PROJECT SUMMARY/ABSTRACT
Heart failure (HF) is a growing pandemic; in the U.S., the number of those diagnosed with HF is expected to
rise to 8 million with annual costs at $69 billion by 2030. Despite effective interventions to reduce HF morbidity
and mortality, vulnerable populations with HF suffer disproportionately from hospitalization and mortality
especially in the southern U.S. states. Self-management (SM) behavioral interventions to improve HF
outcomes are therefore imperative. Remote interventions to promote SM behaviors present an important
strategy to address the widening geographical and racial health disparities in HF outcomes. One promising
approach is the use of sensor-controlled digital games (SCDGs), which offer affordable, portable, scalable tools
to facilitate engagement in HF SM behaviors that show the poorest adherence (weight monitoring and physical
activity) while being enjoyable and easy to use. The primary goal of this study is to evaluate the efficacy of a
SCDG intervention that integrates HF participants’ behavioral data from weight scale and activity tracker
sensors to activate game progress, rewards, and feedback. For Aim 1, we will refine an SCDG that we have
already developed for mobile smartphones to be playable for longer durations for sustained behavior
adherence to weight-monitoring and physical activity. For Aim 2, using a randomized controlled clinical trial, we
will compare the SCDG intervention versus a sensor-only intervention for the primary outcome of rate of
engagement in the HF SM behavior of weight-monitoring and the secondary outcomes of physical activity
behavior engagement, HF SM knowledge, self-efficacy, HF functional status, hospitalization, and quality of life
at baseline and at 6, 12, and 24 weeks. For our sample, we will recruit adults aged 45 years or older from 7
southern U.S. states and hospitalized with HF within the past 6 months. We will randomize 200 participants to
either the SCDG intervention group, in which participants will receive sensors that track weight monitoring and
activity and will play the SCDG on a mobile smartphone, or a control group that will receive sensors, an app
that tracks activity and weight monitoring, and standardized written HF educational materials. For Aim 3, we
will conduct a mixed-methods assessment to discern facilitators and barriers impacting participants’
engagement with the sensor-based interventions for HF SM behavior adherence. For Aim 4, based on daily HF
SM weight-monitoring and physical activity behavior data and ecological momentary assessments of
symptoms, mood, satisfaction, and cognitive status, we will conduct digital phenotyping of HF SM weight-
monitoring and physical activity behaviors. This project will generate insight and guidance for scalable and
easy-to-use digital gaming solutions to motivate persistent adherence to HF SM behaviors and improve health
outcomes among individuals with HF.
