A Self-Care Mobile Application for Patients with Acute Decompensated Heart Failure During the COVID-19 Pandemic

Background: Mobile health applications may support self-care following acute decompensated heart failure (ADHF), particularly when conventional healthcare contact is limited. We evaluated the integration of the Aintree Heart Failure Passport (AHFP) application into a specialist ambulatory ADHF pathway and described self-care behaviour, medication adherence and 30-day heart failure rehospitalisation among app users. Methods: This prospective, single-centre observational study included consecutive patients treated with day-case intravenous diuretics in a consultant-led ambulatory heart failure unit at a UK university hospital between March 2020 and July 2021. Patients with access to a smartphone were offered the AHFP application. Self-care behaviour and medication adherence were assessed two weeks after presentation using the nine-item European Heart Failure Self-care Behaviour Scale (EHFScB-9) and five-item Medication Adherence Report Scale (MARS-5), respectively. Thirty-day HF hospitalisation among application users was compared with a separate cohort of hospitalised HF patients recorded in the National Heart Failure Audit (73/382, 19.1%). This inpatient cohort was used as a contextual benchmark rather than a matched control group. Results: Of 221 consecutive patients treated for ADHF, 148 (67%) downloaded and registered with the AHFP application. Their mean age was 62 ± 6.1 years, and 45% were women. At two weeks, the mean EHFScB-9 score was 19.1 ± 6.7, and the mean MARS-5 score was 23.3 ± 1.0. Within 30 days, 16 patients (10.8%; 95% CI 6.8-16.8%) were hospitalised with HF, accounting for 73 inpatient bed-days. The corresponding 30-day readmission rate in the separate inpatient audit cohort was 19.1% (73/382). Conclusions: The AHFP application was downloaded and registered by 67% of patients treated within an ambulatory ADHF pathway. Self-care behaviour and medication adherence were assessed at two weeks. The observed 30-day HF hospitalisation rate was lower than that of a separate inpatient audit cohort, although differences in patient selection and care setting preclude attribution to the application. These findings support the feasibility of integrating a self-care application into specialist ambulatory HF care and warrant further evaluation in controlled studies.