Background: To prevent the further development of cardiovascular diseases, it is a growing global priority to detect untreated hypertension in patients and ensure adequate blood pressure control via drug therapy. However, few effective tools that facilitate the initiation of antihypertensive medications among such patients have been identified.
Objective: We aimed to determine whether a mobile health (mHealth) app facilitates the initiation of antihypertensive medications among patients with untreated hypertension.
Methods: We analyzed a large longitudinal integrated database mainly comprised of data from middle-aged, employed people and their families. The database contained data from health checkups, health insurance claims, and the mHealth app kencom. kencom is used to manage daily life logs (eg, weight, number of steps) and to provide health information tailored to customers. Patients with untreated hypertension were identified using the baseline health checkup data, and follow-up health checkups were conducted to identify the rate of initiation of antihypertensive medications between mHealth app users and nonusers. Antihypertensive medication status was confirmed via a questionnaire administered during the medical checkup as well as a review of the health insurance claims database. We conducted a modified Poisson regression analysis, weighted by inverse probability of treatment weighting, to examine the effect of mHealth app usage on the initiation of antihypertensive medications. Additionally, data from four lifestyle questionnaires from the baseline and follow-up health checkups were collected to evaluate lifestyle modifications that could be attributed to the mHealth app.
Results: Data were collected from 50,803 eligible patients (mean age 49, SD 9 years; men n=39,412, 77.6%; women n=11,391, 22.4%) with a median follow-up period of 3.0 (IQR 2.3-3.1) years. The rate of initiation of antihypertensive medications was significantly higher in the mHealth app user group than in the nonuser group: 23.4% (3482/14,879) versus 18.5% (6646/35,924; P<.001), respectively. The risk ratio of mHealth app usage for initiated antihypertensive medications was 1.28 (95% CI 1.23-1.33). Among those who did not intend to improve their lifestyle habits such as exercise and diet at baseline, the rate of lifestyle improvement at follow-up was compared between mHealth app users and nonusers, using data from the questionnaires; mHealth app users demonstrated a significantly higher rate of lifestyle changes than nonusers.
Conclusions: For patients with untreated hypertension, the use of the mHealth app kencom, which was not dedicated to hypertension treatment, was associated with a higher initiation of antihypertensive medications.
Background: Heart failure (HF) is a complex syndrome associated with high morbidity and mortality and increased health care use. Patient education is key to improving health outcomes, achieved by promoting self-management to optimize medical management. Newer digital tools like SMS text messaging and smartphone apps provide novel patient education approaches.
Objective: This study aimed to partner with clinicians and people with lived experience of HF to identify the priority educational topic areas to inform the development and delivery of a bank of electronic-message driven tips (e-TIPS) to support HF self-management.
Methods: We conducted 3 focus groups with cardiovascular clinicians, people with lived experience of HF, and their caregivers, which consisted of 2 stages: stage 1 (an exploratory qualitative study to identify the unmet educational needs of people living with HF; previously reported) and stage 2 (a co-design feedback session to identify educational topic areas and inform the delivery of e-TIPS). This paper reports the findings of the co-design feedback session.
Results: We identified 5 key considerations in delivering e-TIPS and 5 relevant HF educational topics for their content. Key considerations in e-TIP delivery included (1) timing of the e-TIPS; (2) clear and concise e-TIPS; (3) embedding a feedback mechanism; (4) distinguishing actionable and nonactionable e-TIPS; and (5) frequency of e-TIP delivery. Relevant educational topic areas included the following: (1) cardiovascular risk reduction, (2) self-management, (3) food and nutrition, (4) sleep hygiene, and (5) mental health.
Conclusions: The findings from this co-design case study have provided a foundation for developing a bank of e-TIPS. These will now be evaluated for usability in the BANDAIDS e-TIPS, a single-group, quasi-experimental study of a 24-week e-TIP program (personalized educational messages) delivered via SMS text messaging (ACTRN12623000644662).
Background: Heart failure (HF) is a complex syndrome associated with high morbidity and mortality and increased healthcare utilisation. Patient education is key to improving health outcomes, achieved by promoting self-management to optimise medical management. Newer digital tools like text messaging and smartphone applications provide novel patient education approaches.
Objective: To partner with clinicians and people with lived experience of HF to identify the priority educational topic areas to inform the development and delivery of a bank of electronic-message driven tips ('e-TIPS') to support HF self-management.
