Digital Health Interventions for Heart Failure Management in Underserved Rural Areas of the United States: A Systematic Review of Randomized Trials

• Published in: Journal of the American Heart Association Vol. 13; no. 2; p. e030956
• Main Authors: Azizi, Zahra, Broadwin, Cassandra, Islam, Sumaiya, Schenk, Jamie, Din, Natasha, Hernandez, Mario Funes, Wang, Paul, Longenecker, Chris T, Rodriguez, Fatima, Sandhu, Alex T
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 16.01.2024; Wiley
• Subjects: Biomarkers; Digital Health; digital health intervention; Female; heart failure; Heart Failure - diagnosis; Heart Failure - therapy; Humans; JAHA Spotlight: The AHA Strategically Focused Research Network on Health Technologies and Innovation; Male; Original Research; randomized controlled trials; Randomized Controlled Trials as Topic; Telemedicine - methods; underserved rural areas; United States; United States; heart failure; underserved rural areas; digital health intervention; randomized controlled trials; United States
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.123.030956

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. 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. 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. URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022366923.