School of Nursing, Capital Medical University, Beijing, China.
J Med Internet Res. 2024 Jun 11;26:e52341. doi: 10.2196/52341.
BACKGROUND: Coronary heart disease (CHD) is the leading cause of death globally. In addition, 20% to 40% of the patients with CHD have comorbid mental health issues such as anxiety or depression, affecting the prognosis and quality of life (QoL). Mobile health (mHealth) interventions have been developed and are widely used; however, the evidence for the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD is currently ambiguous. OBJECTIVE: In this study, we aimed to assess the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD. METHODS: We searched the Cochrane Library, PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure, and Wanfang databases from inception to August 12, 2023. Eligible studies were randomized controlled trials that involved patients with CHD who received mHealth interventions and that reported on QoL, anxiety, or depression outcomes. We used the Cochrane risk-of-bias tool for randomized trials to evaluate the risk of bias in the studies, ensuring a rigorous and methodologically sound analysis. Review Manager (desktop version 5.4; The Cochrane Collaboration) and Stata MP (version 17.0; StataCorp LLC) were used to conduct the meta-analysis. The effect size was calculated using the standardized mean difference (SMD) and its 95% CI. RESULTS: The meta-analysis included 23 studies (5406 participants in total) and showed that mHealth interventions significantly improved QoL in patients with CHD (SMD 0.49, 95% CI 0.25-0.72; Z=4.07; P<.001) as well as relieved their anxiety (SMD -0.46, 95% CI -0.83 to -0.08; Z=2.38; P=.02) and depression (SMD -0.34, 95% CI -0.56 to -0.12; Z=3.00; P=.003) compared to usual care. The subgroup analyses indicated a significant effect favoring the mHealth intervention on reducing anxiety and depressive symptoms compared to usual care, especially when (1) the intervention duration was ≥6 months (P=.04 and P=.001), (2) the mHealth intervention was a simple one (only 1 mHealth intervention was used) (P=.01 and P<.001), (3) it was implemented during the COVID-19 pandemic (P=.04 and P=.01), (4) it was implemented in low- or middle-income countries (P=.01 and P=.02), (5) the intervention focused on mental health (P=.01 and P=.007), and (6) adherence rates were high (≥90%; P=.03 and P=.002). In addition, comparing mHealth interventions to usual care, there was an improvement in QoL when (1) the mHealth intervention was a simple one (P<.001), (2) it was implemented in low- or middle-income countries (P<.001), and (3) the intervention focused on mental health (P<.001). CONCLUSIONS: On the basis of the existing evidence, mHealth interventions might be effective in improving QoL and reducing anxiety and depression in patients with CHD. However, large sample, high-quality, and rigorously designed randomized controlled trials are needed to provide further evidence. TRIAL REGISTRATION: PROSPERO CRD42022383858; https://tinyurl.com/3ea2npxf.
背景：冠心病（CHD）是全球范围内的主要死亡原因。此外，20%至 40%的 CHD 患者伴有焦虑或抑郁等精神健康问题，这会影响预后和生活质量（QoL）。已经开发并广泛使用了移动健康（mHealth）干预措施；然而，目前关于 mHealth 干预措施对 CHD 患者 QoL、焦虑和抑郁影响的证据尚不清楚。
目的：本研究旨在评估 mHealth 干预措施对 CHD 患者 QoL、焦虑和抑郁的影响。
方法：我们从建库至 2023 年 8 月 12 日，在 Cochrane 图书馆、PubMed、Embase、CINAHL、Web of Science、中国国家知识基础设施和万方数据库中搜索了符合条件的研究。纳入的研究为涉及接受 mHealth 干预并报告 QoL、焦虑或抑郁结果的 CHD 患者的随机对照试验。我们使用 Cochrane 随机试验偏倚风险工具评估研究的偏倚风险，以确保进行严格和方法学合理的分析。使用 Review Manager（桌面版 5.4；Cochrane 协作网）和 Stata MP（版本 17.0；StataCorp LLC）进行荟萃分析。使用标准化均数差（SMD）及其 95%置信区间（CI）来计算效应量。
结果：荟萃分析纳入了 23 项研究（共 5406 名参与者），结果表明，mHealth 干预措施可显著改善 CHD 患者的 QoL（SMD 0.49，95%CI 0.25-0.72；Z=4.07；P<.001），同时缓解其焦虑（SMD -0.46，95%CI -0.83 至 -0.08；Z=2.38；P=.02）和抑郁（SMD -0.34，95%CI -0.56 至 -0.12；Z=3.00；P=.003），与常规护理相比。亚组分析表明，与常规护理相比，mHealth 干预措施在降低焦虑和抑郁症状方面具有显著效果，尤其是在以下情况下（1）干预持续时间≥6 个月（P=.04 和 P=.001），（2）mHealth 干预措施简单（仅使用 1 种 mHealth 干预措施）（P=.01 和 P<.001），（3）在 COVID-19 大流行期间实施（P=.04 和 P=.01），（4）在中低收入国家实施（P=.01 和 P=.02），（5）干预重点是心理健康（P=.01 和 P=.007），（6）依从率较高（≥90%）（P=.03 和 P=.002）。此外，与常规护理相比，当 mHealth 干预措施简单（P<.001）、在中低收入国家实施（P<.001）或干预重点是心理健康（P<.001）时，患者的 QoL 也有所改善。
结论：基于现有证据，mHealth 干预措施可能对改善 CHD 患者的 QoL 和减轻焦虑和抑郁有效。然而，需要开展更大样本量、高质量和严格设计的随机对照试验，以提供进一步的证据。
试验注册：PROSPERO CRD42022383858；https://tinyurl.com/3ea2npxf。
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