Table 1.
Study characteristics and outcomes
| Study | CHD, n (female) | Control group, n (female) | CHD diagnosis or severity (n) | Study design | Age ± SD (range), y/mo/d | eHealth intervention | Application programming interface | Results | Study acronym | Area |
|---|---|---|---|---|---|---|---|---|---|---|
| Teledevices | ||||||||||
| Black et al., 201426 | 9 ES | 9 HC | HLHS + AA + MA or MS (4), HLHS + AS + MA or MS (1), HLHS+ MA + VSD + DORV (1), HLHS + AA + MA + cor triatriatum (1), DILV + TGA + coarctation of aorta (1), complex DORV (1) | Pilot study | 23 ± 33 (4-90 d) | Infant digital scale (model UC-321 pbt) pulse oximeter (model Pm-50): 12 months | All transmitted data were managed on a customized WebPortal (Tele-Modem; Aerotel Medical Systems Ltd, Holon, Israel). | 9 ED visits for ES vs 11 unscheduled ED visits for HC. Sudden death in 1 of 9 HC and 2 of 9 ES. | / | HM |
| Cooper et al., 202018 | 109 (51) | 110 (46) | RACHS-1 ≥ II: 1: 0 (0), 2: 10 (9.4), 3: 37 (34.1), 4: 21 (19.4), 5: 2 (2.4), 6: 38 (34.6) | Randomized trial | 38.9 ± 0.1 (/ d) | Telehealth home monitoring program with digital scale and pulse oximeter: 4 months | Automated communication through the Buddy Check Network (Caryl Technologies). | Infant growth in both groups was suboptimal. More infants in the IG were readmitted to the hospital (66% in IG vs 57% in CG; P < 0.001). | REACH | HM |
| Donati et al., 202121 | 26 (14) | 19 (/) | CHD and/or arrhythmia | Clinical trial | 25 ± 37 mo (1-7 y) | Pulsoximeter GIMA OXY-10, Thermometer TAIDOC TD-1241B, scale GIMA BABY, scale AND UC-351PBT-Ci, ECG device MR&D pulse v3: 2-6 months | Smart-hub software application, eg, E@syCare with integration with EMR. | Improvement in well-being and sleep quality, with a consequent reduction in anxious and stressful situations. | AIR CARDIO | HM |
| Harahsheh et al., 201622 | 56 (23) | 42 (20) | HLHS (38), other (18) | Cohort study | 5.9 ± 3.9 (/ d) | ExpressMDTM home telemedicine monitoring device (scales, pulse oximeter, blood pressure monitor, and glucose meter) during interstage period | Individual patient results available via a web-based portal. | Post-SVTF group had lower complications after stage II (18.4% vs 34.1%, P < 0.02), higher weight-for-age z scores at stage II (–1.5 ± 0.97 vs –1.58 ± 1.34, P < 0.02) and were less likely to have a stage II weight-for-age z score below –2 (26.5 vs 31.7%, P < 0.03). | SVTF | HM |
| Khoury et al., 202027 | 2 (1) | / | Fontan | Pilot study | 12 and 14 y | Home-based high-intensity interval trial program with telemedicine ergometer (MedBike): 8 weeks | The MedBike is a custom telemedicine ergometer for remote medical supervision and modulation of work. | Increased exercise capacity at postintervention CPET: VO2max (50% for subject 1 and 8% for subject 2) and peak power output (50% for subject 1 and 8% for subject 2). | / | PAP |
| Kauw et al., 20196 | 109 (73) | / | Simple (25), moderate (50), severe (34) | Prospective study | 44.8 ± 13.1 (/ y) | Single-lead ECG (Kardia, AliveCor), wireless digital blood pressure monitor (Omron), and a wireless and digital weight scale (iHealth), connected to their smartphone: 12-month follow-up | Mobile applications for heart rhythm recordings (Kardia) and blood pressure and weight (cVitals). Integration in EMR. | In 25% of the patients with diagnosed arrhythmias (14 of 56) recurrences were detected; 13% of the patients with undiagnosed palpitations (4 of 32) were diagnosed with novel arrhythmias. | / | HM |
| Koole et al., 201924 | 55 (36) | / | NYHA class ≥II: simple (6), moderate (29), severe (20) | Prospective study | Median age 45 y (19-70 y) | Single-lead ECG measurements, blood pressure (Omron), and a scale for body weight measurement (iHealth): 3-month follow-up | Smartphone applications (cVitals) to receive and transfer data. Integration in EMR. | Quality of life (CaRe-QoL CHF [social, physical, and safety] and EQ-5D-5L) improved by 51.7% (P < 0.502), 14.3% (P < 0.28), 3.3% (P < 0.87), and 0.2% (P < 0.89). | HartWacht | HM |
| Nederend et al., 202123 | 24 (12) | / | TGA (16), ccTGA (8) | Cohort study | Median age 47 y (/ y) | Blood pressure monitor (Withings Wi-Fi Smart), scale (Withings Body), step counter (Withings Move), and rhythm monitor (Alivecor KardiaMobile). Biweekly sacubitril/valsartan titration visits were replaced by electronic visits: 17-month follow-up | Health Mate app for iOS and Android transmits data (ECG recordings, blood pressure values to doctors). | 68 titration trips to hospital were replaced by virtual visits facilitated by remote monitoring. | / | HM |
| Mobile applications | ||||||||||
| Bingler et al., 201817 | 31 (13) | 1 month: 16 (9) 2 months: 15 (4) |
Single ventricle cardiac disease | Randomized crossover design | 1 mo: 1.44 (0.80-2.13 mo) 2 mo: 0.70 (0.47-1.43 mo) |
