Mixed results with mobile integrated health strategy in HF

ACC.25 – In the MIGHTy-Heart trial, a mobile integrated health strategy did not reduce 30-day hospital readmissions or improve health status in patients with HF compared with standard follow-up phone calls. However, the treatment effect was modified by age and sex.

This summary is based on the presentation of Ruth Masterson Creber, PhD (New York, NY, USA) at the ACC.25 Scientific Session - Comparative Effectiveness of Mobile Integrated Health Versus a Transitions of Care Coordinator in Patients With Heart Failure: Results From the MIGHTy-Heart Trial.

Introduction and methods

Transitions of care programs have been implemented in hospitals to reduce the burden of readmissions. The MIGHTy-Heart trial compared the effectiveness of two transition of care programs, a mobile integrated health (MIH) approach versus a transition of care coordinator (TOCC), in post-acute patients with HF.

The MIGHTy-Heart (Using Mobile Integrated Health and Telehealth to Support Transitions of Care among Patients with Heart Failure) trial was a multicenter, pragmatic RCT conducted across 11 hospitals in New York City in the US. 2003 patients were randomized in a 1:1 ratio to MIH or TOCC. The MIH arm received a follow-up call from a nurse care coordinator 48 to 72 hours post-discharge, home visits by community paramedics, a facilitated telehealth visit with an emergency medicine physician, and case management by a nurse. The TOCC arm only received a follow-up call from a nurse care coordinator 48 to 72 hours post-discharge. Patients were followed for 30 days.

The co-primary outcomes were health status, as assessed by KCCQ Overall Summary Score (KCCQ-OSS), and all-cause 30-day hospital readmissions.

Main results

Overall population

• At 30 days, the KCCQ-OSS improved in both study arms, with no significant differences between the groups (β: 1.83; 95%CI: -0.75–4.4).
• There was also no difference in 30-day all-cause readmissions between the MIH arm and the TOCC arm (20.3% vs. 20.4%; OR: 0.97; 95%CI: 0.80–1.16).

Subgroup analyses

• There was a significant interaction between the treatment effect on health status by age (P=0.02). The effect on hospital readmission was modified by sex (P=0.04).
• Among younger patients, there was an improvement in health status in the MIH group compared with the TOCC group (difference in KCCQ-OSS: +4.5 points). These effects were not seen among older patients.
• Among women who were assigned to the MIH strategy, there were 30% fewer hospital admissions at 30 days compared with men assigned to the MIH strategy (OR: 0.70; 95%CI: 0.49–0.99).

Conclusion

In the overall study population of MIGHTy-Heart, there were no differences in the co-primary outcomes between the MIH strategy and the TOCC strategy. However, there were significant interactions effects by age and sex. “The next steps here is to really understand what is driving the differential effects by age and sex to be able to improve MIH and be able to tailor future implementation for patients who are most likely to benefit,” concluded Ruth Masterson Creber.

- Our reporting is based on the information provided at the ACC.25 Scientific Session -