Mobile integrated health shows promise for women, younger patients
A program that delivered in-home visits from a trained paramedic team to people with heart failure did not significantly reduce 30-day hospital readmissions or improve health status compared with standard follow-up phone calls, according to research presented at the American College of Cardiology’s Annual Scientific Session (ACC.25).
Although the study did not meet its co-primary endpoint for preventing readmissions overall or improving health status, researchers said the study provides evidence that the mobile integrated health program works well in a highly diverse population with a high burden of disease. The findings suggest the in-home program may be particularly beneficial for women with heart failure, as well as younger patients who did not respond as well to standard follow-up calls.
“Mobile integrated health programs are an emerging model of care for different chronic conditions,” said Ruth Masterson Creber, PhD, RN, Mary Crawford Professor of Nursing at Columbia University School of Nursing in New York and the study’s co-first author. “It brings together nurse care coordinators, community paramedics and facilitated telehealth so that patients can get rapid access to an emergency medicine doctor to be able to navigate their symptom exacerbations.”
In patients with heart failure, the heart becomes too weak or too stiff to pump blood effectively throughout the body. A variety of interventions have been developed to help patients manage their symptoms and treatment at home, but many patients and health systems struggle with frequent heart failure readmissions.
For the MIGHTy-Heart study, researchers compared outcomes among participants in a mobile integrated health program with patients who received a phone call from a transitions of care coordinator 48-72 hours after discharge. In the mobile integrated health program, patients could request in-home visits from paramedics who assessed their symptoms and home environment in addition to setting up a laptop and internet connection for a live telehealth visit with a physician.
“[The paramedics] are doing a lot more than what you’re going to get with just a follow-up call,” Masterson Creber said. “They’re going in, doing medication reconciliation, looking for fall hazards, looking to make sure they have food in the fridge, making sure they know when all their appointments are and reviewing discharge instructions, in addition to bringing facilitated telehealth.”
The trial enrolled 2,003 patients who had been hospitalized for heart failure at one of 11 academic and community hospitals in two health systems in New York City. All participants were enrolled in Medicaid or Medicare. Participants had a median age of 67 years, just over half were female, 47% were Black and 27% were Hispanic. About 30%-40% also had ischemic cardiomyopathy, atrial fibrillation, diabetes or chronic kidney disease—diseases that commonly co-occur with heart failure.
Half of the patients were randomly assigned to join the mobile integrated health program and half received follow-up calls from a transitions of care coordinator. Outcomes were assessed based on electronic health records, Medicare claims and patient questionnaires. The study’s two primary endpoints, assessed at 30 days, were all-cause hospital readmission and change in overall summary score on the Kansas City Cardiomyopathy Questionnaire (KCCQ), which measures health status and quality of life for people with heart failure.
Overall, the two study groups did not see any significant difference in hospital readmissions at 30 days. However, the results revealed differences by sex. Women were 30% less likely to be readmitted for an all-cause hospitalization and 36% less likely to have a heart failure-related readmission compared to men in the mobile integrated health arm.
The results also suggested that patients younger than 70 years of age may be most likely to benefit from mobile integrated health. KCCQ scores improved in both study groups overall, but when patients older and younger than 70 years of age were analyzed separately, the improvement with mobile integrated health remained the same in both groups while younger patients saw less of an improvement with a transitions of care coordinator.
“Our observational data suggests that the patients who are sicker and those who are more affected by social determinants of health (financial stressors, lack of caregiving support) likely benefit more from this intervention,” Masterson Creber said.
The researchers plan to assess how factors such as neighborhood environment and poverty might influence which patients are most likely to benefit from in-home visits. They also intend to compare data from the first half of the study (2020-2022) and the second half (2022-2024) to assess whether the COVID-19 pandemic might have affected the results or the readmission rates, which were lower for both groups than the national average. Masterson Creber said that different health systems, such as those in rural versus urban areas, would likely have a different set of capabilities and limitations for implementing mobile integrated health.
Further research into the cost effectiveness of mobile integrated health programs is also needed.
“We recognize that it is resource intensive, and you have to weigh the costs of the program versus the benefits and the goals of institution,” Masterson Creber said. “Our system really values the patient experience and health equity and inclusion. The reimbursement models around these types of interventions have not been worked out yet, so your return on investment and revenue generation are fairly limited.”
The study was funded by the Patient-Centered Outcomes Research Institute (PCORI).
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Masterson Creber will be available to the media in an embargoed press conference on Saturday, March 29, at 4:15 p.m. CT / 21:15 UTC in Room N226.
Masterson Creber will present the study, “Comparative Effectiveness of Mobile Integrated Health Versus a Transitions of Care Coordinator in Patients with Heart Failure: Results from the MIGHTy-Heart Trial,” on Sunday, March 30, 2025, at 8:00 a.m. CT / 13:00 UTC in the Main Tent, North Hall B.
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