Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Non-invasive telemonitoring (TM) can be used in heart failure (HF) patients to perform early detection of decompensation at home, prevent unnecessary healthcare utilization, and decrease healthcare costs. However, the evidence is not sufficient to be part of HF guidelines for follow-up care and we have no knowledge of how TM is used in the Nordic Baltic region. Objective: The aim was to describe health care professionals’ (HCPs) (1) perception of and presumed experience with non-invasive TM in daily HF patient care, (2) perspectives of the relevance of and reasons for applying non- invasive TM and (3) barriers to the use of non-invasive TM. Methods: A cross-sectional survey was performed between September and December 2016 in Norway and in Lithuania with physicians and nurses treating HF patients at either a hospital ward or an outpatient clinic. A total of 784 questionnaires were sent nationwide by postal mail to 107 hospitals. The questionnaire consisted of 43-items with closed- and open- ended questions. In Norway, the response rate was 69%, with 57 of 60 hospitals participating, whereas the response rate was 68% in Lithuania, with 41 of 47 hospitals participating. Responses to the closed questions were analyzed using descriptive statistics and the open-ended questions were analyzed using summative content analysis. Results: This study showed that non-invasive TM is not part of current daily clinical practice in Norway or Lithuania. A minority of HCPs responded to be familiar with non-invasive TM in HF care in Norway (48 of 226, 21%) and in Lithuania (64 of 310, 20%). Around half of the HCPs in both countries perceived non-invasive TM to be relevant in follow-up of HF patients in Norway (58%) and Lithuania (49%). For physicians in both countries and nurses in Norway the three most mentioned reasons for introducing non-invasive TM were: to improve self-care, to reduce hospitalizations and to provide high quality care, while the Lithuanian nurses described: ability to treat more patients and reducing their workload. The main barriers to implement non-invasive TM were lack of funding from health care authorities or the Territorial Patient Fund. Moreover, HCPs perceive HF patients’ themselves could represent barriers due their physical or mental condition in addition to a lack of internet access. Conclusions: HCPs in Norway and Lithuania are currently non-users of TM in daily HF care. However, they perceive a future with TM to improve the quality of care for HF patients. Financial barriers and HF patients’ condition may have an impact on the use of TM, whereas sufficient funding from health care authorities and improved knowledge may encourage the more widespread use of TM in the Nordic Baltic region and beyond.

Background: Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. Objective: This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. Methods: This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals—one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the CardioSet Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. Results: The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. Conclusions: Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions.

Self-care monitoring at home can be a challenge for patients with heart failure (HF). Tools that leverage information and communication technology (ICT), comprise medical devices, or have written material may support their efforts at home. The aim of this study was to describe HF patients’ experiences and their prioritization of tools that support, or could support, self-care monitoring at home. A descriptive qualitative design employing semi-structured interviews was used with HF patients living at home and attending an HF outpatient clinic in Norway. We used a deductive analysis approach, using the concept of self-care monitoring with ICT tools, paper-based tools, medical devices, and tools to consult with healthcare professionals (HCPs) as the categorization matrix. Nineteen HF patients with a mean age of 64 years participated. ICT tools are used by individual participants to identify changes in their HF symptoms, but are not available by healthcare services. Paper-based tools, medical devices, and face-to-face consultation with healthcare professionals are traditional tools that are available and used by individual participants. HF patients use traditional and ICT tools to support recognizing, identifying, and responding to HF symptoms at home, suggesting that they could be used if they are available and supplemented by in-person consultation with HCPs.

Informal caregivers have an important role in caring for family members at home. Supporting persons with a chronic illness such as heart failure (HF) in managing their self-care is reported to be a challenge and telemonitoring has been suggested to be of support. Aim: to explore informal caregivers’ experiences with performing non-invasive telemonitoring to support persons with HF at home for 30 days following hospital discharge in Norway and Lithuania. Methods: A qualitative explorative study of informal caregivers performing non-invasive telemonitoring using lung-impedance measurements and short message service (SMS). Data was collected using semi-structured interviews with informal caregivers of persons with HF in NYHA class III-IV in Norway and Lithuania. Results: Nine interviews were conducted with informal caregivers of persons with HF who performed non-invasive telemonitoring at home. A sequential process of three categories emerged from the data: access to support, towards routinizing, and mastering non-invasive telemonitoring. Conclusion: Informal caregivers performed non-invasive telemonitoring for the first time in this study. Their experiences were of a sequential process that included access to support from health care professionals, establishing a routine together, and access to nurses or physicians in HF care as part of mastering. This study highlights involving informal caregivers and persons with HF together in the implementation and future research of telemonitoring in HF care.

