Background and objectives: Heart failure requires complex and daily self-care that many patients struggle with for a range of reasons including limited health literacy, cognitive impairment, comorbidities, and emotional distress. This study describes the user-centred design and development of a mobile app (SmartHeart) to support comprehensive self-monitoring and improve self-care engagement for people with heart failure. Methods: Building on previous co-design research and expert panel feedback, we developed an initial Figma prototype following user-centred design principles. Two online sessions were conducted with adults living with heart failure (n=7), including a focus group session and a follow-up individual feedback session. The same participants took part in both sessions to provide feedback on the functionality, aesthetics, navigation, and content. Data were analysed deductively based on heuristic principles of user interface design, with findings informing the iterative development of the SmartHeart mobile app. The functional app was tested in-home by two participants over two weeks to evaluate real-world usability and gather contextual feedback to inform further refinement. Results: The SmartHeart prototype was developed through expert workshops and user feedback. Participants emphasised simplicity, leading to a streamlined design with clear navigation, adaptable graphics, and larger fonts. The app’s health tracking features were iteratively improved. User-driven modifications included personalised threshold alerts, simplified symptom reporting, and integrated medication reminders. Participants reported high satisfaction with the prototype interface and health monitoring capabilities; however, formative testing identified reliability issues that are being addressed prior to pilot evaluation. Findings primarily inform design refinements before evaluating clinical effectiveness. Conclusion: The SmartHeart app was refined through user-centred design process involving direct feedback from individuals with heart failure, resulting in a self-care tool with user-friendly features, to be further evaluated in future research. These user-driven enhancements support self-care engagement and highlight the app’s potential for real-world use and broader clinical integration. ... Read more

Background:
Heart failure (HF) is a chronic, progressive condition where the heart cannot pump enough blood to meet the body’s needs. In addition to the daily challenges that HF poses, acute exacerbations can lead to costly hospitalizations and increased mortality. High health care costs and the burden of HF have led to the emerging application of new technologies to support people living with HF to stay well while living in the community. However, many digital solutions have not involved consumers and health care professionals in their design, leading to poor adoption. The SmartHeart project aimed to codevelop a smart health ecosystem to support the early detection of HF deterioration and encourage self-care, potentially preventing hospitalizations.

Objective:
This study aims to provide an overview of the SmartHeart project by describing our approach to designing the SmartHeart system, outlining its features, and describing the planned pilot study to determine the feasibility of the system.

Methods:
We used the Integrate, Design, Assess, and Share (IDEAS) framework to guide the development of the SmartHeart system, involving users (people with HF and their caregivers) and stakeholders (health care providers involved in the management of HF) in its design. SmartHeart is a complete remote heart health monitoring and automated feedback delivery system. It includes 2 user interfaces for patients: an Amazon Alexa conversational agent and a smartphone app. The system collects physiological, symptom, and behavioral data through wireless sensors and self-reports from users. These data are processed and analyzed to provide personalized health insights, self-care support, and alerts in case of health deterioration. The system also includes a web-based user interface for health care professionals, allowing them to access data, send messages to users, and receive notifications about potential health deterioration. A single-arm, multicenter pilot trial (N=20) is planned to determine the feasibility and acceptability of SmartHeart before evaluation through a randomized controlled trial. The primary outcome will be a description of the study's feasibility (recruitment, attrition, engagement, and changes in self-care).

Results:
The SmartHeart study started in January 2021 on procurement of funding. Recruitment for the pilot trial started in August 2024 and will be completed by March 2025. We have currently enrolled 12 participants. Follow-up of all participants will be completed by the end of May 2025.

Conclusions:
We have co-designed and developed a complete remote heart health monitoring and automated feedback delivery system for the early detection of HF deterioration and prevention of HF-related hospitalizations. The next step is a pilot study, which will provide valuable information on feasibility and preliminary effects to inform a larger evaluation trial. SmartHeart has the potential to augment existing health services and help people with HF stay well while living in the community. ... Read more