The ManageHF Just-in-Time Adaptive Mobile App Interventions to Promote Self-Management and Improve Outcomes in Heart...

Area of Science:

• Cardiology
• Digital Health
• Health Services Research

Background:

• Heart failure (HF) affects nearly one million older adults annually in the US, with self-management challenges impacting quality of life and leading to hospitalizations.
• Gaps in recognizing worsening symptoms and adhering to sodium restrictions are key issues in HF self-management.
• Existing mobile health (mHealth) strategies for HF self-management have yielded inconsistent results, necessitating novel approaches.

Purpose of the Study:

• To evaluate the effectiveness of two just-in-time adaptive interventions delivered via mobile app for enhancing HF self-management.
• To assess the impact of these interventions on symptom recognition and dietary sodium restriction adherence.
• To determine the interventions' effect on reducing hospital readmissions and improving health-related quality of life (HRQOL) over 12 weeks.

Main Methods:

• A 2x2 factorial, double-blind, randomized controlled trial involving participants recently hospitalized for acute HF.
• Participants were randomized into four groups: both interventions, either intervention alone, or an active control.
• The primary outcome was a composite measure of all-cause death, HF readmission, and changes in HRQOL using the Minnesota Living with HF Questionnaire.

Main Results:

• The trial was prematurely discontinued due to COVID-19 pandemic-related recruitment challenges, with 62 participants enrolled and 43 completing the study.
• The participant cohort was diverse, with a mean age of 55 years, 32% female, and 55% Black or African American.
• The small sample size and early termination limited the statistical power to detect significant differences between groups.

Conclusions:

• The ManageHF trial suggests that mobile health technology holds potential for supporting heart failure management and improving HRQOL.
• Further research with robust recruitment and retention strategies is essential to definitively establish the efficacy of these mHealth interventions.
• Innovative digital health solutions are needed to address self-management deficits in heart failure patients and improve clinical outcomes.