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Usefulness of telemedicine-based heart failure monitoring according to ‘eHealth literacy’ domains: Insights from the iCOR randomized controlled trial

  • Sergi Yun
    Affiliations
    Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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  • Cristina Enjuanes
    Affiliations
    Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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  • Esther Calero-Molina
    Affiliations
    Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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  • Encarnación Hidalgo
    Affiliations
    Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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  • Núria José-Bazán
    Affiliations
    Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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  • Marta Ruiz
    Affiliations
    Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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  • José María Verdú-Rotellar
    Affiliations
    Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

    Jordi Gol Primary Care Research Institute, Catalan Institute of Heath, Barcelona, Spain
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  • Paloma Garcimartín
    Affiliations
    Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    Chief nursing officers. Hospital del Mar, Parc de Salut Mar, Barcelona, Spain

    Escuela Superior de Enfermería del Mar, Parc de Salut Mar, Barcelona, Spain
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  • Santiago Jiménez-Marrero
    Affiliations
    Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Cardio-Oncology Unit. Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
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  • Alberto Garay
    Affiliations
    Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Cardio-Oncology Unit. Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
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  • Mar Ras
    Affiliations
    Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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  • Raúl Ramos
    Affiliations
    Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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  • Alexandra Pons-Riverola
    Affiliations
    Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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  • Pedro Moliner
    Affiliations
    Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Cardio-Oncology Unit. Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
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  • Xavier Corbella
    Affiliations
    Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Systemic Diseases and Ageing Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Hestia Chair in Integrated Health and Social Care, School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
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  • Josep Comín-Colet
    Correspondence
    Corresponding author at: Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
    Affiliations
    Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

    Department of Clinical Sciences, School of Medicine, University of Barcelona (UB), Barcelona, Spain
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Published:April 25, 2022DOI:https://doi.org/10.1016/j.ejim.2022.04.008

      Highlights

      • ‘eHealth literacy’ has been defined to assess competences in an eHealth framework.
      • ‘Computer and traditional literacy’ have been tested in an eHealth-based HF-care.
      • eHealth-based HF-care is effective regardless of 2 ‘eHealth literacy’ domains.
      • It's key to integrate assessments to evaluate ‘eHealth literacy’ in HF programs.

      Abstract

      Background

      The potential positive effect of electronic health (eHealth)-based heart failure (HF) monitoring remains uncertain mainly in the ‘low literacy’ or ‘computer or digital illiterate’ patients. The aim of this study was to determine the effectiveness of a telemedicine (TM)-based managed care solution across literacy levels and information and communications technology (ICT) skills.

      Methods

      We performed a sub-analysis on the basis of two literacy domains encompassed in the definition of ‘eHealth literacy’ to the HF-patients included in the ‘insuficiència Cardíaca Optimització Remota’ (iCOR) randomized study comparing TM vs. usual care (UC) in HF-patients. The primary study endpoint was the incidence of a non-fatal HF event after 6 months of inclusion. The event rates of primary and secondary study endpoints were calculated for each literacy domains and its combination. Cox proportional-hazards regression models were used to evaluate the effect of ‘eHealth literacy’ dimensions, treatment group and the interaction term ‘eHealth literacy’ domains by treatment group on study endpoints.

      Results

      The beneficial effect of TM compared to UC strategy was consistent across all literacy domains (p-value for interaction 0.207 and 0.117 respectively). The risk of experiencing a primary event was significantly lower in patients that underwent allocation to the TM arm compared to UC in both clustered in the ‘lower literacy’ (p-value=0.001) and those allocated to the ‘lower ICT skills’ (p-value=0.001) subgroup.

      Conclusions

      Non-invasive eHealth-based HF monitoring tools are effective compared to UC in preventing HF events in the early post-discharge period, regardless of two ‘eHealth literacy’ domains (‘traditional and computer literacy’).

      Keywords

      Abbreviations and acronyms:

      ADL (activities of daily living), AF (atrial fibrillation), APGAR (adaptability, partnership, growth, affection, resolve), BP (blood pressure), CI (confidence interval), CKD (chronic kidney disease), COPD (chronic obstructive pulmonary disease), COVID (SARS-CoV-2 disease), CV (cardiovascular), eHealth (electronic health), EHFScBS (European heart failure self-care behaviour scale), ESC (European Society of Cardiology), GDS (geriatric depression scale), HR (heart rate), HF (heart failure), iCOR (insuficiència Cardíaca Optimització Remota), ICT (information and communications technology), IQR (interquartile range), LVEF (left ventricular ejection fraction), MLHFQ (Minnesota living with heart failure questionnaire), MMSE (mini-mental state examination), NYHA (New York Heart Association), QoL (quality of life), RCT (randomized clinical trial), SD (standard deviation), TIM-HF2 (Telemedical Interventional Management in Heart Failure II), TM (telemedicine), UC (usual care)
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