JMIR Cardio. 2026 Jan 23. doi: 10.2196/83022. Online ahead of print.
ABSTRACT
BACKGROUND: Heart failure (HF) is a prevalent chronic condition associated with substantial morbidity, mortality, and healthcare utilization. Optimal management depends not only on guideline-directed medical therapy but also on patients' understanding of their disease, recognition of warning signs, and sustained medication adherence, areas that remain challenging in routine care, particularly in polymorbid patients with complex treatment regimens. Mobile health interventions may provide scalable support for therapeutic education and self-management; however, many available applications lack validated content and local relevance. Cardio-Meds is a mobile application developed at Geneva University Hospitals to support HF self-management through structured educational content, interactive quizzes with feedback, medication lists with optional reminders and intake confirmation, and tools for monitoring weight and vital signs.
OBJECTIVE: To evaluate the impact of a 30-day Cardio-Meds intervention on HF knowledge and self-management, and on medication adherence, in patients with HF with reduced or mildly reduced ejection fraction.
METHODS: We conducted a single-centre, pilot randomized controlled trial in patients followed at the outpatient HF clinic or enrolled in cardiac rehabilitation at Geneva University Hospitals between March and November 2024. Eligible participants had HF with left ventricular ejection fraction <50%, were receiving HF-specific pharmacotherapy, were able to communicate in French, and owned a smartphone. Participants were recruited by phone and were randomized to Cardio-Meds use for 30 days, a self-guided intervention with a single standardized technical support call, plus usual care or to usual care alone. The outcomes were self-assessed using standardized questionnaires. HF knowledge and self-management were assessed at baseline and 30 days using the Dutch Heart Failure Knowledge Scale (DHFKS; score range 0-15). Medication adherence was evaluated using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS®), covering initiation, implementation, and persistence. Usability in the intervention group was assessed using the System Usability Scale (SUS; score range 0-100). Between-group differences in DHFKS scores were analysed using analysis of covariance adjusted for baseline values.
RESULTS: A total of 49 participants were included (25 intervention, 24 control; 78% male; mean age 62±11.4 years). In intervention group, median app usage was 123 minutes (IQR 74-273), with median of 43 logins (IQR 19-85). Baseline DHFKS scores were similar between groups (intervention 11.1±2.4 vs control 10.5±2.9). At 30 days, DHFKS scores increased significantly in the intervention group (12.4±2.4; mean change +1.3, p<0.001) and remained stable in the control group (10.4±3.0; mean change -0.1, p=0.82), with a significant adjusted between-group difference of +1.3 points (p<0.001). No significant between-group differences were observed for medication adherence across BAASIS® domains. Usability was excellent (mean SUS 84.3±15.0), and 64% of intervention participants reported they would continue using the application.
CONCLUSIONS: In a stable ambulatory HF population, a 30-day Cardio-Meds intervention demonstrated short-term improvement in HF knowledge, while no effect was observed on medication adherence within the 30-day follow-up period. The application demonstrated high usability and acceptability. Larger multicentre studies with longer follow-up are needed to assess whether improved knowledge translates into sustained adherence and improved clinical outcomes.
PMID:41575456 | DOI:10.2196/83022