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Zhang W, Wang X, Wu X, Tang S. Influence of Comprehensive Nursing Care on Heart Failure Patient Management: A Systematic Review and Meta-Analysis. Cardiology 2024:1-14. [PMID: 39053435 DOI: 10.1159/000540387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Heart failure is a common chronic illness associated with high readmission rates and death. Comprehensive nursing care, management of symptoms, and psychological support are increasingly seen as critical components of successful heart failure therapy. OBJECTIVE This systematic review and meta-analysis aimed to determine the effect of comprehensive nursing care on clinical outcomes and quality of life in heart failure patients. METHODS We searched electronic databases (PubMed, PROSPERO, and Web of Science) for randomised controlled trials and observational studies on comprehensive nursing care treatments for heart failure patients. Data on readmission rates, mortality rates, and quality of life were obtained and examined. RESULTS A total of 693 studies satisfied the inclusion criteria. A meta-analysis found that comprehensive nursing care reduced heart failure-related readmissions considerably when compared to conventional therapy (odds ratio [OR]: 0.77; 95% CI: 0.66-0.88, p = 0.0002). There was a significant difference in all-cause mortality (OR: 0.76; 95% CI: 0.60-0.97, p = 0.03), but comprehensive treatment enhanced quality of life and functional status (standardised mean difference -0.05, 95% CI: -0.21 to 0.10, p = 0.49). CONCLUSION Comprehensive nursing care improves clinical outcomes and quality of life for heart failure patients. This study stresses the need to add comprehensive nurse interventions in normal heart failure treatment programmes.
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Affiliation(s)
- Wenying Zhang
- Department of Cardiology, First People's Hospital of Foshan City, Foshan, China
| | - Xuezhen Wang
- Department of Cardiology, First People's Hospital of Foshan City, Foshan, China
| | - Xuefeng Wu
- Department of Cardiology, First People's Hospital of Foshan City, Foshan, China
| | - Shaomei Tang
- Department of Cardiology, First People's Hospital of Foshan City, Foshan, China
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Li D, Huang LT, Zhang F, Wang JH. Comparative effectiveness of ehealth self-management interventions for patients with heart failure: A Bayesian network meta-analysis. PATIENT EDUCATION AND COUNSELING 2024; 124:108277. [PMID: 38613991 DOI: 10.1016/j.pec.2024.108277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/15/2024] [Accepted: 03/23/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE This study evaluated the effectiveness of electronic self-management support interventions in reducing all-cause mortality, cardiovascular mortality, readmission rates, and HF-related readmission in heart failure patients. METHODS Following the PRISMA-P guidelines and PRISMS taxonomy, we searched Pubmed, Cochrane Library, and Embase for RCTs and trials of electronic health technologies for heart failure interventions. Develop support programs in advance for education, monitoring, reminders, or a combination of these to screen and categorize studies. The Cochrane ROB2 tool was used to assess the risk of bias. RESULTS The monitoring interventions may improve all-cause mortality (OR 0.77, 95% CI 0.63 to 0.93) and cardiovascular mortality (OR 0.75, 95% CI 0.61 to 0.93) compared to usual care. Reminder interventions were associated with significantly reducing readmission rates (OR 0.07, 95% CI 0.00 to 0.94). Mixed interventions were most effective in reducing HF-related readmission rates (OR 0.75, 95% CI 0.56 to 0.99). CONCLUSION Electronic self-management interventions, particularly monitoring and reminders, can potentially improve outcomes of heart failure patients, including reducing all-cause mortality, cardiovascular mortality, and readmission rates. PRACTICE IMPLICATIONS The eHealth model and the combination of self-management are significant for long-term intervention in patients with HF to improve their quality of life and prognosis.