BACKGROUND Noninvasive telemonitoring (TM) can be used in heart failure (HF) patients to perform early detection of decompensation at home, prevent unnecessary health care utilization, and decrease health care costs. However, the evidence is not sufficient to be part of HF guidelines for follow-up care, and we have no knowledge of how TM is used in the Nordic Baltic region. OBJECTIVE The aim of this study was to describe health care professionals’ (HCPs) perception of and presumed experience with noninvasive TM in daily HF patient care, perspectives of the relevance of and reasons for applying noninvasive TM, and barriers to the use of noninvasive TM. METHODS A cross-sectional survey was performed between September and December 2016 in Norway and Lithuania with physicians and nurses treating HF patients at either a hospital ward or an outpatient clinic. A total of 784 questionnaires were sent nationwide by postal mail to 107 hospitals. The questionnaire consisted of 43 items with close- and open-ended questions. In Norway, the response rate was 68.7% (226/329), with 57 of 60 hospitals participating, whereas the response rate was 68.1% (310/455) in Lithuania, with 41 of 47 hospitals participating. Responses to the closed questions were analyzed using descriptive statistics, and the open-ended questions were analyzed using summative content analysis. RESULTS This study showed that noninvasive TM is not part of the current daily clinical practice in Norway or Lithuania. A minority of HCPs responded to be familiar with noninvasive TM in HF care in Norway (48/226, 21.2%) and Lithuania (64/310, 20.6%). Approximately half of the HCPs in both countries perceived noninvasive TM to be relevant in follow-up of HF patients in Norway (131/226, 58.0%) and Lithuania (172/310, 55.5%). For physicians in both countries and nurses in Norway, the 3 most mentioned reasons for introducing noninvasive TM were to improve self-care, to reduce hospitalizations, and to provide high-quality care, whereas the Lithuanian nurses described ability to treat more patients and to reduce their workload as reasons for introducing noninvasive TM. The main barriers to implement noninvasive TM were lack of funding from health care authorities or the Territorial Patient Fund. Moreover, HCPs perceive that HF patients themselves could represent barriers because of their physical or mental condition in addition to a lack of internet access. CONCLUSIONS HCPs in Norway and Lithuania are currently nonusers of TM in daily HF care. However, they perceive a future with TM to improve the quality of care for HF patients. Financial barriers and HF patients’ condition may have an impact on the use of TM, whereas sufficient funding from health care authorities and improved knowledge may encourage the more widespread use of TM in the Nordic Baltic region and beyond.

Background: Adolescents and young adults (AYAs) with complex congenital heart disease (CHD) may benefit from eHealth interventions, particularly when early signs of deterioration or self-management challenges arise. eHealth can enhance self-management skills and communication with health care professionals (HCPs). However, systematic reviews examining eHealth interventions for this population remain limited and heterogeneous, indicating a need for a systematic review of the literature to guide the development, implementation, and evaluation of such interventions. Objective: In this systematic review, we aimed to synthesize the content, theoretical foundations, outcomes, and effectiveness of eHealth interventions targeting AYAs with complex CHD that involve interaction with HCPs. Methods: We conducted this systematic review in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. An a priori protocol was registered in PROSPERO (CRD42023400211). The review was reported according to the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), the PRISMA-S (PRISMA Literature Search Extension), and the SWiM (Synthesis Without Meta-Analysis) checklists. The final comprehensive bibliographic search was conducted on March 16, 2026, across MEDLINE ALL (Ovid), Embase (Ovid), APA PsycInfo (Ovid), ERIC (EBSCOhost), CINAHL (EBSCOhost), and the Web of Science Core Collection (Clarivate). Studies were eligible if they included AYAs aged 10-29 years diagnosed with CHD who received eHealth interventions delivered by HCPs regardless of care setting; measured effects of eHealth interventions using experimental or quasiexperimental designs; and were published in English or a Scandinavian language. The researchers assessed eligibility in pairs, risk of bias using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for randomized studies and the Risk of Bias in Non-Randomized Studies of Exposures (ROBINS-E) for nonrandomized studies, and extracted data. Overall risk of bias was high. Due to heterogeneity among the included studies, a narrative synthesis was conducted. Results: We included 8 studies, with sample sizes ranging from 20 to 158, totaling 551 participants. Five studies reported improvements in the eHealth intervention groups, evaluating educational interventions to improve disease-specific knowledge, self-management, physical activity, psychosocial impact, and transition readiness in AYAs with CHD. However, the content, delivery mode and format, and target outcomes varied across studies. Seven studies lacked a theoretical foundation for the intervention. Conclusions: The evidence remains inconsistent and limited by heterogeneity, absence of theoretical foundations, risk of bias, and high dropout rates; further refinement is thus needed. Future research may benefit from theory-driven, user-centered, co-designed approaches with AYAs with CHD from the outset to enhance relevance, engagement, and long-term sustainability. Standardized outcome measures and long-term evaluations could clarify the long-term impact and implementation potential of eHealth interventions. This study emphasizes factors like tailoring content to medical complexity, integrating interactive interprofessional teams, and incorporating structured peer support in planning and developing eHealth intervention research in the future.