authors wrote. “These data have important implications for designing more effective lifestyle interventions in patients with heart failure.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Felker M, Sharma A, Mentz RJ, et al. A randomized controlled trial of mobile health intervention in patients with heart failure and diabetes. J Card Fail. Published online July 22, 2022. doi:10.1016/j.cardfail.2022.07.048