Highlights
- •‘eHealth literacy’ has been defined to assess competences in an eHealth framework.
- •‘Computer and traditional literacy’ have been tested in an eHealth-based HF-care.
- •eHealth-based HF-care is effective regardless of 2 ‘eHealth literacy’ domains.
- •It's key to integrate assessments to evaluate ‘eHealth literacy’ in HF programs.
Abstract
Background
The potential positive effect of electronic health (eHealth)-based heart failure (HF)
monitoring remains uncertain mainly in the ‘low literacy’ or ‘computer or digital
illiterate’ patients. The aim of this study was to determine the effectiveness of
a telemedicine (TM)-based managed care solution across literacy levels and information
and communications technology (ICT) skills.
Methods
We performed a sub-analysis on the basis of two literacy domains encompassed in the
definition of ‘eHealth literacy’ to the HF-patients included in the ‘insuficiència Cardíaca Optimització Remota’ (iCOR) randomized study comparing TM vs. usual care (UC) in HF-patients. The primary
study endpoint was the incidence of a non-fatal HF event after 6 months of inclusion.
The event rates of primary and secondary study endpoints were calculated for each
literacy domains and its combination. Cox proportional-hazards regression models were
used to evaluate the effect of ‘eHealth literacy’ dimensions, treatment group and
the interaction term ‘eHealth literacy’ domains by treatment group on study endpoints.
Results
The beneficial effect of TM compared to UC strategy was consistent across all literacy
domains (p-value for interaction 0.207 and 0.117 respectively). The risk of experiencing
a primary event was significantly lower in patients that underwent allocation to the
TM arm compared to UC in both clustered in the ‘lower literacy’ (p-value=0.001) and
those allocated to the ‘lower ICT skills’ (p-value=0.001) subgroup.
Conclusions
Non-invasive eHealth-based HF monitoring tools are effective compared to UC in preventing
HF events in the early post-discharge period, regardless of two ‘eHealth literacy’
domains (‘traditional and computer literacy’).
Keywords
Abbreviations and acronyms:
ADL (activities of daily living), AF (atrial fibrillation), APGAR (adaptability, partnership, growth, affection, resolve), BP (blood pressure), CI (confidence interval), CKD (chronic kidney disease), COPD (chronic obstructive pulmonary disease), COVID (SARS-CoV-2 disease), CV (cardiovascular), eHealth (electronic health), EHFScBS (European heart failure self-care behaviour scale), ESC (European Society of Cardiology), GDS (geriatric depression scale), HR (heart rate), HF (heart failure), iCOR (insuficiència Cardíaca Optimització Remota), ICT (information and communications technology), IQR (interquartile range), LVEF (left ventricular ejection fraction), MLHFQ (Minnesota living with heart failure questionnaire), MMSE (mini-mental state examination), NYHA (New York Heart Association), QoL (quality of life), RCT (randomized clinical trial), SD (standard deviation), TIM-HF2 (Telemedical Interventional Management in Heart Failure II), TM (telemedicine), UC (usual care)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 25, 2022
Accepted:
April 7,
2022
Received in revised form:
April 3,
2022
Received:
January 28,
2022
Identification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