Methods: We conducted three focus groups with cardiovascular clinicians, people with lived experience of HF and their caregivers, which consisted of two stages: Stage 1 - an exploratory qualitative study to identify the unmet educational needs of people living with HF (previously reported) and Stage 2 - a co-design feedback session to identify educational topic areas and inform the delivery of e-TIPS. This paper reports the findings of the co-design feedback session.
Results: We identified five key considerations in delivering e-TIPS and five relevant HF educational topics for their content. Key considerations in e-TIP delivery included: (i) Timing of the e-TIPS; (ii) Clear and concise e-TIPS; (iii) Embedding a feedback mechanism; (iv) Distinguishing actionable and non-actionable e-TIPS; and (v) Frequency of e-TIP delivery. Relevant educational topic areas included: (i) cardiovascular risk reduction; (ii) Self-management; (iii) Food and nutrition; (iv) Sleep hygiene; and (v) Mental health.
Conclusions: The findings from this co-design case study have provided a foundation for developing a bank of e-TIPS. These will now be evaluated for usability in the BANDAIDS e-TIPS, a single group, quasi-experimental study of a 24-week e-TIP program (personalised educational messages) delivered via Short Message Service (ACTRN12623000644662).
Clinicaltrial:
The majority of Black women with hypertension in the United States have smartphones or tablets and use social media, and many use wearable activity trackers and health or wellness apps, digital tools that can be used to support lifestyle changes and medication adherence.
Background: For a decade, despite results from many studies, telemedicine systems have suffered from a lack of recommendations for chronic heart failure (CHF) care because of variable study results. Another limitation is the hospital-based architecture of most telemedicine systems. Some systems use an algorithm based on daily weight, transcutaneous oxygen measurement, and heart rate to detect and treat acute heart failure (AHF) in patients with CHF as early on as possible.
Objective: The aim of this study is to determine the efficacy of a telemonitoring system in detecting clinical destabilization in real-life settings (out-of-hospital management) without generating too many false positive alerts.
Methods: All patients self-monitoring at home using the system after a congestive AHF event treated at a cardiology clinic in France between March 2020 and March 2021 with at least 75% compliance on daily measurements were included retrospectively. New-onset AHF was defined by the presence of at least 1 of the following criteria: transcutaneous oxygen saturation loss, defined as a transcutaneous oxygen measurement under 90%; rise of cardiac frequency above 110 beats per minute; weight gain of at least 2 kg; and symptoms of congestive AHF, described over the phone. An AHF alert was generated when the criteria reached our definition of new-onset acute congestive heart failure (HF).
Results: A total of 111 consecutive patients (n=70 men) with a median age of 76.60 (IQR 69.5-83.4) years receiving the telemonitoring system were included. Thirty-nine patients (35.1%) reached the HF warning level, and 28 patients (25%) had confirmed HF destabilization during follow-up. No patient had AHF without being detected by the telemonitoring system. Among incorrect AHF alerts (n=11), 5 patients (45%) had taken inaccurate measurements, 3 patients (27%) had supraventricular arrhythmia, 1 patient (9%) had a pulmonary bacterial infection, and 1 patient (9%) contracted COVID-19. A weight gain of at least 2 kg within 4 days was significantly associated with a correct AHF alert (P=.004), and a heart rate of more than 110 beats per minute was more significantly associated with an incorrect AHF alert (P=.007).
Conclusions: This single-center study highlighted the efficacy of the telemedicine system in detecting and quickly treating cardiac instability complicating the course of CHF by detecting new-onset AHF as well as supraventricular arrhythmia, thus helping cardiologists provide better follow-up to ambulatory patients.
Background: Heart failure (HF) is a burdensome condition and a leading cause of 30-day hospital readmissions in the United States. Clinical and social factors are key drivers of hospitalization. These 2 strategies, digital platforms and home-based social needs care, have shown preliminary effectiveness in improving adherence to clinical care plans and reducing acute care use in HF. Few studies, if any, have tested combining these 2 strategies in a single intervention.
Objective: This study aims to perform a pilot randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of a 30-day digitally-enabled community health worker (CHW) intervention in HF.
