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Huang X, Lu L, Pan X, Lai TF, Huang D, Liu Z. Smartphone Use by Caregivers for Patients With Heart Failure During Hospitalization: An Investigation. J Patient Exp 2024; 11:23743735241273658. [PMID: 39119514 PMCID: PMC11307366 DOI: 10.1177/23743735241273658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
This study investigated the use of smartphones by family caregivers for hospitalized patients with chronic heart failure (CHF). In total, 120 patients and their unpaid family caregivers participated in this study. The caregivers were divided into two groups based on the perceived importance of smartphones in patient care. Both groups completed the General Demographic Information Survey, Problematic Mobile Phone Use Questionnaire, Barthel Index Scale, Modified Early Warning Score (MEWS), Johns Hopkins Fall Risk Assessment Tool (JH-FRAT), and Family Burden Scale of Diseases Survey. Moreover, left ventricular ejection fraction (LVEF) and stroke volume (SV) were measured in all participants. The age of hospitalized patients with CHF was correlated with the Barthel Index Scale, MEWS, and JH-FRAT, whereas LVEF and SV were correlated with MEWS. The important group had a much higher financial burden than the nonimportant group. Linear regression analysis revealed that financial burden and mental health had a remarkable impact on the content of mobile calls about treatment. Furthermore, the economic status of family caregivers determined the importance of smartphone calls in the care of patients with CHF during hospitalization.
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Affiliation(s)
- XianNan Huang
- Department of Cardiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Youjiang Medical University for Nationalities, Baise, P.R. China
| | - Liuxue Lu
- Department of Cardiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Youjiang Medical University for Nationalities, Baise, P.R. China
| | - Xingshou Pan
- Department of Cardiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Youjiang Medical University for Nationalities, Baise, P.R. China
| | - Teng Fang Lai
- Department of Cardiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Youjiang Medical University for Nationalities, Baise, P.R. China
| | - Da Huang
- Department of Cardiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Youjiang Medical University for Nationalities, Baise, P.R. China
| | - ZhengJiang Liu
- Department of Cardiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Youjiang Medical University for Nationalities, Baise, P.R. China
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Lalthanthuami H, Ramamoorthy L, Satheesh S, Subrahmanyam D, Zayaraz G. Assessment of Heart Failure Post-discharge Management Strategies, Needs and Acceptance of Mobile Application-based Remote Patient Management in South India. J Patient Exp 2024; 11:23743735241253557. [PMID: 38756453 PMCID: PMC11097740 DOI: 10.1177/23743735241253557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
The demand for digital platforms in managing heart failure (HF) is expected to increase with promising effects on readmission and health expenditure. The study aims to explore current post-discharge management strategies and identify the need and acceptance of digital platforms, to ensure the development of a user-friendly mobile application for HF patients. Using a cross-sectional analytical research design, 90 consecutive patients diagnosed with HF who were discharged from a Tertiary Care Center were enrolled. Tele-interview was conducted using a self-developed and validated tool. The mean age of participants was 55.54 ± 10.33 years. The participants' adherence to HF management strategies was low in terms of physical exercise and weight monitoring. More than one-third were willing to self-record their measurements and use a mobile application. The common mobile application features requested were medication information/reminder (88.6%), health education (84.3%), chat with nurses (84.3%), physical activity (81.4%), symptoms (78.6%), diet (78.6%) and weight management (72.9%). The findings from this initial phase of mobile development are expected to help leverage better development of digital interventions for HF patients.
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Affiliation(s)
- H.T. Lalthanthuami
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Lakshmi Ramamoorthy
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - D.K.S. Subrahmanyam
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - G. Zayaraz
- Department of Computer Science and Engineering, Puducherry Technological University, Puducherry, India
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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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Yoon M, Lee S, Choi JY, Jung MH, Youn JC, Shim CY, Choi JO, Kim EJ, Kim H, Yoo BS, Son YJ, Choi DJ. Effectiveness of a Smartphone App-Based Intervention With Bluetooth-Connected Monitoring Devices and a Feedback System in Heart Failure (SMART-HF Trial): Randomized Controlled Trial. J Med Internet Res 2024; 26:e52075. [PMID: 38683665 PMCID: PMC11091801 DOI: 10.2196/52075] [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: 08/22/2023] [Revised: 11/07/2023] [Accepted: 03/12/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Current heart failure (HF) guidelines recommend a multidisciplinary approach, discharge education, and self-management for HF. However, the recommendations are challenging to implement in real-world clinical settings. OBJECTIVE We developed a mobile health (mHealth) platform for HF self-care to evaluate whether a smartphone app-based intervention with Bluetooth-connected monitoring devices and a feedback system can help improve HF symptoms. METHODS In this prospective, randomized, multicenter study, we enrolled patients 20 years of age and older, hospitalized for acute HF, and who could use a smartphone from 7 tertiary hospitals in South Korea. In the intervention group (n=39), the apps were automatically paired with Bluetooth-connected monitoring devices. The patients could enter information on vital signs, HF symptoms, diet, medications, and exercise regimen into the app daily and receive feedback or alerts on their input. In the control group (n=38), patients could only enter their blood pressure, heart rate, and weight using conventional, non-Bluetooth devices and could not receive any feedback or alerts from the app. The primary end point was the change in dyspnea symptom scores from baseline to 4 weeks, assessed using a questionnaire. RESULTS At 4 weeks, the change in dyspnea symptom score from baseline was significantly greater in the intervention group than in the control group (mean -1.3, SD 2.1 vs mean -0.3, SD 2.3; P=.048). A significant reduction was found in body water composition from baseline to the final measurement in the intervention group (baseline level mean 7.4, SD 2.5 vs final level mean 6.6, SD 2.5; P=.003). App adherence, which was assessed based on log-in or the percentage of days when symptoms were first observed, was higher in the intervention group than in the control group. Composite end points, including death, rehospitalization, and urgent HF visits, were not significantly different between the 2 groups. CONCLUSIONS The mobile-based health platform with Bluetooth-connected monitoring devices and a feedback system demonstrated improvement in dyspnea symptoms in patients with HF. This study provides evidence and rationale for implementing mobile app-based self-care strategies and feedback for patients with HF. TRIAL REGISTRATION ClinicalTrials.gov NCT05668000; https://clinicaltrials.gov/study/NCT05668000.
