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World J Methodol. Sep 20, 2026; 16(3): 117065
Published online Sep 20, 2026. doi: 10.5662/wjm.117065
Smartphone-based mobile health impact on oral anticoagulation adherence, quality of life, and healthcare utilization in adult atrial fibrillation
Muhammad Farhan, Tirath Patel, Waleed Harazeen, Yara Mohamed, Abdullah Al Azzawi, Heba Intabli, Nada Ahmed, Mohammed Al-Hadi Naseer Obais, Mohammad Riyad Alkhazali, Bhumi Daishik Patel, Asfaq Ahmad, Ayoola Awosika
Muhammad Farhan, Waleed Harazeen, Abdullah Al Azzawi, Mohammed Al-Hadi Naseer Obais, Mohammad Riyad Alkhazali, Department of Internal Medicine, Ajman University, Ajman 6263, United Arab Emirates
Tirath Patel, Department of Medicine, Trinity Medical Sciences University School of Medicine, Kingstown VC0100, Saint George, Saint Vincent and the Grenadines
Yara Mohamed, Heba Intabli, Department of Internal Medicine, RAK Hospitals, Ras Al Khaimah, Ra’s al Khaymah 6263, Ra’s al Khaymah, United Arab Emirates
Nada Ahmed, Department of Medicine, Al Quwain Hospital, Umm al Qaywayn 6263, United Arab Emirates
Bhumi Daishik Patel, Department of Internal Medicine, Windsor University School of Medicine, St Kitts 01000, Saint Kitts and Nevis
Asfaq Ahmad, Department of Internal Medicine, Gomal Medical College, Dera Ismail Khan, Khanpur 01000, Punjab, Pakistan
Ayoola Awosika, Department of Family Medicine, University of Illinois College of Medicine Peoria, Bloomington, IL 61601, United States
Co-first authors: Muhammad Farhan and Tirath Patel.
Author contributions: Patel T was involved in conceptualization, data analysis, data acquisition, design of the work, and writing the first draft; Farhan M contributed to conceptualization, study design, article screening; Harazeen W contributed to literature review, data extraction, and discussion development; Mohamed Y contributed to quality assessment, and methodology refinement; Azzawi AA contributed to data interpretation and manuscript review; Intabli H contributed to risk-of-bias assessment, data synthesis, and writing the results section; Ahmed N contributed to article screening, reference management, and figure preparation; Obais MAHN contributed to conceptualization, writing and reviewing the introduction and discussion sections; Alkhazali MR contributed to article screening, Formal analysis, contributed to writing first draft; Patel BD contributed to quality assessment, original draft, review and editing the manuscript; Ahmad A contributed to preparing table, writing, methodology, discussion development; Awosika A was involved in conceptualization, data analysis, data acquisition, writing first and review final draft; Farhan M and Patel T ave played important and indispensable roles in the manuscript preparation as the co-corresponding authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Ayoola Awosika, MD, Department of Family Medicine, University of Illinois College of Medicine Peoria, 1 Illini Drive, Bloomington, IL 61601, United States.
ayoolaawosika@yahoo.com
Received: November 28, 2025
Revised: January 1, 2026
Accepted: January 29, 2026
Published online: September 20, 2026
Processing time: 225 Days and 9.1 Hours
BACKGROUND
Atrial fibrillation (AF) is a prevalent arrhythmia associated with increased stroke risk, morbidity, and healthcare burden. Oral anticoagulation (OAC) is essential for stroke prevention, but adherence is often suboptimal. Smartphone-based mobile health (mHealth) applications offer potential to enhance adherence, quality of life (QoL), and reduce healthcare utilization.
AIM
To systematically review randomized controlled trials (RCTs) evaluating the impact of smartphone-based mHealth interventions on OAC adherence, health-related QoL, and healthcare utilization in adults with AF.
METHODS
Following PRISMA guidelines and a PROSPERO-registered protocol (CRD420251169904), databases (PubMed, Scopus, Web of Science, EMBASE, Cochrane CENTRAL, CINAHL, ClinicalTrials.gov) were searched from January 1, 2000, to July 30, 2025. Eligible studies were RCTs of mHealth apps for AF management in adults (≥ 18 years). Two reviewers screened records, extracted data, and assessed risk of bias using Cochrane risk of bias 2. Narrative synthesis was used due to heterogeneity.
RESULTS
Of 968 records, 16 RCTs (n = 209-3324 participants) were included, primarily from China, United States, Taiwan, and South Korea. Integrated interventions (e.g., mAFA-II aligning with AF better care pathway) improved OAC adherence (e.g., higher self-reported scores, P < 0.05; increased OAC persistence, P < 0.001), enhanced QoL (e.g., EQ-5D improvements, P < 0.001), and reduced healthcare utilization (e.g., rehospitalizations hazard ratio = 0.32, P < 0.001) without increasing bleeding risks. Simpler apps showed inconsistent benefits. Heterogeneity in designs, adherence measures, and follow-up (3 months to 2 years) limited generalizability. Risk of bias was high in 10 studies due to open-label designs and post-hoc analyses.
CONCLUSION
mHealth apps, especially comprehensive ones, can improve OAC adherence, QoL, and reduce utilization in AF patients. Future research should focus on long-term efficacy, cost-effectiveness, and equitable implementation for diverse populations.
Core Tip: Atrial fibrillation (AF) is a prevalent arrhythmia associated with increased stroke risk, morbidity, and healthcare burden. Oral anticoagulation (OAC) is essential for stroke prevention, but adherence is often suboptimal. Smartphone-based mobile health (mHealth) applications offer potential to enhance adherence, quality of life (QoL), and reduce healthcare utilization. mHealth apps, especially comprehensive ones, can improve OAC adherence, QoL, and reduce utilization in AF patients. Future research should focus on long-term efficacy, cost-effectiveness, and equitable implementation for diverse populations.
