From: Smartphones in the secondary prevention of cardiovascular disease: a systematic review
Scherr, 2006 (FUU) | Scherr, 2009 (RCT) | Seto, 2012 (RCT) | Vuorinen 2014 (RCT) | |
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n = | 20 14 CHF; 6 HTN | 120 66 TMG (54 + 12 never beginners) 54 CG | 100 50 TMG; 50 SCG | 94 (47 TMG; 47 CG) |
Program completion | 95% (n = 19 of 20) CHF: 93% (n = 13 of 14) HTN: 100% | 87% (n = 104 of 120) TMG: 76% (n = 50 of 66, includes never beginners) or 93% (n = 50 of 54) CG: 100% | 97% (n = 97 of 100) TMG: 88% (n = 44 of 47, includes 3 deaths) or 94% (n = 47 of 50, excludes 3 deaths) SCG: 100% | 99% (n = 1 of 94) TMG: 98% (n = 1 of 47) CG: 100% |
Mean age (years) | 50 (SD14) CHF: 53 (13); HTN: 42 (16) | 66 (IQR 64–74) TMG: 66 years (IQR 62–73) CG: 67 years (IQR 61–72) | TMG: 55.1 ± 13.7 SCG: 52.3 ± 13.7 | TMG: 58.3 ± 11.6 CG: 57.9 ± 11.9 |
Technology (Reported inconsistently) | ||||
Feasibility | ✓high | |||
Usability/Acceptability | 80% did not report any problems with data entry | 98% system availability | 10–20 min initial education on use of mobile phone app. TMG: 1 patient withdrew due to increased anxiety from monitoring his condition. | |
Technical | 98% data transmission and website availability One (5%) withdrawl (poor vision) | 12 never beginners (median age 68 years (IQR 64–74) were unable to begin transmission of data (reasons NR) | TMG: 2 participants withdrew due to technical difficulties | TMG: 6 telephone calls re technical problems. 3 nurse initiated calls for start-up support; 3 patient calls initiated for failed internet connection. |
Engagement/Adherence/ Usage/Task completion | 94% (CHF) and 84% (HTN) self-measurement and data entry | 95% patient adherence | Completion of daily readings: 84% completed 50%; 66% completed 80%; 32% completed 95%. | Proportion of weekly submitted self-measurements by TMG: 86% weight (median = 28 (IQ 23–33); 89% BP, HR, and symptoms (median BP and symptoms = 32 (IQR 27–43). |
Patient | ||||
Patient satisfaction | 85% of patients continued telemonitoring at study completion | 96% responded to user experience questionnaire 95% - measures very or quite useful 91% - automatic feedback very or quite useful (9% no benefit) 66% - feedback drew attention to essential issues of disease 91% - feedback was motivational | ||
Quality of Life | ǂ overall MLHFQ ǂ Physical ǂ Emotional ++ Overall change (p = 0.05) | |||
Self-care | ǂ †Maintenance ǂ †Management ++ Maintenance | ns ǂ †| ||
New York Heart Association class | Study completion vs baseline Class I: n = 3 vs 0 Class II: n = 11 vs 10 Class III: n = 0 vs 4 | ++ (PPA) | ǂ †| |
Left Ventricular Ejection Fraction | ↑ in mean to 35% at study completion (vs 32% at baseline) | PPA: ns improvement TMG: 25% (IQR 20–38) to 35% (IQR 25–45) CG: 29% (IQR 21–36) to 35% (IQR 24–40) | ǂ †| ns ǂ †|
Blood Pressure | HTN: mean study completion SBP 135 (SD18); DPB 78 (7) vs baseline SBP 134 (21); DBP 80 (8) | |||
Medication | CHF: 71% had beta-blocker therapy initiated with a titrated increase HTN: antihypertensive medication stable | Ç‚ Aldosterone antagonists | ++ Medication change, both increases and decreases. | |
Biochemistry | ns Serum potassium, creatinine, sodium. | |||
Brain Natriuretic Peptide | ǂ †| ns ǂ | ||
Mortality/Health service utilization | ITT: ns TMG: 17% (0 deaths/11) hospitalizations CG: 31% (1 death/17 hospitalizations) PPA: ++ TMG: 15% (0 deaths/8 hospitalizations) PPA: ++ shorter length of hospital stay | TMG: 6% (n = 3) deaths (2 non-heart related) SCG: 0 deaths ns hospital admissions; nights in hospital; ED visits ++ Heart Function Clinic visits (TMG: 3.5 (SD 3.6); SCG 2.5 (2.5) | No mortality in TMG or CG ns HF related hospital days ++ TMG nurse time, telephone contact and visits ++ TMG unplanned clinic visits ++ patient initiated telephone contact ns physician time and visits |