Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Internal Medicine https://dx.doi.org/10.1001/jamainternmed.2025.4483 Dr. Ruth Masterson Creber et al.
Points
- Researchers investigated if mobile integrated health added value to standard transitions of care for heart failure.
- The Mighty-Heart randomized clinical trial included 2003 participants hospitalized with heart failure.
- No overall improvement in health status was observed with the addition of mobile integrated health.
- Thirty-day all-cause hospital readmission rates were similar between both intervention groups.
- Preliminary findings suggest potential benefits of mobile integrated health for younger patient subgroups.
Summary
This randomized clinical trial, named Mighty-Heart, investigated the added benefit of mobile integrated health (MIH) when supplemented with a transitions of care coordinator (TOCC) for patients discharged after heart failure. The study enrolled 2003 adult Medicare- or Medicaid-enrolled patients hospitalized with heart failure across 11 New York City hospitals between January 2021 and September 2024. Participants were randomized 1:1 to either MIH plus TOCC or TOCC alone. The TOCC intervention involved a nurse follow-up call 48-72 hours post-discharge, while the MIH arm additionally included ongoing nurse care coordination, community paramedic home visits, and facilitated synchronous telehealth with emergency medicine physicians for 30 days post-discharge.
The coprimary outcomes were health status at 30 days, measured by the Kansas City Cardiomyopathy Questionnaire Overall Summary score, and 30-day all-cause hospital readmission. Analysis revealed no adjusted differences in health status scores at 30 days between the MIH and TOCC groups (mean difference, 1.83; 95% CI, −0.75 to 4.40; P = .16). Similarly, there were no significant differences in overall 30-day all-cause readmissions, with rates of 20.3% in the MIH group versus 20.4% in the TOCC alone group (odds ratio, 0.99; 95% CI, 0.83 to 1.19; P = .95).
However, exploratory analyses suggested potential subgroup benefits. A significant age-by-treatment interaction effect was observed, indicating that younger participants (under 70 years) who received MIH experienced a larger improvement in health status (β: 4.40; 95% CI, 1.01 to 7.79). The study concluded that MIH provided no overall additional benefit for health status or 30-day readmissions compared to TOCC alone for the broader post-acute heart failure population. Nevertheless, the preliminary subgroup findings suggest that specific patient characteristics, such as age and potentially sex, might influence MIH effectiveness, warranting further targeted research.
Link to the article: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2838721
References
Meghan, T., Brock, D., & Ruth Masterson, C. (2025). Mobile integrated health vs a transitions of care coordinator for patients discharged after heart failure the mighty-heart randomized clinical trial. https://dx.doi.org/10.1001/jamainternmed.2025.4483