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Affiliation(s)
- Minjae Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seognam, Republic of Korea
| | - Seonhwa Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Oh Choi
- Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Byung-Su Yoo
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Woonju, Republic of Korea
| | - Yeon Joo Son
- Healthcare Business Department, AI/DX Convergence Business Group, KT, Seoul, Republic of Korea
| | - Dong-Ju Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seognam, Republic of Korea
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Keogh A, Brennan C, Johnston W, Dickson J, Leslie SJ, Burke D, Megyesi P, Caulfield B. Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study. JMIR Form Res 2024; 8:e52442. [PMID: 38427410 PMCID: PMC10959238 DOI: 10.2196/52442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centered design development of a digital tool to support self-care of HF, the next step was to pilot the tool over a period of time to establish people's acceptance of it in practice. OBJECTIVE This study aims to conduct an observational pilot study to examine the usability, adherence, and feasibility of a digital health tool for HF within the Irish health care system. METHODS A total of 19 participants with HF were provided with a digital tool comprising a mobile app and the Fitbit Charge 4 and Aria Air smart scales for a period of 6 months. Changes to their self-care were assessed before and after the study with the 9-item European HF Self-care Behavior Scale (EHFScBS) and the Minnesota Living with HF Questionnaire (MLwHFQ) using a Wilcoxon signed rank test. After the study, 3 usability questionnaires were implemented and descriptively analyzed: the System Usability Scale (SUS), Wearable Technology Motivation Scale (WTMS), and Comfort Rating Scale (CRS). Participants also undertook a semistructured interview regarding their experiences with the digital tool. Interviews were analyzed deductively using the Theoretical Domains Framework. RESULTS Participants wore their devices for an average of 86.2% of the days in the 6-month testing period ranging from 40.6% to 98%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (P=.10 and P=.70, respectively, where P>.03, after a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (IQR 55.0-60.0; range 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (median 6.0, IQR 5.0-7.0; range 1.0-7.0), whereas the Fitbit was considered very comfortable as demonstrated by the low CRS results (median 0.0, IQR 0.0-0.0; range 0.0-2.0). According to participant interviews, the digital tool supported self-management through increased knowledge, improved awareness, decision-making, and confidence in their own data, and improving their social support through a feeling of comfort in being watched. CONCLUSIONS The digital health tool demonstrated high levels of adherence and acceptance among participants. Although the SUS results suggest low usability, this may be explained by participants uncertainty that they were using it fully, rather than it being unusable, especially given the experiences documented in their interviews. The digital tool targeted key self-management behaviors and feelings of social support. However, a number of changes to the tool, and the health service, are required before it can be implemented at scale. A full-scale feasibility trial conducted at a wider level is required to fully determine its potential effectiveness and wider implementation needs.
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Affiliation(s)
- Alison Keogh
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Carol Brennan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - William Johnston
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
| | - Jane Dickson
- Physiotherapy Department, Beacon Hospital, Dublin, Ireland
- Cardiology, Beacon Hospital, Dublin, Ireland
| | | | - David Burke
- Cardiology, Beacon Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Peter Megyesi
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Brian Caulfield
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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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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Masterson Creber R, Dodson JA, Bidwell J, Breathett K, Lyles C, Harmon Still C, Ooi SY, Yancy C, Kitsiou S. Telehealth and Health Equity in Older Adults With Heart Failure: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2023; 16:e000123. [PMID: 37909212 DOI: 10.1161/hcq.0000000000000123] [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] [Indexed: 11/02/2023]
Abstract
Enhancing access to care using telehealth is a priority for improving outcomes among older adults with heart failure, increasing quality of care, and decreasing costs. Telehealth has the potential to increase access to care for patients who live in underresourced geographic regions, have physical disabilities or poor access to transportation, and may not otherwise have access to cardiologists with expertise in heart failure. During the COVID-19 pandemic, access to telehealth expanded, and yet barriers to access, including broadband inequality, low digital literacy, and structural barriers, prevented many of the disadvantaged patients from getting equitable access. Using a health equity lens, this scientific statement reviews the literature on telehealth for older adults with heart failure; provides an overview of structural, organizational, and personal barriers to telehealth; and presents novel interventions that pair telemedicine with in-person services to mitigate existing barriers and structural inequities.
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Achury Saldaña DM, Rodríguez Parrado IY, González RA. Cardio SEM: A Novel Approach for a Traffic Light System for Heart Failure Warning Signs. Comput Inform Nurs 2023; 41:673-678. [PMID: 37165833 DOI: 10.1097/cin.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Existing literature on the follow-up of heart failure patients with warning signs shows that it is necessary to increase patients' knowledge and of seeking help in a timely manner. This suggests an opportunity to implement strategies that integrate technology to visualize the risk of decompensation. This article studies the acceptance of Cardio Sem, a traffic light system mobile application for patients with heart failure. A descriptive, observational pilot study was performed with 23 outpatients belonging to a heart failure program. For 4 weeks, patients used Cardio Sem, which allows visualizing the risk of decompensation through a series of questions that patients must answer daily and provides guidance for managing signs and symptoms of decompensation. A technology acceptance questionnaire was applied to all patients, resulting in acceptance of the application, especially in the dimensions that emphasized perceived usefulness (100%), social influence (100%), and behavioral intent (99.8%). Cardio Sem is useful for early detection of symptoms that allow for early response to complications. Acceptance of the application by patients and its ease of use present the possibility to implement it as a complementary tool to promote self-care and effective management of symptoms.
