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      A Hospital-Community-Family–Based Telehealth Program for Patients With Chronic Heart Failure: Single-Arm, Prospective Feasibility Study

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          Abstract

          Background

          An increasing number of patients with chronic heart failure (CHF) are demanding more convenient and efficient modern health care systems, especially in remote areas away from central cities. Telehealth is receiving increasing attention, which may be useful to patients with CHF.

          Objective

          This study aimed to evaluate the feasibility of a hospital-community-family (HCF)–based telehealth program, which was designed to implement remote hierarchical management in patients with CHF.

          Methods

          This was a single-arm prospective study in which 70 patients with CHF participated in the HCF-based telehealth program for remote intervention for at least 4 months. The participants were recruited from the clinic and educated on the use of smart health tracking devices and mobile apps to collect and manually upload comprehensive data elements related to the risk of CHF self-care management. They were also instructed on how to use the remote platform and mobile app to send text messages, check notifications, and open video channels. The general practitioners viewed the index of each participant on the mobile app and provided primary care periodically, and cardiologists in the regional central hospital offered remote guidance, if necessary. The assessed outcomes included accomplishments of the program, usability and satisfaction, engagement with the intervention, and changes of heart failure–related health behaviors.

          Results

          As of February 2018, a total of 66 individuals, aged 40-79 years, completed the 4-month study. Throughout the study period, 294 electronic medical records were formed on the remote monitoring service platform. In addition, a total of 89 remote consultations and 196 remote ward rounds were conducted. Participants indicated that they were generally satisfied with the intervention for its ease of use and usefulness. More than 91% (21/23) of physicians believed the program was effective, and 87% (20/23) of physicians stated that their professional knowledge could always be refreshed and enhanced through a library hosted on the platform and remote consultation. More than 60% (40/66) of participants showed good adherence to the care plan in the study period, and 79% (52/66) of patients maintained a consistent pattern of reporting and viewing their data over the course of the 4-month follow-up period. The program showed a positive effect on self-management for patients (healthy diet: P=.046, more fruit and vegetable intake: P=.02, weight monitoring: P=.002, blood pressure: P<.001, correct time: P=.049, and daily dosages of medicine taken: P=.006).

          Conclusions

          The HCF-based telehealth program is feasible and provided researchers with evidence of remote hierarchical management for patients with CHF, which can enhance participants’ and their families’ access and motivation to engage in self-management. Further prospective studies with a larger sample size are necessary to confirm the program’s effectiveness.

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          Most cited references22

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          ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.

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            Mobile Health Devices as Tools for Worldwide Cardiovascular Risk Reduction and Disease Management.

            We examined evidence on whether mobile health (mHealth) tools, including interactive voice response calls, short message service, or text messaging, and smartphones, can improve lifestyle behaviors and management related to cardiovascular diseases throughout the world. We conducted a state-of-the-art review and literature synthesis of peer-reviewed and gray literature published since 2004. The review prioritized randomized trials and studies focused on cardiovascular diseases and risk factors, but included other reports when they represented the best available evidence. The search emphasized reports on the potential benefits of mHealth interventions implemented in low- and middle-income countries. Interactive voice response and short message service interventions can improve cardiovascular preventive care in developed countries by addressing risk factors including weight, smoking, and physical activity. Interactive voice response and short message service-based interventions for cardiovascular disease management also have shown benefits with respect to hypertension management, hospital readmissions, and diabetic glycemic control. Multimodal interventions including Web-based communication with clinicians and mHealth-enabled clinical monitoring with feedback also have shown benefits. The evidence regarding the potential benefits of interventions using smartphones and social media is still developing. Studies of mHealth interventions have been conducted in >30 low- and middle-income countries, and evidence to date suggests that programs are feasible and may improve medication adherence and disease outcomes. Emerging evidence suggests that mHealth interventions may improve cardiovascular-related lifestyle behaviors and disease management. Next-generation mHealth programs developed worldwide should be based on evidence-based behavioral theories and incorporate advances in artificial intelligence for adapting systems automatically to patients' unique and changing needs.
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              Effectiveness of an mHealth intervention to improve the cardiometabolic profile of people with prehypertension in low-resource urban settings in Latin America: a randomised controlled trial.

              Poor diet and physical inactivity strongly affect the growing epidemic of cardiovascular disease worldwide. Mobile phone-based health interventions (mHealth) have been shown to help promote weight loss and increase physical activity and are an attractive approach for health-care systems with limited resources. We aimed to assess whether mHealth with advice for lifestyle improvements would reduce blood pressure, promote weight loss, and improve diet quality and physical activity in individuals with prehypertension living in low-resource urban settings in Latin America.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                December 2019
                13 December 2019
                : 7
                : 12
                : e13229
                Affiliations
                [1 ] Clinical Medical College Yangzhou University Yangzhou, Jiangsu China
                [2 ] Dalian Medical University Dalian, Liaoning China
                [3 ] Department of Cardiology Subei People’s Hospital Yangzhou, Jiangsu China
                Author notes
                Corresponding Author: Xiang Gu guxiang@ 123456yzu.edu.cn
                Author information
                https://orcid.org/0000-0002-7261-5368
                https://orcid.org/0000-0002-0240-9403
                https://orcid.org/0000-0001-9092-8301
                https://orcid.org/0000-0001-8338-6604
                https://orcid.org/0000-0003-2253-2342
                https://orcid.org/0000-0003-4281-8890
                https://orcid.org/0000-0003-4350-3719
                https://orcid.org/0000-0001-8986-630X
                https://orcid.org/0000-0003-2013-325X
                https://orcid.org/0000-0002-6729-8310
                Article
                v7i12e13229
                10.2196/13229
                6935047
                31833835
                7887a709-91f2-4a82-b1fc-5330988606a7
                ©Xiaorong Guo, Xiang Gu, Jiang Jiang, Hongxiao Li, Ruoyu Duan, Yi Zhang, Lei Sun, Zhengyu Bao, Jianhua Shen, Fukun Chen. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 13.12.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

                History
                : 23 December 2018
                : 11 April 2019
                : 6 June 2019
                : 26 September 2019
                Categories
                Original Paper
                Original Paper

                telehealth,chronic heart failure,feasibility studies,precise follow-up,self-management

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