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heart failure, self-management, symptom management, mHealth, technology



  1. Schmaderer, Myra S. PhD, MSN, RN
  2. Struwe, Leeza PhD, MSN, RN
  3. Loecker, Courtney APRN-NP, AGACNP-BC, MSN
  4. Lier, Lauren DNP, AGACNP-BC, RN
  5. Lundgren, Scott W. DO
  6. Wichman, Chris PhD
  7. Pozehl, Bunny PhD, APRN-NP, FHFSA, FAHA, FAAN
  8. Zimmerman, Lani PhD, RN, FAHA, FAAN


Background: Heart failure (HF) is a multifaceted syndrome that requires self-management for adherence to treatment to control symptoms. Symptoms need to be monitored to prevent impending HF exacerbations. Few HF study authors have assessed efficacy of mobile health (mHealth) interventions particularly with virtual visits to evaluate outcomes such as symptoms and healthcare utilization.


Objective: The aim of this pilot study was to evaluate the potential effect of mHealth self-management interventions on symptom status and health-related quality of life and describe health care utilization in patients with HF.


Methods: This 3-month pilot study included 74 patients with HF and used a randomized 3-group repeated-measures design (enhanced usual care, mHealth, and mHealth plus [+] virtual visits). Surveys included the Heart Failure Symptom Survey, EuroQol, and a specialized phone application for patients to report weights and medications.


Results: The mHealth groups had an overall decrease in most symptom severity and frequency, particularly shortness of breath. Compared to enhanced usual care, both the mHealth+ and mHealth groups showed promise with medium effect sizes (range .55-.60) in relation to shortness of breath and a medium effect (.51) for lower extremity edema for the mHealth+ group. There was a trend toward improvement in health-related quality of life in both intervention groups at month 3. The mHealth+ group had fewer rehospitalizations.


Conclusions: In general, both mHealth groups fared better on symptoms and health care utilization. Small to medium effect sizes on selected symptom outcomes warrant this study to be conducted in a fully powered study. Virtual visits may assist in symptom recognition and self-management.