Plain English Summary
Background and study aims
In recent years, heart disease has become more common in developing countries and less so in developed countries. This problem is made worse with resource-limited areas receiving a disproportionately low amount of global resources needed to look after patients including diagnostic tests and trained healthcare professionals. Coupled with the increase of rheumatic heart disease (a long-term heart condition which follows rheumatic fever, a sudden illness caused by a bacterial infection) and structural heart disease (an condition in which the heart does not function properly due to a problem with the valves or chambers), there is an urgent need to find a way to deliver cost-effective care. Smartphone-connected mobile health (mHeath) devices are providing new ways for patients to remotely monitor long-term conditions, and for providers to improve healthcare delivery at the point-of-care. Such mHealth devices include smartphone apps, wearable and wireless devices such as the smartphone-ECG (devices to monitor the electrical activity of the heart), sensor-based technologies, pocket-sized ultrasounds and miniaturized laboratory tests. The aim of this study is to investigate the effectiveness of these mHealth devices in the treatment of patients with rheumatic and structural heart disease in resource-limited areas.
Who can participate?
Patients with rheumatic or structural heart disease.
What does the study involve?
Participants are randomly allocated to one of two groups. Those in the first group receive standard health care. Those in the second group receive mHealth care at a mHealth clinic. This involves having their vital signs and health heart monitored using a range of mobile devices. Participants in both groups receive a complete transthoracic echocardiogram (ultrasound of the chest to view the heart) to establish the severity of their rheumatic or structural heart disease. Participants are followed up over 12 months to find out how quickly participants are able to receive surgery to correct their heart defect.
What are the possible benefits and risks of participating?
Participants benefit from receiving a more timely decision about treatment and a more comprehensive assessment of the severity of disease at the time they see a doctor. In addition, participants in this study benefit from being closely monitored through follow up. There are no notable risks involved with participating.
Where is the study run from?
Sri Sathya Sai Institute of Higher Medical Sciences (India)
When is the study starting and how long is it expected to run for?
August 2014 to October 2015
Who is funding the study?
Academic Medical Center (Netherlands)
Who is the main contact?
Dr Partho Sengupta
Dr Partho Sengupta
Icahn School of Medicine at Mount Sinai
1 Gustave L. Levy Place
United States of America
+! 212 659 9121
sssihms (wf)/HR/14 /)
A Randomized Trial of Mobile Health Device Assessments in Structural Heart Disease Clinics
mHealth in Structural Heart Disease
A mHealth assessment with smartphone-based diagnostic devices such as the smartphone-ECG, handheld ultrasound, activity monitoring, and point-of-care laboratory tests accelerates medical-decision-making and shortens the time to definitive therapy among patients with structural heart disease in a resource limited area.
Sri Sathya Sai Institute of Higher Medical Sciences - Institutional Review Board, 05/01/2014
Nested multi-centre randomized controlled trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet
1. Rheumatic Heart Disease
2. Structural Heart Disease
Consecutive subjects are randomly assigned to an initial evaluation with mHealth or to standard-care. Study subjects are evaluated in either one of 5-mHealth or 5-standard-care sites.
Intervention group: Participants undergo an initial assessment of heart disease with mHealth devices including:
1. Structural abnormalities with handheld-echocardiography (Vscan®, GE Healthcare)
2. Vital signs with smartphone-connected oxymetry and blood pressure monitors (iHealthLabs®)
3. Functional assessments on a 6-minute walk test with a trial-axial activity monitor (Ozeri®)
4. Cardiac rhythm abnormalities with smartphone-connected-iECG (AliveCor®)
5. Point-of-care testing with fingerstick B-type natriuretic peptide (Alere)
Control group: Participants undergo a usual assessment with diagnostic tests that are available at the institution. This includes a physical examination, electrocardiography and radiographic and laboratory tests where necessary.
All study participants undergo a comprehensive transthoracic echocardiogram for anatomical assessments of the severity of rheumatic and structural heart disease and underwent a consultation by expert cardiologists prior to percutaneous valvuloplasty or a surgical valve replacement.
Primary outcome measure
Time to definitive treatment with valvuloplasty or valve replacement over 12-months is determined at the time of a healthcare encounter for valvuloplasty or valve replacement through monthly medical record review.
Secondary outcome measures
Occurrence of a cardiovascular hospitalization and/or death over 12-months is determined via monthly medical record review, community health worker visitation to the home, and text message follow up with the patient and care giver inquiring about a hospitalization and/or death.
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Symptomatic outpatients with a new or an established diagnosis of rheumatic and structural heart disease, including valvular disease, left/right ventricular failure, rheumatic valvular disease, congenital heart defects
2. Adult, pediatric, and pregnant patients
3. Patients with a prior valvuloplasty or valve replacement for structural heart disease can also be included
Target number of participants
Participant exclusion criteria
1. Neonatal patients
2. Those with an unstable hemodynamic status
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Sri Sathya Sai Institute of Higher Medical Sciences
EPIP Area, Whitefield Karnataka
American Society of Echocardiography Foundation
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Peer review medical journal with submission planned for 2016
Intention to publish date
Participant level data
To be made available at a later date
Basic results (scientific)
1. 2017 results in https://www.ncbi.nlm.nih.gov/pubmed/28917688 (added 29/01/2019)