Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
JMIR Mhealth Uhealth. 2021 Apr 13;9(4):e24271. doi: 10.2196/24271.
Heart failure (HF) remains a major public health challenge, while HF self-care is particularly challenging. Mobile health (mHealth)-based interventions taking advantage of smartphone technology have shown particular promise in increasing the quality of self-care among these patients, and in turn improving the outcomes of their disease.
The objective of this study was to co-develop with physicians, patients with HF, and their caregivers a patient-oriented mHealth app, perform usability assessment, and investigate its effect on the quality of life of patients with HF and rate of hospitalizations in a pilot study.
The development of an mHealth app (The Hellenic Educational Self-care and Support Heart Failure app [ThessHF app]) was evidence based, including features based on previous clinically tested mHealth interventions and selected by a panel of HF expert physicians and discussed with patients with HF. At the end of alpha development, the app was rated by mHealth experts with the Mobile Application Rating Scale (MARS). The beta version was tested by patients with HF, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF [THe Effect of a Specialized Smartphone app on Heart Failure patients' quality of self-care, quality of life and hospitalization rate]) was performed to investigate the effect of app use on patients with HF over a 3-month follow-up period. The primary endpoint was patients' quality of life, which was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 5-level EQ-5D version (EQ-5D-5L). The secondary endpoints were the European Heart Failure Self-care Behavior Scale (EHFScBS) score and the hospitalization rate.
A systematic review of mHealth-based HF interventions and expert panel suggestions yielded 18 separate app features, most of which were incorporated into the ThessHF app. A total of 14 patients and 5 mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score 2.37 [SD 0.63], where 1 is the best, and a median MARS score of 4.55/5). Finally, 30 patients (male: n=26, 87%) participated in the THESS-HF pilot study (mean age 68.7 [SD 12.4] years). A significant increase in the quality of self-care was noted according to the EHFScBS, which increased by 4.4% (SD 7.2%) (P=.002). The mean quality of life increased nonsignificantly after 3 months according to both KCCQ (mean increase 5.8 [SD 15] points, P=.054) and EQ-5D-5L (mean increase 5.6% [SD 15.6%], P=.06) scores. The hospitalization rate for the follow-up duration was 3%.
The need for telehealth services and remote self-care management in HF is of vital importance, especially in periods such as the COVID-19 pandemic. We developed a user-friendly mHealth app to promote remote self-care support in HF. In this pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multicenter study will investigate the effect of the app use on long-term outcomes in patients with HF.
心力衰竭（HF）仍然是一个主要的公共卫生挑战，而 HF 自我护理特别具有挑战性。利用智能手机技术的移动医疗（mHealth）干预措施在提高这些患者自我护理质量方面显示出了特别的前景，并进而改善了他们疾病的预后。
本研究旨在与医生、HF 患者及其护理人员共同开发一款面向患者的 mHealth 应用程序，进行可用性评估，并在一项试点研究中调查其对 HF 患者生活质量和住院率的影响。
mHealth 应用程序（希腊教育自我护理和支持心力衰竭应用程序[ThessHF 应用程序]）的开发是基于证据的，包括基于先前经过临床测试的 mHealth 干预措施的功能，并由一组 HF 专家医生选择，并与 HF 患者讨论。在 alpha 开发结束时，mHealth 专家使用移动应用程序评级量表（MARS）对应用程序进行了评分。HF 患者对 beta 版本进行了测试，他们通过使用后系统可用性问卷（PSSUQ）对其设计和内容进行了评分。随后，进行了一项前瞻性试点研究（THESS-HF [专门的智能手机应用程序对心力衰竭患者自我护理质量、生活质量和住院率的影响]），以在 3 个月的随访期间调查应用程序使用对 HF 患者的影响。主要终点是患者的生活质量，用堪萨斯城心肌病问卷（KCCQ）和 5 级 EQ-5D 版本（EQ-5D-5L）进行测量。次要终点是欧洲心力衰竭自我护理行为量表（EHFScBS）评分和住院率。
对 mHealth 为基础的 HF 干预措施的系统评价和专家小组建议产生了 18 个单独的应用程序功能，其中大部分都被纳入 ThessHF 应用程序。共有 14 名患者和 5 名 mHealth 专家对该应用程序进行了评估。结果显示用户体验非常好（总体 PSSUQ 评分 2.37[SD 0.63]，其中 1 为最佳，中位数 MARS 评分为 4.55/5）。最后，30 名患者（男性：n=26，87%）参加了 THESS-HF 试点研究（平均年龄 68.7[SD 12.4]岁）。根据 EHFScBS，自我护理质量显著提高，提高了 4.4%（SD 7.2%）（P=.002）。根据 KCCQ（平均增加 5.8[SD 15]分，P=.054）和 EQ-5D-5L（平均增加 5.6%[SD 15.6%]，P=.06）评分，3 个月后生活质量的平均水平也有了显著提高。随访期间的住院率为 3%。
远程医疗服务和 HF 远程自我护理管理的需求至关重要，尤其是在 COVID-19 大流行等时期。我们开发了一个用户友好的 mHealth 应用程序，以促进 HF 的远程自我护理支持。在这项试点研究中，使用 ThessHF 应用程序与自我护理质量的提高有关。未来的多中心研究将调查该应用程序使用对 HF 患者长期预后的影响。
