Bezerra Giordan Leticia, Tong Huong Ly, Atherton John J, Ronto Rimante, Chau Josephine, Kaye David, Shaw Tim, Chow Clara, Laranjo Liliana
Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Department of Health Sciences, Macquarie University, Sydney, Australia.
JMIR Cardio. 2022 Mar 31;6(1):e33839. doi: 10.2196/33839.
Heart failure self-management is essential to avoid decompensation and readmissions. Mobile apps seem promising in supporting heart failure self-management, and there has been a rapid growth in publications in this area. However, to date, systematic reviews have mostly focused on remote monitoring interventions using nonapp types of mobile technologies to transmit data to health care providers, rarely focusing on supporting patient self-management of heart failure.
This study aims to systematically review the evidence on the effect of heart failure self-management apps on health outcomes, patient-reported outcomes, and patient experience.
Four databases (PubMed, Embase, CINAHL, and PsycINFO) were searched for studies examining interventions that comprised a mobile app targeting heart failure self-management and reported any health-related outcomes or patient-reported outcomes or perspectives published from 2008 to December 2021. The studies were independently screened. The risk of bias was appraised using Cochrane tools. We performed a narrative synthesis of the results. The protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42020158041).
A total of 28 articles (randomized controlled trials [RCTs]: n=10, 36%), assessing 23 apps, and a total of 1397 participants were included. The most common app features were weight monitoring (19/23, 83%), symptom monitoring (18/23, 78%), and vital sign monitoring (15/23, 65%). Only 26% (6/23) of the apps provided all guideline-defined core components of heart failure self-management programs: education, symptom monitoring, medication support, and physical activity support. RCTs were small, involving altogether 717 participants, had ≤6 months of follow-up, and outcomes were predominantly self-reported. Approximately 20% (2/10) of RCTs reported a significant improvement in their primary outcomes: heart failure knowledge (P=.002) and self-care (P=.004). One of the RCTs found a significant reduction in readmissions (P=.02), and 20% (2/10) of RCTs reported higher unplanned clinic visits. Other experimental studies also found significant improvements in knowledge, self-care, and readmissions, among others. Less than half of the studies involved patients and clinicians in the design of apps. Engagement with the intervention was poorly reported, with only 11% (3/28) of studies quantifying app engagement metrics such as frequency of use over the study duration. The most desirable app features were automated self-monitoring and feedback, personalization, communication with clinicians, and data sharing and integration.
Mobile apps may improve heart failure self-management; however, more robust evaluation studies are needed to analyze key end points for heart failure. On the basis of the results of this review, we provide a road map for future studies in this area.
心力衰竭自我管理对于避免失代偿和再入院至关重要。移动应用程序在支持心力衰竭自我管理方面似乎很有前景，并且该领域的出版物数量迅速增长。然而，迄今为止，系统评价大多集中在使用非应用类型的移动技术进行远程监测干预，以将数据传输给医疗保健提供者，很少关注支持患者对心力衰竭的自我管理。
本研究旨在系统评价心力衰竭自我管理应用程序对健康结局、患者报告结局和患者体验影响的证据。
检索了四个数据库（PubMed、Embase、CINAHL和PsycINFO），以查找研究针对心力衰竭自我管理的移动应用程序干预措施并报告2008年至2021年12月期间发表的任何健康相关结局、患者报告结局或观点的研究。对这些研究进行独立筛选。使用Cochrane工具评估偏倚风险。我们对结果进行了叙述性综合分析。该方案已在PROSPERO（国际系统评价前瞻性注册库；CRD42020158041）上注册。
共纳入28篇文章（随机对照试验[RCT]：n = 10，36%），评估了23个应用程序，共有1397名参与者。最常见的应用程序功能是体重监测（19/23，83%）、症状监测（18/23，78%）和生命体征监测（15/23，65%）。只有26%（6/23）的应用程序提供了心力衰竭自我管理计划的所有指南定义的核心组成部分：教育、症状监测、药物支持和身体活动支持。随机对照试验规模较小，总共涉及717名参与者，随访时间≤6个月，结局主要是自我报告的。大约20%（2/10）的随机对照试验报告其主要结局有显著改善：心力衰竭知识（P = .002）和自我护理（P = .004）。其中一项随机对照试验发现再入院率显著降低（P = .02），20%（2/10）的随机对照试验报告计划外门诊就诊次数增加。其他实验研究也发现知识、自我护理和再入院等方面有显著改善。不到一半的研究让患者和临床医生参与应用程序的设计。对干预措施的参与情况报告不佳，只有11%（3/28）的研究对应用程序参与指标进行了量化，如研究期间的使用频率。最理想的应用程序功能是自动自我监测和反馈、个性化、与临床医生沟通以及数据共享和整合。
移动应用程序可能会改善心力衰竭自我管理；然而，需要更有力的评估研究来分析心力衰竭的关键终点。基于本综述的结果，我们为该领域的未来研究提供了路线图。
