JMIR Publications

ABSTRACT

Background:

Heart failure is a common cause of hospitalization and patient self-management is essential to avoid decompensation and readmissions. Mobile applications (apps) seem promising in supporting heart failure self-management.

Objective:

This study systematically reviews the evidence on the impact of heart failure self-management apps on health outcomes and patient experience.

Methods:

Four databases (Medline, Embase, CINAHL, and PsycINFO) were searched for studies published from 2008 to 2020 examining interventions that comprised a mobile app targeting heart failure self-management and reported any health-related outcomes or patient perspectives. Studies were independently screened. We performed a narrative synthesis of results. PRISMA guidelines were followed. The protocol was registered in PROSPERO (CRD42020158041).

Results:

Nineteen articles [4 randomized controlled trials (RCTs)], assessing 16 apps and a total of 930 participants were included. The most common app features were symptom monitoring (14 of 16 apps), weight monitoring (13/16), and vital signs monitoring (12/16). RCTs were small and outcomes were predominantly self-reported. Two RCTs reported significant improvement in self-care scale measures, including ‘self-management’ (p=0.01), ‘self-confidence’ (p=0.03) and ‘self-maintenance’ (p=0.03) Two RCTs reported higher unplanned clinic visits. Mortality and emergency department visits were reported in two RCTs and hospital re-admissions in one RCT, with no significant differences. Engagement with the intervention was poorly reported. The most desirable app characteristics were automated self-monitoring and feedback, data integration and sharing, and personalization.

Conclusions:

Mobile apps may improve self-care, particularly if enabling automated self-monitoring and personalized feedback, but more robust evaluation studies are needed addressing key endpoints for heart failure.