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Affiliation(s)
- Dan Li
- Department of Family Medicine, Shengjing Hospital of China Medical University, Shenyang, PR China
| | - Le-Tian Huang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, PR China
| | - Fei Zhang
- Department of Family Medicine, Shengjing Hospital of China Medical University, Shenyang, PR China
| | - Jia-He Wang
- Department of Family Medicine, Shengjing Hospital of China Medical University, Shenyang, PR China.
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Achury-Saldaña DM, Gonzalez RA, Garcia A, Mariño A, Bohorquez WR. Efficacy of a Telemonitoring System as a Complementary Strategy in the Treatment of Patients With Heart Failure: Randomized Clinical Trial. Comput Inform Nurs 2024; 42:522-529. [PMID: 38657019 DOI: 10.1097/cin.0000000000001115] [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: 04/26/2024]
Abstract
Episodes of decompensation are the main cause of hospital admissions in patients with heart failure. For this reason, the use of mobile apps emerges as an excellent strategy to improve coverage, real-time monitoring, and timeliness of care. ControlVit is an electronic application for early detection of complications studied within the context of a tertiary university hospital. Patients were randomized to the use of ControlVit versus placebo, during a 6-month follow-up. The primary outcome was the difference in numbers of readmissions and deaths for heart failure between both groups. One hundred forty patients were included (intervention = 71, placebo = 69), with an average age of 66 years old; 71% were men. The main etiology of heart failure was ischemic (60%), whereas the main comorbidities were arterial hypertension (44%), dyslipidemia (42%), hypothyroidism (38%), chronic kidney disease (38%), and diabetes mellitus (27%). The primary outcome occurred more frequently in the control group: readmission due to decompensation for heart failure (control group n = 14 vs intervention group n = 3; P = .0081), and death (control group n = 11 vs intervention group n = 3; P = .024). In heart failure patients, ControlVit is a useful and supplementary tool, which reduces hospital admissions due to episodes of decompensation.
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Affiliation(s)
- Diana M Achury-Saldaña
- Author Affiliations: Faculty of Nursing. Pontificia Universidad Javeriana (Ms Achury-Saldaña), Bogota, Colombia; Faculty of Engineering, Pontificia Universidad Javeriana (Dr Gonzalez), Bogota, Colombia; Faculty of Medicine, Pontificia Universidad Javeriana, Bogota (Dr Garcia), Colombia; Pontificia Universidad Javeriana and Heart Failure Clinic Hospital Universitario San Ignacio (Dr Mariño), Bogota, Colombia; and Faculty of Medicine, Pontificia Universidad Javeriana (Dr Bohorquez), Bogota, Colombia
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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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Zhang N, Li Q, Chen S, Wu Y, Xin B, Wan Q, Shi P, He Y, Yang S, Jiang W. Effectiveness of nurse-led electronic health interventions on illness management in patients with chronic heart failure: A systematic review and meta-analysis. Int J Nurs Stud 2024; 150:104630. [PMID: 38029453 DOI: 10.1016/j.ijnurstu.2023.104630] [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: 05/03/2023] [Revised: 10/08/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Chronic heart failure (CHF) is a global health concern, and nurse-led electronic health is an effective management strategy for this condition. OBJECTIVE This systematic review and meta-analysis aimed to identify current patterns and strategies for nurse-led electronic health interventions and examine the effects of nurse-led electronic health interventions for illness management in patients with chronic heart failure. DESIGN This study combined a systematic review and meta-analyses. PARTICIPANTS Twenty-four articles, involving a total of 3660 patients, met the inclusion criteria. METHODS We conducted a large amount of literature review using seven English databases: namely PubMed, Embase, Web of Science, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and SCOPUS, along with three Chinese databases: China National Knowledge Infrastructure(CNKI), WanFang, and the VIP Database. Databases were searched from inception until September 2022. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The studies were independently screened by two reviewers who extracted of the details of those meeting the inclusion criteria study. The Joanna Briggs Institute randomized controlled trial checklist was used to evaluate the methodological value of each incorporation study. Meta-analysis was performed by the use of Manager 5.3. RESULTS The main patterns of electronic health intervention involve smartphone, Internet and specialized (portable) electronic monitoring devices that are used for the illness management of patients with chronic heart failure, mainly including providing self-management guidance for chronic heart failure, and tracking of the patient's health information, providing peer support, and facilizing medical and health resources. The collective findings of 9 studies reported that electronic health interventions improved self-care (MD: 15.30, 95 % CI: 1.59 to 29.02, p < 0.05). Regarding psychosocial well-being outcomes, the incorporative conclusions indicated that electronic health interventions effectively increased quality of life, reduced depression and anxiety, and improved patient satisfaction. Regarding disease-related examinations, electronic health interventions significantly increased cardiac function during the 6-minute walk test. Regarding healthy economic outcomes, electronic health interventions significantly decreased the rehospitalization rate and the cost of medical care services. CONCLUSIONS The findings of this review suggest that nurse-led electronic health interventions involving multiple patterns have an active influence on managing patients with chronic heart failure, including enhancing self-care, and medication adherence; increasing quality of life; reducing depression, anxiety, and improved patient satisfaction; increasing cardiac function, and reducing rehospitalization rate and hospitalization costs. Thus, it could be a promising alternative in the clinical settings. REGISTRATION CRD42023389450.
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Affiliation(s)
- Na Zhang
- School of Nursing, Health Science Center, Xian Jiaotong University, Xi'an, China
| | - Qing Li
- School of Nursing, Health Science Center, Xian Jiaotong University, Xi'an, China
| | - Shuoxin Chen
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yixin Wu
- School of Nursing, Health Science Center, Xian Jiaotong University, Xi'an, China
| | - Bo Xin
- School of Nursing, Health Science Center, Xian Jiaotong University, Xi'an, China
| | - Qiuyuan Wan
- School of Nursing, Health Science Center, Xian Jiaotong University, Xi'an, China
| | - Panpan Shi
- School of Nursing, Health Science Center, Xian Jiaotong University, Xi'an, China
| | - Yuxin He
- School of Nursing, Health Science Center, Xian Jiaotong University, Xi'an, China
| | - Shan Yang
- School of Nursing, Health Science Center, Xian Jiaotong University, Xi'an, China
| | - Wenhui Jiang
- School of Nursing, Health Science Center, Xian Jiaotong University, Xi'an, China.
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Xia J, Brownell NK, Fonarow GC, Ziaeian B. New models for heart failure care delivery. Prog Cardiovasc Dis 2024; 82:70-89. [PMID: 38311306 DOI: 10.1016/j.pcad.2024.01.009] [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: 01/13/2024] [Accepted: 01/13/2024] [Indexed: 02/10/2024]
Abstract
Heart failure (HF) is a common disease with increasing prevalence around the world. There is high morbidity and mortality associated with poorly controlled HF along with increasing costs and strain on healthcare systems due to a high rate of rehospitalization and resource utilization. Despite the establishment of clear evidence-based guideline directed medical therapies (GDMT) proven to improve HF morbidity and mortality, there remains significant clinical inertia to optimizing HF patients on GDMT. Only a minority of HF patients are prescribed on all four classes of GDMT. To bridge the gap between the vulnerable population of HF patients and lifesaving GDMT, HF implementation is of increasing importance. HF implementation involves strategies and techniques to improve GDMT optimization along with other modalities to improve HF management. HF implementation meets patients where they are, including at the time of acute decompensation in the inpatient setting, at the vulnerable discharge stage, and at the chronic management stage in the outpatient setting. Inpatient HF implementation strategies include protocolized rapid titration of GDMT, site-level audit-and-feedback, virtual GDMT optimization teams, and electronic health record notifications and alerts. Discharge HF implementation strategies include education at patient and provider levels, discharge summaries, and HF transitional programs. Outpatient HF implementation strategies include digital innovations such as electronic health record utilization and mobile applications, population level strategies such as registries and clinical dashboards), changes in HF team structure and member roles, remote monitoring with implanted devices and telemonitoring, and hospital at home care model. With a growing population of HF patients, there is an increasing need for novel and creative HF implementation and monitoring methods.
