Background: Consumer-facing mobile health applications (mHealth apps) are being increasingly integrated into routine heart failure (HF)-related self-care. However, there is a dearth of research on patient engagement with consumer-facing mHealth apps in real-world settings and the effect of such engagement on HF outcomes. Objectives: This study examine the patterns of patient engagement with a consumer-facing mHealth app,and the effects of engagement on HF outcomes. Method: This was a longitudinal observational study of patients who used a consumer-facing mHealth app, OnTrack to Health, for self-care of HF in a real-world setting between 2012 and 2020. Patient engagement was assessed as the percentage of assigned self-care activities checked off and transmitted daily to the nursing team via the app interface, within the first 575 days of use. Bilinear spline growth models were used to examine patterns of patient engagement during free subscription and post-free subscription periods and to determine the predictors of the engagement. The effects of patient engagement on medication adherence were examined using linear mixed effect models. Results: A total of 229 participants (148/229, 64.6% male), with a mean age of 62.2 (SD 14) years used the app. The mean (SD) daily patient engagement and medication adherence were 77.3 (27.5)%, and 98.4 (3.7)%, respectively. Patient engagement with OnTrack to Health app decreased overtime during the free subscription (β -.490, 95% CI -0.796 to -0.184, P = .002 ) and post-free subscription patient engagement(β -.567, 95% CI -0.860 to -0.272, P <.001) periods, attainment of target doses of guideline-directed medical therapy (β .002, 95% CI 0.001 to 0.003, P <.001), and being a long-term vs. short-term app user (β .191, 95% CI 0.063 to 0.319, P =.003) were associated with a higher rate of patient engagement over time. Patient engagement was not significantly associated with the rates of changes in medication adherence over time (β .002, 95% CI -0.003 to 0.007, P= .360) Conclusion: The declining trend of patient engagement with consumer-grade apps, indicates a need for effective strategies to sustain patient engagement, and such strategies may include financing models that place no or minimal financial responsibility on patients.

BACKGROUND Publicly available patient-focused mobile health applications (mHealth apps) are being increasingly integrated into routine heart failure (HF)-related self-care. However, there is a dearth of research on patients’ experiences using mHealth apps for self-care in real-world settings. OBJECTIVE The purpose of this study was to explore patients’ experiences using a commercially available mHealth app, OnTrack to Health, for HF self-care in a real-world setting. METHODS Patient satisfaction, measured with a 5-point Likert scale and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients’ responses was conducted with qualitative software, Atlas. ti version 8. RESULTS Patients (median IQR age 64, 57-71 years; 17/23, 74% male) used OnTrack to Health for a median(IQR) duration of 164 (51-640) days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Five themes emerged from the responses to the open-ended questions: (1) features that enhanced self-care of HF (medication tracker, graphic performance feedback and automated alerts, secured messaging features, and HF self-care education); (2) perceived benefits (provided assurance of safety, improved HF self-care, and decreased hospitalization rates ); (3) challenges with using apps for self-care (giving up previous self-care strategies); (4) facilitators (perceived ease of use, availability of technical support); and (5) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features). CONCLUSIONS Patients were satisfied with using Ontrack to Health for self-care. They perceived the features of the app as valuable tools for improving self-care ability and decreasing hospitalization rates. The development of apps in collaboration with end-users is essential to ensure high-quality patient experiences related to app use for self-care.

Background Publicly available patient-focused mobile health (mHealth) apps are being increasingly integrated into routine heart failure (HF)–related self-care. However, there is a dearth of research on patients’ experiences using mHealth apps for self-care in real-world settings. Objective The purpose of this study was to explore patients’ experiences using a commercially available mHealth app, OnTrack to Health, for HF self-care in a real-world setting. Methods Patient satisfaction, measured with a 5-point Likert scale, and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients’ responses was conducted with the qualitative software Atlas.ti (version 8; ATLAS.ti Scientific Software Development GmbH). Results Patients (median age 64, IQR 57-71 years; 17/23, 74% male) used OnTrack to Health for a median 164 (IQR 51-640) days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Five themes emerged from the responses to the open-ended questions: (1) features that enhanced self-care of HF (medication tracker, graphic performance feedback and automated alerts, secured messaging features, and HF self-care education); (2) perceived benefits (provided assurance of safety, improved HF self-care, and decreased hospitalization rates); (3) challenges with using apps for self-care (giving up previous self-care strategies); (4) facilitators (perceived ease of use and availability of technical support); and (5) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features). Conclusions Patients were satisfied with using OnTrack to Health for self-care. They perceived the features of the app as valuable tools for improving self-care ability and decreasing hospitalization rates. The development of apps in collaboration with end users is essential to ensure high-quality patient experiences related to app use for self-care.