BP control rates after MI similar with smart technology, regular visits
Follow-up after an acute MI using a smart technology approach, which utilized smartphone-compatible devices including a BP monitor, weight scale, step counter and rhythm monitor, yielded similar rates of regulated BP compared with the standard of care.
“This trial shows that smart technology and e-visits are feasible to implement in the follow-up of low-risk patients after acute MI,” Roderick W. Treskes, PhD student in the department of cardiology at Leiden University Medical Center in the Netherlands, and colleagues wrote in JAMA Network Open.
Patients with acute MI
Researchers analyzed data from 200 patients (median age, 60 years; 78% men) who were admitted for STEMI or non-ST-segment ACS between May 2016 and December 2018. Patients were assigned follow-up with smart technology (n = 100) or regular follow-up (n = 100).
The intervention included the replacement of follow-up visits at 1 month and 6 months with electronic visits, which consisted of a patient interview with a nurse practitioner through a secured video connection. These patients were also given a step counter (Pulse Ox, Withings), BP monitor (Wireless Blood Pressure Monitor, Withings), weight scale (Smart Body Scale Analyzer, Withings) and a single-lead ECG device (Kardia, AliveCor). Data from all devices were transferred to medical records or to a medical professional for review. Patients were contacted when new arrhythmias were diagnosed or when their BP exceeded 139 mm Hg systolic or 89 mm Hg diastolic.
Patients assigned regular follow-up went to an outpatient clinic for visits at 1, 3, 6 and 12 months after acute MI. Several tests were performed at all or some of the visits including 12-lead ECG, BP measurement, patient interview with a nurse practitioner, stress echocardiogram and laboratory testing.
The primary endpoint was the percentage of patients with controlled BP after 1 year of follow-up. Secondary outcomes included measurement adherence, patient satisfaction, hospitalizations for nonfatal adverse cardiac events and all-cause mortality.
After 1 year of follow-up, the rate of BP control was similar in the intervention group vs. the control group (79% vs. 76%, respectively; P = .64). Both groups also had similar scores on the Patient Satisfaction Questionnaire (82.6 vs. 82, respectively; P = .88).
The rate of all-cause mortality in both groups was 2% (P > .99). Twenty hospitalizations for nonfatal adverse cardiac events occurred, with eight in the intervention group and 12 in the control group.
Weekly measurements were sent by 32% of all patients who completed the intervention, with 63% sending this information for more than 80% of the time they participated in the study. More than 90% of patients reported satisfaction with the smart technology intervention.
“Future research should corroborate these findings and should be performed to further define subgroups most likely to benefit from smartphone technology and to customize the smart technology intervention to an individual patient’s specific needs,” Treskes and colleagues wrote.
Assessing new health care approaches
In a related editorial, Steven M. Bradley, MD, MPH, senior consulting cardiologist and associate medical director of the Center for Healthcare Delivery Innovation at Minneapolis Heart Institute and associate editor of JAMA Network Open, wrote: “Patient health remains the yardstick against which changes in health care must be measured. However, when new approaches to health care delivery achieve similar health outcomes, it is important to assess the other ways in which a new care delivery approach might be better or worse. Although evidence suggesting mHealth and patient-generated data improve health is sparse, this should not temper enthusiasm for the potential of mHealth and patient-generated data to address shortcomings in traditional health care delivery or for studies of how these tools might make health care better.” – by Darlene Dobkowski
Disclosures: Treskes reports he received personal fees from Boston Scientific and his institution received unrestricted research and educational grants from Biotronik, Boston Scientific and Medtronic. The other authors of the study and Bradley report no relevant financial disclosures.