Racial Disparities and the Use of Technology for Self-Management in Blacks with Heart Failure: A Literature Review

Abstract

Heart failure is a debilitating illness that requires patients to be actively engaged in self-management. Self-management practices, including maintenance and management of an evidence-based medication regimen, are associated with improved outcomes. Yet, sustained engagement with self-management practices remains a challenge. Both self-management practices and clinical outcomes differ by race, with the poorest self-management and clinical outcomes reported in Blacks. Contemporary interventions to address self-management and reverse current trends in outcomes have evaluated the use of technology. Technological innovations, such as text messaging, social networking, and online learning platforms may provide a more accessible means for self-management of heart failure, yet these innovations have been understudied in the population at greatest risk – Blacks with heart failure. We conducted a review and discovered only four studies evaluating use of technology for self-management in Blacks. More studies are needed to close the gap on racial disparities and use of technology for self-management.

Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews

“…Table 1 provides a summary of the reviews’ characteristics that focused on RPM in heart failure outcomes. Studies were published from 2006 to 2015 and consisted of a minimum of 4 [ 23 ] and a maximum of 56 original studies [ 24 ] with the methodology of RCT, cohort studies, and/or pre-post studies. The follow-up period ranged from 1 to 26 months.…”

“…One systematic review included 3 RCTs that examined the effect of videoconferencing and compared the intervention with usual care or telephone support [ 8 ]. One RCT and 1 pre-post study cited by 2 systematic reviews [ 10 , 23 ] examined mobile phone interventions. In 1 systematic review [ 10 ], 11 RCTs investigated the effect of PDAs.…”

“…Assessing the methodological quality of included systematic reviews and meta-analyses revealed that the quality of 12 systematic reviews [ 8 , 10 , 11 , 13 , 14 , 16 , 18 - 22 , 25 ] was moderate as they were scored between 4 and 7. A total of 6 systematic reviews [ 12 , 15 , 17 , 23 , 24 , 26 ] had a very low quality (scored 3 and less) and only 1 systematic review was identified as highest quality (scored 10) [ 9 ]. Overall, many of the reviews displayed important limitations.…”

Description and initial evaluation of incorporating electronic follow-up of study participants in a longstanding multisite cohort study

“…These latter percentages are comparable to the percent of participants with email addresses in CARDIA (60.0 of blacks, 47.4 of those with ≤ 12 years of education, and 46.2 % with annual household income < $35,000; not shown in tables). Few studies have examined the effectiveness of technology use in healthcare settings among minority and/or low-income populations, but there is some evidence suggesting text messaging interventions improve health behaviors and disease management [ 7 , 8 ]. Future work is needed to determine whether text messaging or a smartphone application may improve contact with harder-to-reach participants.…”

Cost‐Effectiveness of Remote Cardiac Monitoring With theCardioMEMSHeart Failure System

“…[7][8][9] Telemonitoring was not shown to reduce readmission rates significantly in 2 recent large studies. 10,11 Remote monitoring may be more beneficial for certain populations than others, 12 although few studies have examined this question in detail. However, recent published studies have started to explore the literature on remote monitoring to understand variation in success rates and the inconsistent definition of remote monitoring.…”