Abstract 4139306: Digital engagement with a patient smartphone app and text messaging is associated with increased compliance in patients undergoing long-term continuous ambulatory cardiac monitoring

Introduction: Although home-based diagnostics have dramatically reshaped care delivery, greater patient activation could affect compliance. For home enrollment and activation (HE) of long-term continuous ambulatory cardiac monitoring (LTCM) devices, patients must receive the device by mail, self-apply the patch, wear it for up to 14 days, and return by mail for ECG interpretation. We developed two direct-to-patient digital interventions and evaluated association of use of these to compliance outcomes after US-wide implementation. Methods: MyZio® is an optional smartphone app (iOS&Android) for patients for use with Zio® LTCM (iRhythm Technologies, Inc; San Francisco, CA) that tracks shipping status, enables registration, provides educational content and instruction on application/activation/wear, notifies users of remaining wear time and gives return reminders. Patients with a mobile number may also opt-in to short messages services (SMS) text notifications. Opt-in patients receive texts regarding delivery, application/wear, billing information, device return and prompts to download MyZio. We evaluated patient compliance (activation, wear, and device return) in all patients shipped Zio LTCM with HE between Oct 1 and Apr 3, 2024; the period after launch of MyZio version 2.0. We calculated return rates, stratified by use of one or both digital interventions. Odds ratios were calculated and the Chi Square test was used to report associated p-values compared to the reference (no intervention). Results: The distribution of the use of digital tools and compliance outcomes in 169,131 patients are shown in Table 1. Compliance was lowest (74.6%) when both the app and text messaging were not used. App use was associated with the highest gains in compliance, largely irrespective of concomitant text messaging. Opting into SMS text was associated with compliance improvement but was inferior to app use. Conclusion: In patch-based ECG LTCM, a dedicated patient app and SMS texting were associated with improved device return rates, although the app had a stronger effect. These data support the use of patient digital health interventions in home-based diagnostics and underscore the importance of post-implementation evaluation of outcomes.