Table 1.
Characteristics of included eHealth intervention studies involving patients with heart failure (HF; N=18).
| Study (country) | Design | Sample size | Content, focus, and mode of instruction | Duration | MMATa scores out of 7, n (%) | ||
|
|
|
Total sample (N) | Ib, n (%) | Cc, n (%) |
|
|
|
| Athilingam et al [35] (United States) | RCTd | 18 | 9 (50) | 9 (50) | Telemonitoring (HeartMapp); daily measures of weight, heart rate, blood pressure, and HF symptoms. HF education: 10 modules, home visit after 2-3 days by a nurse. A phone call to all participants. Nurses checked the dashboard daily to monitor participants’ progress. | 30 days | 2 (29) |
| Comin-Colet et al [45] (Spain) | RCT | 178 | 81 (45.5) | 97 (54.5) | Telemonitoring and telephone support. Daily measures of weight, heart rate, and blood pressure. HF nurses reviewed alarms and alerts from the system every day. | 6 months | 6 (86) |
| Dunbar [36] (United States) | RCT | 134 | 70 (52.2) | 64 (47.8) | Telephone support; education and counseling on diet, medications, self-monitoring, symptoms, and physical activity; self-monitored blood glucose level and weight; self-care with follow-up home visits and telephone counseling. | 6 months | 4 (57) |
| Evangelista et al [37] (United States) | Quasi-experimental | 42 | 21 (50) | 21 (50) | Telemonitoring and telephone support; daily measures of weight, heart rate, and blood pressure. Telemonitoring provided alerts and feedback in the case of worrisome responses to questions or if vital signs were outside of preset limits. The research nurse communicated with the patient through teleconferencing and collaborated with the patient’s primary care provider to facilitate a plan of action. Telephone support as usual to the control group. | 3 months | 7 (100) |
| Frederix et al [46] (Belgium) | RCT | 160 | 80 (50) | 80 (50) | Telemonitoring; daily measurements of weight, heart rate, and blood pressure were forwarded to a central computer. If the recordings were outside of predefined alert limits, both the general practitioner and HF clinic were alerted by email. At that moment, per protocol, the general practitioner (or cardiologist) was asked to visit or contact the patient and adapt the treatment if they felt that it was necessary. The HF nurse contacted the patient by telephone 1-3 days after the alert to verify whether the intervention had been effective. | 6 months | 6 (86) |
| Gallagher et al [38] (United States) | RCT | 40 | 20 (50) | 20 (50) | Telemonitoring; electronic measurement of adherence to loop diuretics. A licensed clinical social worker reviewed adherence data daily during the first 7 days after discharge and weekly after that and then contacted participants who were nonadherent for ≥2 days per week. | 30 days | 7 (100) |
| Hwang et al [48] (Australia) | RCT | 53 | 24 (45.3) | 29 (54.7) | Telemonitoring and telephone support; participants were instructed to self-monitor and verbally report their blood pressure, heart rate, and oxygen saturation levels at the start of each rehabilitation session. The intervention group received electronic education sessions. | 3 months | 7 (100) |
| Jayaram et al [39] (United States) | RCT | 1521 | 756 (49.7) | 765 (50.3) | Telephone calls are used for technical support by interactive voice response; symptoms and daily weight; patients were instructed to call a toll-free number daily for 6 months, respond to a series of automated questions regarding their symptoms, and enter their daily weight. They were also provided with educational materials. | 6 months | 6 (86) |
| Kotooka et al [47] (Japan) | RCT | 181 | 90 (50) | 91 (50) | Telemonitoring and telephone support, measurement of weight, heart rate, and blood pressure daily. Physicians could provide telephone guidance, change medications, and order hospital readmission if required. Full-time nurses monitored acquired data on a secure website. Telephone support from a physician as usual. | 15 months | 6 (86) |
| Kraai et al [50] (Netherlands) | RCT | 176 | 83 (47.2) | 93 (52.8) | Telemonitoring and telephone support; daily measurement of weight, heart rate, and blood pressure. HF nurses automatically received notifications by mobile phone and email and then discussed symptoms and treatment with patients within 2 hours. | 9 months | 6 (86) |
| Köberich et al [51] (Germany) | RCT | 110 | 58 (52.7) | 52 (47.3) | Telephone support; nurse-led symptom monitoring, education on signs and symptoms of worsening HF, HF-specific diet, and fluid restriction. When seeking help, patients were advised to use a diary to document body weight, blood pressure, heart rate, and edema on a daily basis. If necessary, after discharge from the hospital, patients received 4 telephone calls within 3 months about changes in HF-related symptoms and treatment. | 3 months | 5 (71) |
| Lycholip et al [49] (Netherlands) | RCT | 118 | 58 (49.2) | 60 (50.8) | Telemonitoring and telephone support; daily measurement of body weight, blood pressure, and heart rate. HF nurses automatically received notifications by mobile phone and email and, within 2 hours, discussed the symptoms and treatment with the patients. An HF nurse provided education on HF. | 9 months | 6 (86) |
| Masterson- Creber et al [40] (United States) | RCT | 67 | 41 (61.2) | 26 (38.8) | Telephone support MIe: a tailored intervention at discharge to improve self-care, involving a home visit and follow-up calls. A nurse used the MI approach to identify client-directed self-care goals. Participants received written educational material. | 3 months | 6 (86) |
| Ong et al [41] (United States) | RCT | 1437 | 715 (49.7) | 722 (50.3) | Telemonitoring and telephone support; weight, heart rate, and blood pressure were measured daily. A total of 9 telephone health coaching calls over 6 months, generally from the same call center nurse. | 6 months | 5 (71) |
| Pedone et al [52] (Italy) | RCT | 96 | 50 (52/1) | 46 (47.9) | Telemonitoring and telephone support; measurement of blood pressure, oxygen saturation, weight, and heart rate daily; a geriatrician evaluated the data received every day. Participants received education on medical treatment and lifestyle counseling by telephone. | 6 months | 6 (86) |
| Ritchie et al [42] (United States) | RCT | 511 | 253 (49.5) | 258 (50.5) | Interactive voice response and telephone support; symptoms and body weight measured daily; E-Coach intervention: an intervention with condition-specific customization and in-hospital and postdischarge support by a care transition nurse, interactive voice response, postdischarge calls, and care transition nurse follow-up. | 2 months | 7 (100) |
| Srivastava et al [43] (United States) | Cohort–control | 1067 | 197 (18.5) | 870 (81.5) | Telemonitoring and telephone support; measurement of heart rate and blood pressure daily. Data were monitored on weekdays by a telehealth nurse who analyzed the data for abnormalities and lack of response; if clinical data caused concern for declining health status, a phone call was initiated to the patient. All patients also received a monthly follow-up call. | 12 months | 6 (86) |
| Young et al [44] (United States) | RCT | 105 | 54 (51.4) | 51 (48.6) | Telephone support: the patient-activated care at home intervention contained a variety of formats (eg, verbal, written, and visual) with 12 weeks of post discharge education sessions delivered by telephone. Besides self-management workbooks, each subject was provided with a self-management toolkit, including a calendar for weight and daily salt-intake logging, a step-on weight scale with large and bright readings, and an electronic pill organizer reminder alarm. | 6 months | 6 (86) |
aMMAT: Mixed Methods Appraisal Tool.
bI: intervention.
cC: control.
dRCT: randomized controlled trial.
eMI: motivational interview.