Digital Health Intervention in Acute Myocardial Infarction.
BACKGROUND: Thirty-day readmissions among patients with acute myocardial infarction (AMI) contribute to the US health care burden of preventable complications and costs. Digital health interventions (DHIs) may improve patient health care self-management and outcomes. We aimed to determine if patients with AMI using a DHI have lower 30-day unplanned all-cause readmissions than a historical control.
METHODS: This nonrandomized controlled trial with a historical control, conducted at 4 US hospitals from 2015 to 2019, included 1064 patients with AMI (DHI n=200, control n=864). The DHI integrated a smartphone application, smartwatch, and blood pressure monitor to support guideline-directed care during hospitalization and through 30-days post-discharge via (1) medication reminders, (2) vital sign and activity tracking, (3) education, and (4) outpatient care coordination. The Patient Activation Measure assessed patient knowledge, skills, and confidence for health care self-management. All-cause 30-day readmissions were measured through administrative databases. Propensity score-adjusted Cox proportional hazard models estimated hazard ratios of readmission for the DHI group relative to the control group.
RESULTS: Following propensity score adjustment, baseline characteristics were well-balanced between the DHI versus control patients (standardized differences
CONCLUSIONS: Our results suggest that in patients with AMI, the DHI may be associated with high patient activation for health care self-management and lower risk of all-cause unplanned 30-day readmissions. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03760796.
Published In/Presented At
Marvel, F. A., Spaulding, E. M., Lee, M. A., Yang, W. E., Demo, R., Ding, J., Wang, J., Xun, H., Shah, L. M., Weng, D., Carter, J., Majmudar, M., Elgin, E., Sheidy, J., McLin, R., Flowers, J., Vilarino, V., Lumelsky, D. N., Bhardwaj, V., Padula, W. V., … Martin, S. S. (2021). Digital Health Intervention in Acute Myocardial Infarction. Circulation. Cardiovascular quality and outcomes, 14(7), e007741. https://doi.org/10.1161/CIRCOUTCOMES.121.007741
Medicine and Health Sciences
Department of Medicine, Cardiology Division