A smartphone model for post-acute care decreases all-cause mortality with improved left ventricular ejection fraction in patients hospitalized with heart failure in Taiwan

Abstract

Objectives

This study investigates the impact of the use of a smartphone application on outcomes for patients with heart failure receiving post-acute care.

Methods

We employed a propensity score-matched analysis of patients who underwent post-acute care following hospitalization for heart failure. The smartphone application consisted of immediate feedback, recommendations, and a knowledge platform. We assessed seven variables before and after post-acute care: left ventricular ejection fraction, and scores on the Minnesota Living with Heart Failure Questionnaire, Mini-Nutritional Assessment–Short Form, Instrumental Activities of Daily Living, Brief Symptom Rating Scale-5, 6-minute walk test, and European Quality of Life-5 Dimensions Questionnaire. The functional progression dose effect was evaluated using receiver operating characteristic curves. Application users and non-users were matched to minimize the impacts of confounding variables, including age, gender, and education. The Cox proportional hazards model and the sub-distribution hazard method assessed the impact of the smartphone application on post-discharge outcomes.

Results

From 2018 to 2023, 493 patients (average age 65.4 ± 15.1 years) participated in the study. Over an average follow-up of 2.35 years, the results indicated that each additional unit of functional improvement was associated with a 38 % reduction in overall mortality, a 23 % decrease in readmissions or emergency room visits, and a 36 % lower risk of cardiovascular mortality. Among 119 matched pairs, application users demonstrated significantly lower mortality risk and better left ventricular ejection fraction than non-users. Kaplan-Meier curves showed that application users with improved left ventricular ejection fraction had the best survival outcomes, followed by non-application users with improved left ventricular ejection fraction, application users without improved left ventricular ejection fraction, and non-application users without improved left ventricular ejection fraction (P < 0.001).

Conclusions

The findings suggest that smartphone applications could enhance transitional care for patients with heart failure by improving left ventricular ejection fraction and reducing mortality.