Affiliation:
1. Center for Digital Health Stanford University Stanford CA USA
2. Stanford University Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine Stanford University Stanford CA USA
3. Veterans Affairs Palo Alto Healthcare System Palo Alto CA USA
4. Division of Cardiology and Department of Global Health University of Washington Seattle WA USA
Abstract
Background
Heart failure disproportionately affects individuals residing in rural areas, leading to worse health outcomes. Digital health interventions have been proposed as a promising approach for improving heart failure management. This systematic review aims to identify randomized trials of digital health interventions for individuals living in underserved rural areas with heart failure.
Methods and Results
We conducted a systematic review by searching 6 databases (CINAHL, EMBASE, MEDLINE, Web of Science, Scopus, and PubMed; 2000–2023). A total of 30 426 articles were identified and screened. Inclusion criteria consisted of digital health randomized trials that were conducted in underserved rural areas of the United States based on the US Census Bureau's classification. Two independent reviewers screened the studies using the National Heart, Lung, and Blood Institute tool to evaluate the risk of bias. The review included 5 trials from 6 US states, involving 870 participants (42.9% female). Each of the 5 studies employed telemedicine, 2 studies used remote monitoring, and 1 study used mobile health technology. The studies reported improvement in self‐care behaviors in 4 trials, increased knowledge in 2, and decreased cardiovascular mortality in 1 study. However, 3 trials revealed no change or an increase in health care resource use, 2 showed no change in cardiac biomarkers, and 2 demonstrated an increase in anxiety.
Conclusions
The results suggest that digital health interventions have the potential to enhance self‐care and knowledge of patients with heart failure living in underserved rural areas. However, further research is necessary to evaluate their impact on clinical outcomes, biomarkers, and health care resource use.
Registration
URL:
https://www.crd.york.ac.uk/prospero/
; Unique identifier: CRD42022366923.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine