Sustained reduction in healthcare utilisation with long-term digital remote patient monitoring for heart failure with reduced ejection fraction: a propensity-matched retrospective cohort study
S Zaman, M Kelshiker, A Sidhu, P Bachtiger, S Nakhare, M Shah, F Windsor, A Varnava, N W F Linton, C Barton, G D Cole, D Auger, N S Peters, C M PlymenAbstract
Background
Frequent hospital attendances and emergency admissions are key drivers of the economic burden of heart failure with reduced ejection fraction (HFrEF)(1). Remote monitoring (RM) aims to support treatment optimisation and admission avoidance through monitoring vital signs and symptoms (2). Previous studies demonstrate a reduction in secondary care usage and costs associated with non-invasive digital RM in the early period after a HF diagnosis (3). Whether these clinical and operational benefits are sustained with long-term use remains unknown (4).
Purpose
To evaluate the long-term impact on healthcare utilisation of non-invasive, smartphone-based RM for HFrEF, compared to standard care without RM.
Methods
In this retrospective propensity-matched cohort study, patients with HFrEF referred since April 2021 with at least 6 months of follow-up by May 2024 were identified. The ‘RM group’ included patients onboarded to and using the RM platform for at least 6 months. The ‘control’ group, who did not have RM, was selected from the remaining patients using 1:1 propensity matching for left ventricular ejection fraction (LVEF), demographic variables and clinical co-morbidities. Emergency department (ED) attendances, unplanned hospital admissions, and associated costs were extracted from the DISCOVER-NOW dataset (5). Healthcare utilisation outcomes were calculated as counts per person-year of follow-up. After accounting for overdispersion in a Poisson regression model, between-group comparisons were reported as incidence rate ratios (IRR) using negative binomial regression. Kaplan-Meier event analysis was used to compare time to first ED attendance or unplanned admission between groups.
Results
294 patients were included (RM group=147; matched controls=147). Median follow up was 42 months (IQR 32-48). Groups were well matched for baseline characteristics including HF severity and clinical co-morbidities (Table 1). Compared to the control group, there was a lower incidence of ED attendance (IRR 0.71 [0.53-0.96], p=0.02) and unplanned hospital admission (IRR 0.68 [0.47-0.98], p=0.04) in the RM group. The likelihood of ED or unplanned admission costs were lower in the RM group (Table 1). In the event analysis, time to first ED attendance (HR = 0.711 [0.55-0.93]; p=0.01) and unplanned hospital admission (HR = 0.63 [0.46-0.87]; p<0.01) was lower in the RM group (Figure 1).
Conclusions
This study shows ~30% reduction in acute secondary healthcare use with digital RM for HFrEF, sustained over a long follow-up. Overall, secondary healthcare usage remains high in both groups. These findings fill a gap in the evidence base, supporting a role for ongoing smartphone-based RM, even in the chronic phase of HFrEF. Further research with randomised design is recommended to investigate the mechanisms of these benefits, which may include greater clinical vigilance, therapeutic concordance and patient activation.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.