Feasibility and acceptability of a combined digital platform and community health worker intervention for patients with heart failure: A single arm pilot study

BACKGROUND: Heart failure (HF) is one of the leading causes of hospital admissions. Clinical (e.g. complex comorbidities, low ejection fraction) and social needs factors (e.g. access to transportation, food security, housing security) have both contributed to hospitalizations, emphasizing the importance of increased clinical and social needs support at home. Digital platforms designed for remote monitoring of HF can improve clinical outcomes, but their effectiveness has been limited by patient barriers such as lack of familiarity with technology and unmet social care needs. To address these barriers, this study explored combining a digital platform with community health worker (CHW) social needs care for patients with HF.

OBJECTIVE: To determine the feasibility and acceptability of an intervention combining digital platform use and CHW social needs care for patients with HF. METHODS: Adults (age ≥18) with HF receiving care at a single health care institution and with a history of hospital admission in the previous 12 months were enrolled in a single arm pilot study July - November 2021 (N=14). The 30-day intervention used a digital platform within a mobile phone application that included symptom questionnaire and educational videos connected to a biometric sensor (tracking heart rate, oxygenation, steps taken), a digital weight scale, and a digital blood pressure monitor. All patients were paired with a CHW who had access to the digital platform data. A CHW provided routine phone calls to patients throughout the study period to discuss their biometric data and to address barriers to any social needs. Feasibility outcomes were patient use of the platform and engagement with the CHW. The acceptability outcome was patient willingness to use the intervention again. RESULTS: Participants (N= 14) were 67.7 (SD 11.7) years old; 8 (57.1%) were women, and 7 (50.0%) were insured by Medicare. Participants wore the sensor for 82.2% of study days with an average of 13.5 hours/day. Participants used the digital blood pressure monitor and digital weight scale an average of 1.2 times/day (SD=0.17) and 1.1 times/day (SD=0.12), respectively. All participants completed the symptom questionnaire on at least 71% of study days; 11 (78.6%) participants had ≥3 CHW interactions, and 11 (78.6%) indicated that if given the opportunity, they would use the platform again in the future. Exit interviews found that despite some platform "glitches," participants generally found the remote monitoring platform to be "helpful" and "motivating."

CONCLUSIONS: A novel intervention combining a digital platform with CHW social needs care for patients with HF was feasible and acceptable. The majority of participants were engaged throughout the study and indicated their willingness to use the intervention again. A future clinical trial is needed to determine the effectiveness of this intervention on clinical outcomes, such as hospital readmissions and emergency department visits.