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Affiliation(s)
- Diana Marcela Achury Saldaña
- Author Affiliations : School of Nursing, Pontificia Universidad Javeriana (Ms Achury Saldaña); Clínica Palermo (Ms Parrado); and Engineering Faculty, Pontificia Universidad Javeriana (Dr González), Bogotá, Colombia
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9
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Madujibeya I, Lennie TA, Pelzel J, Moser DK. Patients' Experiences Using a Mobile Health App for Self-Care of Heart Failure in a Real-World Setting: Qualitative Analysis. JMIR Form Res 2023; 7:e39525. [PMID: 37581912 PMCID: PMC10466157 DOI: 10.2196/39525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Publicly available patient-focused mobile health (mHealth) apps are being increasingly integrated into routine heart failure (HF)-related self-care. However, there is a dearth of research on patients' experiences using mHealth apps for self-care in real-world settings. OBJECTIVE The purpose of this study was to explore patients' experiences using a commercially available mHealth app, OnTrack to Health, for HF self-care in a real-world setting. METHODS Patient satisfaction, measured with a 5-point Likert scale, and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients' responses was conducted with the qualitative software Atlas.ti (version 8; ATLAS.ti Scientific Software Development GmbH). RESULTS Patients (median age 64, IQR 57-71 years; 17/23, 74% male) used OnTrack to Health for a median 164 (IQR 51-640) days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Five themes emerged from the responses to the open-ended questions: (1) features that enhanced self-care of HF (medication tracker, graphic performance feedback and automated alerts, secured messaging features, and HF self-care education); (2) perceived benefits (provided assurance of safety, improved HF self-care, and decreased hospitalization rates); (3) challenges with using apps for self-care (giving up previous self-care strategies); (4) facilitators (perceived ease of use and availability of technical support); and (5) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features). CONCLUSIONS Patients were satisfied with using OnTrack to Health for self-care. They perceived the features of the app as valuable tools for improving self-care ability and decreasing hospitalization rates. The development of apps in collaboration with end users is essential to ensure high-quality patient experiences related to app use for self-care.
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Affiliation(s)
- Ifeanyi Madujibeya
- Research and Interventions for Cardiovascular Health Heart Program, College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Terry A Lennie
- Center for Nutritional Sciences, College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Jamie Pelzel
- Heart and Vascular Center, CentraCare, St Cloud, MN, United States
| | - Debra K Moser
- Research and Interventions for Cardiovascular Health Heart Program, College of Nursing, University of Kentucky, Lexington, KY, United States
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Yokota T, Fukushima A, Tsuchihashi-Makaya M, Abe T, Takada S, Furihata T, Ishimori N, Fujino T, Kinugawa S, Ohta M, Kakinoki S, Yokota I, Endoh A, Yoshino M, Tsutsui H. The AppCare-HF randomized clinical trial: a feasibility study of a novel self-care support mobile app for individuals with chronic heart failure. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:325-336. [PMID: 37538146 PMCID: PMC10393880 DOI: 10.1093/ehjdh/ztad032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 04/23/2023] [Accepted: 05/09/2023] [Indexed: 08/05/2023]
Abstract
Aims We evaluated a self-care intervention with a novel mobile application (app) in chronic heart failure (HF) patients. To facilitate patient-centred care in HF management, we developed a self-care support mobile app to boost HF patients' optimal self-care. Methods and results We conducted a multicentre, randomized, controlled study evaluating the feasibility of the self-care support mobile app designed for use by HF patients. The app consists of a self-monitoring assistant, education, and automated alerts of possible worsening HF. The intervention group received a tablet personal computer (PC) with the self-care support app installed, and the control group received a HF diary. All patients performed self-monitoring at home for 2 months. Their self-care behaviours were evaluated by the European Heart Failure Self-Care Behaviour Scale. We enrolled 24 outpatients with chronic HF (ages 31-78 years; 6 women, 18 men) who had a history of HF hospitalization. During the 2 month study period, the intervention group (n = 13) showed excellent adherence to the self-monitoring of each vital sign, with a median [interquartile range (IQR)] ratio of self-monitoring adherence for blood pressure, body weight, and body temperature at 100% (92-100%) and for oxygen saturation at 100% (91-100%). At 2 months, the intervention group's self-care behaviour score was significantly improved compared with the control group (n = 11) [median (IQR): 16 (16-22) vs. 28 (20-36), P = 0.02], but the HF Knowledge Scale, the General Self-Efficacy Scale, and the Short Form-8 Health Survey scores did not differ between the groups. Conclusion The novel mobile app for HF is feasible.
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Affiliation(s)
- Takashi Yokota
- Corresponding author. Tel: +81 11 706 6001, Fax: +81 11 706 7613,
| | - Arata Fukushima
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo 060-8638, Japan
- Asabu Heart and Gastrointestinal Clinic, 1-1, Kita-40 Nishi-4, Kita-Ku, Sapporo 001-0040, Japan
| | - Miyuki Tsuchihashi-Makaya
- School of Nursing, Kitasato University, 2-1-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0329, Japan
| | - Takahiro Abe
- Department of Rehabilitation, Hokkaido University Hospital, Kita-14 Nishi-5, Kita-Ku, Sapporo 060-8648, Japan
| | - Shingo Takada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo 060-8638, Japan
| | - Takaaki Furihata
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo 060-8638, Japan
| | - Naoki Ishimori
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo 060-8638, Japan
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
- Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
| | - Masayuki Ohta
- Research and Development Group, Hitachi, Ltd., 1-280, Higashi-Koigakubo, Kokubunji, Tokyo 185-8601, Japan
| | - Shigeo Kakinoki
- Department of Cardiology, Otaru Kyokai Hospital, 6-15, 1-Chome, Suminoe, Otaru, Hokkaido 047-8510, Japan
| | - Isao Yokota
- Department of Biostatistics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo 060-8638, Japan
| | - Akira Endoh
- Department of Medical Informatics, Hokkaido University Hospital, Kita-14 Nishi-5, Kita-Ku, Sapporo 060-8648, Japan
| | - Masanori Yoshino
- Center of Innovation, Hokkaido University, Kita-21 Nishi-11, Kita-Ku, Sapporo 001-0021, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
- Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
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Rafati F, Pourshahrokhi N, Bahador RS, Dastyar N, Mehralizadeh A. The effect of mobile app-based self-care training on the quality of marital relations and the severity of menopausal symptoms in postmenopausal women: a clinical trial study in Iran. BMC Womens Health 2023; 23:306. [PMID: 37308866 DOI: 10.1186/s12905-023-02463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/07/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Educational interventions for self-care are a necessary solution to help postmenopausal women properly deal with menopausal problems. The present study aimed to investigate the effect of self-care training using an application on the quality of marital relations and the severity of menopausal symptoms in postmenopausal women in Iran. METHODS In this study, 60 postmenopausal women selected using the convenience sampling method were divided into two groups, intervention and control, using simple random allocation (lottery). The intervention group used the menopause self-care application for eight weeks in addition to routine care, but the control group only received the routine care. The Menopause Rating Scale (MRS) and the Perceived Relationship Quality Components (PRQC) questionnaire were completed in two stages, before and immediately after eight weeks, in both groups. Data were analyzed using SPSS software (version 16), descriptive (mean and standard deviation), and inferential (ANCOVA and Bonferroni post hoc) statistics. RESULTS The ANCOVA results showed that the use of the menopause self-care application decreased the severity of the participants' menopause symptoms (P = 0.001) and improved the quality of their marital relations (P = 0.001). CONCLUSION Implementation of a self-care training program through the application helped improve the quality of marital relations and reduce the severity of postmenopausal women's symptoms, so it can be used as an effective method to prevent the unpleasant consequences of menopause. TRIAL REGISTRATION The present study was registered at https://fa.irct.ir/ on 2021-05-28 (registration number: IRCT20201226049833N1).
