Mobile technology in the self-management of heart failure: a systematic review and a qualitative study

Background: Self-management is essential to improve heart failure outcomes. Aims: Review evidence on mobile application (app) interventions for heart failure self-management and understand patients' and clinicians' perspectives on their use. Methods: A systematic review and a qualitative study were conducted. A systematic search was performed in Medline, Embase, CINAHL, and PsycINFO to identify primary studies published between 2008 and 2020. The review included experimental and qualitative studies evaluating apps for heart failure self-management, focusing on any health-related outcomes or patients' perspectives. The qualitative study comprised semi-structured interviews with heart failure patients and clinicians to understand their perspectives on using apps in heart failure self-management. Transcripts were thematically analysed. Results: The systematic review showed that the use of apps in heart failure self-management is still in an early stage of research. Nineteen articles were included, with most studies being quasi-experimental or qualitative, and only four published randomized controlled trials (RCTs). Improvement in self-care behaviour was the most consistent finding among experimental studies, although there was inconsistency in the self-care components tested. Findings from included qualitative studies revealed that the most preferred app features included: automated and personalized self-monitoring and feedback, education, liquid intake tracking, and integration with other health-related platforms to enable data sharing and communication with clinicians and family. The qualitative study was conducted through face-to-face interviews of 6 patients and 6 clinicians in a primary care clinic and expanded on these results by highlighting the relevance of app features supporting patient-reported outcomes and mental health, and by reinforcing that patient-clinician communication and automated and personalized feedback are essential to improve knowledge, motivation, and self-management skills. Conclusion: Apps seem promising in improving heart failure self-management. Highly valued features by patients and clinicians included automated and personalized self-monitoring and feedback, ability to track and manage other health conditions, and patient-clinician communication -- abstract.