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Affiliation(s)
- Jeffrey Xia
- Department of Medicine David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Nicholas K Brownell
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
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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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Feng C, Wang Y, Li S, Qu Z, Zheng S. Effect of self-management intervention on prognosis of patients with chronic heart failure: A meta-analysis. Nurs Open 2023; 10:2015-2029. [PMID: 36403127 PMCID: PMC10006670 DOI: 10.1002/nop2.1489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 05/29/2022] [Accepted: 11/04/2022] [Indexed: 11/21/2022] Open
Abstract
AIM The purpose of this study is to explore the influence of self-management intervention on four prognostic indicators of readmission rate, mortality rate, self-management ability and quality of life in patients with chronic heart failure. DESIGN A meta-analysis. METHODS This study was selected from the related studies published from January 1999 to January 2022, and was searched by searching five databases: PubMed, Science of Website, China National Knowledge Infrastructure (CNKI), Wan Fang and Wei Pu (VIP). All standardized randomized controlled trial studies were collected, and the quality evaluation and meta-analysis of the included literature were conducted. RESULTS This study included 20 randomized controlled trials involving 3459 patients with chronic heart failure. Meta-analysis results showed that self-management intervention could reduce the readmission rate of patients with chronic heart failure, improved self-management ability of patients, improved quality of life, but there was no statistical significance in mortality.
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Affiliation(s)
- Chunqian Feng
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Yanmei Wang
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Shuang Li
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Zhi Qu
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Shanqing Zheng
- School of Basic Medical Sciences, Henan University, Kaifeng, China
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Rebolledo Del Toro M, Herrera Leaño NM, Barahona-Correa JE, Muñoz Velandia OM, Fernández Ávila DG, García Peña ÁA. Effectiveness of mobile telemonitoring applications in heart failure patients: systematic review of literature and meta-analysis. Heart Fail Rev 2023; 28:431-452. [PMID: 36652096 PMCID: PMC9845822 DOI: 10.1007/s10741-022-10291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 01/19/2023]
Abstract
Close and frequent follow-up of heart failure (HF) patients improves clinical outcomes. Mobile telemonitoring applications are advantageous alternatives due to their wide availability, portability, low cost, computing power, and interconnectivity. This study aims to evaluate the impact of telemonitoring apps on mortality, hospitalization, and quality of life (QoL) in HF patients. We conducted a registered (PROSPERO CRD42022299516) systematic review of randomized clinical trials (RCTs) evaluating mobile-based telemonitoring strategies in patients with HF, published between January 2000 and December 2021 in 4 databases (PubMed, EMBASE, BVSalud/LILACS, Cochrane Reviews). We assessed the risk of bias using the RoB2 tool. The outcome of interest was the effect on mortality, hospitalization risk, and/or QoL. We performed meta-analysis when appropriate; heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses are offered. We screened 900 references and 19 RCTs were included for review. The risk of bias for mortality and hospitalization was mostly low, whereas for QoL was high. We observed a reduced risk of hospitalization due to HF with the use of mobile-based telemonitoring strategies (RR 0.77 [0.67; 0.89]; I2 7%). Non-statistically significant reduction in mortality risk was observed. The impact on QoL was variable between studies, with different scores and reporting measures used, thus limiting data pooling. The use of mobile-based telemonitoring strategies in patients with HF reduces risk of hospitalization due to HF. As smartphones and wirelessly connected devices are increasingly available, further research on this topic is warranted, particularly in the foundational therapy.
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Affiliation(s)
- Martín Rebolledo Del Toro
- Division of Cardiology, Hospital Universitario San Ignacio, Bogota, Colombia.