Cardiac High Acuity Monitoring Program (CHAMP) is a tablet PC–based app (oxygen saturation, intake, output, infant weight, 15-second videos, preselected patient-specific red flag warnings, and parental concerns) | CHAMP provides instantaneous transfer of home monitoring data via cellular service. | CHAMP group had significantly fewer unplanned intensive care unit days/100 interstage days, shorter delays in care, lower resource utilization at readmissions, and lower incidence of interstage growth failure. | CHAMP | HM |
| Stagg et al., 202325 | 29 (/) | 43 (/) | HLHS, DORV, ToF/PS, PA | Prospective oberservational study | Infants | Software embedded in the EMR (Epic Systems Corporation, Verona, WI) to conduct telemedicine visits during interstage period | Epic Care Companion app in MyChart to upload monitoring data. | Median ED visits/patient/month were significantly lower than the same calendar period of the prior year (P < 0.0004). | Infant Single Ventricle Monitoring Program | HM |
| Zhang et al., 202220 | 42 (18) | 42 (19) | VSD (24), PDA (8), PS (3), ToF (2), endocardial cushion defect (2) | Prospective randomized controlled study | 3.3 ± 3.1 (/ mo) | WeChat (Tencent Ltd, Shenzhen, China): Smartphone-based social media application delivering remote health education and feeding guidance: 1 month | Medical staff was online in the WeChat group at 18:00 to 21:00 to explain parents’ problems. | Body weight, albumin, prealbumin, hemoglobin, and STRONGkids score of infants in the IG significantly higher than in CG 1 month after discharge (P < 0.05). | / | HM |
| Nashat et al., 202228 | 103 (46) | / | Simple (4), moderate (53), severe (45) | Pilot study | Median age 39 y (16-73 y) | Huma Royal Brompton Hospital (RBH) ACHD therapeutic digital application (heart rate, blood pressure, oxygen saturation, and weight): 6 months | Information submitted via the smartphone application was transferred to a web-based clinical dashboard. | 18 flagged events during the 6-month observation period, and 50% of received early clinical intervention. | / | HM |
| Lin et al., 202119 | 47 (28) | 47 (29) | Acynotic (36), cyanotic (11) | Randomized controlled trial | 19.47 ± 2.87 (14.6-24.7 y) | Care & Organize Our Lifestyle (COOL) Passport—a mobile health care application: 12 months | Health Promotion Cloud and gameplay on interactive platforms in addition to COOL Passport. | No significant differences between the groups in any domain of disease knowledge or physical activity intensity. | COOL | PAP |
| Wearables | ||||||||||
| Jacobsen et al., 201630 | 14 (6) | / | Fontan | Pilot study | Median age 10 y (8-12 y) | FitBit Flex: home-based cardiac physical activity program: 12 weeks | Online group through the FitBit website | Significant change in calculated VO2max from baseline to the 12-week session (P < 0.001). The mean shuttle time improved from baseline to the 6-week session (P < 0.003). No improvement in HRQoL. | / | PAP |
| Fernie et al., 202329 | 9 (4) | / | Fontan | Pilot study | 13.5 ± 3.0 (7-31 y) | Garmin Vivosmart 4: home-based, individualized physical activity program: 12 months | Garmin online community | No pre-post difference in maximal or submaximal VO2, peak heart rate, or oxygen saturation. Significant pre-post increase in systolic blood pressure (P < 0.004) and minute ventilation (P < 0.012) at peak exercise. | Heart chargers | PAP |
| Amedro et al., 202416 | 70 (38) | 70 (35) | NYHA (%): I 35/63 (55), II 27/63 (43), III 1/63 (2) | Randomized controlled trial | 17.1. ± 3.5 (13-25 y) | Garmin Forerunner 25: “hybrid” cardiac rehabilitation program: 12 weeks | Nationwide health provider company (Stimulab) | Improved HRQoL, cardiovascular outcomes, disease knowledge, and the level of physical activity. | QUALIREHAB | CRP |
“/” denotes no given criteria.
AA, aortic atresia; ACHD, adult CHD; AS, aortic stenosis; CHD, congenital heart disease; CG, control group; CPET, cardiopulmonary exercise testing; CRP, cardiac rehabilitation program; DILV, double inlet left ventricle; DORV, double outlet right ventricle; ECG, electrocardiogram; ED, emergency department; eHealth, electronic health; EMR, electronic medical record; ES, enrolled subjects; HC, historical controls; HLHS, hypoplastic left heart syndrome; HM, home monitoring; HRQoL, health-related quality of life; IG, intervention group; MA, mitral atresia; MS, mitral stenosis; NYHA, New York Heart Association; PA, pulmonary atresia; PAP, physical activity program; PDA, patent ductus arteriosus; PS, pulmonary stenosis; RACHS-1, risk adjustment for congenital heart surgery; SD, standard deviation; STRONGkids, Screening Tool Risk on Nutritional Status and Growth; SVTF, single ventricle task force; TGA, transposition of the great arteries; ToF, tetralogy of Fallot; VO2max, maximal oxygen uptake; VSD, ventricular septal defect.