A smartphone model for post-acute care decreases all-cause mortality with improved left ventricular ejection fraction in patients hospitalized with heart failure in Taiwan

Shuo-Chun Weng; Wei-Wen Lin; Jin-Long Huang; Chin-Yi Chao; Chiann-Yi Hsu; Shih-Yi Lin

doi:10.1016/j.maturitas.2025.108269

A smartphone model for post-acute care decreases all-cause mortality with improved left ventricular ejection fraction in patients hospitalized with heart failure in Taiwan

Maturitas. 2025 Jun:197:108269. doi: 10.1016/j.maturitas.2025.108269. Epub 2025 Apr 15.

Authors

Shuo-Chun Weng¹, Wei-Wen Lin², Jin-Long Huang³, Chin-Yi Chao⁴, Chiann-Yi Hsu⁵, Shih-Yi Lin⁶

Affiliations

¹ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan; Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan; Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan. Electronic address: wengsc0830@nchu.edu.tw.
² Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
³ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung 407219, Taiwan; Cardiovascular Research Center, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan. Electronic address: golden@vghtc.gov.tw.
⁴ Nursing Department of Taichung Veterans General Hospital, Taichung 407219, Taiwan.
⁵ Biostatistics Task Force of Taichung Veterans General Hospital, Taichung 407219, Taiwan. Electronic address: chiann@vghtc.gov.tw.
⁶ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan; Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan; Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan; Center for Geriatrics and Gerontology, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan. Electronic address: sylin@vghtc.gov.tw.

PMID: 40252555
DOI: 10.1016/j.maturitas.2025.108269

Abstract

Objectives: This study investigates the impact of the use of a smartphone application on outcomes for patients with heart failure receiving post-acute care.

Methods: We employed a propensity score-matched analysis of patients who underwent post-acute care following hospitalization for heart failure. The smartphone application consisted of immediate feedback, recommendations, and a knowledge platform. We assessed seven variables before and after post-acute care: left ventricular ejection fraction, and scores on the Minnesota Living with Heart Failure Questionnaire, Mini-Nutritional Assessment-Short Form, Instrumental Activities of Daily Living, Brief Symptom Rating Scale-5, 6-minute walk test, and European Quality of Life-5 Dimensions Questionnaire. The functional progression dose effect was evaluated using receiver operating characteristic curves. Application users and non-users were matched to minimize the impacts of confounding variables, including age, gender, and education. The Cox proportional hazards model and the sub-distribution hazard method assessed the impact of the smartphone application on post-discharge outcomes.

Results: From 2018 to 2023, 493 patients (average age 65.4 ± 15.1 years) participated in the study. Over an average follow-up of 2.35 years, the results indicated that each additional unit of functional improvement was associated with a 38 % reduction in overall mortality, a 23 % decrease in readmissions or emergency room visits, and a 36 % lower risk of cardiovascular mortality. Among 119 matched pairs, application users demonstrated significantly lower mortality risk and better left ventricular ejection fraction than non-users. Kaplan-Meier curves showed that application users with improved left ventricular ejection fraction had the best survival outcomes, followed by non-application users with improved left ventricular ejection fraction, application users without improved left ventricular ejection fraction, and non-application users without improved left ventricular ejection fraction (P < 0.001).

Conclusions: The findings suggest that smartphone applications could enhance transitional care for patients with heart failure by improving left ventricular ejection fraction and reducing mortality.

Keywords: Heart failure; Outcomes; Post-acute care; Propensity score matching; Smartphone.

MeSH terms

Activities of Daily Living
Aged
Female
Heart Failure* / mortality
Heart Failure* / physiopathology
Heart Failure* / therapy
Hospitalization
Humans
Male
Middle Aged
Mobile Applications*
Propensity Score
Quality of Life
Smartphone*
Stroke Volume*
Subacute Care* / methods
Surveys and Questionnaires
Taiwan
Ventricular Function, Left*