Discussion
depression, heart failure, chronic disease
HEART FAILURE, HEART, SECONDARY, CHRONIC DISEASE
This study developed a mobile app of the Heart Failure-Smart Life that is a comprehensive self-management program for patients with heart failure and evaluated the effects of the program through a RCT design. It demonstrated no changes in the primary outcomes of psychosocial (depression and QoL) and behavioral factors (medication adherence and self-management behavior), but there seemed to be beneficial effects on the secondary outcomes of patients’ NYHA functional class and cardiac diastolic function.Mobile apps have the advantage of providing flexibility in obtaining and using health-related information at a pace desired by the patients, regardless of time and place [In the present study, the participating patients utilized the Heart Failure-Smart Life app and showed improvement tendency in the NYHA functional class and E/Ea ratio. The NYHA classification system grades patients’ functional class from having no restriction of physical activity because of one’s symptoms (Class I) to having symptoms typical of heart failure (Class IV) [Furthermore, the present study found that the patients who participated in the Heart Failure-Smart Life app showed a significant improvement in their E/Ea ratio. E/Ea ratio is the value of LV diastolic function measured by the noninvasive echocardiographic estimation, an essential evaluation tool as a strong prognostic indicator in patients with heart failure [However, the Heart Failure-Smart Life mobile app program did not show any differences between the two groups in a number of the physiological, psychosocial, and behavioral outcomes measured in the present study. There has been controversy regarding results for those outcomes in previous studies, but above all, a possible reason for the present findings is that the intervention duration was only 3 months. This length of time may be insufficient to change the measured psychological and behavioral factors in patients with heart failure.Although the importance of self-management in the treatment of heart failure is being emphasized generally by healthcare providers, it is not easy for patients to maintain it efficiently. Nevertheless, mobile apps could be a practical strategy for improving and maintaining self-management capabilities for patients with heart failure. In particular, considering the pandemic era, such as the COVID-19 pandemic, the availability of non-face-to-face strategies, like mobile apps, will be critical, and their impact on patients who are remaining at home should be investigated. Through further clinical trials using mobile apps, it can expand the potential to give patients with diverse chronic diseases better engagement and ownership of lifelong self-management at home [There are several limitations in this study to note. First, the study was a RCT study with a small sample. Possibly because of this small sample size, significant differences that could affect the prognosis of heart failure were observed in the baseline characteristics, such as age and SBP between the experimental and the control groups. Moreover, the interaction effects of time and group were not detected even some variables showed the different patterns over time between the two groups. Second, we could not collect information about the patient’s medications and laboratory findings, such as serum or urine sodium levels, that may affect the study results. Third, the intervention period of 3 months is a relatively short period for assessing psychosocial and behavioral changes of the patients. Future studies are needed that include a larger number of participants, more extensive patient information collection, and an extended period of intervention and follow-up. In addition, the usability of the mobile app for chronic disease self-management can be further increased through the app development process that reflects the expectations and needs of users and includes prior user testing [