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Affiliation(s)
- Foozieh Rafati
- School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran
| | | | - Raziyeh Sadat Bahador
- School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Neda Dastyar
- Department of Midwifery, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran.
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Zolezzi M, Elhakim A, Hejazi T, Kattan L, Mustafa D, Aboelbaha S, Homs S, Al Hamarneh YN. Translating and piloting a cardiovascular risk assessment and management online tool using mobile technology. Saudi Pharm J 2023; 31:492-498. [PMID: 37063447 PMCID: PMC10102547 DOI: 10.1016/j.jsps.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Background Cardiovascular disease (CVD) risk assessment and management (RAM) services face many challenges and barriers in the community. Mobile technology offers the opportunity to empower patients and improve access to health prevention strategies to overcome these barriers. However, there is limited information on the availability and use of CVDRAM-related mobile technology in the Arabic language. Objectives To pilot test an Arabic version of a CVDRAM application among potential end-users accessing community pharmacy services in Qatar. Methodology Translation of an established cardiovascular risk calculator (EPI·RxISK™) into the Arabic language was conducted. The English/Arabic version of the calculator was tested by potential end-users, consisting of a sample of community pharmacists (CRxs) and members of the public (MOP) accessing community pharmacy services. Semi-structured interviews were conducted based on the quality attributes of the Mobile Application Rating Scale (MARS). Data were analyzed using deductive content analysis. Results A total of 10 CRxs and 5 MOP were interviewed. Five themes emerged to describe the EPI·RxISK™ calculator: Engagement, Functionality, Attractiveness, Education, and Responsiveness. For the most part, positive subthemes were associated with each of these themes. The functionality and educational themes had some negative subthemes. Conclusion End-users of the EPI·RxISK™ calculator had mostly positive descriptors that were aligned with all five quality attributes of the web and mobile applications.
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Heart Failure-Smart Life: a randomized controlled trial of a mobile app for self-management in patients with heart failure. BMC Cardiovasc Disord 2023; 23:7. [PMID: 36624373 PMCID: PMC9827017 DOI: 10.1186/s12872-023-03039-8] [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: 07/27/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND It is an important strategy for healthcare providers to support heart failure patients with comprehensive aspects of self-management. A practical alternative to a comprehensive and user-friendly self-management program for heart failure patients is needed. This study aimed to develop a mobile self-management app program for patients with heart failure and to identify the impact of the program. METHODS We developed a mobile app, called Heart Failure-Smart Life. The app was to provide educational materials using a daily health check-up diary, Q & A, and 1:1 chat, considering individual users' convenience. An experimental study was employed using a randomized controlled trial to evaluate the effects of the program in patients with heart failure from July 2018 to June 2019. The experimental group (n = 36) participated in using the mobile app that provided feedback on their self-management and allowed monitoring of their daily health status by cardiac nurses for 3 months, and the control group (n = 38) continued to undergo their usual care. The differences in the physical, psychosocial, and behavioral factors between the two groups over time were analyzed using the analysis of covariance. RESULTS After 3 months of intervention, significant differences between experimental and control groups were shown in the New York Heart Association functional class (p = 0.003) and cardiac diastolic function (p = 0.024). The improvements over time in the experimental group tended to be higher than those in the control group in considered variables. However, no changes in psychosocial and behavioral variables were observed between the groups over time. CONCLUSIONS This study provides evidence that the mobile app program may provide benefits to its users, specifically improvements of symptom and cardiac diastolic function in patients with heart failure. Healthcare providers can effectively and practically guide and support patients with heart failure using comprehensive and convenient self-management tools such as smartphone apps.
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de Sousa MM, Lopes CT, Almeida AAM, Almeida TDCF, Gouveia BDLA, Oliveira SHDS. Development and validation of a mobile application for heart failure patients self-care. Rev Esc Enferm USP 2023; 56:e20220315. [PMID: 36625659 PMCID: PMC10081647 DOI: 10.1590/1980-220x-reeusp-2022-0315en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/04/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To develop and verify content and face validity evidence of a mobile application prototype for heart failure patients self-care. METHOD Study of technological development based on Contextualized Instructional Design. In the validation stage, six cardiology specialist nurses evaluated the content through the Suitability Assessment of Materials and 13 people with heart failure underwent face validity assessment, through content validity index. Data were analyzed using descriptive statistics. RESULTS The prototype of the application, called "Tum Tum", has an interface and free navigation screens covering the concept of heart failure, its causes, symptoms and signs, diagnosis, and treatment. It has a mosaic with educational guidelines, resources for early recognition of signs of clinical decompensation, registration for body weight control, reminders for medication use, consultation and exam schedule. The technology proved to be adequate among specialists and the target audience. CONCLUSION It was possible to develop and validate the content and face of the "Tum Tum" application prototype, which demonstrates the potential to promote self-care in people with heart failure.
