Mighty-Heart: Mobile Integrated Health Offers No Benefit in Heart Failure Readmissions

Mobile integrated health (MIH) confers no additional benefit to either health status or 30-day readmissions for postacute patients with heart failure (HF) compared to a transitions of care coordinator (TOCC), according to results from the Mighty-Heart trial.1

HF is the leading cause of hospitalization among older adults in the US. It also has the highest 30-day all-cause readmission rates among Medicare beneficiaries. For those facing adverse social determinants of health, these readmissions can also create substantial financial and psychosocial burdens.1

“Multiple interventions have been tested to improve care transitions and postdischarge outcomes for patients hospitalized for heart failure, yet few comparative effectiveness trials have evaluated alternative strategies,” Ruth Masterson Creber, PhD, Mary Crawford Professor of Nursing, Columbia University, and colleagues wrote. “Two possible interventions—mobile integrated health (MIH) and a transitions of care coordinator (TOCC)—have shown effectiveness in smaller trials or observational studies on postacute health care utilization and health status; however, they have not previously been directly compared in a randomized clinical trial.”1

To this end, Creber and colleagues conducted the Mighty-Heart trial, a multicenter, pragmatic randomized clinical trial divided into 2 main cohorts. The MIH arm involved monitoring patients after hospital discharge and providing home-based interventions through community paramedics. This arm aimed to address symptom exacerbations and other unplanned readmission causes among patients with HF.2

The TOCC arm instead consisted of a follow-up phone call from a nurse within 48-72 hours of discharge, during which time the nurse would assess the patient’s clinical status, identify unmet needs, and reinforce patient education. The nurse could also connect patients to care coordinators for non-emergent clinical and social needs.2

The trial was conducted across 11 academic and community hospitals affiliated with New York Presbyterian and Mount Sinai Health. Patients were included if they were enrolled in Medicare or Medicaid, expected to be discharged home, and were ≥18 years old. Patients with a diagnosis of dementia or unstable psychiatric illness, as well as those with advanced HF, were excluded.1

Patients were given a baseline survey aiming to capture self-reported sociodemographic information and baseline health status using the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ). After completion, patients were randomly assigned in a 1:1 ratio to either MIH or TOCC, stratified by health system.1

The final analysis included 2003 of the 2012 patients randomized between 2021 and 2024 – 1005 were assigned to MIH and 998 to TOCC. Median age was 67 (19-98) years. A total of 1070 patients completed the KCCQ score; the observed mean (standard deviation [SD]) baseline KCCQ score was 46 (25) in the MIH group and 46 (26) in the TOCC group.1

Investigators found no significant differences in 30-day KCCQ scores between the 2 groups (MIH, 9.82 vs TOCC, 7.99; adjusted mean difference: 1.83; 95% CI, -0.75 to 4.4; P = .16). Although age-specific subgroup analysis indicated MIH was associated with better health status among younger patients (ß = 4.4; 95% CI, 1.01 to 7.79), but not adults (ß = -1.87; 95% CI, -5.91 to 2.17). Age-by-treatment interaction was statistically significant (P = .02).1

A total of 408 participants (204 with MIH and 204 with TOCC) were readmitted within 30 days of discharge. The team found no significant main treatment effects on 30-day all-cause readmissions in unadjusted (odds ratio [OR], 0.99; 95% CI, 0.83 to 1.19; P = .95) or adjusted analyses (OR, 0.97; 95% CI, 0.8 to 1.16; P = .72). A total of 259 experienced an HF specific readmission within 30 days, without significant main treatment effects on 30-day HF specific readmissions in unadjusted (OR, 0.9; 95% CI, 0.74 to 1.09; P = .27) or adjusted (OR, 0.9; 95% CI, 0.74 to 1.1; P = .32) analyses.1

Ultimately, investigators found no significant differences between MIH and TOCC – however, the finding of significantly worse health status outcomes with TOCC among younger participants is consistent with prior studies.1

“However, the exploratory findings that MIH may have supported better health status in younger patients underscores the importance of further research to better define optimal transition of care strategies for patients hospitalized with heart failure,” Creber and colleagues wrote.1

References

1. Masterson Creber R, Daniels B, Reading Turchioe M, et al. Mobile Integrated Health vs a Transitions of Care Coordinator for Patients Discharged After Heart Failure: The Mighty-Heart Randomized Clinical Trial. JAMA Intern Med. Published online September 15, 2025. doi:10.1001/jamainternmed.2025.4483

2. Masterson Creber RM, Daniels B, Munjal K, et al. Using Mobile Integrated Health and telehealth to support transitions of care among patients with heart failure (MIGHTy-Heart): protocol for a pragmatic randomised controlled trial. BMJ Open. 2022;12(3):e054956. Published 2022 Mar 10. doi:10.1136/bmjopen-2021-054956