Effect of mobile phone applications on medication adherence among patients with coronary artery diseases: A scoping review

Table 1 Inclusion and exclusion criteria for the selection of the articles under study

Criteria	Inclusion	Exclusion
Time period	2019-2023	Before 2019
Language	English	Other than English
Type of article	Quantitative, qualitative or mixed-method	Not peer reviewed, reviews, systematic or scoping reviews, chapters
Study focus	That examine the effect of mobile phone applications on medication adherence among CAD patients	Studies focusing on factors other than effect of mobile phone applications on medication adherence among CAD patients/or those featuring non-CAD/general patients

CAD: Coronary artery disease.

Table 2 General characteristics of the selected studies

Ref.	Year	Design	Objectives	Intervention	Follow up	Findings
Ni et al[23]	2018	RCT	To assess if the mobile phone-based mHealth intervention could improve medication adherence and relevant health outcomes among patients with CHD	mHealth	90 days	Nonadherence decreased more significantly in the experimental group
Devaraju et al[24]	2022	RCT	To study the use of technology on ensuring clinical follow ups of post percutaneous transluminal coronary angioplasty patients treatment compliance and study its effectiveness on modification of risk factors and adherence to lifestyle	Jayadeva Hrudaya Spandana	6 months	Adherence increased significantly in the experimental group
Chapman-Goetz et al[25]	2023	Prospective, single-blinded RCT	To assess the acceptability and feasibility of an app in supporting medication adherence in heart failure	Tiered intervention added to the NPS MedicineWise dose reminder app (MedicineWise app)	6 months	Protocol (results not known)
Li et al[26]	2022	Parallel designed, open-label, single-center, RCT	To explore the effect of a self-management mobile app to be used at home on the long-term use of secondary prevention medications in patients with CHD in China	Digital therapeutics app	12 + 6 months	Significant increase in adherence after using the app
Olivier et al[27]	2021	Open-label, single-center RCT	To evaluate the efficacy of a blended intervention with custom-designed mobile application and personalized health coaching to improve adherence to cardiovascular medications and risk factors	Bright Heart program, (mobile intervention)	90 ± 10 days	Not much significant difference was found between the intervention and control arms
Park et al[28]	2020	Qualitative	To examine the efficacy of a mHealth intervention using text messaging to improve adherence to antiplatelet and statin medications among patients with a history of myocardial infarction and/or percutaneous coronary intervention	TM + mobile app	4 weeks	TM increase compliance
Dorje et al[29]	2019	Parallel-group, single-blind, RCT	To assess the effectiveness of a smartphone-based cardiac rehabilitation and secondary prevention programme delivered via the social media platform WeChat (SMART-CR/SP)	SMART-CR/SP	12 months	SMART-CR/SP was found to be a cardiac rehabilitation and secondary prevention service model with high efficacy and accessibility and to be easy to use
Kauw et al[30]	2019	Prospective study	To investigate what advantages mHealth offers in the management of adults with CHD and to evaluate the acceptance of mHealth through adherence and patient experience	mHealth	12 months	Adherence to weekly measurements of weight and blood pressure were measured (non-pharmacological adherence)
Gallagher et al[31]	2019	RCT	To evaluate the impact of a game-based mobile app, in secondary prevention behaviours for cardiovascular risk factors	MyHeartMate	6 months	Protocol (results not known)
Santo et al[32]	2019	Parallel-design, single-centre, single-blind RCT	To assess the reach, acceptability, utility, and engagement with the apps that were used in the MEDication reminder APPlications (apps) to improve medication adherence in coronary heart disease (MedApp-CHD) study	MEDAPP	3 months	The participants in the medication reminder app groups had a significantly higher medication adherence, when compared to the usual care group

CHD: Congenital heart disease; mHealth: Mobile health; RCT: Randomized control trial; TM: Text messages.

Table 3 Results of the selected studies

Ref.	Design	Sample size	Results
Ni et al[23]	RCT	I: 103, C: 93	Non adherence	Decreased to 23.06% in I, 1.13% in C
Devaraju et al[24]	RCT	I: 100, C: 100	Compliance, adverse events	89 in I, 78 in C, 11%, 3 vs 15, 14% less in Intervention group
Chapman-Goetz et al[25]	RCT	N = 55, equal in both arms	Medication adherence	Protocol (results not known)
Li et al[26]	RCT	I:143, C: 147	Medication adherence	I: 86.2% adherence, C: 69.2% adherence
Olivier et al[27]	RCT	I: 11, C: 15 (trial failure), planned sample size: 132	Medication adherence	I: 88% (PDC), C: 94% (PDC)
Park et al[28]	Qualitative	28	Compliance (increase)	TM reminders + app increases compliance. Multiple verbatims supported this
Dorje et al[29]	RCT	I: 156, C: 156	Compliance (increase)	I: 37% adherence, C: 22% adherence
Kauw et al[30]	Prospective	109	Adherence to weekly measurements of weight and blood pressure	Adherence of more than 70% was registered in 77% of the patients
Gallagher et al[31]	RCT	I: 197, C: 197	Behaviour change, adherence	Protocol (results not available)
Santo et al[32]	RCT	I1: 54, I2: 53, C: 56	Compliance	More than 50% of the I1, more than 75% of the I2