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Affiliation(s)
| | - Camila Takáo Lopes
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil
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Ali Sherazi B, Laeer S, Krutisch S, Dabidian A, Schlottau S, Obarcanin E. Functions of mHealth Diabetes Apps That Enable the Provision of Pharmaceutical Care: Criteria Development and Evaluation of Popular Apps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:64. [PMID: 36612402 PMCID: PMC9819585 DOI: 10.3390/ijerph20010064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Personal digital health apps for managing diabetes should include functions that enable the provision of pharmaceutical care services and allow within-app communication with pharmacists and other healthcare providers, thereby improving patient outcomes. The primary aim of this study was to assess the functions of diabetes apps that were relevant to providing pharmaceutical care services (i.e., medication management, adherence, non-pharmacological management, interoperability, and communication). Sixteen criteria related to pharmaceutical care were developed and then used to assess ten popular diabetes apps. The highest numbers of pharmaceutical care criteria were met by the apps Diabetes:M and mySugr (11 criteria); Contour™Diabetes, Dario Health, and OneTouch Reveal® (ten); and DiabetesConnect and ESYSTA (nine); followed by Glucose Buddy (eight), meala (seven), and lumind (three). The most prevalent functions were related to promoting adherence and non-pharmacological management, but most criteria relevant to medication management were lacking. Five apps allowed within-app communication between patients and healthcare professionals (HCPs); however, no app included communication with pharmacists. High-quality diabetes apps are powerful tools to support pharmaceutical care and remotely monitor diabetes patients. Improvements are needed as they often lack many medication management functions, including within-app communication with HCPs (especially pharmacists). To maximize diabetes app use and improve outcomes, app developers should consider including pharmacists alongside other healthcare providers when customizing app designs.
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Affiliation(s)
- Bushra Ali Sherazi
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Universitätsstraße 1, 40225 Düsseldorf, Germany
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Pakistan
| | - Stephanie Laeer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | | | - Armin Dabidian
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Sabina Schlottau
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Emina Obarcanin
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Universitätsstraße 1, 40225 Düsseldorf, Germany
- Department of Pharmacy, National University Singapore, 18 Science Drive 4, Singapore 117559, Singapore
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Bylappa BK, Kamath DY, Josephine IS, Shaikh J, Kamath A, Rioniz P, Kulkarni S, Varghese K, Xavier D. Usability and feasibility assessment of a smartphone application (Suhriday) for heart failure self-care remote monitoring in an Indian tertiary health care setting: a pilot mixed-methods study. BMJ Open 2022; 12:e056962. [PMID: 36002201 PMCID: PMC9413287 DOI: 10.1136/bmjopen-2021-056962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/OBJECTIVES Remote monitoring as a component of chronic heart failure (CHF) management programmes has demonstrated utility in reducing the risk of rehospitalisation and mortality. There is little evidence on mobile health app facilitated remote monitoring in India. We conducted a pilot usability and feasibility assessment of a smartphone-based application (Suhriday) to remotely monitor patients with CHF. METHODS We used a mixed-methods design. Usability testing consisted of the think-aloud approach followed by semistructured in-depth interviews (SSIs) and a satisfaction questionnaire. Feasibility testing was done using acceptability and user satisfaction questionnaires in addition to SSIs. We trained five purposively sampled patients with CHF (based on health literacy and gender) and their caregivers (n=10) in self-care monitoring and app use. Usability was assessed using metrics such as task completion, time required for task completion and user satisfaction using Brooke's System Usability Scale (SUS). Content analysis of the transcripts with deductive coding was performed for both usability and feasibility interviews. The number and types of medical alerts transmitted through the app were captured and escalated to the treating team. RESULTS Critical tasks involving (1) opening the app and identifying task list, (2) reporting blood pressure, weight, heart rate and fluid intake and (3) reporting symptoms were completed within 60 s by four patients. Median (IQR) SUS score was 85 (75-92.5) indicating high level of usability. There were 62 alerts from four patients over 4 weeks, with 36 (58.1%) excess fluid intake alerts and 16 (25.8%) blood pressure variations being the most frequent. One participant had challenges using the app and was monitored through active phone calls. CONCLUSION Overall usability and satisfaction with Suhriday were good and we were able to remotely manage patients. However, patients with limited health literacy and those facing technological challenges required active structured telephone support.
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Affiliation(s)
| | - Deepak Y Kamath
- Pharmacology, St John's Medical College Hospital, Bangalore, Karnataka, India
- Division of Clinical Research and Training, St John's Research Institute, Bangalore, Karnataka, India
| | | | - Jabraan Shaikh
- Cardiology, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Anant Kamath
- National Institute of Advanced Studies, Indian Institute of Science, Bangalore, Karnataka, India
| | - Preethi Rioniz
- Pharmacology, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Shruthi Kulkarni
- Medicine, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Kiron Varghese
- Cardiology, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Denis Xavier
- Pharmacology, St John's Medical College Hospital, Bangalore, Karnataka, India
- Division of Clinical Research and Training, St John's Research Institute, Bangalore, Karnataka, India
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Madujibeya I, Lennie T, Aroh A, Chung ML, Moser D. Measures of Engagement With mHealth Interventions in Patients With Heart Failure: Scoping Review. JMIR Mhealth Uhealth 2022; 10:e35657. [PMID: 35994345 PMCID: PMC9446141 DOI: 10.2196/35657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/04/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite the potential of mobile health (mHealth) interventions to facilitate the early detection of signs of heart failure (HF) decompensation and provide personalized management of symptoms, the outcomes of such interventions in patients with HF have been inconsistent. As engagement with mHealth is required for interventions to be effective, poor patient engagement with mHealth interventions may be associated with mixed evidence. It is crucial to understand how engagement with mHealth interventions is measured in patients with HF, and the effects of engagement on HF outcomes. Objective In this review, we aimed to describe measures of patient engagement with mHealth interventions and the effects of engagement on HF outcomes. Methods We conducted a systematic literature search in 7 databases for relevant studies published in the English language from 2009 to September 2021 and reported the descriptive characteristics of the studies. We used content analysis to identify themes that described patient engagement with mHealth interventions in the qualitative studies included in the review. Results We synthesized 32 studies that operationalized engagement with mHealth interventions in 4771 patients with HF (3239/4771, 67.88%, male), ranging from a sample of 7 to 1571 (median 53.3) patients, followed for a median duration of 90 (IQR 45-180) days. Patient engagement with mHealth interventions was measured only quantitatively based on system usage data in 72% (23/32) of the studies, only qualitatively based on data from semistructured interviews and focus groups in 6% (2/32) of studies, and by a combination of both quantitative and qualitative data in 22% (7/32) of studies. System usage data were evaluated using 6 metrics of engagement: number of physiological parameters transmitted (19/30, 63% studies), number of HF questionnaires completed (2/30, 7% studies), number of log-ins (4/30, 13% studies), number of SMS text message responses (1/30, 3% studies), time spent (5/30, 17% studies), and the number of features accessed and screen viewed (4/30, 13% studies). There was a lack of consistency in how the system usage metrics were reported across studies. In total, 80% of the studies reported only descriptive characteristics of system usage data. The emotional, cognitive, and behavioral domains of patient engagement were identified through qualitative studies. Patient engagement levels ranged from 45% to 100% and decreased over time. The effects of engagement on HF knowledge, self-care, exercise adherence, and HF hospitalization were inconclusive. Conclusions The measures of patient engagement with mHealth interventions in patients with HF are underreported and lack consistency. The application of inferential analytical methods to engagement data is extremely limited. There is a need for a working group on mHealth that may consolidate the previous operational definitions of patient engagement into an optimal and standardized measure.
