As healthcare evolves from its traditionally more reactive attitude of healing a person already sick, toward prevention that strives to predict who may get sick and providing more precise treatment based on individual needs, the need for improved patient-physician communication takes on greater importance.
Facilitating this move toward more personalized, preventive healthcare is the emerging use of mobile health applications. Zubin J. Eapen, MD, the medical director of the Duke Heart Failure Same Day Access at Duke University Medical Center, in Durham, North Carolina, spoke at the American Heart Association (AHA) meeting on the use of mobile health applications in the management of heart failure.
Citing projected statistics that illustrate the need for improving the management of heart failure, Eapen highlighted that 40% of patients diagnosed with heart failure will have a >1 hospitalization due to the condition within 5 years of diagnosis. Among elderly Americans, heart failure is the leading cause of readmission with an average cost of $13,000 per readmission and an annual cost of $32 billion.
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The imperatives for using mobile health applications for heart failure are to objectify the subjective in clinical practice; to prevent, predict, and preempt the disease through research; and to empower and engage patients through education.
Eapen described a number of examples of mobile health care delivery innovations:
- an application (app) called Apple Health Kit with options to track a patient’s weight, blood pressure, and pulse rate;
- a self-administered 6-minute walk test app (SA-6MWTapp) to independently predict a person’s risk of heart failure severity, hospitalizations, and death;
- a tri-axial accelerometer in multisensory device that monitors body posture and detects worsening body posture and activity in patients living with heart failure; and
- an implant approved by the Food and Drug Administration (FDA) in May 2014 for quantifying congestion in patients with class III heart failure. Data show a significant reduction in hospitalizations in patients implanted with the device compared to controls. Eapen highlighted that the success of the trial depended on effective processing of large data, the participation of heart failure nurses to monitor trends, and oversight by heart failure physicians who were adept at interpreting hemodynamics.
He ended the talk with a summary of data from a study that looked at the impact of a lifestyle-focused support program delivered by mobile text messaging on cardiovascular risk factors. Called the Tobacco, Exercise, and Diet Messages (TEXT ME) trial, the study randomized patients with coronary heart disease to receive four text messages per week for six months (intervention) or to a usual care (control) group. The study showed a significant decrease in cholesterol, blood pressure, and body mass index in patients in the intervention group as well as a significant increase in physical activity and smoking cessation (Chow CK, et al. JAMA 2015;314:1255-1263).