C: Control; I: Intervention; PDC: Proportion of days covered; RCT: Randomized control trial.

Table 4 Intervention/app details

Ref.	App	App/intervention details
Ni et al[23]	mHealth	WeChat (Tencent Inc) and message express (Blue Mobile), message delivery apps (Reminders)
Devaraju et al[24]	Jayadeva Hrudaya Spandana	Risk factors, symptom, compliance, discharge report
Chapman-Goetz et al[25]	MedicineWise app	Tiered intervention added to the NPS MedicineWise dose reminder app
Li et al[26]	Digital therapeutics app	Three modules: Discharge module, home management module, follow up module, alarm system
Olivier et al[27]	Bright Heart program, (mobile intervention)	A mobile therapeutic intervention (WellnessMate, Cupertino, CA, United States) of personal health coaching with components of cardiac rehabilitation
Park et al[28]	MEMS	The mHealth mobile tech
Dorje et al[29]	SMART-CR/SP	WeChat based, pedometer, heart rate monitor, medicine reminder
Gallagher et al[31]	MyHeartMate	App based mobile game using heart avatar
Santo et al[32]	MEDAPP	Basic app: Alarm reminders. Advanced app: Snooze, taken and missed options

mHealth: Mobile health.

Table 5 Risk of bias using revised Cochrane risk-of-bias tool for randomized trials

Domain	Ni et al[23]	Devaraju et al[24]	Li et al[26]	Olivier et al[27]	Dorje et al[29]	Santo et al[32]
Domain-1: Risk of bias arising from the randomization process
1.1	Y	NI	Y	Y	Y	Y
1.2	Y	NI	Y	Y	Y	PY
1.3	N	NI	N	N	N	PN
	Low risk	Some concerns	Low risk	Low risk	Low risk	Low risk
Domain-2: Risk of bias due to deviations from the intended interventions (effect of assignment to intervention)
2.1	Y	Y	Y	Y	Y	Y
2.2	Y	Y	Y	Y	N	Y
2.3	N	N	N	Y	N	N
2.4	NA	NA	NA	Y	NA	NA
2.5	NA	NA	NA	N	NA	NA
2.6	PY	NI	PY	PN	PY	NI
2.7	NA	PN	NA	PY	NA	N
	Low risk	Some concerns	Low risk	High risk	Low risk	Some concerns
Domain 3: Risk of bias due to deviations from the intended interventions (effect of adhering to intervention)
3.1	Y	Y	Y	Y	Y	Y
3.2	Y	Y	Y	Y	N	Y
3.3	NA	NI	NA	PN	NA	NA
3.4	N	NA	N	Y	N	N
3.5	N	NA	N	Y	N	N
3.6	NA	NI	NA	PN	NA	NA
	Low risk	High risk	Low risk	High risk	Low risk	Low risk
Domain 4: Risk of bias due to missing outcome data
4.1	Y	Y	Y	N	Y	Y
4.2	NA	NA	NA	N	NA	NA
4.3	NA	NA	NA	N	NA	NA
4.4	NA	NA	NA	NA	NA	NA
	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Domain 5: Risk of bias in measurement of the outcome
5.1	N	PY	N	N	N	PN
5.2	N	PN	N	N	N	N
5.3	Y	NA	Y	Y	Y	Y
5.4	N	NA	N	N	N	N
5.5	NA	NA	NA	NA	NA	NA
	Low risk	High risk	Low risk	Low risk	Low risk	Low risk
Domain 6: Risk of bias in selection of the reported result
6.1	Y	NI	Y	Y	Y	Y
6.2	N	PN	N	N	N	N
6.3	N	PN	N	N	N	N
	Low risk	Some concerns	Low risk	Low risk	Low risk	Low risk
Overall risk-of-bias judgement	Low risk	High risk	Low risk	High risk	Low risk	Some concerns

N: No; NA: Not available; NI: No information; PN: Probably no; PY: Probably yes; Y: Yes.