Aims: The aim of this study was to identify the effects of a 24‐week interactive text message‐based mobile health intervention (called) on enhancing the self‐care behaviours of patients with heart failure.Background: Whether text message‐based mobile health intervention can be used to improve long‐term adherence to self‐care behaviours among heart failure patients remains unclear.Design: A quasi‐experimental study with a pretest–post‐test design and repeated measures.Methods: Data from 100 patients (mean age, 58.78 years; 83.0% men) were analysed. The intervention group (n = 50) used the program over 24 weeks, which consisted of weekly goal setting and interactive text messaging, while the control group (n = 50) received usual care. Trained research assistants collected data using self‐reported Likert questionnaires. Primary (self‐care behaviours) and secondary (health literacy, eHealth literacy, and disease knowledge) outcome variables were measured at baseline and at 1, 3 and 6 months after intervention for follow‐up.Results: The findings showed that the intervention group demonstrated significantly better self‐care behaviours than the control group during the 6 months. Notably, the trajectory of self‐care behaviours of the patients in the intervention group showed a steep rise between the first‐ and third‐month follow‐up, followed by high stability between the third‐ and sixth‐month follow‐up. In addition, the intervention group had significantly higher disease knowledge than the control group at the first‐ and sixth‐month follow‐up.Conclusions: We found that the program, as an interactive text messaging service, may be an optimal strategy for improving long‐term adherence to self‐care behaviours through motivating and providing social support.Relevance to the Nursing Practice: The WithUs program can help nurses and other healthcare professionals to track patients' health indicators such as symptom severity, diet and physical activity. In addition, nurses can take an important role in evaluating the efficacy of the app in relation to patients' health outcome.Patient or Public Contribution: Patients have completed a self‐reported questionnaire after providing informed consent.

Purpose: This study aimed to identify distinct trajectories of self‐care behaviors over 6 months after hospital discharge in patients with heart failure, including the baseline predictors affecting these trajectories.Design: This was a prospective longitudinal observational cohort study with a 6‐month follow‐up.Methods: A total of 158 patients with heart failure (mean age = 66.75 years, 62.7% men) were included in this study. Patients' characteristics, including cognitive function, health literacy, and social support were collected as possible baseline predictors of self‐care behavior trajectories using a structured questionnaire and an electronic medical record review. Self‐care behaviors were evaluated using the Korean version of the nine‐item European Heart Failure Self‐care Behavior Scale at baseline, 1, 3, and 6 months after hospital discharge. Latent growth model analysis was conducted to identify the homogeneous subgroups with distinct trajectories of self‐care behaviors. Subsequently, multinomial logistic regression was used to assess whether baseline predictors were associated with these trajectories in patients with heart failure.Results: Three distinct self‐care behavior trajectory groups were identified: “low‐decreased” (n = 33, 20.9%), “middle‐increased” (n = 93, 58.9%), and “high‐sustained” (n = 32, 20.2%). The multinomial logistic regression analysis showed that baseline adequate health literacy and positive social support significantly predicted patients' belonging to both the middle‐increased and high‐sustained self‐care behavior trajectory groups compared to the low‐decreased group. Importantly, better cognitive function at baseline was only significantly associated with the high‐sustained self‐care behavior trajectory compared to the low‐decreased trajectory.Conclusion: Our study revealed that only one‐fifth of the patients belonged to the high‐sustained self‐care behavior group 6 months after hospital discharge. Strategies aimed at improving cognitive function, health literacy, and social support should be developed to sustain satisfactory self‐care behaviors in patients with heart failure. Further studies with long‐term follow‐ups are required to identify other possible factors, as well as the baseline predictors of this study affecting longitudinal trajectories of self‐care behaviors.Clinical relevance: Healthcare providers should recognize and evaluate the distinct patterns of self‐care behaviors over time in patients with heart failure. Importantly, assessing baseline cognitive function, health literacy, and social support before hospital discharge may be necessary to prevent a decline in self‐care behaviors over time.

This cross‐sectional study aimed to identify the impact of multimorbidity on self‐reported sarcopenia and compare the differences in the prevalence and associated factors of sarcopenia in community‐dwelling older adults with and without multimorbidity. We enrolled 876 community‐dwelling older adults in South Korea. Multimorbidity was defined as the coexistence of two or more chronic diseases, and sarcopenia was evaluated using the Strength, Assistance in walking, Rising from a chair, Climbing stairs, and Falling Questionnaire. Binomial logistic regression analyses were performed. Our study revealed that the prevalence of sarcopenia was significantly higher (43.5%) in older adults with multimorbidity than in those without multimorbidity (20.8%). This finding underscores the significant impact of multimorbidity on sarcopenia. We also found that poor perceived health status was the strongest predictor of sarcopenia in older adults with multimorbidity, while oldest‐old age (≥ 85 years) was the strongest predictor of sarcopenia in those without multimorbidity. Large prospective cohort studies using objective sarcopenia screening tools are needed to demonstrate the synergistic effects of multimorbidity and sarcopenia on health outcomes among community‐dwelling older adults.

