Instant Messaging-Based mHealth for Integrated Care in Chronic Heart Failure: Impact on Emergency Visits, Hospitalizations, and Quality of Life in Thailand
Abstract
Objective: To evaluate the impact of an instant messaging-based mobile health (mHealth) application integrated with heart failure (HF) clinic care on emergency department (ED) visits, hospitalizations, and quality of life (QoL) in HF patients over one year.
Material and Methods: A retrospective cohort study was conducted at Songklanagarind Hospital, Thailand, including 88 HF patients who used an instant messaging-based HF application for self-care monitoring between 2021 and 2025. ED visits, hospitalizations, and Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores were compared before and after the intervention using zero-inflated Poisson regression and paired t-tests. High usage was defined as ≥100 data submissions/year. Logistic regression analysis was performed to identify the factors associated with a favorable treatment response.
Results: Post-intervention, ED visits decreased from 2.01 ± 1.80 to 0.75 ± 1.20 events/year (IRR=0.37, 95% CI [0.28, 0.49], p < 0.001), while hospitalizations decreased from 1.69 ± 1.00 to 0.56 ± 0.92 events/year (IRR=0.33, 95% CI [0.24, 0.45], p < 0.001). MLHFQ scores improved from 50.8 ± 22.6 to 31.9 ± 24.3 (mean difference=18.9, 95% CI [14.8, 23.0], p < 0.001). High-usage patients demonstrated greater QoL improvement (p = 0.01). Patient clinical status, particularly functional severity, was associated with treatment response.
Conclusion: Integration of an instant messaging-based mHealth application with HF clinic care significantly reduced healthcare utilization and improved QoL in Thai HF patients. Patient clinical status may influence responsiveness to the intervention, highlighting the importance of individualized care. These findings support mHealth adoption in Thailand’s healthcare system.
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