Developing a patient-centric remote monitoring platform for heart failure: a usability and feasibility pilot

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Implantable cardiac devices can invasively measure physiological markers. Although it was anticipated that these markers could help predict worsening heart failure, results have been conflicting1. However, the Triage-HF Plus study has shown that combining device-derived measures with telephone-based symptom assessment markedly increased sensitivity for detecting worsening heart failure to 98.6%2. Nevertheless, telephone assessment increases clinician workload and is dependent on patient availability. The Care Information Exchange is the largest integrated patient-facing digital care portal in the NHS and is a tool which could be employed in remote monitoring of patient symptoms. We aimed to assess the usability and feasibility of using the Care Information Exchange digital platform for symptom data collection amongst heart failure patients with Heart Failure Risk Score-enabled devices and identify barriers preventing its use so that this could be addressed in the future. METHODS AND RESULTS: A digital readiness questionnaire was conducted at enrolment. Weekly symptom questionnaires were sent using the Care Information Exchange platform for up to 5 weeks. Afterwards, semi-structured interviews on the usability and feasibility of the platform were conducted. Of 131 eligible patients, 87 were successfully contacted, of which 56% enrolled. Reasons for declining to participate included: disinterest (45%), illness (18%) or no device ownership (18%). 53% of those enrolled successfully engaged in one to five symptom questionnaire and the mean weekly adherence rate for the symptom questionnaires was 68% amongst patients who had activated their Care Information Exchange account. Amongst those who engaged, 96% of patients agreed that the digital platform was easy to navigate and 100% agreed that they would be willing to use the platform again for health-related questionnaires. 77% of patients who never engaged did not have activated Care Information Exchange accounts due to barriers such as lack of assistance, technological problems and time constraints. CONCLUSION: For the current generation of heart failure patients with devices, feasibility is limited for the digital platform symptom assessment, but the platform was usable in those who engaged. As both clinical services and research trials seek to expand the scope of information which can be collected digitally and remotely, these findings may be used to highlight the steps needed to ensure equitable delivery in making digital health interventions accessible to all patients. [Figure: see text]