Effect of mHealth on the prognosis of patients with heart failure according to left ventricular ejection fraction: subanalysis of the HERMeS Trial
A Pons Riverola, S Yun, P Moliner, M Cobo, P Llacer, J M Garcia-Pinilla, A Gonzalez-Franco, J L Morales-Rull, E Garcia-Romero, J Nunez, C Fernandez, S Jovells-Vaque, M Corbella, C Enjuanes, J Comin-ColetAbstract
Background
Recent studies have shown that incorporating digital health solutions—including mobile health (mHealth)—into heart failure (HF) management programs may improve clinical outcomes. However, it remains unclear whether this benefit is consistent across the different left ventricular ejection fraction (LVEF) phenotypes. This analysis aimed to evaluate the effectiveness of an mHealth-based intervention across the three LVEF groups: preserved (HFpEF), mildly reduced (HFmrEF), and reduced (HFrEF), and to compare it with usual care (UC).
Purpose
To assess whether an mHealth intervention improves the risk of cardiovascular (CV) death or HF decompensation across LVEF categories following a recent hospitalization for HF worsening.
Methods
We conducted a post-hoc analysis of the Heart failure Events reduction with Remote Monitoring and eHealth Support (HERMeS) trial, focusing on outcomes according to baseline LVEF. HERMeS was a multicenter, controlled, open-label trial with blinded adjudication of clinical events conducted in ten hospitals in Spain. The intervention combined telemonitoring and teleintervention through videoconferencing using mHealth tools in patients recently discharged after HF decompensation. Participants were randomized to mHealth or UC at hospital discharge and followed for 6 months. The primary endpoint for this analysis was the composite of CV death or HF decompensation (time to first event) at 6 months, stratified by baseline LVEF.
Results
A total of 506 patients were included (255 mHealth, 251 UC). Mean age was 73±13 years, and 41% were women. Overall, 45% had HFrEF, 13% HFmrEF, and 42% HFpEF. Across all LVEF subgroups, mHealth showed a consistent benefit independent of baseline LVEF (interaction p>0.05), with the greatest effect observed in the HFrEF group. Only in the HFmrEF subgroup the difference between mHealth and UC did not reach statistical significance, although a trend toward event reduction with mHealth was observed.
Conclusions
Integration of mHealth into HF programs effectively reduces fatal and non-fatal CV events across all HF phenotypes, independently of LVEF.lvef--image.pngtable3.png