Effect of telemedicine on self-care in patients with heart failure: a meta-analysis of randomized controlled trials.

Heart failure (HF) is the fastest growing cardiovascular condition globally; associated management costs and hospitalizations place an immense burden on healthcare systems. Wearable electronic devices (WEDs) may be useful tools to enhance HF management and mitigate negative health outcomes. We aimed to perform a systematic review to examine the potential of WEDs to support HF self-care in ambulatory patients at home. Five databases were searched for studies published between 2007 and May 2022, including OVID MEDLINE, EMBASE (OVID), APA PsycINFO (OVID), Cochrane Central Register of Controlled Trials (OVID), and CINAHL Plus with Full Text (Ebsco). After 6210 duplicates were removed, 4045 records were screened and 6 were included for review (2 conference abstracts and 4 full-text citations). All studies used WEDs as 1 component of a larger intervention. Outcome measures included quality of life, physical activity, self-efficacy, self-care, functional status, time to readmission, social isolation, and mood. Studies were of moderate to high quality and mixed findings were reported. Enhanced exercise habits and motivational behavior to exercise, as well as decreased adverse symptoms of fatigue and dyspnea, were identified in 2 studies. However, improvements in exercise capacity and increased motivational behavior did not lead to exercise adherence in another 2 studies. The findings from this review suggest that WEDs may be a viable health behavior improvement strategy for patients with HF. However, studies of higher quality, with the primary intervention being a WED, and consistent outcome measures are needed to replicate the positive findings of studies identified in this review.

This updated meta-analysis set out to investigate the effect of nurse-led telecoaching on anxiety, depression, heart failure knowledge, self-care, and quality of life among patients suffering from heart failure. We systematically searched PubMed, the Cochrane Library, Scopus, and Web of Science up to June 10, 2025, to find randomized controlled trials evaluating the effect of nurse-led telecoaching on anxiety, depression, heart failure knowledge, self-care, and quality of life among patients suffering from heart failure. We adopted a random-effects model to pool data and employed the revised RoB2 tool to determine the risk of bias. In total, 19 studies with 2917 participants were included in this meta-analysis. We found that despite some improvements compared to usual care, nurse-led telecoaching did not significantly change the heart failure knowledge of patients [standardized mean difference (SMD) 2.09, 95% confidence interval (CI) (-0.01-4.18), I2 = 99.41%], depression [SMD -0.27, 95% CI (-0.59-0.04), I2 = 78.21%], anxiety [SMD -0.06, 95% CI (-0.22-0.10), I2 = 0.00%], self-care [SMD 0.12, 95% CI (-0.67-0.91), I2 = 98.45%], and quality of life [SMD -0.33, 95% CI (-0.82-0.17), I2 = 96.53%] scores among patients with heart failure. Despite some degrees of improvement, nurse-led telecoaching did not significantly improve the heart failure knowledge, anxiety, depression, self-care, and quality of life of those suffering from heart failure.

The purpose of this systematic review and meta-analysis is to examine the impact of telemedicine interventions on the quality of life (QoL) and depression in individuals with spinal cord injury (SCI). A literature search was conducted in four electronic databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) from their inception to February 1, 2024. Two authors independently screened the studies and extracted the data. Cochrane's bias risk tool for randomized controlled trials was used to examine the methodological quality of the included studies. A meta-analysis was conducted using Review Manager (version 5.4) to synthesize the results of the included studies. A total of 10 trials with 728 participants were included in the review. The results of the meta-analysis showed that telemedicine interventions significantly improved QoL [Standardized Mean Difference (SMD)=0.72, 95% Confidence Interval (CI) (0.11, 1.32), P=0.02] and reduced depression scores [SMD=-0.18, 95% CI (-0.31, -0.05), P=0.006]. Telemedicine interventions are a feasible method to support people with SCI, and can mitigate depression and enhance quality of life. In the future, studies should involve larger sample sizes and extended follow-up periods to validate these findings and to identify the most effective telemedicine interventions for improving the overall health outcomes of individuals with SCI. https://www.crd.york.ac.uk/prospero/, identifier CRD42024508702.

