Effectiveness of mobile health applications on clinical outcomes and health behaviors in patients with coronary heart disease: A systematic review and meta-analysis.
Yining Zhu, Yuhan Zhao, Ying Wu
PMID 38707688WHAT IT FOUND
For patients with coronary heart disease, app-based programs reduced major adverse cardiac events and hospital readmissions.
They also improved medication adherence, exercise capacity, total cholesterol, triglycerides, anxiety and depression; blood pressure, weight and smoking did not change.
Key findings
01Compared with control groups, app-based programs lowered the incidence of major adverse cardiac events by 32% and lowered the readmission rate by 44%.
02Medication adherence improved: the MMAS-8 score increased by 0.96, and the medication adherence rate ratio was 1.24.
03Exercise capacity increased: maximum oxygen consumption rose by 1.89 and 6-minute walk distance rose by 19.43.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
Only 24 of the 34 studies fully described random sequence generation, and only 4 showed sufficient allocation concealment. Most trials could not blind participants, and only 10 reported blinding of outcome assessment. The apps and care bundles differed widely in theory, content, frequency, duration, devices and staff roles, which increased heterogeneity. Publication bias was detected for major adverse cardiac events (P = 0.038), although trim-and-fill analysis did not reverse the pooled result. Many included trials were single-center and small-scale. Medication adherence was mostly assessed by self-report questionnaires. Not every outcome was analysed in every study, and sensitivity analyses changed some results, including HDL-C.
Declared interests
Funding was from the National Natural Science Foundation research program [72034005]. The authors state the funder had no role in design, implementation or analysis. They declare no competing financial or personal interests.
The easy way to misread this
Do not conclude that a mobile app by itself reduces major adverse cardiac events or readmissions. The trials delivered apps alongside education, reminders, real-time interaction, goal setting, feedback, wearable monitoring and staff follow-up, and the review could not separate the app's contribution.