A Hospital-Community-Family–Based Telehealth Program for Patients With Chronic Heart Failure: Single-Arm, Prospective Feasibility Study (Preprint)

Abstract

BACKGROUND An increasing number of patients with chronic heart failure (CHF) are demanding more convenient and efficient modern health care systems, especially in remote areas away from central cities. Telehealth is receiving increasing attention, which may be useful to patients with CHF. OBJECTIVE This study aimed to evaluate the feasibility of a hospital-community-family (HCF)–based telehealth program, which was designed to implement remote hierarchical management in patients with CHF. METHODS This was a single-arm prospective study in which 70 patients with CHF participated in the HCF-based telehealth program for remote intervention for at least 4 months. The participants were recruited from the clinic and educated on the use of smart health tracking devices and mobile apps to collect and manually upload comprehensive data elements related to the risk of CHF self-care management. They were also instructed on how to use the remote platform and mobile app to send text messages, check notifications, and open video channels. The general practitioners viewed the index of each participant on the mobile app and provided primary care periodically, and cardiologists in the regional central hospital offered remote guidance, if necessary. The assessed outcomes included accomplishments of the program, usability and satisfaction, engagement with the intervention, and changes of heart failure–related health behaviors. RESULTS As of February 2018, a total of 66 individuals, aged 40-79 years, completed the 4-month study. Throughout the study period, 294 electronic medical records were formed on the remote monitoring service platform. In addition, a total of 89 remote consultations and 196 remote ward rounds were conducted. Participants indicated that they were generally satisfied with the intervention for its ease of use and usefulness. More than 91% (21/23) of physicians believed the program was effective, and 87% (20/23) of physicians stated that their professional knowledge could always be refreshed and enhanced through a library hosted on the platform and remote consultation. More than 60% (40/66) of participants showed good adherence to the care plan in the study period, and 79% (52/66) of patients maintained a consistent pattern of reporting and viewing their data over the course of the 4-month follow-up period. The program showed a positive effect on self-management for patients (healthy diet: <italic>P</italic>=.046, more fruit and vegetable intake: <italic>P</italic>=.02, weight monitoring: <italic>P</italic>=.002, blood pressure: <italic>P</italic><.001, correct time: <italic>P</italic>=.049, and daily dosages of medicine taken: <italic>P</italic>=.006). CONCLUSIONS The HCF-based telehealth program is feasible and provided researchers with evidence of remote hierarchical management for patients with CHF, which can enhance participants’ and their families’ access and motivation to engage in self-management. Further prospective studies with a larger sample size are necessary to confirm the program’s effectiveness.

The Recent Advances of Mobile Healthcare in Cardiology Practice

“…The analysis showed that studies on the use of mobile applications were conducted in the USA (n=7) ( 30 - 36 ), Sweden (n=3) ( 37 - 39 ), Republic of Korea (n=1) ( 40 ), Brazil (n=1) ( 41 ), Norway (n=2) ( 42 , 43 ), Switzerland (n=1) ( 44 ), Belgium (n=1) ( 45 ), China (n=9) ( 22 , 46 - 53 ), Romania (n=1) ( 54 ), Japan (n=1) ( 55 ), Finland (n=1) ( 24 ), France (n=1) ( 56 ), New Zealand (n=1) ( 57 ), Iran (n=2) ( 58 , 59 ), Georgia (n=1) ( 60 ), Spain (n=2) ( 61 , 62 ), Palestine (n=1) ( 63 ) and Germany (n=3) ( 64 - 66 ). Two studies were conducted simultaneously in India (n=2) ( 67 , 68 ).…”

“…In terms of application, mobile applications were designed for patients with diagnoses such as heart failure ( 24 , 46 , 58 ), supraventricular tachycardia ( 30 , 33 ), cardiac arrest ( 37 ), acute coronary syndrome ( 39 , 68 ), hypertension ( 31 , 35 , 41 , 59 - 61 , 63 ), ischemic heart disease ( 36 , 48 , 69 ), coronary artery disease ( 45 , 65 ) or after coronary artery bypass grafting ( 51 ), myocardial infarction ( 38 , 49 , 50 ), atrial fibrillation ( 52 , 55 ), obstructive coronary artery disease ( 70 ), ( 47 ) and general CVD ( 32 , 40 , 53 , 54 , 62 , 64 ).…”

“…There were prospective ( 22 , 46 , 55 , 60 , 66 ), retrospective ( 40 , 49 , 50 , 61 ), RCTs ( 22 , 24 , 32 , 35 , 39 , 40 , 42 , 51 , 53 , 56 - 63 , 67 , 68 ).…”

“…Apart from that, it should be noted that many mobile applications, were employed as an additional tool for medical personnel to monitor the condition of patients ( 22 , 24 , 31 , 35 , 36 , 46 , 52 ).…”

“…In addition to the analysis of mobile application, we also studies text messages ( 31 , 36 , 38 , 46 , 56 , 58 ), educational materials ( 38 , 51 , 55 , 58 , 59 , 64 ), video instructions for using the application and monitoring the health status ( 31 , 46 , 65 , 70 ), reminder functions ( 35 , 36 , 41 , 46 , 48 , 51 , 55 , 61 , 63 , 68 ) and as a symptom-tracking tool ( 39 , 41 ).…”