App Effectively Maintains, Manages HF Self-Care Following Discharge

A mobile health app that targets postdischarge self-care of patients living with heart failure (HF) had a positive impact on their survival outcomes, especially their ability to maintain and manage their recommended care regimen, according to data¹ presented at the recent American Society for Preventive Cardiology’s Congress on CVD Prevention, held in Arlington, Texas, July 21-23.

Potential implications of these findings include guidance for the future development of new clinical management strategies, optimizing patient education on and adherence to self-care, and reductions in HF-related readmissions and health care costs.

Emelia Asamoah, PhD, MSN, RN

“Heart failure is a complex clinical syndrome of multiple symptoms, functional impairments, and poor health-related outcomes,” wrote study author Emelia Asamoah, PhD, MSN, RN, Nursing Department, Morgan State University School of Community Health & Policy. “Patients with HF are frequently hospitalized for cardiovascular conditions—such as uncontrolled hypertension, ischemia, arrhythmias, congestion, and hypervolemia—and noncardiovascular comorbidities, despite therapeutic advances.”

The population of this mixed-methods study, all of whom had been discharged following a HF-related hospitalization, was randomized 1:1 to a group that utilized the Heart Failure Health Storylines (HFHS) app and discharge notes (n = 20; the experimental group) or discharge notes only (n = 40; the control group). App users also received instruction on how to document their self-care through the app and daily reminders to practice self-care. To participate, individuals had to speak English, have a smartphone, and have New York Heart Association class I, II, or III disease.

Previous research shows a 25% readmission rate within 30 days of an initial hospitalization and that upwards of 50% of readmissions related to HF can be prevented through care plan adherence.²

For the 15 behaviors analyzed, via Chi-square analyses, the patients using the HFHS application were significantly more confident of the following vs those who only used discharge instructions:

• Take medication (χ² = 29.441; P = .000)
• Exercise (χ² = 10.794; P = .005)
• Low-sodium diet (χ² = 17.195; P = .000)
• Obtain salt information (χ² = 16.810; P = .001)
• Fluid intake (χ² = 12.267; P = .007)
• Keep medical appointments (χ² = 27.143; P = .000)
• Knowledge about HF (χ² = 32.762; P = .000)
• Obtain health information (χ² = 32.762; P = .000)
• Follow treatment advice (χ² = 10.952; P = .012)
• Recognize health changes (χ² = 15.448; P = .000)
• Relieve symptoms (χ² = 9.107; P = .011)
• Change self-care (χ² = 18.727; P = .000)

No significant differences were seen for evaluating shortness of breath (χ² = 5.796; P = .055) or checking swelling (χ² = 5.767; P = .050), and the experimental group was just “more confident” in their ability to check weight through the app (χ² = 11.760; P .003).

“These findings demonstrate a change in behavior that impacted health outcomes,” Asamoah wrote. “This study introduces to HF patients types of motivation that had positive health outcomes for the experimental group. However, use of the application must supplement discharge instructions to improve patients’ confidence in their ability to maintain and manage self-care effectively at home after discharge.”

Reference

1. Asamoah E. Efficacy of using a mobile application in support of postdischarge compliance among heart failure patients. Presented at: ASPC Congress on CVD Prevention; July 21-23, 2023; Arlington, Texas. Poster 107.

2. Kilgore M, Patel HK, Kielhorn A, Maya JF, Sharma P. Economic burden of hospitalizations of Medicare beneficiaries with heart failure. Risk Manag Healthc Policy. 2017;10:63-70. doi:10.2147/RMHP.S130341