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.