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogota, Colombia.
| | - Nancy M Herrera Leaño
- Division of Cardiology, Hospital Universitario San Ignacio, Bogota, Colombia
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | - Oscar M Muñoz Velandia
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
- Department of Internal Medicine, Hospital Universitario San Ignacio, Bogota, Colombia
- Colombia GRADE Network, Bogota, Colombia
| | - Daniel G Fernández Ávila
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
- Division of Rheumatology, Hospital Universitario San Ignacio, Bogota, Colombia
| | - Ángel A García Peña
- Division of Cardiology, Hospital Universitario San Ignacio, Bogota, Colombia
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
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Li Z, Long Y, Yang Q, Liu J, Wang Y. Smartphone-based interventions in the secondary prevention of cardiovascular disease: A meta-analysis. Technol Health Care 2023; 31:1935-1948. [PMID: 37125588 DOI: 10.3233/thc-230022] [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] [Indexed: 05/02/2023]
Abstract
BACKGROUND A variety of reviews have indicated the effectiveness of smartphone-based interventions in preventing secondary cardiovascular disease (CVD). However, few studies have focused on clinical outcomes. OBJECTIVE This meta-analysis aimed to evaluate the potential benefits of application interventions and short message service (SMS) interventions on CVD outcomes. METHODS Electronic databases were searched to identify randomized controlled trials (RCT) investigating an application or SMS intervention for secondary CVD prevention. Primary outcomes included major adverse cardiovascular events (MACE), cardiovascular death, and cardiac hospitalization. Secondary outcomes were cardiovascular risk factors (BMI, blood pressure, and cholesterol). RESULTS A total of 26 RCTs were included, with 16 investigating applications and 10 assessing SMS. Overall, there was no significant difference in MACE, cardiovascular death, and cardiac hospitalization when comparing application interventions with usual care, as well as comparing SMS with usual care. Subgroup analysis revealed that patients who received applications without a medical interface had a significantly lower incidence of MACE (OR = 0.56; 95% CI: 0.33, 0.98). Participants who received applications with a medical interface showed a tendency towards higher rates of cardiac hospitalization (OR = 2.03; 95% CI: 0.85, 4.87). Significant reduction in waist circumference (SMD =-0.80; 95% CI: -1.58, -0.03) was found in application interventions compared to usual care; while significant reductions in SBP (SMD =-0.08; 95% CI: -0.15, -0.01) and TC (SMD =-0.31; 95% CI: -0.57, -0.08) were found in SMS interventions compared to usual care. CONCLUSION Smartphone-based interventions, including applications and SMS, have the potential to benefit the secondary prevention of CVD. Applications may reduce the incidence of cardiovascular-related adverse events, while SMS interventions may improve cardiovascular risk factors.
