Mobile health application platform ‘Corrie’ personalises and empowers the heart attack recovery patient experience in the hospital and at home for an underserved heart attack survivor

Hung, George; Yang, William; Marvel, Francoise A; Martin, Seth S.

doi:10.1136/bcr-2019-231801

Cited by 8 publications

(6 citation statements)

References 17 publications

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“…Third, underserved patients were included via our iShare program to improve the generalizability of our findings to vulnerable populations. 15 , 40 Fourth, we employed an interdisciplinary approach to patient-centered technology development and clinical implementation. 10 , 41 …”

Section: Discussionmentioning

confidence: 99%

Digital Health Intervention in Acute Myocardial Infarction

Marvel

Spaulding

Lee

et al. 2021

Circ: Cardiovascular Quality and Outcomes

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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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Section: Discussionmentioning

confidence: 99%

Digital Health Intervention in Acute Myocardial Infarction

Marvel

Spaulding

Lee

et al. 2021

Circ: Cardiovascular Quality and Outcomes

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“…26 For some patients with limited transportation, insurance coverage, or time, a mobile app may especially increase access to care over in-person sessions. 12 In future practice, the integration of digital heath into BP evaluation requires systems that would allow clinicians to prescribe DHIs and for it to be reimbursed by payers. This is especially pertinent in the COVID-19 pandemic, as many health systems have increasingly adopted telehealth models.…”

Section: Discussionmentioning

confidence: 99%

“…To reduce selection bias, participants who did not own an iPhone were given a loaner phone to use for the duration of the study. 11 , 12 Data exclusion criteria for this sub-study analysis were: (1) BP values outside of the manufacturer-specified measurement ranges of 60-260 mmHg systolic BP or 40-199 mmHg diastolic BP, 13 (2) participants who were not given an iHealth BP monitor (due to participation during the pilot phase or lack of cuff availability in appropriate size) to minimize erroneous values, 10 and (3) participants who only recorded BP values on a single day that would preclude assessment of trends over time. Ethical approval was obtained from the Johns Hopkins University School of Medicine Institutional Review Board and other participating sites.…”

Section: Methodsmentioning

confidence: 99%

Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology

Shan

Ding

Weng

et al. 2020

American Journal of Preventive Cardiology

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Objective There is rising interest in digital health in preventive cardiology, particularly for blood pressure (BP) management. In a digital health study of early BP assessment following acute myocardial infarction (AMI), we sought to examine feasibility and the (1) proportion of post-AMI patients with controlled BP and hypotension, and (2) association between prior cardiovascular disease (CVD) and BP post-AMI. Methods In this substudy of the parent Myocardial infarction, COmbined-device, Recovery Enhancement (MiCORE) study, type 1 AMI patients were enrolled between October 2017 and April 2019. Participants self-monitored their BP through 30 days after hospital discharge using an FDA-approved wireless BP monitor connected with a smartphone application. Linear mixed-effects models assessed the association between prior CVD and BP trajectory post-discharge, adjusting for antihypertensive medications and a propensity score inclusive of CVD risk factors. Results Sixty-eight AMI patients (mean age 58±10 years, 75% male, 68% white race, 68% history of hypertension, 24% prior CVD) provided 2,638 measurements over 30 days. The percentage of BP control <130/80 mmHg was 59.6% (95% CI: 54.3 - 64.9%) and <140/90 mmHg was 83.7% (95% CI: 80.3-87.2%). The percentage of systolic BP <90 mmHg was 1.1% (95% CI: 0.17-2.0%) and the percentage of diastolic BP <60 mmHg was 3.9% (95% CI: 2.6-5.2%). Prior CVD was associated with 12.2 mmHg higher mean daily systolic BP during admission (95% CI: 3.5-20.9 mmHg), which persisted over follow-up. There was no association between prior CVD and diastolic BP. Conclusion The digital health program was feasible and ∼40% of post-AMI patients who engaged in it had uncontrolled BP according to recent guideline cutpoints, while hypotension occurred rarely. The gap in BP control was especially large in patients in whom AMI represented recurrent CVD. These data suggest an opportunity for more aggressive secondary prevention early after MI as care models integrate digital health.

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“…In addition to the development of the language, its evaluation and demonstration of its usability are essential parts of language development [11]. In a third and final step, the developed DSML will be applied to a real-world smart health scenario, the myocardial infarction combined-device recovery enhancement (MiCORE) study and the associated Corrie Health platform for myocardial infarction patients at John Hopkins University [13,26].The result of the development process is the Smart Health Modelling Language (SHML), a domain-specific language with which it is possible to model information systems, digital platforms or entire ecosystems with a focus on smart products and services within the smart health domain.…”

Section: Methodsmentioning

confidence: 99%

“…The modelled scenario describes the Corrie digital health platform of John Hopkins University for patients after myocardial infarction (Figure 3) (Corrie Health) [13,26].…”

Section: Demonstration and Evaluationmentioning

confidence: 99%

Health in the Era of the Internet of Things: A Domain-Specific Modelling Language

Strobel

2021

Proceedings of the Annual Hawaii International Conference on System Sciences

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Based on the cultural, social and technological development of the last hundred years, the pursuit of health driven by primal instincts has been transformed in most areas worldwide into a quasi de facto standard. But this security is deceptive. Not only the global developments of the last few months, but also creeping factors such as demographic change or the steadily growing world population are putting increasing pressure on the healthcare system. Today, more and more health care systems based on continuous demand for medical resources are increasingly reaching their limits. Technologies such as the Internet of Things are not a panacea, but offer great potential for increasing the flexibility and efficiency of healthcare systems. However, the development of such IoT-based healthcare systems requires a holistic understanding of the information technology as well as the domain itself. Against this background, the paper presents a domain-specific modelling language for IoT-based healthcare systems.

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Mobile health application platform ‘Corrie’ personalises and empowers the heart attack recovery patient experience in the hospital and at home for an underserved heart attack survivor

Cited by 8 publications

References 17 publications

Digital Health Intervention in Acute Myocardial Infarction

Digital Health Intervention in Acute Myocardial Infarction

Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology

Health in the Era of the Internet of Things: A Domain-Specific Modelling Language

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