Comparison With Prior Work
comorbidity
DISEASE, RECRUITMENT
The extent to which older patients registered into the Health eHeart Study compared to their younger counterparts supports the notion that remote recruitment via email can be particularly effective in enrolling older people in the right context. This can be partially attributed to the study’s disease focus and institutional affiliation; heart health may inherently be more interesting to older patients seeking cardiovascular care at a research hospital compared to older people exploring a public forum. This finding contrasts with literature showing that those who enrolled in a research study through various digital channels tend to veer younger relative to the recruited population [Female patients, to a lesser effect, were also more likely to participate in the Health eHeart Study compared to male patients. The underrepresentation of women in conventional studies has been partially attributed to structural factors, such as time demands and scheduling, study type (eg, randomized trial), financial incentives, seasonality, and clinical environment, among many other reasons [Consistent with existing trends [Furthermore, patients with Medicaid or “unknown or declined to state” insurance were less likely to register compared to those with commercial insurance. However, there was a significant drop-off at the consent stage observed among patients with Medicaid insurance. Systemic factors such as lack of adequate insurance coverage and internet access are especially burdensome for racial or ethnic minorities and those with lower SES. Patients’ state of insurance coverage may be an indicator of their digital research participation [Most medical conditions that we studied, and medical comorbidity burden in general, did not appear to be obstacles to enrollment after adjustment for other factors. Patients with a low comorbidity burden, either CCI score of 1 or 2, were more likely to register compared to those with no relevant comorbidities. This contrasts with the classic “healthy volunteer” effect that suggests those who join clinical trials or studies are healthier than those who decide not to participate [Operational considerations of a recruitment plan are also important for maximizing study enrollment [