Grant: Project Grant

Heart failure (HF) is a global concern, with 30% of patients dying less than one year after being told they have HF. The costs of taking care of HF patients are very high, largely because they are frequently admitted to hospital. Medly is a HF remote patient management program that has been proven through trials in Ontario to improve patient health outcomes, patient experience, care team well-being, and health equity, while also reducing costs. However, Medly has only been implemented in hospitals in Ontario, Canada. The main goal of this multi-site trial is to determine how to successfully implement the Medly program outside of Ontario, both in Canada and internationally. The secondary goal is to explore if Medly will reduce deaths and hospitalizations outside of Ontario. IIn total, 410 patients will be recruited across 5 sites (one in Alberta, Canada; two in Manchester, United Kingdom; and two in Tasmania, Australia). The Consolidated Framework for Implementation Research 2.0 will guide the implementation preparations across the sites, and will guide the identification of the implementation barriers and facilitators. Proctor's Implementation Outcome Framework will be used to guide the evaluation of the implementation outcomes which will include the dimensions of adoption, feasibility, fidelity, implementation costs, and sustainability. The trial will include both quantitative data (eg, adoption will include patient adherence to daily measurements) and qualitative data through patient and provider interviews. To provide evidence on the clinical effectiveness, the number of deaths or all-cause unplanned readmissions at 180 days of the participants will be compared to similar patients within the same clinic a year prior to implementing Medly. This study will enable the spread of proven-effective digital health innovations, such as Medly, so that they can be part of standard of care and benefit as many patients as possible both nationally and internationally.