Presentation
Digital Health Interventions That Address Mental Health Needs of Heart Failure Patients and Their Caregivers: A Scoping Review
DescriptionINTRODUCTION
Background/Rationale: Individuals with heart failure and their caregivers are at an increased risk for various mental illnesses. Digital health interventions (e.g., health apps, wearables) offer potential solutions to support their mental health needs by providing remote support accessible twenty-four hours a day, seven days a week. However, there is a lack of synthesized evidence specifically focusing on digital health interventions for these populations. Indeed, existing review papers on digital health interventions designed to address comorbid mental health challenges have mostly focused on other chronic conditions (e.g., cancer) leaving a gap in evidence synthesis with respect to digital health interventions for people living with heart failure. Thus, synthesizing this evidence is essential.
Aim/Objectives: This review aimed to inform an ongoing project in which our team is co-designing an app-based digital health intervention to address the mental health challenges of heart failure patients and their caregivers. The objectives were to (1) map the evidence on digital health interventions that address the mental health challenges faced by these groups and (2) describe the characteristics of these interventions, including their modalities and content.
METHODS
Online databases—MEDLINE and Embase—were used to identify studies on DHIs that addressed mental health challenges or enhanced the well-being of heart failure patients and/or their caregivers. A total of 37 studies (39 publications) were included in the review. The screening and data charting processes were conducted independently by two authors each using Covidence in a double-blinded approach. Reporting adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.
RESULTS
Selection of Sources of Evidence: A total of 856 studies were identified from searches of electronic databases, of which 35 duplicates were removed. Based on the title and the abstract, 697 were excluded. As a result, 124 full-text studies were retrieved and assessed for eligibility. Of these, 87 were excluded for the following reasons: 29 did not discuss mental health, 13 were not specific to heart failure, 3 were not intervention-focused, and 11 were not a full report or manuscript (i.e., conference abstract). We excluded 3 studies because we were unable to retrieve them. The remaining 37 studies (39 publications) were considered eligible for this review.
Synthesis of Results:
-Country of origin. The majority are from the United States of America (43.2%, n = 16), followed by China (21.6%, n = 8), and Italy (5.4%, n = 2). Other countries with only one study include: Australia, Denmark, France, Germany, Iceland, Iran, Israel, Poland, Singapore, Spain, and Japan.
-Study design. The vast majority of studies used randomized controlled trials (51.4%, n = 19). Other designs included feasibility studies (13.5%, n = 5), cohort studies (8.1%, n = 3), pilot studies (8.1%, n = 3), non-randomized experimental studies (5.4%, n = 2), usability studies (2.7%, n = 1), and other designs (8.1%, n = 3).
-Populations. The majority were conducted among heart failure patients (91.9%, n = 34). Only three studies reported analyses of both patients and caregivers (8.1%). Across 37 studies, the average number of participants included was 263 (SD = 529), while they had a range of 10 to 3,182. The average age of participants recruited was 64.5 years (SD = 8.9), while the range was between 30 to 73. The average percentage of males included was 65% (SD = 18.0), while the average percentage of females included was 35.7% (SD = 18.5).
-Modality. Most studies—35 out of 37 (94.6%)—adopted a multi-modal approach for their interventions, applying at least two different types of modalities. Phone calls were the most common modality (70.3%, n = 25). Computers (27.0%, n = 10) and print media (24.3%, n = 9) were also frequently utilized. Less common modalities included video conferencing, apps or mobile devices, other electronic devices, and in-person sessions (18.9%, n = 7 each). Recorded videos were used in 6 studies (16.2%). A smaller number of studies used text messaging apps (e.g., WeChat, QQ) (13.5%, n = 5), text messages (8.1%, n = 3), wearables (5.4%, n = 2) and/or emails (5.4%, n = 2).
-Contents. Each intervention developed by a study (e.g., telerehabilitation program) was composed of multiple contents (e.g., education, follow-up, symptom monitoring, etc.). We identified a total of 254 contents across the 37 studies. The average number of contents per study was 6.86. We categorized these contents into seven main categories based on thematic similarities. Remote Monitoring emerged as the most prevalent category, accounting for 24.4% (n = 62) of all contents. This was closely followed by Patient Education and Self-Management (22.8%, n = 58), Communication and Care Coordination (18.5%, n = 47), and Physical Activity and Rehabilitation (12.2%, n = 31). Meanwhile, Psychological Support and Counseling was less common, comprising only 8.7% (n = 22), followed by Medication Management (5.9%, n = 15) and Lifestyle Modification (5.1%, n = 13). A small portion of contents (2.4%, n = 6) were classified as Others, which included unique or specialized intervention components that did not easily fit into the main categories. This distribution highlights the multifaceted approach to mental health care for heart failure patients and their caregivers, with a notable emphasis on remote monitoring, patient education, and care coordination.
