Abstract
BACKGROUND: Heart failure (HF) is a significant global health challenge, requiring innovative management strategies like eHealth. However, the success of eHealth in managing HF heavily relies on patient adherence, an area currently not sufficiently investigated despite its critical role in ensuring the effectiveness of this approach. OBJECTIVE: This review was initiated to gather evidence on adherence to eHealth devices among patients with HF. The goal was to survey the current state of adherence, pinpoint factors that promote successful engagement, and identify gaps needing further research. METHODS: A scoping review was conducted to gather quantitative data on eHealth engagement from relevant clinical HF studies indexed in PubMed, CINAHL, and PsycINFO up to February 2025. Descriptive characteristics of the publications were extracted, and generalized mixed model analyses were used to identify eHealth characteristics affecting patient adherence. RESULTS: Our analysis included 70 studies, primarily using noninvasive eHealth interventions with wearables (n=51), followed by wearables only (n=8), noninvasive eHealth interventions without wearables (n=6), invasive devices (n=3), and telephone support (n=2). The median number of patients per study was 49 (IQR 20-139), and the median follow-up duration was 180 (IQR 84-360) days. Variability in reporting and definitions of eHealth adherence was noted. In total, 20 studies assessed adherence trends, with 13 noting a decline, 6 observing no change, and 1 reporting an increase over time. Factors influencing adherence were explored in 29 studies; 7 indicated higher adherence with increasing patient age, 2 showed a negative correlation, and 9 detected no age-related differences. No gender differences were found in the 10 publications that reported on gender, and 9 studies found no association between adherence and the New York Heart Association classification, while 1 noted higher adherence in patients with more severe symptoms. In 35 (50%) studies, adherence was quantified as the percentage of mean days the intervention was used, yielding a median adherence rate of 78% (IQR 61%-86%; range 31%-98%). No significant correlations were found between adherence rates and the number of eHealth device users, type of intervention, follow-up duration, number of parameters monitored, or data collection frequency. CONCLUSIONS: Reporting and definitions of patient adherence in HF studies are incomplete and inconsistent. Trends indicate a decrease in eHealth use over time. Customizing devices to meet patient needs may help mitigate this issue. Future research should offer a more detailed description of adherence to pinpoint factors that enhance patient adherence with eHealth technologies.