Effects of Web-Based Symptom Monitoring Program on Symptom Interference, Physical Activity, and Emergency Department Readmissions in Patients With Pre-Capillary Pulmonary Hypertension: Randomized Controlled Trial

Abstract

Background: Pre-capillary pulmonary hypertension (PH) is a progressive and incurable disease characterized by high morbidity, frequent emergency department (ED) visits, and persistently poor survival despite targeted therapies. Web-based symptom monitoring programs offer a promising, non-invasive approach to support self-management and enable the early detection of decompensation. Objective: This study aimed to evaluate the effects of a web-based symptom-monitoring program on symptom interference, physical activity, and ED readmission in patients with pre-capillary PH. Methods: This parallel-group, single-blind, randomized controlled trial recruited patients with precapillary PH from a cardiology outpatient department in northern Taiwan. Patients were included if they had been diagnosed with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension and had a mean pulmonary arterial pressure of >20 mmHg confirmed via right heart catheterization. Participants were randomized into 2 groups: an intervention group (n=26), which received a 6-month symptom monitoring program delivered via a web-based application, or a control group (n=25), which received standard care. Outcomes were assessed by comparing measures at baseline (enrollment) with measures at 3, 6, and 9 months postintervention. The primary outcome was symptom interference, and the secondary outcomes included physical activity based on the 6-minute walk test, hemodynamic data, and readmissions to the ED. Changes in baseline measurements were analyzed using generalized estimating equations. Results: The mean age of the 51 participants was 59.6 (SD 13.6) years. Most patients were diagnosed with connective tissue disease-associated pulmonary arterial hypertension (39.2%), with a mean duration of PH since diagnosis of 3.38 (SD 2.55) years. The patient characteristics did not differ significantly between the groups. Compared with the control group, the intervention group experienced greater reduction in symptom interference, and over the 9-month intervention period, the intervention group showed a significantly greater improvement in the 6-minute walk test, with the distance increasing by an average of 9.8 meters every 3 months (β=9.81; 95% CI 0.93 to 18.70; P=.03). Additionally, generalized estimating equations analysis demonstrated that, compared to the control group, the intervention group had a 65% decrease (β=−1.03; OR=0.35; P=.04) in the likelihood of ED readmissions for every 3-month interval during the 9-month study period. Conclusions: A web-based symptom monitoring program effectively reduced symptom interference, improved physical activity, and decreased ED visits in patients with pre-capillary PH.