JMIR Publications

ABSTRACT

Background:

Heart failure (HF) is a significant global health challenge, requiring innovative management strategies like eHealth. However, the success of eHealth in managing HF heavily relies on patient adherence, an area currently not sufficiently investigated despite its critical role in ensuring the effectiveness of this approach.

Objective:

This review was initiated to gather evidence on adherence to eHealth devices among HF patients. The goal was to survey the current state of adherence, pinpoint factors that promote successful engagement, and identify gaps needing further research.

Methods:

A scoping review was conducted to gather quantitative data on eHealth engagement from relevant clinical HF trials indexed in PubMed, CINAHL, and PsycInfo up to February 2024. Descriptive characteristics of the trials were extracted, and generalized mixed model analyses were used to identify eHealth characteristics affecting patient adherence.

Results:

Our analysis included 61 studies, primarily utilizing non-invasive eHealth interventions with wearables (n=44), followed by non-invasive eHealth interventions without wearables (n=6), wearables only (n=6), invasive devices (n=3), and telephone support (n=2). The median number of patients per study was 51 (interquartile range (IQR): 20-150), and the median follow-up duration was 180 days (IQR: 84-360). Variability in reporting and definitions of eHealth adherence was noted. Seventeen trials assessed adherence trends, with 12 noting a decline, four observing no change, and one reporting an increase over time. Factors influencing adherence were explored in 27 trials; six indicated higher adherence with increasing patient age, one showed a negative correlation, and nine detected no age-related differences. No gender differences were found in the nine studies that reported on gender, and eight trials found no association between adherence and the NYHA classification, while one noted higher adherence in patients with more severe symptoms. In 33 trials (54%), adherence was quantified as the percentage of mean days the intervention was utilized, yielding a median adherence rate of 78% (IQR: 59-86; range: 31-98). No significant correlations were found between adherence rates and the number of eHealth device users, type of intervention, follow-up duration, number of parameters monitored, or data collection frequency.

Conclusions:

Reporting and definitions of patient adherence in HF trials are incomplete and inconsistent. Trends indicate a decrease in eHealth usage over time. Customizing devices to meet patient needs may help mitigate this issue. Future research should offer a more detailed description of adherence to pinpoint factors that enhance patient adherence with eHealth technologies.