Commonality Between Depression and Heart Failure

This review is an update of a previously published review in the Cochrane Database of Systematic Reviews Issue 1, 2013 on Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease.Patients with advanced progressive disease often experience muscle weakness, which can impact adversely on their ability to be independent and their quality of life. In those patients who are unable or unwilling to undertake whole-body exercise, neuromuscular electrical stimulation (NMES) may be an alternative treatment to enhance lower limb muscle strength. Programmes of NMES appear to be acceptable to patients and have led to improvements in muscle function, exercise capacity, and quality of life. However, estimates regarding the effectiveness of NMES based on individual studies lack power and precision. Primary objective: to evaluate the effectiveness of NMES on quadriceps muscle strength in adults with advanced disease. Secondary objectives: to examine the safety and acceptability of NMES, and its effect on peripheral muscle function (strength or endurance), muscle mass, exercise capacity, breathlessness, and health-related quality of life. We identified studies from searches of the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), and Database of Abstracts of Reviews of Effects (DARE) (the Cochrane Library), MEDLINE (OVID), Embase (OVID), CINAHL (EBSCO), and PsycINFO (OVID) databases to January 2016; citation searches, conference proceedings, and previous systematic reviews. We included randomised controlled trials in adults with advanced chronic respiratory disease, chronic heart failure, cancer, or HIV/AIDS comparing a programme of NMES as a sole or adjunct intervention to no treatment, placebo NMES, or an active control. We imposed no language restriction. Two review authors independently extracted data on study design, participants, interventions, and outcomes. We assessed risk of bias using the Cochrane 'Risk of bias' tool. We calculated mean differences (MD) or standardised mean differences (SMD) between intervention and control groups for outcomes with sufficient data; for other outcomes we described findings from individual studies. We assessed the evidence using GRADE and created a 'Summary of findings' table. Eighteen studies (20 reports) involving a total of 933 participants with COPD, chronic respiratory disease, chronic heart failure, and/or thoracic cancer met the inclusion criteria for this update, an additional seven studies since the previous version of this review. All but one study that compared NMES to resistance training compared a programme of NMES to no treatment or placebo NMES. Most studies were conducted in a single centre and had a risk of bias arising from a lack of participant or assessor blinding and small study size. The quality of the evidence using GRADE comparing NMES to control was low for quadriceps muscle strength, moderate for occurrence of adverse events, and very low to low for all other secondary outcomes. We downgraded the quality of evidence ratings predominantly due to inconsistency among study findings and imprecision regarding estimates of effect. The included studies reported no serious adverse events and a low incidence of muscle soreness following NMES.NMES led to a statistically significant improvement in quadriceps muscle strength as compared to the control (12 studies; 781 participants; SMD 0.53, 95% confidence interval (CI) 0.19 to 0.87), equating to a difference of approximately 1.1 kg. An increase in muscle mass was also observed following NMES, though the observable effect appeared dependent on the assessment modality used (eight studies, 314 participants). Across tests of exercise performance, mean differences compared to control were statistically significant for the 6-minute walk test (seven studies; 317 participants; 35 m, 95% CI 14 to 56), but not for the incremental shuttle walk test (three studies; 434 participants; 9 m, 95% CI -35 to 52), endurance shuttle walk test (four studies; 452 participants; 64 m, 95% CI -18 to 146), or for cardiopulmonary exercise testing with cycle ergometry (six studies; 141 participants; 45 mL/minute, 95% CI -7 to 97). Limited data were available for other secondary outcomes, and we could not determine the most beneficial type of NMES programme. The overall conclusions have not changed from the last publication of this review, although we have included more data, new analyses, and an assessment of the quality of the evidence using the GRADE approach. NMES may be an effective treatment for muscle weakness in adults with advanced progressive disease, and could be considered as an exercise treatment for use within rehabilitation programmes. Further research is very likely to have an important impact on our confidence in the estimate of effect and may change the estimate. We recommend further research to understand the role of NMES as a component of, and in relation to, existing rehabilitation approaches. For example, studies may consider examining NMES as an adjuvant treatment to enhance the strengthening effect of programmes, or support patients with muscle weakness who have difficulty engaging with existing services.

Exercise-based cardiac rehabilitation has positive benefits for patients with chronic heart failure (CHF), but the choice of exercise intensity has been controversial. The aim of this systematic review and meta-analysis was to investigate the effects of different exercise intensities on cardiopulmonary function and quality of life (QoL) of patients with CHF. Randomized controlled trials (RCTs) of different exercise intensities applied to patients with CHF were searched in PubMed, Web of Science, the Cochrane Library, and Embase databases from inception to December 2021. Study selection and data extraction were performed simultaneously by two independent reviewers, using the Physiotherapy Evidence Database Scale (PEDro) for quality assessment of the included literature. The weighted mean differences (WMD) or standardized mean difference (SMD) were calculated by employing afixed or random effects model. Other statistical analyses included subgroup analysis and sensitivity analysis. Quality of evidence was evaluated by the Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) method. Eight RCTs were included. Analyses reported no significant improvement in left ventricular ejection fractions (LVEF; WMD = 0.47, 95% CI [-4.10, 5.03], p = 0.841), peak oxygen uptake (peakVO2) (SMD = 0.38, 95% CI [-0.03, 0.80], p = 0.069) and 6‑min walking distance (6MWD) (WMD = 14.10, 95% CI [-9.51, 37.72], p = 0.242). Exercise interventions of varying intensity produced small-to-moderate beneficial effects on QoL (WMD = -4.99, 95% CI [-8.29, -1.68], p = 0.003), which appeared to be attenuated at long-term follow-up (WMD = 2.12, 95% CI [-2.91, 7.16], p = 0.409). High-intensity exercise does not have asignificant advantage over moderate-intensity exercise in improving cardiopulmonary function and aerobic capacity in patients with CHF. Beneficial changes in QoL from high-intensity exercise also appeared to decrease during long-term follow-up, indicating acumulative effect of the efficacy of high-intensity exercise.

