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

Background: The potential positive effect of electronic health (eHealth)-based heart failure (HF) monitoring re-mains 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 insuficiencia Cardiaca Optimitzacio 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').

Automated summary

This study evaluated the effectiveness of a telemedicine-based managed care solution for heart failure patients. The results showed that eHealth-based monitoring tools were effective in preventing heart failure events in the early post-discharge period, regardless of patients' literacy levels and information and communications technology skills.