Effect of a Smartphone-Based App on the Quality of Life of Patients With Heart Failure: Randomized Controlled Trial

Benchmarking the clinical outcomes of Healthentia SaMD in chronic disease management: a systematic literature review comparison

Background

Software as a Medical Device (SaMD) and mobile health (mHealth) applications have revolutionized the healthcare landscape in the areas of remote patient monitoring (RPM) and digital therapeutics (DTx). These technological advancements offer a range of benefits, from improved patient engagement and real-time monitoring, to evidence-based personalized treatment plans, risk prediction, and enhanced clinical outcomes.

Objective

The systematic literature review aims to provide a comprehensive overview of the status of SaMD and mHealth apps, highlight the promising results, and discuss what is the potential of these technologies for improving health outcomes.

Methods

The research methodology was structured in two phases. In the first phase, a search was conducted in the EuropePMC (EPMC) database up to April 2024 for systematic reviews on studies using the PICO model. The study population comprised individuals afflicted by chronic diseases; the intervention involved the utilization of mHealth solutions in comparison to any alternative intervention; the desired outcome focused on the efficient monitoring of patients. Systematic reviews fulfilling these criteria were incorporated within the framework of this study. The second phase of the investigation involved identifying and assessing clinical studies referenced in the systematic reviews, followed by the synthesis of their risk profiles and clinical benefits.

Results

The results are rather positive, demonstrating how SaMDs can support the management of chronic diseases, satisfying patient safety and performance requirements. The principal findings, after the analysis of the extraction table referring to the 35 primary studies included, are: 24 studies (68.6%) analyzed clinical indications for type 2 diabetes mellitus (T2DM), six studies (17.1%) analyzed clinical indications for cardiovascular conditions, three studies (8.7%) analyzed clinical indications for cancer, one study (2.8%) analyzed clinical indications for chronic obstructive pulmonary disease (COPD), and one study (2.8%) analyzed clinical indications for hypertension. No severe adverse events related to the use of mHealth were reported in any of them. However, five studies (14.3%) reported mild adverse events (related to hypoglycemia, uncontrolled hypertension), and four studies (11.4%) reported technical issues with the devices (related to missing patient adherence requirements, Bluetooth unsuccessful pairing, and poor network connections). For what concerns variables of interest, out of the 35 studies, 14 reported positive results on the reduction of glycated hemoglobin (HbA1c) with the use of mHealth devices. Eight studies examined health-related quality of life (HRQoL); in three cases, there were no statistically significant differences, while the groups using mHealth devices in the other five studies experienced better HRQoL. Seven studies focused on physical activity and performance, all reflecting increased attention to physical activity levels. Six studies addressed depression and anxiety, with mostly self-reported benefits observed. Four studies each reported improvements in body fat and adherence to medications in the mHealth solutions arm. Three studies examined blood pressure (BP), reporting reduction in BP, and three studies addressed BMI, with one finding no statistically significant change and two instead BMI reduction. Two studies reported significant weight/waist reduction and reduced hospital readmissions. Finally, individual studies noted improvements in sleep quality/time, self-care/management, six-minute walk distance (6MWD), and exacerbation outcomes.

Conclusion

The systematic literature review demonstrates the significant potential of software as a medical device (SaMD) and mobile health (mHealth) applications in revolutionizing chronic disease management through remote patient monitoring (RPM) and digital therapeutics (DTx). The evidence synthesized from multiple systematic reviews and clinical studies indicates that these technologies, exemplified by solutions like Healthentia, can effectively support patient monitoring and improve health outcomes while meeting crucial safety and performance requirements. The positive results observed across various chronic conditions underscore the transformative role of digital health interventions in modern healthcare delivery. However, further research is needed to address long-term efficacy, cost-effectiveness, and integration into existing healthcare systems. As the field rapidly evolves, continued evaluation and refinement of these technologies will be essential to fully realize their potential in enhancing patient care and health management strategies.

Mobile Application-Based Interventions for People with Heart Failure: A Systematic Review and Meta-Analysis

Aim

To examine the effectiveness of mobile health application-based interventions on mortality, hospitalization rate, self-care, and quality of life in people with heart failure.

Background

Mobile health application-based interventions are reported to potentially help people with heart failure improve health-related clinical outcomes. However, evidence on the effects of mobile health application-based interventions on mortality, hospitalization, self-care, and quality of life remains inconclusive and limited.

Methods

A systematic literature search was conducted in six databases (MEDLINE, CINAHL Plus with Full Text, PsycINFO, Web of Science, EMBASE, and CENTRAL) to identify relevant studies from inception to 21 October 2023. Two authors independently extracted the data and assessed the risk of bias using the Cochrane risk-of-bias tool. The meta-analysis was conducted in Review Manager (version 5.4) and the statistical software R 4.3.3. Sensitivity analysis and subgroup analysis were also performed. The certainty of the evidence was evaluated by the GRADE approach.

Results

Twenty-four studies involving 2886 participants were identified in this review. The pooled analysis showed that mobile health application-based interventions had statistically significant beneficial effects on reducing heart failure-related hospitalization (RR = 0.72, 95% CI 0.57 to 0.91, p=0.01) and improving quality of life (SMD = 0.46, 95% CI 0.09 to 0.83, p=0.02), but had no statistically significant effects on all-cause mortality (RR = 0.90, 95% CI 0.66 to 1.25, p=0.47), cardiovascular mortality (RR = 0.87, 95% CI 0.59 to 1.26, p=0.24), all-cause hospitalization (RR = 0.74, 95% CI 0.39 to 1.42, p=0.29), or self-care (MD = -2.42, 95% CI -15.07 to 10.24, p=0.64). Subgroup analyses indicated that intervention duration and monitoring frequency may influence the effects of mobile health application-based interventions on quality of life.