Most heart failure patients have multiple comorbidities. This study aims to test the moderating effect of comorbidity on the relationship between self-efficacy and self-care in adults with heart failure. Secondary analysis of four mixed methods studies (n = 114) was done. Self-care and self-efficacy were measured using the Self-Care of Heart Failure Index. Comorbidity was measured with the Charlson Comorbidity Index. Parametric statistics were used to examine the relationships among self-efficacy, self-care, and the moderating influence of comorbidity. Qualitative data yielded themes about self-efficacy in self-care and explained the influence of comorbidity on self-care. Most (79%) reported two or more comorbidities. There was a significant relationship between self-care and the number of comorbidities (r = -.25; p = .03). There were significant differences in self-care by comorbidity level (self-care maintenance, F[1, 112], 5.96, p = .019, and self-care management, F[1, 72], 4.66, p = .034). Using moderator analysis of the effect of comorbidity on self-efficacy and self-care, a significant effect was found only in self-care maintenance among those who had moderate levels of comorbidity (b = .620, p = .022, F(change) df[6,48], 5.61, p = .022). In the qualitative data, self-efficacy emerged as an important variable influencing self-care by shaping how individuals prioritized and integrated multiple and often competing self-care instructions. Comorbidity influences the relationship between self-efficacy and self-care maintenance, but only when levels of comorbidity are moderately high. Methods of improving self-efficacy may improve self-care in those with multiple comorbidities.

Section 6: Nonpharmacologic Management and Health Care Maintenance in Patients With Chronic Heart Failure

The relationship between self-efficacy and self-care behaviors in

Most patients with cancer experience psychological or physical distress, which can adversely affect their quality of life (QOL). Smartphone app interventions are increasingly being used to improve QOL and psychological outcomes in patients with cancer. However, there is insufficient evidence regarding the effect of this type of intervention, with conflicting results in the literature. In this systematic review and meta-analysis, we investigated the effectiveness of mobile phone app interventions on QOL and psychological outcomes in adult patients with cancer, with a special focus on intervention duration, type of cancer, intervention theory, treatment strategy, and intervention delivery format. We conducted a literature search of PubMed, Web of Science, the Cochrane Library, Embase, Scopus, China National Knowledge Infrastructure, and WanFang to identify studies involving apps that focused on cancer survivors and QOL or psychological symptoms published from inception to October 30, 2022. We selected only randomized controlled trials that met the inclusion criteria and performed systematic review and meta-analysis. The standardized mean difference (SMD) with a 95% CI was pooled when needed. Sensitivity and subgroup analyses were also conducted. In total, 30 randomized controlled trials with a total of 5353 participants were included in this meta-analysis. Compared with routine care, app interventions might improve QOL (SMD=0.39, 95% CI 0.27-0.51; P<.001); enhance self-efficacy (SMD=0.15, 95% CI 0.02-0.29; P=.03); and alleviate anxiety (SMD=-0.64, 95% CI -0.73 to -0.56; P<.001), depression (SMD=-0.33, 95% CI -0.58 to -0.08; P=.009), and distress (SMD=-0.34, 95% CI -0.61 to -0.08; P=.01). Short-term (duration of ≤3 months), physician-patient interaction (2-way communication using a smartphone app), and cognitive behavioral therapy interventions might be the most effective for improving QOL and alleviating adverse psychological effects. Our study showed that interventions using mobile health apps might improve QOL and self-efficacy as well as alleviate anxiety, depression, and distress in adult cancer survivors. However, these results should be interpreted with caution because of the heterogeneity of the interventions and the study design. More rigorous trials are warranted to confirm the suitable duration and validate the different intervention theories as well as address methodological flaws in previous studies. PROSPERO CRD42022370599; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=370599.