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Affiliation(s)
- Ifeanyi Madujibeya
- College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Terry Lennie
- College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Adaeze Aroh
- Department of Public Health, College of Health Professions, Slippery Rock University, Slippery Rock, PA, United States
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Debra Moser
- College of Nursing, University of Kentucky, Lexington, KY, United States
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Rezaei S, Vaezi F, Afzal G, Naderi N, Mehralian G. Medication Adherence and Health Literacy in Patients with Heart Failure: A Cross-Sectional Survey in Iran. Health Lit Res Pract 2022; 6:e191-e199. [PMID: 35943838 PMCID: PMC9359808 DOI: 10.3928/24748307-20220718-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Heart failure is a costly condition with high morbidity and mortality rates in low- and middle-income countries. Nonadherence to prescribed therapies can lead to severe problems such as poorer health outcomes, higher health care expenditures, increased hospitalizations, and even higher mortality rates in patients with advanced heart disease. Objective: The aim of the present study is to investigate medication adherence and the association between medication adherence and health literacy in Iranian patients with heart failure. Methods: This study was conducted in the heart failure outpatient clinic of Shahid Rajaee Cardiovascular, Medical, and Research Center in Tehran, Iran. Medical records and validated questionnaires were used to collect the necessary information on the survey variables, including sociodemographic characteristics, medication adherence, and health literacy, for a total of 250 patients with heart failure. Stepwise logistic regression analysis was performed to identify the variables that independently and significantly predicted medication nonadherence. Key Results: The results showed that most patients with heart failure had low medication adherence. Some factors, including gender, health literacy, and duration of illness, were associated with adherence. The study results showed a positive association between higher health literacy and better medication adherence. Conclusion: In view of the results, further studies on heart failure are needed to investigate other factors related to medication adherence and health literacy level to achieve better disease management and improve patients' treatment adherence. [HLRP: Health Literacy Research and Practice. 2022;6(3):e191–e199.] Plain Language Summary: This study investigated the relationship between medication adherence and health literacy in Iranian patients with heart failure. The results showed that most patients had inadequate health literacy. Moreover, it showed a significant and positive relationship between health literacy and medication adherence.
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Affiliation(s)
| | | | | | | | - Gholamhossein Mehralian
- Address correspondence to Gholamhossein Mehralian, PhD, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Hashemi Highway, Valiasr Avenue, P.O. Box 14155-6153, Tehran, Iran;
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Kompala T, Neinstein AB. Smart Insulin Pens: Advancing Digital Transformation and a Connected Diabetes Care Ecosystem. J Diabetes Sci Technol 2022; 16:596-604. [PMID: 33435704 PMCID: PMC9294591 DOI: 10.1177/1932296820984490] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the first commercially available smart insulin pens, the predominant insulin delivery device for millions of people living with diabetes is now coming into the digital age. Smart insulin pens (SIPs) have the potential to reshape a connected diabetes care ecosystem for patients, providers, and health systems. Existing SIPs are enhanced with real-time wireless connectivity, digital dose capture, and integration with personalized dosing decision support. Automatic dose capture can promote effective retrospective review of insulin dose data, particularly when paired with glucose data. Patients, providers, and diabetes care teams will be able to make increasingly data-driven decisions and recommendations, in real time, during scheduled visits, and in a more continuous, asynchronous care model. As SIPs continue to progress along the path of digital transformation, we can expect additional benefits: iteratively improving software, machine learning, and advanced decision support. Both these technological advances, and future care delivery models with asynchronous interactions, will depend on easy, open, and continuous data exchange between the growing number of diabetes devices. SIPs have a key role in modernizing diabetes care for a large population of people living with diabetes.
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Affiliation(s)
- Tejaswi Kompala
- Department of Medicine, University of
California, San Francisco, San Francisco, CA, USA
- Tejaswi Kompala, MD, University of
California, San Francisco, 1700 Owens Street, Suite 541, San Francisco, CA
94158, USA.
| | - Aaron B. Neinstein
- Department of Medicine, University of
California, San Francisco, San Francisco, CA, USA
- Center for Digital Health Innovation,
University of California, San Francisco, San Francisco, CA, USA
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Khedraki R, Srivastava AV, Bhavnani SP. Framework for Digital Health Phenotypes in Heart Failure. Heart Fail Clin 2022; 18:223-244. [DOI: 10.1016/j.hfc.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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de Sousa MM, Lopes CT, Almeida AAM, Almeida TDCF, Gouveia BDLA, Oliveira SHDS. Desenvolvimento e validação de aplicativo móvel para o autocuidado de pessoas com insuficiência cardíaca. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0315pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RESUMO Objetivo: Desenvolver e verificar as evidências de validade de conteúdo e face de um protótipo de aplicativo móvel para o autocuidado de pessoas com insuficiência cardíaca. Método: Estudo de desenvolvimento tecnológico baseado no Design Instrucional Contextualizado. Na etapa de validação, seis enfermeiros especialistas em cardiologia avaliaram o conteúdo por meio do Suitability Assessment of Materials e 13 pessoas com insuficiência cardíaca realizaram avaliação de face, pelo índice de validade de conteúdo. Os dados foram analisados por meio de estatística descritiva. Resultados: O protótipo do aplicativo, nomeado “Tum Tum”, possui interface e telas de livre navegação que abordam o conceito da insuficiência cardíaca, causas, sinais e sintomas, diagnóstico e tratamento. Apresenta mosaico com orientações educativas, recursos para o reconhecimento precoce de sinais de descompensação clínica, registro para controle do peso corporal, lembretes para o uso de medicamentos, agenda de consultas e exames. A tecnologia mostrou-se adequada entre especialistas e público-alvo. Conclusão: Foi possível desenvolver e validar o conteúdo e face do protótipo do aplicativo “Tum Tum”, que demonstra potencial para promover o autocuidado em pessoas com insuficiência cardíaca.
