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Mouselimis D, Tsarouchas A, Vassilikos VP, Mitsas AC, Lazaridis C, Androulakis E, Briasoulis A, Kampaktsis P, Papadopoulos CE, Bakogiannis C. The role of patient-oriented mHealth interventions in improving heart failure outcomes: A systematic review of the literature. Hellenic J Cardiol 2024; 77:81-92. [PMID: 37926237 DOI: 10.1016/j.hjc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023] Open
Abstract
Heart failure (HF) is a debilitating disease with 26 million patients worldwide. Consistent and complex self-care is required on the part of patients to adequately adhere to medication and to the lifestyle changes that the disease necessitates. Mobile health (mHealth) is being increasingly incorporated in patient interventions in HF, as smartphones prove to be ideal platforms for patient education and self-help assistance. This systematic review aims to summarize and report on all studies that have tested the effect of mHealth on HF patient outcomes. Our search yielded 17 studies, namely 11 randomized controlled trials and six non-randomized prospective studies. In these, patients with the assistance of an mHealth intervention regularly measured their blood pressure and/or body weight and assessed their symptoms. The outcomes were mostly related to hospitalizations, clinical biomarkers, patients' knowledge about HF, quality of life (QoL) and quality of self-care. QoL consistently increased in patients who received mHealth interventions, while study results on all other outcomes were not as ubiquitously positive. The first mHealth interventions in HF were not universally successful in improving patient outcomes but provided valuable insights for patient-oriented application development. Future trials are expected to build on these insights and deploy applications that measurably assist HF patients.
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Affiliation(s)
- Dimitrios Mouselimis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Angelos C Mitsas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Lazaridis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanuel Androulakis
- Heart Imaging Centre, Royal Brompton, and Harefield Hospitals, London, United Kingdom
| | - Alexandros Briasoulis
- University of Iowa Hospitals & Clinics and the National and Kapodistrian University of Athens, Athens, Greece
| | - Polydoros Kampaktsis
- Division of Cardiology, New York University Langone Medical Center, New York, NY, USA
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Chapman-Goetz J, Packham N, Yu K, Gabb G, Potts C, Prosser A, Arstall MA, Burdeniuk C, Chan A, Wilson T, Hotham E, Suppiah V. NPS MedicineWise application in supporting medication adherence in chronic heart failure: an acceptability and feasibility pilot study. Front Digit Health 2023; 5:1274355. [PMID: 38034908 PMCID: PMC10684918 DOI: 10.3389/fdgth.2023.1274355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Heart failure (HF) is an increasing global concern. Despite evidence-based pharmacotherapy, associated morbidity and mortality remain high. This study aimed to assess the acceptability, feasibility, and value of the NPS MedicineWise dose reminder app in a tiered, pharmacist-led intervention to address medication non-adherence in patients with HF. Methods This prospective, single-blinded, randomised controlled trial recruited 55 patients with HF between September 2019 and October 2020. Participants were randomly assigned to either the intervention or control arms. Intervention participants used the app which prompted medication administration at each dosing interval. Control participants received standard care and remained blinded to the app throughout the study. Treatment non-adherence prompted a tiered, pharmacist-led intervention. Comparison of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) at baseline and 6-months measured the app's value in supporting medication adherence. Secondary outcome measures included self-reported medication knowledge, health-related quality of life, psychological wellbeing, and signs and symptoms of HF. Data were analysed using standard statistical tests with significance set at α 0.05. Results Approximately half of respondents reported managing HF and medications better by using the MedicineWise app (Tier 1). Most respondents expressed satisfaction with the in-app messages (Tier 2) and pharmacists' phone calls (Tier 3). The intervention participants demonstrated a significant improvement in the SEAMS between baseline and 6-months follow-up. Discussion It is feasible and potentially of value to use the MedicineWise app with a tiered, pharmacist-led intervention to support medication adherence in patients with HF. Our findings provide clinicians with "real-world" information on the practicality and potential value of using mobile health to support treatment adherence in patients with HF. Trial registration number Australian New Zealand Clinical Trials Registry Clinical trial registration number: ACTRN12619000289112p (http://www.ANZCTR.org.au/ACTRN12619000289112p.aspx).
