Mobile Heart Failure Programs Face Sustainability Challenges

Mobile integrated health programs supporting patients after hospitalization for heart failure were well received by patients and health systems, but reimbursement and regulatory constraints threatened their sustainability, according to a qualitative study published in JAMA Network Open.

The study was embedded within the MIGHTy-Heart randomized clinical trial, conducted from January 2021 through September 2024 at two large urban health systems in New York City. The mobile integrated health intervention combined home visits by community paramedics, ongoing nurse care coordination, and facilitated telehealth consultations. Researchers interviewed 20 patients and 25 stakeholders, including clinicians, paramedics, caregivers, and program leaders.

Across the participating health systems, 73,343 patients received heart failure care during the trial period. Of 1,005 trial participants randomized to mobile integrated health, 414 received at least one visit. Participants had similar age and sex distributions to the broader heart failure population but greater racial and ethnic diversity; 50% were Black, 27% were Hispanic or Latino, and 25% were White.

Interview findings identified patient trust, leadership engagement, institutional alignment, and interdisciplinary coordination as facilitators of adoption and implementation. High patient satisfaction was identified as supporting program maintenance. However, misaligned reimbursement and regulatory limits on the scope of emergency medical services practice were persistent barriers. The parent trial found no significant difference between mobile integrated health and care-transition coordination in 30-day readmissions or Kansas City Cardiomyopathy Questionnaire scores.

The authors concluded that supportive payment models and policy changes may be needed to sustain and scale mobile integrated health. They cautioned that the findings reflected one program design at two urban health systems, excluded patients with New York Heart Association class IV heart failure, and included only two caregivers, limiting assessment of caregiver perspectives and broader applicability.

Source: Reading Turchioe M, Ellison M, Topaz LS, et al. Mobile Integrated Health and Post–Hospital Discharge Heart Failure Care. JAMA Netw Open. 2026;9(8):e2630229. doi:10.1001/jamanetworkopen.2026.30229