This study aimed to investigate the effects of exercise on aerobic capacity and quality of life (QOL) in heart failure (HF) patients and to identify the optimal exercise prescription for improving aerobic capacity and QOL. A comprehensive search was conducted in Embase, PubMed, Cochrane Library, Web of Science, and Scopus covering data published up to 9 October 2024. The Population, Intervention, Comparison, Outcome (PICO) framework was used to define the inclusion. (a) Population: patients with HF; (b) Intervention: randomized controlled trials (RCTs) with subjects randomly assigned to either the intervention or control group; (c) Comparison: studies that measured peak oxygen uptake (VO2peak), maximal oxygen uptake (VO2max), or the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at baseline and compared results post-intervention; (d) Outcome: the primary outcomes were aerobic capacity and QOL. The Physiotherapy Evidence Database (PEDro) scale and the Cochrane Risk of Bias 2 (RoB-2) tool were used to assess the quality of the included studies. Weighted mean difference (WMD), standardized mean difference (SMD), and 95% confidence interval were used to pool data. A total of 47 studies met the inclusion criteria. Exercise significantly improved aerobic capacity (WMD, 2.85, p &lt; 0.00001) and QOL (SMD, −0.79, p &lt; 0.00001) in HF patients. Subgroup analyses indicated that combined exercise, session duration ≥ 60 min, ≥3 sessions per week, ≥180 min per week, and supervised exercise showed more significant improvements in aerobic capacity and QOL. Additionally, exercise had greater benefits in middle-aged patients. To improve aerobic capacity and QOL, the optimal exercise prescription for HF patients involves engaging in supervised combined exercise at least three times per week, with each session lasting at least 60 min, to achieve a total weekly duration of 180 min. These recommendations are particularly relevant for middle-aged patients, who may experience greater benefits from exercise interventions. The protocol has been registered on PROSPERO with the registration number CRD420250632915.

Relation of Baseline Systolic Blood Pressure and Long-Term Outcomes in Ambulatory Patients With Chronic Mild to Moderate Heart Failure

Adults with implantable cardioverter defibrillators (ICDs) frequently experience psychological distress, characterized as elevated symptoms of anxiety and depression; this significantly compromises their health-related quality of life (HRQoL). This review aims to synthesize the evidence on telemedicine interventions and evaluates their effectiveness on anxiety, depression, and HRQoL among adults with ICDs. A comprehensive search was conducted across eight databases including Embase, PubMed, Cochrane Library, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and ProQuest Dissertations and Theses. The quality of the studies was assessed using the revised Cochrane risk of bias tool for randomized trials (RoB2). Meta-analyses were performed using the Review Manager Web, employing a random-effects model. Nine studies encompassing a total of 1147 participants were included. Telemedicine interventions included phone calls, web-based platforms, mobile application, and remote monitoring. The meta-analysis results showed no significant differences between telemedicine interventions and standard care in perceived anxiety [standardized mean difference (SMD): -0.21; 95% confidence interval (CI): -0.64, 0.22; P = 0.34, very low certainty], perceived depression (mean difference: -0.40; 95% CI: -2.14, 1.34; P = 0.65, very low certainty), and HRQoL (SMD: 0.01; 95% CI: -0.18, 0.20, P = 0.92, low certainty). Although no statistically significant differences were observed between telemedicine and standard care interventions in improving anxiety, depression, and HRQoL in adults with ICDs, telemedicine should continue to serve as a valuable complement to existing standard care. Future high-quality randomized controlled trials are needed to establish its effectiveness. PROSPERO: CRD42025648188.

Effect of Angiotensin Converting Enzyme Inhibitors on Functional Capacity in Elderly Patients with Heart Failure and Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

BackgroundThe cornerstone of effective management in heart failure (HF) is the ability to self-care.Aims include i) To determine factors influencing self-care in HF patients with cognitive impairment (CI) and ii) to determine the influence of cognitive domains on self-care in patients with HF and CI.MethodsMEDLINE, CINAHL, EMBASE, EBSCOHost, PsychINFO, ProQuest Research Library, Health Technology Assessment Database, The Cochrane Library, Web of Science and Scopus databases were systematically searched. Original research describing the relationship between cognition and HF self-care in community-dwelling older persons with dementia/CI in English, published in a peer-reviewed journal from 1stJanuary(2000)-22ndMarch(2016) was identified. Study and population characteristics, data sources, self-care processes, methods of cognitive assessment, cognitive domains affected, study outcomes, impact of impairment, and other risk factors of self-care impairment were abstracted by two reviewers.ResultsOf 10,688 studies identified, 14 met the inclusion criteria. Patients with HF and CI ranged from 14 to 73%. Where reported, self-care maintenance adequacy ranged from 50 to 61%; self-care management adequacy ranged from 14 to 36% and self-care confidence adequacy ranged from 0 to 44% on the Self-care of Heart Failure Index (SCHFI). All but one study predicted poor self-care ability according to poor outcome on cognitive testing. Additionally, specific cognitive domain deficits impaired self-care. Subjects with lower cognitive scores were less likely to seek assistance while subjects with depression had poor self-care abilities.ConclusionsClinicians must consider the type and severity of impairments in cognitive domains to tailor management. Awareness of depression, self-confidence and support access may modulate self-care ability.