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Affiliation(s)
- Jessica Chapman-Goetz
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Nerida Packham
- Consumer Medicines Information Services, NPS MedicineWise, Surry Hills, NSW, Australia
| | - Kitty Yu
- e-Health, NPS MedicineWise, Melbourne, VIC, Australia
| | - Genevieve Gabb
- Department of Cardiology, Noarlunga GP Plus Super Clinic, Adelaide, SA, Australia
| | - Cassandra Potts
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Adaire Prosser
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Margaret A. Arstall
- Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Christine Burdeniuk
- Department of Cardiology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Alicia Chan
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Teena Wilson
- Integrated Cardiovascular Clinical Network, Country Health South Australia, Adelaide, SA, Australia
| | - Elizabeth Hotham
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Vijayaprakash Suppiah
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia
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Niranjan B, de Courten MP, Iyngkaran P, Battersby M. Malthusian Trajectory for Heart Failure and Novel Translational Ambulatory Technologies. Curr Cardiol Rev 2023; 19:e240522205193. [PMID: 35611782 PMCID: PMC10280992 DOI: 10.2174/1573403x18666220524145646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION It has been estimated that congestive heart failure (CHF) will reach epidemic proportions and contribute to large unsustainable impacts on health budgets for any cardiovascular condition. Against other major trends in cardiovascular outcomes, readmission and disease burden continue to rise as the demographics shift. METHODS The rise in heart failure with preserved ejection fraction (HFpEF) among elderly women will present new challenges. Gold standard care delivers sustainable and cost-effective health improvements using organised care programs. When coordinated with large hospitals, this can be replicated universally. RESULTS A gradient of outcomes and ambulatory care needs to be shifted from established institutions and shared with clients and community health services, being a sizeable proportion of CHF care. CONCLUSION In this review, we explore health technologies as an emerging opportunity to address gaps in CHF management.
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Affiliation(s)
- Bidargaddi Niranjan
- Digital Health at College of Medicine and Public Health Flinders University & SAHMRI, Adelaide, Australia
| | - Maximilian P de Courten
- Mitchell Institute for Education and Health Policy, Victoria University, 300 Queen St, Melbourne, Australia
| | - Pupalan Iyngkaran
- Mitchell Institute, Victoria University, Melbourne, Australia and Werribee Mercy Sub School, School of Medicine Sydney, The University of Notre Dame Australia, Werribee, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, South Australian Health and Medical Research Institute, Southern Adelaide Local Health Network, Mental Health Division, Flinders Medical Centre, Flinders University, Adelaide, Australia
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Mobile 5P-Medicine Approach for Cardiovascular Patients. SENSORS 2021; 21:s21216986. [PMID: 34770292 PMCID: PMC8587644 DOI: 10.3390/s21216986] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 12/13/2022]
Abstract
Medicine is heading towards personalized care based on individual situations and conditions. With smartphones and increasingly miniaturized wearable devices, the sensors available on these devices can perform long-term continuous monitoring of several user health-related parameters, making them a powerful tool for a new medicine approach for these patients. Our proposed system, described in this article, aims to develop innovative solutions based on artificial intelligence techniques to empower patients with cardiovascular disease. These solutions will realize a novel 5P (Predictive, Preventive, Participatory, Personalized, and Precision) medicine approach by providing patients with personalized plans for treatment and increasing their ability for self-monitoring. Such capabilities will be derived by learning algorithms from physiological data and behavioral information, collected using wearables and smart devices worn by patients with health conditions. Further, developing an innovative system of smart algorithms will also focus on providing monitoring techniques, predicting extreme events, generating alarms with varying health parameters, and offering opportunities to maintain active engagement of patients in the healthcare process by promoting the adoption of healthy behaviors and well-being outcomes. The multiple features of this future system will increase the quality of life for cardiovascular diseases patients and provide seamless contact with a healthcare professional.