Background: A patient–family caregiver dyad approach is necessary to improve adherence to self-care behaviors by patients with heart failure (HF). However, there is a lack of mobile health (mHealth) interventions that engage both patients and their family caregivers to promote HF self-care. Objective: The purpose of this quasi-experimental study was to develop and confirm the feasibility and effectiveness of a novel mHealth intervention based on patient–family caregiver dyads for promoting adherence to self-care by patients with HF. Methods: We developed a dyadic mHealth program with 2 main features: a basic feature app and an interactive text-based chatbot. The intervention group (35 of 70 HF patient–family caregiver dyads; 50%) underwent a dyadic mHealth program for 24 weeks, while the control group (35 of 70 dyads; 50%) received usual care. Adherence to self-care behaviors, family caregivers’ contributions to self-care behaviors, and health-related quality of life were evaluated. Data were collected using self-administered questionnaires at baseline and at 1 month, 3 months, and 6 months post enrollment. The outcomes were analyzed using intention-to-treat analysis. Results: The intervention group had significantly better adherence to self-care behaviors (β=4.68, 95% CI 0.99-8.37) and family caregivers’ contributions to self-care behaviors (β=8.76, 95% CI 4.63-12.88) over 6 months compared with the control group. The 6-month follow-up health-related quality of life scores for patients (β=0.07, 95% CI 0.00-0.13) and family caregivers (β=0.08, 95% CI 0.03-0.13) were significantly greater in the intervention group than in the control group. The 1-month follow-up disease knowledge scores for patients (β=0.16, 95% CI 0.03-0.29) and family caregivers (β=0.12, 95% CI 0.00-0.25) were significantly greater in the intervention group than in the control group. The intervention also had a significant effect on mutuality at the 1-month follow-up for patients (β=0.11, 95% CI 0.00-0.21) and family caregivers (β=0.15, 95% CI 0.01-0.30). However, health literacy was significantly higher in the intervention group than in the control group only for patients at 1 month (β=0.14, 95% CI 0.04-0.25). The intervention had no significant effects on depressive symptoms, social support with patient and family caregivers, and caregiver burden with family caregivers. Conclusions: This study found that the dyadic mHealth intervention was beneficial for improving patients’ adherence to self-care behaviors and family caregivers’ contributions to self-care behaviors by providing information and motivation and improving health-related quality of life for patients with HF and family caregivers. Further studies should confirm the generalizability, feasibility, and long-term health outcomes of this intervention. Trial Registration: Clinical Research Information Service (CRIS) KCT0008786; https://tinyurl.com/3684ur4r

Sex differences in the prognostic impact of coexisting atrial fibrillation (AF) in older patients with heart failure (HF) have not been well-studied. This study, therefore, compared sex differences in the association between AF and its 90-day adverse outcomes (hospital readmissions and emergency room (ER) visits) among older adults with HF. Of the 250 older adult patients, the prevalence rates of coexisting AF between male and female HF patients were 46.0% and 31.0%, respectively. In both male and female older patients, patients with AF have a significantly higher readmission rate (male 46.0%, and female 34.3%) than those without AF (male 6.8%, and female 12.8%). However, there are no significant differences in the association between AF and ER visits in both male and female older HF patients. The multivariate logistic analysis showed that coexisting AF significantly increased the risk of 90-day hospital readmission in both male and female older patients. In addition, older age in males and longer periods of time after an HF diagnosis in females were associated with an increased risk of hospital readmission. Consequently, prospective cohort studies are needed to identify the impact of coexisting AF on short- and long-term outcomes in older adult HF patients by sex.

Background: With expansion of technology-enabled care, digital health literacy (DHL) has become integral to effective cardiovascular disease (CVD) management. However, quantitative evidence regarding determinants and health outcomes of DHL in CVD remains limited and heterogeneous, necessitating comprehensive evidence synthesis. Objective: This study aimed to (1) estimate DHL levels, (2) synthesize DHL-associated factors, and (3) examine DHL-related health outcomes in CVD. Methods: A systematic review and meta-analysis of DHL in adults with CVD was conducted per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. PubMed, Embase, Cochrane CENTRAL, CINAHL, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed studies published between 2006 and January 31, 2026. Quantitative studies enrolling adults with CVD, which reported a measure of DHL were included. Studies focusing exclusively on primary cerebrovascular disease and non–peer-reviewed articles were excluded. Risk of bias (ROB) was assessed using the Appraisal Tool for Cross-Sectional Studies tool, the Newcastle-Ottawa Scale, the Revised Cochrane Risk-of-Bias Tool for Randomized Trials, and the Risk of Bias in Nonrandomized Studies of Interventions. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Pooled mean eHealth Literacy Scale (eHEALS) scores were synthesized using a random-effects meta-analysis. Heterogeneity was quantified using the I2 statistic and 95% prediction intervals. Results: Twenty studies involving 8581 adults with CVD were included. The overall pooled mean eHEALS score was 24.26 (95% CI 21.19-27.32), with substantial heterogeneity (I2=98.4%; τ2=15.55; τ=3.94) and a wide 95% prediction interval (14.66-33.85). Lower DHL was consistently associated with older age, lower educational attainment, female sex, limited social support, and less experience with digital technologies. Higher DHL was associated with more favorable health-related outcomes, including health behaviors, better quality of life, and greater use and acceptance of digital health technologies. Subgroup analyses showed no statistically significant differences in DHL by region, disease type, or age group. The certainty of evidence was rated as low to very low, and substantial heterogeneity persisted across analyses. Conclusions: Our findings underscore DHL as a foundational capability for digitally supported self-management in CVD care and reveal disparities associated with age and socioeconomic factors. By integrating evidence on DHL levels, associated factors, and DHL-related health outcomes in CVD populations, this review provides a more comprehensive, clinically relevant understanding of DHL beyond studies relying on a single instrument (eg, eHEALS) or examining isolated domains. DHL appears to be a context-dependent competency shaped by broader structural and social determinants. From a clinical and health system perspective, digital health interventions should be accompanied by structured digital inclusion strategies, including routine assessment of DHL and care delivery to patients’ digital capacities. Further longitudinal and interventional studies are warranted to clarify the causal pathways linking DHL to health outcomes in adults with CVD and to incorporate provider- and system-level perspectives beyond individual-level assessments. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD420251068000; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251068000