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22
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Fezza GC, Sansone S, Nolan RP. Therapeutic components of digital counseling for chronic heart failure. Front Psychiatry 2022; 13:888524. [PMID: 36339841 PMCID: PMC9631313 DOI: 10.3389/fpsyt.2022.888524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Task force statements support the use of cognitive behavioral therapy (CBT) and motivational interviewing (MI) to promote self-care in chronic heart failure (CHF) patients. Digital counseling interventions have the potential to complement conventional programs. However, therapeutic components of digital programs associated with improved outcomes are not clearly established. OBJECTIVE Identify therapeutic components of the Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT) protocol that were associated with improved health-related quality of life (HRQL). MATERIALS AND METHODS Ordinal logistic regression was used to identify therapeutic components of the CHF-CePPORT protocol. The primary outcome was the 12-month Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) tertile. Logistic regressions determined the association between 12-month KCCQ-OS tertile, using logon hours for key segments of the protocol, modality of content delivery, and clinical themes. RESULTS A total of 117 patients were enrolled in the e-Counseling arm of the CHF-CePPORT trial. Median age was 60 years (IQR 52-69). Total logon hours in the initial 4-month segment of CHF-CePPORT (Sessions 1-16) was associated with increased 12-month KCCQ-OS tertile (Odds Ratio, OR = 1.31, 95% CI, 1.1-1.5, P = 0.001). Within sessions 1-16, improved KCCQ-OS was associated with logon hours for self-assessment tools/trackers (OR = 1.49, 95% CI, 1.1-2.0, P = 0.007), and videos (OR = 1.57, 95% CI, 1.03-2.4, P = 0.04), but not for CHF information pages. CONCLUSION This study highlights the importance of using evidence-based guidelines from CBT and MI as core components of digital counseling, delivered through videos and interactive tools/trackers, to improve HRQL with CHF.
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Affiliation(s)
- Gabriel C Fezza
- Behavioral Cardiology Research Unit, University Health Network (UHN), Toronto, ON, Canada.,Faculty of Health, York University, Toronto, ON, Canada
| | - Stephanie Sansone
- Behavioral Cardiology Research Unit, University Health Network (UHN), Toronto, ON, Canada.,Faculty of Health, York University, Toronto, ON, Canada
| | - Robert P Nolan
- Behavioral Cardiology Research Unit, University Health Network (UHN), Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Jezrawi R, Balakumar S, Masud R, Gabizon I, Bhagirath V, Varughese J, Brown M, Trottier D, Schwalm JD, McGillion M, Alvarez E, Lokker C. Patient and physician perspectives on the use and outcome measures of mHealth apps: Exploratory survey and focus group study. Digit Health 2022; 8:20552076221102773. [PMID: 35646382 PMCID: PMC9136450 DOI: 10.1177/20552076221102773] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Factors that physicians and patients consider when making decisions about
using or recommending health apps are not well understood. We explored these
factors to better assess how to support such decision making. Methods We conducted an exploratory cross-sectional study in Ontario using
qualitative focus groups and quantitative surveys. 133 physicians and 94
community dwelling adults completed online surveys and we held two focus
groups of nine community dwelling participants who had cardiovascular risk
factors and an interest in using mHealth apps. Quantitative survey data was
analyzed descriptively. Focus groups were audio-recorded and transcribed
verbatim prior to inductive thematic content analysis. We integrated the
results from the surveys and focus groups to understand factors that
influence physicians' and patients' selection and use of such apps. Results Physicians recommend apps to patients but the level of evidence they prefer
to use to guide selection did not align with what they were currently using.
Patients trusted recommendations and reviews from medical organizations and
healthcare professionals when selecting apps and were motivated to continue
using apps when they supported goal setting and tracking, data sharing,
decision making, and empowerment. Conclusions The findings highlight the significance of evaluating mHealth apps based on
metrics that patients and physicians value beyond usage and clinical outcome
data. Patients engage with apps that support them in confidently managing
their health. Increased training and awareness of apps and creating a more
rigorous evidence base showing the value of apps to supporting health goals
will support greater adoption and acceptance of mHealth apps.
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Affiliation(s)
- Rita Jezrawi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Sarmini Balakumar
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Rafia Masud
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Itzhak Gabizon
- Department of Cardiology, Soroka University Medical Center, University of the Negev, Beer-Sheva, Israel
| | - Vinai Bhagirath
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Jobin Varughese
- Department of Family Medicine, McMaster University, Hamilton, Canada.,Queen Square Family Health Team, Brampton, Canada
| | - Michael Brown
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Dan Trottier
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - J D Schwalm
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | | | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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24
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Diaz-Skeete YM, McQuaid D, Akinosun AS, Ekerete I, Carragher N, Carragher L. Analysis of Apps With a Medication List Functionality for Older Adults With Heart Failure Using the Mobile App Rating Scale and the IMS Institute for Healthcare Informatics Functionality Score: Evaluation Study. JMIR Mhealth Uhealth 2021; 9:e30674. [PMID: 34726613 PMCID: PMC8596242 DOI: 10.2196/30674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 12/21/2022] Open
Abstract
Background Managing the care of older adults with heart failure (HF) largely centers on medication management. Because of frequent medication or dosing changes, an app that supports these older adults in keeping an up-to-date list of medications could be advantageous. During the COVID-19 pandemic, HF outpatient consultations are taking place virtually or by telephone. An app with the capability to share a patient’s medication list with health care professionals before consultation could support clinical efficiency, for example, by reducing consultation time. However, the influence of apps on maintaining an up-to-date medication history for older adults with HF in Ireland remains largely unexplored. Objective The aims of this review are twofold: to review apps with a medication list functionality and to assess the quality of the apps included in the review using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scale. Methods A systematic search of apps was conducted in June 2019 using the Google Play Store and iTunes App Store. The MARS was used independently by 4 researchers to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality score. Results Google Play and iTunes App store searches identified 483 potential apps (292 from Google Play and 191 from iTunes App stores). A total of 6 apps (3 across both stores) met the inclusion criteria. Of the 6 apps, 4 achieved an acceptable MARS score (3/5). The Medisafe app had the highest overall MARS score (4/5), and the Medication List & Medical Records app had the lowest overall score (2.5/5). On average, the apps had 8 functions based on the IMS functionality criteria (range 5-11). A total of 2 apps achieved the maximum score for number of features (11 features) according to the IMS Institute for Healthcare Informatics functionality score, and 2 scored the lowest (5 features). Peer-reviewed publications were identified for 3 of the apps. Conclusions The quality of current apps with medication list functionality varies according to their technical aspects. Most of the apps reviewed have an acceptable MARS objective quality (ie, the overall quality of an app). However, subjective quality (ie, satisfaction with the apps) was poor. Only 3 apps are based on scientific evidence and have been tested previously. A total of 2 apps featured all the IMS Institute for Healthcare Informatics functionalities, and half did not provide clear instructions on how to enter medication data, did not display vital parameter data in an easy-to-understand format, and did not guide users on how or when to take their medication.
