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ESC Heart Fail. 2019 Mar 13. doi: 10.1002/ehf2.12425. [Epub ahead of print]

Designing meaningful outcome parameters using mobile technology: a new mobile application for telemonitoring of patients with heart failure.

Author information

Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
DZHK, partner site Göttingen, Göttingen, Germany.
Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany.
Medopad Ltd, London, UK.



Health data captured by commercially available smart devices may represent meaningful patient-reported outcome measures (PROMs) in heart failure (HF) patients. The purpose of this study was to test this hypothesis by evaluating the feasibility of a new telemonitoring concept for patients following initial HF hospitalization.


We designed a cardio patient monitoring platform (CPMP) that comprised mobile iOS-based applications for patients' smartphone/smartwatch and the equivalent application on a physicians' tablet. It allowed for safe and continuous data transmission of self-measured physiological parameters, activity data, and patient-reported symptoms. In a prospective feasibility trial with 692 patient days from 10 patients hospitalized for newly diagnosed HF with reduced ejection fraction (mean left ventricular ejection fraction (LVEF) 26.5 ± 9.8%), we examined the CPMP during the first 2 months following discharge (69 ± 15 observation days per patient). The mean daily step count recorded by the mobile devices emerged as a promising new PROM. Its 14 day average increased over the study period (3612 ± 3311 steps/day at study inclusion and 7069 ± 5006 steps/day at end of study; P < 0.0001). It is unique for continuously reflecting real-life activity and correlated significantly with traditional surrogate parameters of cardiac performance including LVEF (r = 0.44; 95% CI 0.07-0.71; P = 0.0232), 6 min walk test (r = 0.67; 95% CI 0.38-0.84; P = 0.0002), and scores in health-related quality of life questionnaires.


We provide the first patient monitoring platform for HF patients that relies on commercially available iOS/watchOS-based devices. Our study suggests it is ready for implementation as a tool for recording meaningful PROMs in future HF trials and telemonitoring.


Daily step count; Heart failure; Mobile application; Mobile health; Patient-reported outcome measure; Telemonitoring


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