Conclusions

Mobile health application-based interventions were effective at reducing heart failure-related hospitalization and improving quality of life in people with heart failure. More well-designed randomized controlled trials are needed to strengthen the evidence. Implications for Nursing Management. Mobile health application-based interventions may have benefits for improving heart failure-related hospitalization and quality of life. More rigorous studies are warranted to confirm the effects of mobile health application-based interventions for people with heart failure.

Cost Effectiveness of Adding Dapagliflozin to Standard Care in Heart Failure Patients with Reduced Ejection Fraction: A Systematic Review

INTRODUCTION

Dapagliflozin, a new treatment option for heart failure, leads to a significant reduction in the hospitalization of patients with heart failure. We aimed to review studies on the economic evaluation of adding dapagliflozin to standard care compared with standard care alone in heart failure patients with reduced ejection fraction (HFrEF).

METHODS

For this systematic review, the PubMed, EMBASE, Web of Science, Cochrane, Scopus, and CEA Registry scientific databases were searched from 1 January 2020 to 25 March 2022. Two of the present researchers screened titles and abstracts, extracted data from full-text articles, and evaluated their quality using the Quality of Health Economic Studies (QHES) checklist for the quality assessment of health economic studies.

RESULTS

Of the 456 abstracts screened, 19 studies met the inclusion criteria. The mean QHES score for the studies was 0.87 (high quality). Eight studies on cost-effectiveness analysis, ten studies on cost-utility analysis, and one study on cost-minimization analysis were conducted. Based on the available evidence and the present findings, the addition of dapagliflozin to standard care in patients with HFrEF was cost effective in most countries.

CONCLUSIONS

Based on the results of the present study, the addition of dapagliflozin to standard care in patients with HFrEF was cost effective. More studies investigating the cost effectiveness of dapagliflozin in patients with HFrEF are required in light of the actual epidemiological data of countries in the relevant input parameters. It is also recommended to conduct cost-effectiveness studies of dapagliflozin taking into account costs and benefits from a societal perspective.

A Mobile App-Based Intervention Program for Nonprofessional Caregivers to Promote Positive Mental Health: Randomized Controlled Trial

BACKGROUND

While nonprofessional caregivers often experience a sense of fulfillment when they provide care, there is also a significant risk of emotional and physical burnout. Consequently, this can negatively affect both the caregiver and the person being cared for. Intervention programs can help empower nonprofessional caregivers of people with chronic diseases and develop solutions to decrease the physical and psychological consequences resulting from caregiving. However, most clinically tested intervention programs for nonprofessional caregivers require face-to-face training, and many caregivers encounter obstacles that hinder their participation in such programs. Consequently, it is necessary to design internet-based intervention programs for nonprofessional caregivers that address their needs and test the efficacy of the programs.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of a smartphone app-based intervention program to increase positive mental health for nonprofessional caregivers.

METHODS

This study was a randomized controlled trial of 3 months' duration. A total of 152 caregivers over 18 years of age with a minimum of 4 months' experience as nonprofessional caregivers were recruited from primary health care institutions. Nonprofessional caregivers were randomized into two groups. In the intervention group, each caregiver installed a smartphone app and used it for 28 days. This app offered them daily activities that were based on 10 recommendations to promote positive mental health. The level of positive mental health, measured using the Positive Mental Health Questionnaire (PMHQ), and caregiver burden, measured using the 7-item short-form version of the Zarit Caregiver Burden Interview (ZBI-7), were the primary outcomes. Users' satisfaction was also measured.

RESULTS

In all, 113 caregivers completed the study. After the first month of the intervention, only one factor of the PMHQ, F1-Personal satisfaction, showed a significant difference between the groups, but it was not clinically relevant (0.96; P=.03). However, the intervention group obtained a higher mean change for the overall PMHQ score (mean change between groups: 1.40; P=.24). The results after the third month of the intervention showed an increment of PMHQ scores. The mean difference of change in the PMHQ score showed a significant difference between the groups (11.43; P<.001; d=0.82). Significant changes were reported in 5 of the 6 factors, especially F5-Problem solving and self-actualization (5.69; P<.001; d=0.71), F2-Prosocial attitude (2.47; P<.001; d=1.18), and F3-Self-control (0.76; P=.03; d=0.50). The results of the ZBI-7 showed a decrease in caregiver burden in the intervention group, although the results were inconclusive. Approximately 93.9% (46/49) of the app users indicated that they would recommend the app to other caregivers and 56.3% (27/49) agreed that an extension of the program's duration would be beneficial.

CONCLUSIONS

The app-based intervention program analyzed in this study was effective in promoting positive mental health and decreasing the burden of caregivers and achieved a high range of user satisfaction. This study provides evidence that mobile phone app-based intervention programs may be useful tools for increasing nonprofessional caregivers' well-being. The assessment of the effectiveness of intervention programs through clinical trials should be a focus to promote internet-based programs in health policies.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN14818443; http://www.isrctn.com/ISRCTN14818443.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-019-7264-5.