(P217) REMOTE PATIENT MONITORING AND DIGITAL THERAPEUTICS IN HEART FAILURE: IMPACT ON COSTS AND CLINICAL OUTCOMES

Background: Telemedicine is increasingly being used in heart failure (HF), but its impact within the public healthcare Canadian system is under explored. We aimed to address this gap by using our own digital health solution (Continuum, developed with Greybox Solutions Inc), combining remote patient monitoring (RPM) and digital therapeutics (DTx).

METHODS AND RESULTS: HF patients at risk of hospitalization were randomized into 2 groups (standard of care (SOC) versus SOC+Continuum) and followed over 12 weeks. The Continuum program included the following components: 1) a self-care mobile app (smartphone or tablet) where patients entered vital signs, weight, and HF symptoms; 2) the remote monitoring of these data by clinical nurses; and 3) DTx-generated medication suggestions sent to the treating medical team. The workload (and associated costs) of the nurses involved in the Continuum program was closely monitored. Costs related to Continuum licences and to all-cause hospitalizations and emergency visits were collected as well. A compliance sub-analysis was done for the intervention group, and a non-compliant patient was defined as an app use < 1x/week during the follow-up.

Results from the first 91/171 enrolled patients who completed the intervention (45 intervention patients and 46 controls) are presented. Patients were similar in age, NYHA class, and ejection fraction. The Kaplan-Meier analysis showed a significant clinical benefit in favour of Continuum only for compliant patients (p=0.02, 95% confidence interval) (Figure 1). The cost of the Continuum platform was $180 per patient for 12 weeks. The total time spent by the nurse to monitor a patient during the 12-week follow-up period was approximately 45 minutes ( < 1 minute/day). The total costs in the intervention group were not inferior to the control group ($257,675 versus $227,370), but patients who were non compliant to the intervention accounted for 2/3 of the costs (n=8, $167,486). Total costs for compliant patients (n=37) were only $90,189 (Figure 2).

Conclusion: Our preliminary results confirmed potential clinical benefits of digital health solutions on ER visits and hospitalizations, but only for patients compliant to the intervention. Importantly, these benefits were achieved with an associated decrease in costs. These results raise the need for a rapid and better identification of non-compliant patients to provide the required support to keep them engaged.