JMIR Publications

ABSTRACT

Background:

Heart Failure (HF) remains a major public health challenge, while HF self-care is particularly challenging; mHealth-based interventions taking advantage of smartphone technology have shown particular promise in increasing HF patients’ quality of self-care and in turn, improve the outcomes of their disease.

Objective:

The co-development with HF patients and their caregivers of a patient-oriented mHealth app, its usability assessment and the investigation of its effect on HF patients’ quality of life and rate of hospitalizations in a pilot study.

Methods:

The development of an mHealth app (ThessHF app) was evidence-based, including features based on previous clinically tested mHealth interventions and selected by a panel of HF expert physicians and discussed with HF patients. At the end of alpha development, the app was rated by mHealth experts with the Medical Apps Rating Scale (MARS). The beta version was tested by HF patients, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF-Study) was performed to investigate the effect of app use on HF patients over a 3-month follow-up period. The primary endpoint was patient quality of life, measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EQ-5D-5L. Secondary endpoints were European Heart Failure Self-care Behavior Scale score (EHFScBS) and the hospitalization rate.

Results:

A systematic review of mHealth-based HF interventions and expert panel suggestions yielded 18 separate app features, most of which were incorporated in the ThessHF app. Fourteen (14) patients and five (5) mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score of 2.37±0.63, 1 is best and a median MARS score of 4.55/5 respectively). Finally, 30 patients participated in the THESS-HF pilot study (mean age 68.7±12.4 years, 87% male). A significant increase in the quality of self-care was noted per the EHFScBS, which increased by 4.4±7.2% (P=0.002). The mean quality of life increased non-significantly after 3 months according to both KCCQ (mean increase 5.8±15 points, P=0.054). and EQ-5D-5L (mean increase 5.6±15.6%, P=0.064) scores. The hospitalization rate for the follow-up duration was 3%.

Conclusions:

The need of telehealth services and remote self-care management in HF is of vital importance, especially in periods such as the COVID-19 pandemic. We developed a user-friendly mHealth app in order to promote remote self-care support in HF. In a pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multi-center study will investigate the effect of the app use on long-term outcomes in HF patients.