Background:Thirty-day readmissions among patients with acute myocardial infarction (AMI) contribute to the US health care burden of preventable complications and costs. Digital health interventions (DHIs) may improve patient health care self-management and outcomes. We aimed to determine if patients with AMI using a DHI have lower 30-day unplanned all-cause readmissions than a historical control.Methods:This nonrandomized controlled trial with a historical control, conducted at 4 US hospitals from 2015 to 2019, included 1064 patients with AMI (DHI n=200, control n=864). The DHI integrated a smartphone application, smartwatch, and blood pressure monitor to support guideline-directed care during hospitalization and through 30-days post-discharge via (1) medication reminders, (2) vital sign and activity tracking, (3) education, and (4) outpatient care coordination. The Patient Activation Measure assessed patient knowledge, skills, and confidence for health care self-management. All-cause 30-day readmissions were measured through administrative databases. Propensity score–adjusted Cox proportional hazard models estimated hazard ratios of readmission for the DHI group relative to the control group.Results:Following propensity score adjustment, baseline characteristics were well-balanced between the DHI versus control patients (standardized differences <0.07), including a mean age of 59.3 versus 60.1 years, 30% versus 29% Women, 70% versus 70% White, 54% versus 54% with private insurance, 61% versus 60% patients with a non ST-elevation myocardial infarction, and 15% versus 15% with high comorbidity burden. DHI patients were predominantly in the highest levels of patient activation for health care self-management (mean score 71.7±16.6 at 30 days). The DHI group had fewer all-cause 30-day readmissions than the control group (6.5% versus 16.8%, respectively). Adjusting for hospital site and a propensity score inclusive of age, sex, race, AMI type, comorbidities, and 6 additional confounding factors, the DHI group had a 52% lower risk for all-cause 30-day readmissions (hazard ratio, 0.48 [95% CI, 0.26–0.88]). Similar results were obtained in a sensitivity analysis employing propensity matching.Conclusions:Our results suggest that in patients with AMI, the DHI may be associated with high patient activation for health care self-management and lower risk of all-cause unplanned 30-day readmissions.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03760796.

中文翻译：

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急性心肌梗死的数字健康干预

背景：急性心肌梗死 (AMI) 患者的 30 天再入院增加了美国可预防并发症和费用的医疗负担。数字健康干预 (DHI) 可以改善患者医疗保健的自我管理和结果。我们的目的是确定使用 DHI 的 AMI 患者的 30 天计划外全因再入院率是否低于历史对照。方法：这项具有历史对照的非随机对照试验于 2015 年至 2019 年在美国 4 家医院进行，包括 1064 名患者AMI（DHI n=200，对照 n=864）。DHI 集成了智能手机应用程序、智能手表和血压监测器，通过 (1) 药物提醒、(2) 生命体征和活动跟踪、(3) 教育、(4) 门诊护理协调。Patient Activation Measure 评估了患者的知识、技能和医疗保健自我管理的信心。全因 30 天再入院是通过管理数据库来衡量的。倾向评分调整后的 Cox 比例风险模型估计了 DHI 组相对于对照组的再入院风险比。结果：经过倾向评分调整后，DHI 与对照组患者的基线特征得到很好的平衡（标准化差异 <0.07），包括平均年龄 59.3 岁和 60.1 岁，30% 和 29% 女性，70% 和 70% 白人，54% 和 54% 有私人保险，61% 和 60% 非 ST 段抬高心肌梗死患者，15%与 15% 的高合并症负担相比。DHI 患者主要处于医疗保健自我管理的最高患者激活水平（30 天平均得分 71.7±16.6）。DHI 组的 30 天全因再入院率低于对照组（分别为 6.5% 和 16.8%）。调整医院地点和包括年龄、性别、种族、AMI 类型、合并症和 6 个额外混杂因素在内的倾向评分后，DHI 组的全因 30 天再入院风险降低了 52%（风险比，0.48 [ 95% 置信区间，0.26–0.88]）。在采用倾向匹配的敏感性分析中获得了类似的结果。结论：我们的结果表明，在 AMI 患者中，DHI 可能与患者对医疗保健自我管理的高度激活和全因非计划 30 天再入院的风险较低有关.注册：网址：https://www.clinicaltrials.gov；