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Affiliation(s)
| | | | | | | | - Natacha Carragher
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.,Alcohol, Drugs and Addictive Behaviours, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Lucia Carragher
- NetwellCASALA Advanced Research Centre, Dundalk Institute of Technology, Dundalk, Ireland
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25
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Singhal A, Cowie MR. Digital Health: Implications for Heart Failure Management. Card Fail Rev 2021; 7:e08. [PMID: 34035953 PMCID: PMC8135017 DOI: 10.15420/cfr.2020.28] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022] Open
Abstract
Digital health encompasses the use of information and communications technology and the use of advanced computing sciences in healthcare. This review covers the application of digital health in heart failure patients, focusing on teleconsultation, remote monitoring and apps and wearables, looking at how these technologies can be used to support care and improve outcomes. Interest in and use of these technologies, particularly teleconsultation, have been accelerated by the coronavirus disease 2019 pandemic. Remote monitoring of heart failure patients, to identify those patients at high risk of hospitalisation and to support clinical stability, has been studied with mixed results. Remote monitoring of pulmonary artery pressure has a consistent effect on reducing hospitalisation rates for patients with moderately severe symptoms and multiparameter monitoring shows promise for the future. Wearable devices and apps are increasingly used by patients for health and lifestyle support. Some wearable technologies have shown promise in AF detection, and others may be useful in supporting self-care and guiding prognosis, but more evidence is required to guide their optimal use. Support for patients and clinicians wishing to use these technologies is important, along with consideration of data validity and privacy and appropriate recording of decision-making.
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Affiliation(s)
| | - Martin R Cowie
- Royal Brompton Hospital London, UK
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London London, UK
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26
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Silva-Cardoso J, Juanatey JRG, Comin-Colet J, Sousa JM, Cavalheiro A, Moreira E. The Future of Telemedicine in the Management of Heart Failure Patients. Card Fail Rev 2021; 7:e11. [PMID: 34136277 PMCID: PMC8201465 DOI: 10.15420/cfr.2020.32] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/22/2021] [Indexed: 12/20/2022] Open
Abstract
Telemedicine (TM) is potentially a way of escalating heart failure (HF) multidisciplinary integrated care. Despite the initial efforts to implement TM in HF management, we are still at an early stage of its implementation. The coronavirus disease 2019 pandemic led to an increased utilisation of TM. This tendency will probably remain after the resolution of this threat. Face-to-face medical interventions are gradually transitioning to the virtual setting by using TM. TM can improve healthcare accessibility and overcome geographic inequalities. It promotes healthcare system efficiency gains, and improves patient self-management and empowerment. In cooperation with human intervention, artificial intelligence can enhance TM by helping to deal with the complexities of multicomorbidity management in HF, and will play a relevant role towards a personalised HF patient approach. Artificial intelligence-powered/telemedical/heart team/multidisciplinary integrated care may be the next step of HF management. In this review, the authors analyse TM trends in the management of HF patients and foresee its future challenges within the scope of HF multidisciplinary integrated care.
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Affiliation(s)
- José Silva-Cardoso
- Faculty of Medicine, University of PortoPorto, Portugal
- São João University Hospital CentrePorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
| | | | - Josep Comin-Colet
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de LlobregatBarcelona, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L’Hospitalet de LlobregatBarcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - José Maria Sousa
- São João University Hospital CentrePorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
| | - Ana Cavalheiro
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
- Department of Physical Rehabilitation, Centro Hospitalar do PortoPorto, Portugal
| | - Emília Moreira
- Faculty of Medicine, University of PortoPorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
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27
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Moscato F, Gross C, Maw M, Schlöglhofer T, Granegger M, Zimpfer D, Schima H. The left ventricular assist device as a patient monitoring system. Ann Cardiothorac Surg 2021; 10:221-232. [PMID: 33842216 PMCID: PMC8033254 DOI: 10.21037/acs-2020-cfmcs-218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022]
Abstract
Technological progress of left ventricular assist devices (LVADs) towards rotary blood pumps and the optimization of medical management contributed to the significant improvements in patient survival as well as LVAD support duration. Even though LVAD therapy is now well-established for end-stage heart failure patients, the long-term occurrence of adverse events (AE) such as bleeding, infection or stroke, still represent a relevant burden. An early detection of AE, before onset of major symptoms, can lead to further optimization of patient treatment and thus mitigate the burden of AE. Continuous patient monitoring facilitates identification of pathophysiological states and allows anticipation of AE to improve patient management. In this paper, methods, algorithms and possibilities for continuous patient monitoring based on LVAD data are reviewed. While experience with continuous LVAD monitoring is currently limited to a few centers worldwide, the pace of developments in this field is fast and we expect these technologies to have a global impact on the well-being of LVAD patients.
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Affiliation(s)
- Francesco Moscato
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christoph Gross
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Martin Maw
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schlöglhofer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marcus Granegger
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Heinrich Schima
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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28
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Mortara A, Margonato D. Proactive management of heart failure by digital health: is monitoring of invasive pulmonary artery pressure the
Holy Grail
? Eur J Heart Fail 2020; 22:1920-1922. [DOI: 10.1002/ejhf.1966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Andrea Mortara
- Heart Failure Unit and Department of Cardiology Policlinico di Monza Monza Italy
| | - Davide Margonato
- Heart Failure Unit and Department of Cardiology Policlinico di Monza Monza Italy
- Department of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
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