DISCUSSION
Summary of Evidence: In this scoping review, we have identified 37 studies published between 2003 and 2024 that developed or implemented digital health interventions aimed at addressing mental health challenges experienced by heart failure patients and their caregivers.
-Multi-modal approaches. Many of these digital health interventions adopted a multi-modal approach, delivering the same content through various modalities (e.g., educational material available in both video and printed formats) or using complementary modalities to create synergy (e.g., self-care education via video conferencing, followed by assignments checked through messaging to encourage completion).
-Reliance on a phone call modality. However, our findings indicate that the majority of interventions disproportionately relied on a phone call modality (70.3%)—a relatively resource-intensive and elementary medium compared to more scalable digital options (e.g., app, web). This reliance on phone calls, which necessitates human staff investment to personally connect with heart failure patients and/or caregivers, raises questions about sustainability and scalability.
-Transitional homecare settings. Alternatively, the digital health interventions we identified were predominantly utilized in transitional homecare settings—particularly post-discharge—and served as supplementary measures to monitor vital symptoms and educate patients who had been receiving traditional in-person clinical care. For instance, the most frequent content categories were Remote Monitoring (24.4%) and Patient Education and Self-Management (22.8%), reflecting the increasing emphasis on continuity of care in home settings in recent years.
-Gaps in caregiver & mental health support. Nonetheless, a significant gap was identified with respect to caregiver support—there were only three interventions out of 37 that supported their mental health. Furthermore, these interventions tended to focus more on managing physical than mental health, underscoring the need for more contents or interventions directly addressing mental health needs.
Conclusions: This scoping review aims to inform a future study in which our team will co-design an app-based digital health intervention to address the identified gaps. The absence of app-based digital mental health interventions highlights the pressing need to develop solutions that better support the mental health of heart failure patients and their caregivers.
Additionally, the lack of specific interventions for caregivers underscores the necessity for more research to create digital mental health tools that address their unique needs and well-being.
The findings of this review affirm the significance of our ongoing research project, which seeks to co-design an app-based mental health intervention that caters to the mental health needs of both heart failure patients and their caregivers.
Background/Rationale: Individuals with heart failure and their caregivers are at an increased risk for various mental illnesses. Digital health interventions (e.g., health apps, wearables) offer potential solutions to support their mental health needs by providing remote support accessible twenty-four hours a day, seven days a week. However, there is a lack of synthesized evidence specifically focusing on digital health interventions for these populations. Indeed, existing review papers on digital health interventions designed to address comorbid mental health challenges have mostly focused on other chronic conditions (e.g., cancer) leaving a gap in evidence synthesis with respect to digital health interventions for people living with heart failure. Thus, synthesizing this evidence is essential.
Aim/Objectives: This review aimed to inform an ongoing project in which our team is co-designing an app-based digital health intervention to address the mental health challenges of heart failure patients and their caregivers. The objectives were to (1) map the evidence on digital health interventions that address the mental health challenges faced by these groups and (2) describe the characteristics of these interventions, including their modalities and content.
METHODS
Online databases—MEDLINE and Embase—were used to identify studies on DHIs that addressed mental health challenges or enhanced the well-being of heart failure patients and/or their caregivers. A total of 37 studies (39 publications) were included in the review. The screening and data charting processes were conducted independently by two authors each using Covidence in a double-blinded approach. Reporting adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.
RESULTS
Selection of Sources of Evidence: A total of 856 studies were identified from searches of electronic databases, of which 35 duplicates were removed. Based on the title and the abstract, 697 were excluded. As a result, 124 full-text studies were retrieved and assessed for eligibility. Of these, 87 were excluded for the following reasons: 29 did not discuss mental health, 13 were not specific to heart failure, 3 were not intervention-focused, and 11 were not a full report or manuscript (i.e., conference abstract). We excluded 3 studies because we were unable to retrieve them. The remaining 37 studies (39 publications) were considered eligible for this review.
Synthesis of Results:
-Country of origin. The majority are from the United States of America (43.2%, n = 16), followed by China (21.6%, n = 8), and Italy (5.4%, n = 2). Other countries with only one study include: Australia, Denmark, France, Germany, Iceland, Iran, Israel, Poland, Singapore, Spain, and Japan.