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Bakogiannis C, Tsarouchas A, Mouselimis D, Lazaridis C, Theofillogianakos EK, Billis A, Tzikas S, Fragakis N, Bamidis PD, Papadopoulos CE, Vassilikos VP. A Patient-Oriented App (ThessHF) to Improve Self-Care Quality in Heart Failure: From Evidence-Based Design to Pilot Study. JMIR Mhealth Uhealth 2021; 9:e24271. [PMID: 33847599 PMCID: PMC8080140 DOI: 10.2196/24271] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/05/2020] [Accepted: 03/02/2021] [Indexed: 01/01/2023] Open
Abstract
Background Heart failure (HF) remains a major public health challenge, while HF self-care is particularly challenging. Mobile health (mHealth)–based interventions taking advantage of smartphone technology have shown particular promise in increasing the quality of self-care among these patients, and in turn improving the outcomes of their disease. Objective The objective of this study was to co-develop with physicians, patients with HF, and their caregivers a patient-oriented mHealth app, perform usability assessment, and investigate its effect on the quality of life of patients with HF and rate of hospitalizations in a pilot study. Methods The development of an mHealth app (The Hellenic Educational Self-care and Support Heart Failure 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 patients with HF. At the end of alpha development, the app was rated by mHealth experts with the Mobile Application Rating Scale (MARS). The beta version was tested by patients with HF, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF [THe Effect of a Specialized Smartphone app on Heart Failure patients’ quality of self-care, quality of life and hospitalization rate]) was performed to investigate the effect of app use on patients with HF over a 3-month follow-up period. The primary endpoint was patients’ quality of life, which was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 5-level EQ-5D version (EQ-5D-5L). The secondary endpoints were the European Heart Failure Self-care Behavior Scale (EHFScBS) score 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 into the ThessHF app. A total of 14 patients and 5 mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score 2.37 [SD 0.63], where 1 is the best, and a median MARS score of 4.55/5). Finally, 30 patients (male: n=26, 87%) participated in the THESS-HF pilot study (mean age 68.7 [SD 12.4] years). A significant increase in the quality of self-care was noted according to the EHFScBS, which increased by 4.4% (SD 7.2%) (P=.002). The mean quality of life increased nonsignificantly after 3 months according to both KCCQ (mean increase 5.8 [SD 15] points, P=.054) and EQ-5D-5L (mean increase 5.6% [SD 15.6%], P=.06) scores. The hospitalization rate for the follow-up duration was 3%. Conclusions The need for 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 to promote remote self-care support in HF. In this pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multicenter study will investigate the effect of the app use on long-term outcomes in patients with HF.
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Affiliation(s)
- Constantinos Bakogiannis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Mouselimis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Lazaridis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Antonios Billis
- Lab of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stergios Tzikas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis D Bamidis
- Lab of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios P Vassilikos
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Mortara A, Vaira L, Palmieri V, Iacoviello M, Battistoni I, Iacovoni A, Macera F, Pasqualucci D, Bochicchio M, De Maria R. Would You Prescribe Mobile Health Apps for Heart Failure Self-care? An Integrated Review of Commercially Available Mobile Technology for Heart Failure Patients. Card Fail Rev 2020; 6:e13. [PMID: 32537246 PMCID: PMC7277786 DOI: 10.15420/cfr.2019.11] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/05/2019] [Indexed: 02/06/2023] Open
Abstract
Treatment of chronic diseases, such as heart failure, requires complex protocols based on early diagnosis; self-monitoring of symptoms, vital signs and physical activity; regular medication intake; and education of patients and caregivers about relevant aspects of the disease. Smartphones and mobile health applications could be very helpful in improving the efficacy of such protocols, but several barriers make it difficult to fully exploit their technological potential and produce clear clinical evidence of their effectiveness. App suppliers do not help users distinguish between useless/dangerous apps and valid solutions. The latter are few and often characterised by rapid obsolescence, lack of interactivity and lack of authoritative information. Systematic reviews can help physicians and researchers find and assess the ‘best candidate solutions’ in a repeatable manner and pave the way for well-grounded and fruitful discussion on their clinical effectiveness. To this purpose, the authors assess 10 apps for heart failure self-care using the Intercontinental Marketing Statistics score and other criteria, discuss the clinical effectiveness of existing solutions and identify barriers to their use in practice and drivers for change.
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Affiliation(s)
| | - Lucia Vaira
- Department of Engineering for Innovation, University of Salento Lecce, Italy
| | - Vittorio Palmieri
- Department of Cardiac Surgery and Transplantation, AORN dei Colli Monaldi-Cotugno-CTO Naples, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Cardiothoracic Department, University Hospital Policlinico Bari, Italy
| | - Ilaria Battistoni
- SOD Cardiology-Haemodynamics-UTIC, Department of Cardiovascular Sciences, University Hospital Azienda, United Hospitals of Ancona Ancona, Italy
| | - Attilio Iacovoni
- Cardiovascular Department, ASST Pope John XXIII Hospital Bergamo, Italy
| | - Francesca Macera
- Cardiology, Heart Failure and Transplantation, ASST Great Metropolitan Hospital Niguarda Milan, Italy
| | | | - Mario Bochicchio
- Department of Engineering for Innovation, University of Salento Lecce, Italy
| | - Renata De Maria
- National Research Council, Institute of Clinical Physiology, ASST Great Metropolitan Hospital Niguarda Milan, Italy
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