Patients' Experiences of Nurse-Led eHealth Interventions for Chronic Heart Failure: Qualitative Systematic Review and Meta-Synthesis

Clinical Snapshot

Key Findings

• P Value: Not applicable — qualitative methodology

• Effect Size: Not applicable — qualitative meta-synthesis; no quantitative effect size calculated

• Primary Outcome: Four synthesised themes from 23 qualitative and mixed-methods studies (n=424 CHF patients): (1) patient empowerment and enhanced self-management; (2) sense of security and continuity of care under professional support; (3) variations in acceptance and emotional responses; (4) barriers and challenges in implementing eHealth interventions

• Nnt Or Sensitivity: Not applicable — qualitative evidence synthesis; no NNT, sensitivity, specificity, or hazard ratio calculable from this study design

• Confidence Interval: Not applicable — qualitative synthesis; GRADE-CERQual confidence ratings not reported in abstract

Clinical Application

Nurse-led eHealth interventions for CHF are feasible and acceptable to many patients, as evidenced by the positive themes of empowerment and security. However, the identified barriers — including technological usability challenges, digital literacy variability, and patient heterogeneity — indicate that implementation requires careful patient selection, tailored onboarding, and ongoing technical support. Sustainability of engagement over time is flagged as a specific concern requiring further design attention. In Australia, CHF affects approximately 480,000 people and is a leading cause of hospitalisation and healthcare expenditure. The Australian Commission on Safety and Quality in Health Care and RACGP guidelines increasingly support integrated chronic disease management models. Nurse-led telehealth programmes align with the MBS telehealth item numbers expanded post-COVID-19 and with the National Digital Health Strategy. The Heart Foundation of Australia supports self-management education as a core component of CHF care. However, equity of access to eHealth interventions remains a concern for rural and remote populations, Aboriginal and Torres Strait Islander communities, and older patients with limited digital literacy — barriers directly identified in this review. TGA oversight of digital health devices used in remote monitoring would apply to any formal implementation. PBS-listed medications for CHF (e.g., sacubitril-valsartan, SGLT2 inhibitors) are increasingly prescribed in the community, making nurse-led eHealth support for medication adherence monitoring particularly relevant to Australian practice. Adult patients with chronic heart failure managed in post-discharge, outpatient, or community settings who are candidates for nurse-led eHealth or telehealth self-management programmes. Findings are most directly applicable to patients with sufficient digital literacy and access to technology, though barriers identified in the review highlight the need for individualised assessment.

Abstract

BACKGROUND: Chronic heart failure (CHF) is a major chronic condition in the context of global population aging and is associated with high prevalence, frequent rehospitalization, and high mortality. Self-management is widely recognized as an important factor influencing prognosis and quality of life among patients with CHF. Nurse-led eHealth interventions have been increasingly used in postdischarge CHF management and have shown potential for improving adherence and health-related behaviors. However, existing studies have predominantly focused on objective outcomes, and limited systematic synthesis has examined patients' subjective experiences, which may restrict the patient-centered optimization and sustainable implementation of these interventions. OBJECTIVE: This study aimed to systematically synthesize patients' experiences of nurse-led eHealth interventions for CHF, identify facilitators and barriers to engagement and implementation, and inform the patient-centered optimization of intervention design through a qualitative systematic review and meta-synthesis. METHODS: This qualitative systematic review and meta-synthesis was conducted in accordance with the Joanna Briggs Institute methodology for qualitative systematic reviews. A comprehensive search was performed in PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, CNKI, WanFang, and VIP from database inception to April 30, 2026, supplemented by manual searches of the reference lists of the included studies. Following methodological quality appraisal, the findings of the included studies were extracted and synthesized using thematic synthesis. RESULTS: A total of 23 studies involving 424 patients with CHF were included, comprising 17 qualitative studies and 6 mixed methods studies. Four synthesized themes and 12 subthemes were generated: (1) patient empowerment and enhanced self-management, (2) sense of security and continuity of care under professional support, (3) variations in acceptance and emotional responses, and (4) barriers and challenges in implementing eHealth interventions. CONCLUSIONS: Nurse-led eHealth interventions may provide important support for CHF management from the patient perspective by promoting empowerment and extending care support beyond hospital settings. The findings suggest that future intervention design should better address patient heterogeneity, technological usability, and long-term sustainability. Further efforts are needed to strengthen individualized adaptation and technological optimization to enhance the accessibility, acceptability, and patient-centered implementation of these interventions.

References

1. 1.Zhang, Y., Ma, Y., Han, W., Song, Y., Wang, Z., Jin, X., Cheng, W., Yu, S., & Li, R. (2026). Patients' experiences of nurse-led eHealth interventions for chronic heart failure: Qualitative systematic review and meta-synthesis. Journal of Medical Internet Research. https://doi.org/10.2196/82714