Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
J Card Fail. 2022 Oct;28(10):1487-1496. doi: 10.1016/j.cardfail.2022.07.050. Epub 2022 Jul 26.
It is unknown whether digital applications can improve guideline-directed medical therapy (GDMT) and outcomes in heart failure with reduced ejection fraction (HFrEF).
Care Optimization Through Patient and Hospital Engagement Clinical Trial for Heart Failure trial (CONNECT-HF) included an optional, prospective ancillary study of a mobile health application among patients hospitalized due to HFrEF. Digital users were matched to nonusers from the usual-care group. Coprimary outcomes included change in opportunity-based composite HF quality scores and HF rehospitalization or all-cause mortality. Among 2431 patients offered digital applications across the United States, 1526 (63%) had limited digital access or insufficient data, 425 (17%) were digital users, and 480 (20%) declined use. Digital users were similar in age to those who declined use (mean 58 vs 60 years; P = 0.031). Digital users (n = 368) vs matched nonusers (n = 368) had improved composite HF quality scores (48.0% vs 43.6%; + 4.76% [3.27-6.24]; P = 0.001) and composite clinical outcomes (33.0% vs 39.6%; HR 0.76 [0.59-0.97]; P = 0.027).
Among participants in the CONNECT-HF trial, use of digital applications was modest but was associated with higher HF quality-of-care scores, including use of GDMT and better clinical outcomes. Although cause and effect cannot be determined from this study, the application of technology to guide GDMT use and dosing among patients with HFrEF warrants further investigation.
目前尚不清楚数字应用程序是否可以改善射血分数降低的心力衰竭（HFrEF）患者的指南指导的医学治疗（GDMT）和结局。
心力衰竭优化护理通过患者和医院参与临床试验（CONNECT-HF）包括对因 HFrEF 住院的患者进行移动健康应用的可选前瞻性辅助研究。数字用户与常规护理组的非用户相匹配。主要复合结局包括基于机会的 HF 综合质量评分的变化和 HF 再住院或全因死亡率。在美国，为 2431 名提供数字应用的患者中，有 1526 名（63%）数字接入有限或数据不足，425 名（17%）是数字用户，480 名（20%）拒绝使用。数字用户与拒绝使用的患者年龄相似（平均 58 岁比 60 岁；P=0.031）。与匹配的非使用者（n=368）相比，数字使用者（n=368）的复合 HF 质量评分（48.0%对 43.6%；+4.76%[3.27-6.24]；P=0.001）和复合临床结局（33.0%对 39.6%；HR 0.76[0.59-0.97]；P=0.027）得到改善。
在 CONNECT-HF 试验的参与者中，数字应用的使用是适度的，但与更高的 HF 护理质量评分相关，包括 GDMT 的使用和更好的临床结局。尽管无法从这项研究中确定因果关系，但将技术应用于指导 HFrEF 患者的 GDMT 使用和剂量值得进一步研究。
