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Updated: Jul 9, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Association Between Remote Monitoring and Interstage Morbidity and Death in Patients With Single-Ventricle Heart
Bianca Cherestal1, Lori A Erickson1, Janelle R Noel-MacDonnell1,2
1Children's Mercy Kansas City Kansas City MO.
Insights
A remote monitoring program for infants with single-ventricle heart disease showed no difference in outcomes based on socioeconomic status (SES). This digital health technology may help reduce disparities in care for vulnerable infants with complex congenital heart conditions.
Area of Science:
- Pediatric Cardiology
- Digital Health
- Health Disparities
Background:
- Infants with single-ventricle heart disease (SVHD) have high mortality rates, with those from lower socioeconomic status (SES) being particularly vulnerable.
- Existing survival improvements have not fully addressed SES-related outcome disparities in SVHD.
- The Cardiac High Acuity Monitoring Program (CHAMP) is a novel remote monitoring tool designed to improve care for these infants.
Purpose of the Study:
- To determine if the Cardiac High Acuity Monitoring Program (CHAMP) can mitigate outcome differences associated with socioeconomic status (SES) in infants with SVHD.
- To investigate the association between SES and adverse outcomes (death or transplant listing) during the interstage period for infants with SVHD enrolled in CHAMP.
Main Methods:
- A cohort of 610 infants with SVHD across 11 centers from 2014-2021 were enrolled in the CHAMP program, utilizing a mobile application for data transfer.
- Infants were stratified into SES tertiles based on six socioeconomic variables.
- Hierarchical logistic regression was employed to analyze the association between SES tertiles and the primary outcome of death or transplant listing, adjusting for confounding factors.
Main Results:
- The overall rate of death or transplant listing was 6.4% (39 out of 610 infants).
- Unadjusted and multivariable analyses revealed no statistically significant difference in the odds of death or transplant listing across the different SES tertiles.
- Specifically, infants in the middle (OR, 1.7) and highest (OR, 0.997) SES tertiles did not have significantly different odds of the primary outcome compared to those in the lowest SES tertile.
Conclusions:
- The Cardiac High Acuity Monitoring Program (CHAMP) did not demonstrate a difference in outcomes based on socioeconomic status (SES) in a large multicenter cohort of infants with single-ventricle heart disease.
- This digital remote monitoring technology shows promise in potentially reducing outcome disparities for this high-risk pediatric population.
- Further research is warranted to confirm the long-term impact of such technologies on health equity in congenital heart disease.
Background:
Despite improvements in survival over time, the mortality rate for infants with single-ventricle heart disease remains high. Infants of low socioeconomic status (SES) are particularly vulnerable. We sought to determine whether use of a novel remote monitoring program, the Cardiac High Acuity Monitoring Program, mitigates differences in outcomes by SES.
Methods And Results:
Within the Cardiac High Acuity Monitoring Program, we identified 610 infants across 11 centers from 2014 to 2021. All enrolled families had access to a mobile application allowing for near-instantaneous transfer of patient information to the care team. Patients were divided into SES tertiles on the basis of 6 variables relating to SES. Hierarchical logistic regression, adjusted for potential confounding characteristics, was used to determine the association between SES and death or transplant listing during the interstage period. Of 610 infants, 39 (6.4%) died or were listed for transplant. In unadjusted analysis, the rate of reaching the primary outcome between SES tertiles was similar (P=0.24). Even after multivariable adjustment, the odds of death or transplant listing were no different for those in the middle (odds ratio, 1.7 [95% CI, 0.73-3.94) or highest (odds ratio, 0.997 [95% CI, 0.30, 3.36]) SES tertile compared with patients in the lowest (overall P value 0.4).
Conclusions:
In a large multicenter cohort of infants with single-ventricle heart disease enrolled in a digital remote monitoring program during the interstage period, we found no difference in outcomes based on SES. Our study suggests that this novel technology could help mitigate differences in outcomes for this fragile population of patients.
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