JMIR Publications

ABSTRACT

Background:

Community-based management by heart failure specialist nurses (HFSNs) is key to improving, quality of life and self-care in heart failure with reduced ejection fraction (HFrEF). Remote monitoring (RM) can aid management, but the RM experience of both patient and nurse users is under-reported.

Objective:

We present a balanced evaluation of both user groups’ experience of Luscii, a smartphone-based RM strategy combining self-measurement of vital signs, instant messaging and e-learning.

Methods:

A two-part retrospective analysis of HFrEF patients using the RM platform: Part A: Thematic analysis of patient feedback provided via the platform and a focus group of six HFSNs. Part B: Scores for a locally-devised HF questionnaire (HFQ), depression (PHQ-9) & anxiety (GAD-7) questionnaires were extracted from the RM platform at on-boarding and 3 months after. Paired non-parametric tests were used to evaluate differences between median scores across the two time points.

Results:

79 patients (mean age 62 years; 35% female) were included. Part A: There was extensive, bidirectional information exchange between patients and HFSNs using the platform. Positive impacts included increased patient engagement, convenience for both user groups and continuity of care. Negative impacts included information overload for patients & increased workload for nurses. Part B: At 3 months there was no difference in HFQ (p=.57), PHQ-9 (p=.48) and GAD-7 (p=.54) scores compared to onboarding.

Conclusions:

Smartphone-based RM in HFrEF impacts both patients and HFSNs beyond clinical outcomes. To increase adoption and avoid pitfalls, RM providers should involve patient and nurse users in platform-development, and managers should formally recognise RM-usage in nursing job plans.