Methods: Adults hospitalized with a diagnosis of HF at an academic hospital were randomly assigned to receive digitally-enabled CHW care (intervention; digital platform +CHW) or CHW-enhanced usual care (control; CHW only) for 30 days after hospital discharge. Primary outcomes were feasibility (use of the platform) and acceptability (willingness to use the platform in the future). Secondary outcomes assessed preliminary effectiveness (30-day readmissions, emergency department visits, and missed clinic appointments).
Results: A total of 56 participants were randomized (control: n=31; intervention: n=25) and 47 participants (control: n=28; intervention: n=19) completed all trial activities. Intervention participants who completed trial activities wore the digital sensor on 78% of study days with mean use of 11.4 (SD 4.6) hours/day, completed symptom questionnaires on 75% of study days, used the blood pressure monitor 1.1 (SD 0.19) times/day, and used the digital weight scale 1 (SD 0.13) time/day. Of intervention participants, 100% responded very or somewhat true to the statement "If I have access to the [platform] moving forward, I will use it." Some (n=9, 47%) intervention participants indicated they required support to use the digital platform. A total of 19 (100%) intervention participants and 25 (89%) control participants had ≥5 CHW interactions during the 30-day study period. All intervention (n=19, 100%) and control (n=26, 93%) participants who completed trial activities indicated their CHW interactions were "very satisfying." In the full sample (N=56), fewer participants in the intervention group were readmitted 30 days after hospital discharge compared to the control group (n=3, 12% vs n=8, 26%; P=.12). Both arms had similar rates of missed clinic appointments and emergency department visits.
Conclusions: This pilot trial of a digitally-enabled CHW intervention for HF demonstrated feasibility, acceptability, and a clinically relevant reduction in 30-day readmissions among participants who received the intervention. Additional investigation is needed in a larger trial to determine the effect of this intervention on HF home management and clinical
Background: The key to reducing the immense morbidity and mortality burdens of cardiovascular diseases is to help people keep their blood pressure (BP) at safe levels. This requires that more people with hypertension be identified, diagnosed, and given tools to lower their BP. BP monitors are critical to hypertension diagnosis and management. However, there are characteristics of conventional BP monitors (oscillometric cuff sphygmomanometers) that hinder rapid and effective hypertension diagnosis and management. Calibration-free, software-only BP monitors that operate on ubiquitous mobile devices can enable on-demand BP monitoring, overcoming the hardware barriers of conventional BP monitors.
Objective: This study aims to investigate the accuracy of a contactless BP monitor software app for classifying the full range of clinically relevant BPs as hypertensive or nonhypertensive and to evaluate its accuracy for measuring the pulse rate (PR) and BP of people with BPs relevant to stage-1 hypertension.
Methods: The software app, known commercially as Lifelight, was investigated following the data collection and data analysis methodology outlined in International Organization for Standardization (ISO) 81060-2:2018/AMD 1:2020 "Non-invasive Sphygmomanometers-Part 2: Clinical investigation of automated measurement type." This validation study was conducted by the independent laboratory Element Materials Technology Boulder (formerly Clinimark). The study generated data from 85 people aged 18-85 years with a wide-ranging distribution of BPs specified in ISO 81060-2:2018/AMD 1:2020. At least 20% were required to have Fitzpatrick scale skin tones of 5 or 6 (ie, dark skin tones). The accuracy of the app's BP measurements was assessed by comparing its BP measurements with measurements made by dual-observer manual auscultation using the same-arm sequential method specified in ISO 81060-2:2018/AMD 1:2020. The accuracy of the app's PR measurements was assessed by comparing its measurements with concurrent electroencephalography-derived heart rate values.
Results: The app measured PR with an accuracy root-mean-square of 1.3 beats per minute and mean absolute error of 1.1 (SD 0.8) beats per minute. The sensitivity and specificity with which it determined that BPs exceeded the in-clinic systolic threshold for hypertension diagnosis were 70.1% and 71.7%, respectively. These rates are consistent with those reported for conventional BP monitors in a literature review by The National Institute for Health and Care Excellence. The app's mean error for measuring BP in the range of normotension and stage-1 hypertension (ie, 65/85, 76% of participants) was 6.5 (SD 12.9) mm Hg for systolic BP and 0.4 (SD 10.6) mm Hg for diastolic BP. Mean absolute error was 11.3 (SD 10.0) mm Hg and 8.6 (SD 6.8) mm Hg, respectively.
Conclusions: A calibration-free, software-only medi
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