Mobile Health Self-management Interventions for Patients With Heart Failure

Abstract

Background: Heart failure (HF) is a multifaceted syndrome that requires self-management for adherence to treatment to control symptoms. Symptoms need to be monitored to prevent impending HF exacerbations. Few HF study authors have assessed efficacy of mobile health (mHealth) interventions particularly with virtual visits to evaluate outcomes such as symptoms and healthcare utilization. Objective: The aim of this pilot study was to evaluate the potential effect of mHealth self-management interventions on symptom status and health-related quality of life and describe health care utilization in patients with HF. Methods: This 3-month pilot study included 74 patients with HF and used a randomized 3-group repeated-measures design (enhanced usual care, mHealth, and mHealth plus [+] virtual visits). Surveys included the Heart Failure Symptom Survey, EuroQol, and a specialized phone application for patients to report weights and medications. Results: The mHealth groups had an overall decrease in most symptom severity and frequency, particularly shortness of breath. Compared to enhanced usual care, both the mHealth+ and mHealth groups showed promise with medium effect sizes (range .55-.60) in relation to shortness of breath and a medium effect (.51) for lower extremity edema for the mHealth+ group. There was a trend toward improvement in health-related quality of life in both intervention groups at month 3. The mHealth+ group had fewer rehospitalizations. Conclusions: In general, both mHealth groups fared better on symptoms and health care utilization. Small to medium effect sizes on selected symptom outcomes warrant this study to be conducted in a fully powered study. Virtual visits may assist in symptom recognition and self-management.

The Use of Mobile Apps for Heart Failure Self-management: Systematic Review of Experimental and Qualitative Studies

“…All 28 included articles [ 38 - 65 ] were published from 2012 onward and covered 27 studies and 23 interventions (n=4, 17% interventions were evaluated in ≥1 paper, using different study designs [ 39 , 44 , 47 , 52 , 56 , 59 , 63 - 65 ]). Of the 28 studies, there were 18 (64%) experimental studies [ 38 - 55 ], (n=10, 56% RCTs [ 38 - 47 ] and n=8, 44% quasi-experimental [ 48 - 55 ]; n=7, 39% with a qualitative component [ 38 , 44 , 46 , 49 , 51 , 52 , 54 ]; Table 1 ), 9 (32%) qualitative-only studies, 5 (18%) that included interviews [ 56 - 60 ], and 4 (14%) that involved a survey with open-ended questions ( Table 2 ) [ 57 - 64 ].…”

“…Of the 28 studies, there were 18 (64%) experimental studies [ 38 - 55 ], (n=10, 56% RCTs [ 38 - 47 ] and n=8, 44% quasi-experimental [ 48 - 55 ]; n=7, 39% with a qualitative component [ 38 , 44 , 46 , 49 , 51 , 52 , 54 ]; Table 1 ), 9 (32%) qualitative-only studies, 5 (18%) that included interviews [ 56 - 60 ], and 4 (14%) that involved a survey with open-ended questions ( Table 2 ) [ 57 - 64 ]. Most studies were conducted in the United States (15/28, 54%) [ 39 , 40 , 44 , 45 , 48 , 50 , 52 , 54 , 56 , 58 , 60 - 64 ] and Canada (4/28, 14%) [ 47 , 51 , 55 , 59 ], and most were single-center, except for a few (5/28, 18%) [ 38 , 42 , 43 , 55 , 62 ]. There were 1397 participants (n=8-232 in experimental studies and 5-37 in qualitative studies), mean age was 63.4 years, 30% were women, 68% were White (from 15/28, 54% studies that reported on ethnicity), and the average education level was high ( Multimedia Appendix 4 [ 38 - 65 ]).…”

Experiences of Using a Self-management Mobile App Among Individuals With Heart Failure: Qualitative Study

“…Qualitative descriptive research creates a close description of participants' subjective experience [27,28]. Participants were recruited from the intervention groups of a larger parent study using a mobile app related to heart failure self-management [29]. The parent study was a three-group repeated measures randomized controlled pilot study.…”

“…A brief description of the intervention will be provided in this manuscript, as a full description of the sample and study is under review in another paper [29]. The 12-week intervention promoted self-management using mHealth as a platform.…”

mHealth Apps for Self-Management of Cardiovascular Diseases: A Scoping Review

“…[ 14 , 15 ] analyzed the effect of the use of wearables and apps for cardiac rehabilitation of arrhythmia patients, whereas [ 16 , 17 , 18 ] studied a series of prevention and treatment programs for heart failure management through mHealth. Additionally, in [ 2 , 19 , 20 , 21 , 22 ] the functionalities of mHealth apps for heart failure self-management were evaluated.…”