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Affiliation(s)
- Zishuo Li
- Department of Administrative Office, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Yanli Long
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Qing Yang
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Jing Liu
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Yahong Wang
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
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12
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Liu S, Li J, Wan DY, Li R, Qu Z, Hu Y, Liu J. Effectiveness of eHealth Self-management Interventions in Patients With Heart Failure: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e38697. [PMID: 36155484 PMCID: PMC9555330 DOI: 10.2196/38697] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/02/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a common clinical syndrome associated with substantial morbidity, a heavy economic burden, and high risk of readmission. eHealth self-management interventions may be an effective way to improve HF clinical outcomes. OBJECTIVE The aim of this study was to systematically review the evidence for the effectiveness of eHealth self-management in patients with HF. METHODS This study included only randomized controlled trials (RCTs) that compared the effects of eHealth interventions with usual care in adult patients with HF using searches of the EMBASE, PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL databases from January 1, 2011, to July 12, 2022. The Cochrane Risk of Bias tool (RoB 2) was used to assess the risk of bias for each study. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria were used to rate the certainty of the evidence for each outcome of interest. Meta-analyses were performed using Review Manager (RevMan v.5.4) and R (v.4.1.0 x64) software. RESULTS In total, 24 RCTs with 9634 participants met the inclusion criteria. Compared with the usual-care group, eHealth self-management interventions could significantly reduce all-cause mortality (odds ratio [OR] 0.83, 95% CI 0.71-0.98, P=.03; GRADE: low quality) and cardiovascular mortality (OR 0.74, 95% CI 0.59-0.92, P=.008; GRADE: moderate quality), as well as all-cause readmissions (OR 0.82, 95% CI 0.73-0.93, P=.002; GRADE: low quality) and HF-related readmissions (OR 0.77, 95% CI 0.66-0.90, P<.001; GRADE: moderate quality). The meta-analyses also showed that eHealth interventions could increase patients' knowledge of HF and improve their quality of life, but there were no statistically significant effects. However, eHealth interventions could significantly increase medication adherence (OR 1.82, 95% CI 1.42-2.34, P<.001; GRADE: low quality) and improve self-care behaviors (standardized mean difference -1.34, 95% CI -2.46 to -0.22, P=.02; GRADE: very low quality). A subgroup analysis of primary outcomes regarding the enrolled population setting found that eHealth interventions were more effective in patients with HF after discharge compared with those in the ambulatory clinic setting. CONCLUSIONS eHealth self-management interventions could benefit the health of patients with HF in various ways. However, the clinical effects of eHealth interventions in patients with HF are affected by multiple aspects, and more high-quality studies are needed to demonstrate effectiveness.
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Affiliation(s)
- Siru Liu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jili Li
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Ding-Yuan Wan
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Runyi Li
- College of Computer Science, Sichuan University, Chengdu, China
| | - Zhan Qu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yundi Hu
- School of Data Science, Fudan University, Shanghai, China
| | - Jialin Liu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
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Son YJ, Kim EY. The effectiveness and usability of a novel mobile phone-based self-care intervention for patients with heart failure: A mixed-methods pilot study. Eur J Cardiovasc Nurs 2022; 22:254-263. [PMID: 35997293 DOI: 10.1093/eurjcn/zvac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/12/2022]
Abstract
AIM To evaluate the preliminary effectiveness and usability of a novel mobile phone-based self-care intervention (named WithUs) for patients with heart failure (HF). METHODS AND RESULTS We conducted a mixed-methods pilot study with group pretest-posttest design and usability testing. Participants were 26 Korean HF patients (20 men; median age 62 years) who took part in this study after hospital discharge. Data were collected at baseline and after the 24-week intervention, using questionnaires and interviews. The outcome variables were eHealth literacy, disease knowledge, and self-care behaviours. The Wilcoxon signed-rank test was used to compare the pre- and post-intervention results. Thematic analysis was used for analysing qualitative data. The WithUs programme improved the eHealth literacy (p = .005), disease knowledge (p < .001), and self-care behaviours (p < .001) of patients with HF. The median score of total app usability was 4.1 out of 5 (interquartile range = 4.0-5.0). Four themes were identified which complemented the quantitative results. These were increased awareness of the importance of routine self-care behaviours, enhanced motivation toward self-care behaviours, challenges adapting to the new app, and suggestions for improving app adoption. CONCLUSION The app was effective in improving adherence to self-care behaviours, eHealth literacy, and disease knowledge in patients with HF. The usability evaluation results showed that the app is usable and has the potential to support HF patients in self-care. However, the app needs to be modified to improve its adoption.
