Massachusetts General tests education, monitoring app for cardiac patients

By Jonah Comstock
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Massachusetts General Hospital is launching a pilot study of Heart Habits, a cardiac care management app from Jana Care.

“Heart failure patients, as we all know, are pretty complex,” Dr. Nasrien Ibrahim, a cardiologist at MGH and one of the lead investigators, told MobiHealthNews. “They have lots of medication regimens, they get lots of instructions from us, and morbidity and mortality is pretty high. So we’re always looking for ways to improve patient care, reduce morbidity and mortality, to keep these patients out of the hospital or the emergency department, and just improve their overall quality of life. And we look for ways to streamline the education we provide them, because they get a ton of instructions on what to do in terms of their diet, their lifestyle modifications, and, on top of that, all the medications they take.”

The idea behind the app is that heart failure patients will take the app home and use it to track their symptoms, as well as having access to educational content within the app. Patients will track weight, sodium and fluid intake, and activity. Patients have access to the data and trend graphs, and it can also be accessed by physicians.

“With the weight management, we do ask our patients to actually keep track of their weight [currently],” Ibrahim said. “Whether its every day or three times a week, we ask them to write these things down because it affects how we manage our patients. So sometimes patients come in and have it written down just on a piece of paper they bring for us, or a calendar, or some patients put it in their phone. So that weight management is definitely something that, having it in the app and having it in a graph form that’s easy to interpret and look at, that will help us. Prompting the patient every day, that will be helpful for us.”

Additionally, the app will prompt the patient to take a survey about symptoms twice a week or if the parameters they are monitoring suggest a problem.

“It teaches patients about when to seek medical attention,” Ibrahim said. “Signs and symptoms, things they should be wary of, whether their weight is going up, whether they’re more short of breath than usual, to seek medical attention before it turns into something potentially more harmful.”

Finally, the app has a messaging capability so patients can use it to get in touch with their care team.

Jana Care has previously built apps for diabetes care, but this will be the company’s first foray into the cardiac space. AJ Kumar, Jana Care’s chief scientific officer, told MobiHealthNews it was a natural progression for the company.

“The content is often very similar,” he said. “In heart failure as well as diabetes, you’re trying to make people eat healthier and be more physically active. But then there’s subtle differences. Whereas in diabetes you’re watching the fat content and the sugar, in heart failure you really care about the sodium. So we were able to take the same food database but update it so sodium was the key part that’s tracked.”

Additionally, there are demographic differences between the patient populations.

“The average heart failure patient is a little bit older and we’ve tried to take that into account in terms of the user for our app,” he said. “Bigger buttons, bigger text, to make it more user friendly for an older audience that might have a hard time seeing things or might not be as familiar with the smartphone.”

The initial pilot will include 24 patients randomized to either the app or the standard of care — paper documents given to patients to take home. The Mass Gen team will assess whether the app is user friendly, whether patients are adherent to it, and whether patients change their monitoring behavior as a result of the app, as well as whether symptoms improve.

“If the pilot study works, meaning the app is user-friendly, we see improvement in scores, that the patients like it, and that their symptoms have improved, a larger study would involve biomarker testing, outcome measures such as hospital readmissions and emergency department visits, and, essentially, cost as well,” Ibrahim said.