Integrating mhealth-based solutions in heart failure management during the vulnerable phase in the oldest-old patients: a sub-analysis of the HERMeS multicentre randomised controlled trial

Background

Heart failure (HF) patients are at an elevated risk of adverse events mainly during the early post-discharge period. Mobile health (mHealth)-based solutions combining telemonitoring and teleintervention offer non-invasive strategy to improve management, but their impact in this period, particularly among the oldest-old patients (aged >85 years), remains unexplored.

Purpose

To evaluate the effectiveness of incorporating mHealth-based non-invasive solutions combining telemonitoring and teleintervention into routine HF management in the vulnerable phase with a focus on the oldest-old patients.

Methods

We conducted a post hoc sub-analysis of the HERMeS clinical trial stratifying patients into two groups by age (>85 years). The primary endpoint was a composite of worsening heart failure (WHF) or cardiovascular (CV) death. Patient reported outcome measures (PROMS) were assessed using three different instruments: EHFScBS 9 items, VAS, and EQ-5D scores. Regarding patient reported experience measures (PREMS), we used the Net Promoter Score (NPS). Analyses include Cox regression models to estimate hazard ratios and confidence intervals and repeated-measures tests to assess changes in PROMS and PREMS.

Results

506 patients were included in HERMeS clinical trial which a total of 93 (18%) were over 85 years old at the inclusion time of the study predominantly female (45%). During the 6-month follow-up, 62 (67%) of the oldest old patients experienced WHF or CV death, regardless of the group allocation (mHealth or Usual care). The patients allocated in the mHealth group showed a statistically significant risk reduction of the primary endpoint (HR = 0.14 (95% CI: 0.06-0.32; p < 0.001)) (Figure 1) regardless of the age subgroup (p. interaction 0.180). This effect was also registered for the primary endpoint components (WHF, CV death) and the secondary clinical endpoint of the study.

Patients experienced significant improvements in PROMS and PREMS evaluation. Self-care and VAS scores showed statistically significant change overtime in both groups, with a more pronounced effect in the mHealth group (all p. interaction values > 0.05) (Figure 2). However, this trend was not observed in the EQ-5D index score. For the NPS evaluation, all patients regardless of their age and group allocation experienced better global satisfaction with the mHealth-based monitoring in comparison with the usual care management.

Conclusions

Incorporating mHealth-based solutions combining telemonitoring and teleintervention strategies into routine HF management during the vulnerable phase appears to be effective in all patients, even those classified as oldest-old. Therefore, these solutions should be implemented regardless of the patient’s age, as long as they have a reliable support network to assist with the use of these technologies.Kaplan-Meier Curve for Primary EndpointFor image description, please refer to the figure legend and surrounding text.PROMs according treatment and subgroupsFor image description, please refer to the figure legend and surrounding text.