Smart assistance for coronary artery disease patients with low ejection fraction and dilated cardiomyopathy treated with percutaneous coronary intervention: preliminary results from SCAD pilot study

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Abstract Background Coronary artery disease (CAD) and ischemic heart failure (HF) still is one of the leading causes of death worldwide and adherence to medical and physical treatment is crucial to improve patients’ prognosis and reduce hospitalization (1). Purpose To investigate the potential benefit of information and communications technology (ICT) frameworks in daily activities to assist patients with ischemic dilated cardiomyopathy with low ejection fraction (LVEF) treated with percutaneous coronary intervention (PCI) to understand and comply all pharmacological and preventive measures and monitoring the health status (2, 3). Methods patients admitted for ischemic dilated cardiomyopathy associated with LVEF (<40%) were enrolled and underwent block randomization between smart assistance follow up plus standard of care or standard of care alone. Smart assistance group was equipped with smartphone, smartwatch, pulseoximeter and sphygmomanometer and, with the respective caregivers, underwent specific training and education on the use of the devices in addition to routine follow-up visits. On the other hand, the control group control group underwent outpatient visits at 30,90 and 120 days as standard of care in our routinely practice. The primary endpoint was the occurrence of HF hospitalization, secondary endpoints were physical activity, compliance to pharmacological prescriptions, perceived quality of life and all-cause mortality. Results A total of 218 patients were enrolled in the present study: 83 patients were enrolled in the smart assistance group and 135 in the control group. The median age was 61.4 years and the majority of patients were male (83.4%) with a median LVEF of 31%. The follow-up was 164±14 days in the smart assistance group and 171±9 days in the control group. No statistically significant difference at the baseline were found between the two groups. The primary endpoint occurred in the 9 patients in the smart assistance group and in 38 patients in the control group (10.8% vs 25.9%, p<0.01). Compliance to pharmacological treatment occurred in 94% of the smart assistance population and EQ-5D VAS score was higher in the smart assistance group during the follow-up compared to previous studies, 84 (interquartile range [IQR] 76-89) at one month and 83 (IQR 73-87) at 6 months. Physical activity increased during follow-up. No difference was found regarding all-cause mortality. No adverse events related to the smart assistance system was reported during the follow-up. Conclusions ICT frameworks may help in the post-discharge management and follow-up of patients with ischemic dilated cardiomyopathy with low LVEF treated with PCI by reducing HF hospitalization, improving compliance with pharmaceutical and physical treatment and increasing quality of life.

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