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Affiliation(s)
- Youn Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Eun Young Kim
- Soonchunhyang University, Cheonan, South Korea, Dongnamgu, Soonchunhyang 6Gil 31
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Reamer C, Chi WN, Gordon R, Sarswat N, Gupta C, Gaznabi S, White VanGompel E, Szum I, Morton-Jost M, Vaughn J, Larimer K, Victorson D, Erwin J, Halasyamani L, Solomonides A, Padman R, Shah NS. Continuous remote patient monitoring in heart failure patients (CASCADE study): mixed methods feasibility protocol (Preprint). JMIR Res Protoc 2022; 11:e36741. [PMID: 36006689 PMCID: PMC9459840 DOI: 10.2196/36741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022] Open
Abstract
Background Heart failure (HF) is a prevalent chronic disease and is associated with increases in mortality and morbidity. HF is a leading cause of hospitalizations and readmissions in the United States. A potentially promising area for preventing HF readmissions is continuous remote patient monitoring (CRPM). Objective The primary aim of this study is to determine the feasibility and preliminary efficacy of a CRPM solution in patients with HF at NorthShore University HealthSystem. Methods This study is a feasibility study and uses a wearable biosensor to continuously remotely monitor patients with HF for 30 days after discharge. Eligible patients admitted with an HF exacerbation at NorthShore University HealthSystem are being recruited, and the wearable biosensor is placed before discharge. The biosensor collects physiological ambulatory data, which are analyzed for signs of patient deterioration. Participants are also completing a daily survey through a dedicated study smartphone. If prespecified criteria from the physiological data and survey results are met, a notification is triggered, and a predetermined electronic health record–based pathway of telephonic management is completed. In phase 1, which has already been completed, 5 patients were enrolled and monitored for 30 days after discharge. The results of phase 1 were analyzed, and modifications to the program were made to optimize it. After analysis of the phase 1 results, 15 patients are being enrolled for phase 2, which is a calibration and testing period to enable further adjustments to be made. After phase 2, we will enroll 45 patients for phase 3. The combined results of phases 1, 2, and 3 will be analyzed to determine the feasibility of a CRPM program in patients with HF. Semistructured interviews are being conducted with key stakeholders, including patients, and these results will be analyzed using the affective adaptation of the technology acceptance model. Results During phase 1, of the 5 patients, 2 (40%) were readmitted during the study period. The study completion rate for phase 1 was 80% (4/5), and the study attrition rate was 20% (1/5). There were 57 protocol deviations out of 150 patient days in phase 1 of the study. The results of phase 1 were analyzed, and the study protocol was adjusted to optimize it for phases 2 and 3. Phase 2 and phase 3 results will be available by the end of 2022. Conclusions A CRPM program may offer a low-risk solution to improve care of patients with HF after hospital discharge and may help to decrease readmission of patients with HF to the hospital. This protocol may also lay the groundwork for the use of CRPM solutions in other groups of patients considered to be at high risk. International Registered Report Identifier (IRRID) DERR1-10.2196/36741
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Affiliation(s)
- Courtney Reamer
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Wei Ning Chi
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL, United States
| | - Robert Gordon
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Nitasha Sarswat
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Charu Gupta
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Safwan Gaznabi
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Emily White VanGompel
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Izabella Szum
- Home and Hospice Services, NorthShore University HealthSystem, Evanston, IL, United States
| | - Melissa Morton-Jost
- Home and Hospice Services, NorthShore University HealthSystem, Evanston, IL, United States
| | | | | | - David Victorson
- Department of Medical Social Sciences, Northwestern University, Evanston, IL, United States
| | - John Erwin
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Lakshmi Halasyamani
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Anthony Solomonides
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL, United States
| | - Rema Padman
- Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Nirav S Shah
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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15
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Al-Naher A, Downing J, Scott KA, Pirmohamed M. Factors affecting patient and physician engagement in remote healthcare for heart failure: a systematic review (Preprint). JMIR Cardio 2021; 6:e33366. [PMID: 35384851 PMCID: PMC9021943 DOI: 10.2196/33366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/18/2021] [Accepted: 01/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Ahmed Al-Naher
- Institute of Systems Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Jennifer Downing
- Institute of Systems Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Kathryn A Scott
- Institute of Systems Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Munir Pirmohamed
- Institute of Systems Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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