Feasibility and Acceptability of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Single-Arm Pilot Study

Abstract

Background: Heart failure (HF) is one of the leading causes of hospital admissions. Clinical (eg, complex comorbidities and low ejection fraction) and social needs factors (eg, access to transportation, food security, and 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: We aim to determine the feasibility and acceptability of an intervention combining digital platform use and CHW social needs care for patients with HF.

Methods: Adults (aged ≥18 years) 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 from July to November 2021 (N=14). The 30-day intervention used a digital platform within a mobile app that included symptom questionnaire and educational videos connected to a biometric sensor (tracking heart rate, oxygenation, and 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%) were insured by Medicare. Participants wore the sensor for 82.2% (n=24.66) of study days with an average of 13.5 (SD 2.1) hours per day. Participants used the digital blood pressure monitor and digital weight scale for an average of 1.2 (SD 0.17) times per day and 1.1 (SD 0.12) times per day, respectively. All participants completed the symptom questionnaire on at least 71% (n=21.3) 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.

Keywords: acceptability; care; community; community health work; community health worker; digital platform; feasibility; heart; heart failure; heart rate; home-based care; mobile phone; monitoring; oxygenation; pilot study; remote monitoring; social needs care; willingness.

Figure 1

Description of Biofourmis mobile app function for 14 study participants over a 30-day study period. The mobile app included educational videos and articles from the American Heart Association, the ability to record weight and blood pressure, and a daily 4-question symptom questionnaire. AHA: American Heart Association; CHW: community health worker.

Figure 2

Examples of care team notification of patient decline. Occurrences were initiated due to a change in patient symptoms identified by machine learning algorithm Biovitals alerts. Both a change in patient symptoms reported to their CHW via phone and generated Biovitals dashboard alerts from remote monitoring resulted in CHW assessment. From there, the appropriate steps were taken as identified by the study team. This often resulted in CHW reinforcement of care, notification of the patient’s cardiology team, or notification of the patient’s primary care team which lead to medication changes, impromptu appointments, care plan changes, and care plan clarification. CHW: community health worker; NP: nurse practitioner; PCP: primary care physician.