Key Points:
- In the MIGHT-y Heart Trial, 2,003 patients who were hospitalized for heart failure across 11 hospitals in New York City were randomized to receive post-discharge follow-up via a mobile integrated health (MIH) platform versus transitions of care coordinators (TOCC).
- Although there was no significant difference in health status at 30 days between the MIH vs. TOCC arms overall, younger patients in the MIH arm had a 4.5 point higher health status score than younger patients in the TOCC arm.
- There was no significant difference in 30-day all cause hospitalizations between in the MIH vs. TOCC arms overall, but women in the MIH arm were 30% less likely to have an all-cause readmission than women in the TOCC arm.
The transition from hospital to home is a particularly vulnerable time for patients who are hospitalized for heart failure and as many as 25% of patients discharged after a heart failure hospitalization re-present within 30 days. In the MIGHT-y-Heart Trial, a pragmatic comparative effectiveness study, the authors compare the use of mobile integrated health (MIH) to transitions of care coordinators (TOCC) to evaluate post-hospitalization outcomes including healthcare utilization and patient-reported outcomes. Patients in the MIH arm received home visits from a community paramedic and telehealth visits with an emergency medicine physician while those in the TOCC arm received phone-calls from a registered nurse for follow-up. The two primary outcomes were health status measured by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score and all-cause 30-day hospital readmissions.
The trial enrolled 2,003 patients who had a hospitalization for heart failure across 11 academic and community hospitals in New York City from January 2021 to September 2024. Patients with dementia, anticipated discharge to a facility, and Stage D heart failure were excluded from the study. The median patient age was 67 years old and the patient population was diverse (>50% female, 47% Black, 27% Hispanic).
Although the authors found no significant difference in health status at 30 days between the MIH vs. TOCC arms, there were improvements in the scores in both arms between baseline and 30 days. In addition, there was evidence of effect modification by age such that younger patients in the MIH arm had a 4.5 point higher average health status score than younger patients in the TOCC arm. Furthermore, within the TOCC arm, younger patients had a health score that was 6.5 points lower than older patients in the same arm.
For the second primary outcome—all-cause readmissions at 30-days, there was again no significant difference between the MIH vs. TOCC arms (OR: 0.97; 95% CI: 0.80, 1.16). However, women were 30% less likely to have an all-cause readmission if they were enrolled in the MIH arm compared to the TOCC arm (OR: 0.70; 95% CI: 0.49, 0.99).
One important limitations of the study is that there was only 53% follow-up for the health status score at 30-days. It is possible that those who were not able to be evaluated for health status at 30-days were those that were worse off leading to potential bias in the reported health status scores. In addition, trial enrolled during the COVID-19 pandemic, making it potentially non-representative of current patterns. Even with these limitations, this study highlights the potential value-add of MIH platforms for post-heart failure hospitalization follow-up, particularly in women and younger patients.