-Study design. The vast majority of studies used randomized controlled trials (51.4%, n = 19). Other designs included feasibility studies (13.5%, n = 5), cohort studies (8.1%, n = 3), pilot studies (8.1%, n = 3), non-randomized experimental studies (5.4%, n = 2), usability studies (2.7%, n = 1), and other designs (8.1%, n = 3).
-Populations. The majority were conducted among heart failure patients (91.9%, n = 34). Only three studies reported analyses of both patients and caregivers (8.1%). Across 37 studies, the average number of participants included was 263 (SD = 529), while they had a range of 10 to 3,182. The average age of participants recruited was 64.5 years (SD = 8.9), while the range was between 30 to 73. The average percentage of males included was 65% (SD = 18.0), while the average percentage of females included was 35.7% (SD = 18.5).
-Modality. Most studies—35 out of 37 (94.6%)—adopted a multi-modal approach for their interventions, applying at least two different types of modalities. Phone calls were the most common modality (70.3%, n = 25). Computers (27.0%, n = 10) and print media (24.3%, n = 9) were also frequently utilized. Less common modalities included video conferencing, apps or mobile devices, other electronic devices, and in-person sessions (18.9%, n = 7 each). Recorded videos were used in 6 studies (16.2%). A smaller number of studies used text messaging apps (e.g., WeChat, QQ) (13.5%, n = 5), text messages (8.1%, n = 3), wearables (5.4%, n = 2) and/or emails (5.4%, n = 2).
-Contents. Each intervention developed by a study (e.g., telerehabilitation program) was composed of multiple contents (e.g., education, follow-up, symptom monitoring, etc.). We identified a total of 254 contents across the 37 studies. The average number of contents per study was 6.86. We categorized these contents into seven main categories based on thematic similarities. Remote Monitoring emerged as the most prevalent category, accounting for 24.4% (n = 62) of all contents. This was closely followed by Patient Education and Self-Management (22.8%, n = 58), Communication and Care Coordination (18.5%, n = 47), and Physical Activity and Rehabilitation (12.2%, n = 31). Meanwhile, Psychological Support and Counseling was less common, comprising only 8.7% (n = 22), followed by Medication Management (5.9%, n = 15) and Lifestyle Modification (5.1%, n = 13). A small portion of contents (2.4%, n = 6) were classified as Others, which included unique or specialized intervention components that did not easily fit into the main categories. This distribution highlights the multifaceted approach to mental health care for heart failure patients and their caregivers, with a notable emphasis on remote monitoring, patient education, and care coordination.
DISCUSSION
Summary of Evidence: In this scoping review, we have identified 37 studies published between 2003 and 2024 that developed or implemented digital health interventions aimed at addressing mental health challenges experienced by heart failure patients and their caregivers.
-Multi-modal approaches. Many of these digital health interventions adopted a multi-modal approach, delivering the same content through various modalities (e.g., educational material available in both video and printed formats) or using complementary modalities to create synergy (e.g., self-care education via video conferencing, followed by assignments checked through messaging to encourage completion).
-Reliance on a phone call modality. However, our findings indicate that the majority of interventions disproportionately relied on a phone call modality (70.3%)—a relatively resource-intensive and elementary medium compared to more scalable digital options (e.g., app, web). This reliance on phone calls, which necessitates human staff investment to personally connect with heart failure patients and/or caregivers, raises questions about sustainability and scalability.
-Transitional homecare settings. Alternatively, the digital health interventions we identified were predominantly utilized in transitional homecare settings—particularly post-discharge—and served as supplementary measures to monitor vital symptoms and educate patients who had been receiving traditional in-person clinical care. For instance, the most frequent content categories were Remote Monitoring (24.4%) and Patient Education and Self-Management (22.8%), reflecting the increasing emphasis on continuity of care in home settings in recent years.
-Gaps in caregiver & mental health support. Nonetheless, a significant gap was identified with respect to caregiver support—there were only three interventions out of 37 that supported their mental health. Furthermore, these interventions tended to focus more on managing physical than mental health, underscoring the need for more contents or interventions directly addressing mental health needs.
Conclusions: This scoping review aims to inform a future study in which our team will co-design an app-based digital health intervention to address the identified gaps. The absence of app-based digital mental health interventions highlights the pressing need to develop solutions that better support the mental health of heart failure patients and their caregivers.
Additionally, the lack of specific interventions for caregivers underscores the necessity for more research to create digital mental health tools that address their unique needs and well-being.
The findings of this review affirm the significance of our ongoing research project, which seeks to co-design an app-based mental health intervention that caters to the mental health needs of both heart failure patients and their caregivers.
Authors
Event Type
Oral Presentations
TimeTuesday, April 12:00pm - 2:30pm EDT
LocationPier 2/3
Digital Health (DH)