Digital health intervention in acute myocardial infarction
Open accessAbstract
BACKGROUND: Thirty-day readmissions among patients with acute myocardial infarction (AMI) contribute to the US health care burden of preventable complications and costs. Digital health interventions (DHIs) may improve patient health care self-management and outcomes. We aimed to determine if patients with AMI using a DHI have lower 30-day unplanned all-cause readmissions than a historical control. METHODS: This nonrandomized controlled trial with a historical control, conducted at 4 US hospitals from 2015 to 2019, included 1064 patients with AMI (DHI n=200, control n=864). The DHI integrated a smartphone application, smartwatch, and blood pressure monitor to support guideline-directed care during hospitalization and through 30-days post-discharge via (1) medication reminders, (2) vital sign and activity tracking, (3) education, and (4) outpatient care coordination. The Patient Activation Measure assessed patient knowledge, skills, and confidence for health care self-management. All-cause 30-day readmissions were measured through administrative databases. Propensity score-adjusted Cox proportional hazard models estimated hazard ratios of readmission for the DHI group relative to the control group. RESULTS: Following propensity score adjustment, baseline characteristics were well-balanced between the DHI versus control patients (standardized differences <0.07), including a mean age of 59.3 versus 60.1 years, 30% versus 29% Women, 70% versus 70% White, 54% versus 54% with private insurance, 61% versus 60% patients with a non ST-elevation myocardial infarction, and 15% versus 15% with high comorbidity burden. DHI patients were predominantly in the highest levels of patient activation for health care self-management (mean score 71.7±16.6 at 30 days). The DHI group had fewer all-cause 30-day readmissions than the control group (6.5% versus 16.8%, respectively). Adjusting for hospital site and a propensity score inclusive of age, sex, race, AMI type, comorbidities, and 6 additional confounding factors, the DHI group had a 52% lower risk for all-cause 30-day readmissions (hazard ratio, 0.48 [95% CI, 0.26-0.88]). Similar results were obtained in a sensitivity analysis employing propensity matching. CONCLUSIONS: Our results suggest that in patients with AMI, the DHI may be associated with high patient activation for health care self-management and lower risk of all-cause unplanned 30-day readmissions. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03760796.
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In the MiCORE study, improved adherence to guideline-directed therapy in patients with coronary artery disease via self-management programs using integration of an AW and a Bluetooth blood pressure cuff to assess blood pressure and activity level.
“In the context of secondary prevention and monitoring of blood pressure, the COmbined-device, Recovery Enhancement (MiCORE) study showed improved adherence to guideline-directed therapy in patients with coronary artery disease via self-management programs using integration of an AW and a Bluetooth blood pressure cuff to assess blood pressure and activity level.41”
From Unlocking Tomorrow’s Health Care: Expanding the Clinical Scope of Wearables by Applying Artificial Intelligence (2024) · cites this paper as [41]
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“24 Empatica devices are also equipped with sensors for data collection, in combination with clinically validated biomarkers, as they are CE marking and FDA-approved research instruments.”
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“Propensity score methods have previously been used to assess similar real-world CR studies 44,45 but have several disadvantages.”
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“The platform, which integrates a smartphone app with a smartwatch and blood pressure monitor to provide patient tracking of medications, vital signs, education and care coordination, decreased 30-day hospitalizations post-MI by 52% compared with the control group [143].”
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“When connected to EHRs, personal health records (PHRs) can promote a two-way relationship, whereby informationentered directly by thepatientcanbeavailabletotheir clinicians, and information in the EHR can be transmitted to the PHR for patientstoview 23 .”
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“The recent nonrandomized controlled trial with 1064 patients with acute myocardial infarction showed fewer all-cause 30 days readmissions in the digital intervention group compared with the control [45].”
BackgroundPersonalized vascular healthcare: insights from a large international survey
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“This has been acknowledged by the pharmaceutical industry,(13) and demonstrated as feasible in a proof-of-concept study that reduced hospital readmission after acute myocardial infarction through a patient-engaged digital health initiative.(14) Relying on a device-, surgery- or intervention-based approach creates an e…”
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“[6,7] The purpose of this study is to investigate the application and effectiveness of the combined management model of intensive risk awareness and cardiac rehabilitation The authors have no funding and conflicts of interest to disclose.”
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“In this context, eHealth approaches that use apps have been shown to positively influence behavioural realignment.(17,22,25,38) The multicentre, prospective, and randomized CHANGE study will investigate whether an SGSP app, combined with a monitor function compared with standard-of-care, has beneficial effects on over…”
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“For instance, the MiCORE platform, even without advanced AI, showed that patients receiving continuous digital support felt more confident in managing their condition [15].”
InfluentialComprehensive Digital Health Intervention to Improve Delivery of Cardiac Rehabilitation
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Telenfermagem: Implementação das Teleconsultas em um Hospital Universitário
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“However, despite their exponential growth, uptake and usage of health apps by patients is low 19 and there have been limited studies evaluating health apps in critical care settings such as the coronary care unit 20 .”
Patient Centered mobile Health TECHnology Enabled Atrial Fibrillation Management (mTECH Afib)
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Smart devices resulting in big effect: can apps cure heart disease?
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Can Artificial Intelligence Enhance Telemedicine: A New Frontier
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- Authors
- Marvel, F. A., Spaulding, E. M., Lee, M. A., Yang, W. E., Demo, R., Ding, J., Wang, J., Xun, H., Shah, L. M., Weng, D., Carter, J., Majmudar, M., Elgin, E., Sheidy, J., McLin, R., Flowers, J., Vilarino, V., Lumelsky, D. N., Bhardwaj, V., Padula, W. V., Shan, R., Huynh, P. P., Wongvibulsin, S., Leung, C., Allen, J. K., & Martin, S. S.
- Affiliations
- Johns Hopkins University (US)
- Massachusetts General Hospital (US)
- Harvard University (US)
- Reading Hospital (US)
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.).
- University of Southern California (US)
- Corresponding author
- Martin, Seth S.
- ORCID
- Marvel, Francoise A.
- Spaulding, Erin M.
- Lee, Matthias A.
- Yang, William E.
- Demo, Ryan
- Ding, Jie
- Wang, Jane
- Xun, Helen
- Shah, Lochan M.
- Weng, Daniel
- Carter, Jocelyn
- Majmudar, Maulik
- McLin, Renee
- Vilarino, Valerie
- Lumelsky, David N.
- Bhardwaj, Vinayak
- Padula, William V.
- Shan, Rongzi
- Huynh, Pauline P.
- Wongvibulsin, Shannon
- Allen, Jerilyn K.
- Martin, Seth S.
- Venue
- Circulation Cardiovascular Quality and Outcomes
- Published
- 2021-07
- Volume
- 14
- Issue
- 7
- Pages
- e007741-e007741
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- PMC
- PMC8288197
- OpenAlex
- W3182484934
- Cited by
- 84
- References
- 42
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 19 · 2023: 16 · 2022: 14 · 2021: 4
- FWCI
- 14.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23HL150287, T32HL007024)
- National Institute of Nursing Research (F31NR017328)
- National Institute of General Medical Sciences (T32GM136577)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- acute myocardial infarction, digital health interventions, 30-day readmission, unplanned hospital readmission, patient activation, health self-management, mobile application, smartwatches, medication reminders, vital signs monitoring, guideline-directed care, non-ST-elevation myocardial infarction, comorbidities, health care costs, patient education
- MeSH terms
- Non-ST Elevated Myocardial Infarction, Aftercare, Female, Humans, Male, Middle Aged, Myocardial Infarction, Patient Discharge, Patient Readmission, Risk Factors
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