{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T21:13:10Z","timestamp":1781557990445,"version":"3.54.5"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01 HL141773"],"award-info":[{"award-number":["R01 HL141773"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Mobile health (mHealth) regimens can improve health through the continuous monitoring of biometric parameters paired with appropriate interventions. However, adherence to monitoring tends to decay over time. Our randomized controlled trial sought to determine: (1) if a mobile app with gamification and financial incentives significantly increases adherence to mHealth monitoring in a population of heart failure patients; and (2) if activity data correlate with disease-specific symptoms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We recruited individuals with heart failure into a prospective 180-day monitoring study with 3 arms. All 3 arms included monitoring with a connected weight scale and an activity tracker. The second arm included an additional mobile app with gamification, and the third arm included the mobile app and a financial incentive awarded based on adherence to mobile monitoring.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We recruited 111 heart failure patients into the study. We found that the arm including the financial incentive led to significantly higher adherence to activity tracker (95% vs 72.2%, P\u2009=\u2009.01) and weight (87.5% vs 69.4%, P\u2009=\u2009.002) monitoring compared to the arm that included the monitoring devices alone. Furthermore, we found a significant correlation between daily steps and daily symptom severity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion and Conclusion<\/jats:title>\n                  <jats:p>Our findings indicate that mobile apps with added engagement features can be useful tools for improving adherence over time and may thus increase the impact of mHealth-driven interventions. Additionally, activity tracker data can provide passive monitoring of disease burden that may be used to predict future events.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocae221","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T23:32:42Z","timestamp":1724369562000},"page":"181-192","source":"Crossref","is-referenced-by-count":5,"title":["Increasing adherence and collecting symptom-specific biometric signals in remote monitoring of heart failure patients: a randomized controlled trial"],"prefix":"10.1093","volume":"32","author":[{"given":"Sukanya","family":"Mohapatra","sequence":"first","affiliation":[{"name":"Department of Molecular, Cell, and Developmental Biology, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirna","family":"Issa","sequence":"additional","affiliation":[{"name":"Department of Ecology and Evolutionary Biology, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedrana","family":"Ivezic","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Doherty","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Marks","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Lan","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Rozett","sequence":"additional","affiliation":[{"name":"Office of Advanced Research Computing, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Cullen","sequence":"additional","affiliation":[{"name":"Office of Advanced Research Computing, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wren","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Office of Advanced Research Computing, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Rocchio","sequence":"additional","affiliation":[{"name":"Office of Advanced Research Computing, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael K","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0890-8684","authenticated-orcid":false,"given":"William F","family":"Speier","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]},{"name":"Department of Bioengineering, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corey W","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]},{"name":"Department of Bioengineering, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]},{"name":"Department of Pathology & Laboratory Medicine, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"issue":"3","key":"2024121616132756600_ocae221-B1","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1161\/HHF.0b013e318291329a","article-title":"Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association","volume":"6","author":"Heidenreich","year":"2012","journal-title":"Circ Heart Fail"},{"issue":"9","key":"2024121616132756600_ocae221-B2","doi-asserted-by":"publisher","first-page":"E139","DOI":"10.1161\/cir.0000000000000757","article-title":"Heart disease and stroke statistics\u20142020 update a report from the American Heart Association","volume":"141","author":"Virani","year":"2020","journal-title":"Circulation"},{"key":"2024121616132756600_ocae221-B3","author":"Mcdermott","year":"2017"},{"issue":"5","key":"2024121616132756600_ocae221-B4","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1097\/01.NAJ.0000751052.45715.A7","article-title":"Hospital admissions and readmissions for heart failure are on the rise","volume":"121","author":"Nelson","year":"2021","journal-title":"Am J Nurs"},{"issue":"10","key":"2024121616132756600_ocae221-B5","doi-asserted-by":"publisher","first-page":"E56","DOI":"10.1161\/CIR.0000000000000659","article-title":"Heart disease and stroke statistics\u20142019 update: a report from the American Heart Association","volume":"139","author":"Benjamin","year":"2019","journal-title":"Circulation"},{"issue":"2","key":"2024121616132756600_ocae221-B6","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1093\/eurjhf\/hfq219","article-title":"Self-care management of heart failure: practical recommendations from the Patient Care Committee of the Heart Failure Association of the European Society of Cardiology","volume":"13","author":"Lainscak","year":"2011","journal-title":"Eur J Heart Fail"},{"issue":"8","key":"2024121616132756600_ocae221-B7","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1093\/eurheartj\/ehw128","article-title":"2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"18","author":"Ponikowski","year":"2016","journal-title":"Eur J Heart Fail"},{"issue":"12","key":"2024121616132756600_ocae221-B8","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1161\/circulationaha.109","article-title":"State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association","volume":"120","author":"Riegel","year":"2009","journal-title":"Circulation"},{"issue":"5","key":"2024121616132756600_ocae221-B9","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1136\/HRT.80.5.437","article-title":"Preventable causative factors leading to hospital admission with decompensated heart failure","volume":"80","author":"Michalsen","year":"1998","journal-title":"Heart (British Cardiac Society)"},{"issue":"19","key":"2024121616132756600_ocae221-B10","doi-asserted-by":"publisher","first-page":"2337","DOI":"10.1001\/ARCHINTE.161.19.2337","article-title":"Acute precipitants of congestive heart failure exacerbations","volume":"161","author":"Tsuyuki","year":"2001","journal-title":"Arch Intern Med"},{"issue":"6","key":"2024121616132756600_ocae221-B11","article-title":"Care management interventions for older patients with congestive heart failure","volume":"9","author":"Windham","year":"2003","journal-title":"Am J Manag Care"},{"issue":"5","key":"2024121616132756600_ocae221-B12","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1067\/mhl.2001.118611","article-title":"Self-care abilities of patients with heart failure","volume":"30","author":"Carlson","year":"2001","journal-title":"Heart Lung"},{"issue":"8","key":"2024121616132756600_ocae221-B13","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1016\/j.cardfail.2011.04.011","article-title":"Impact of medication nonadherence on hospitalizations and mortality in heart failure","volume":"17","author":"Fitzgerald","year":"2011","journal-title":"J Card Fail"},{"issue":"2","key":"2024121616132756600_ocae221-B14","doi-asserted-by":"publisher","first-page":"e0211768","DOI":"10.1371\/journal.pone.0211768","article-title":"Adherence to self-care recommendations and associated factors among adult heart failure patients. From the patients\u2019 point of view","volume":"14","author":"Seid","year":"2019","journal-title":"PLOS One"},{"issue":"5","key":"2024121616132756600_ocae221-B15","doi-asserted-by":"publisher","first-page":"e95","DOI":"10.2196\/JMIR.2430","article-title":"Mapping mHealth research: a decade of evolution","volume":"15","author":"Fiordelli","year":"2013","journal-title":"J Med Internet Res"},{"issue":"2","key":"2024121616132756600_ocae221-B16","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/J.AMEPRE.2013.03.017","article-title":"Mobile health technology evaluation: the mHealth evidence workshop","volume":"45","author":"Kumar","year":"2013","journal-title":"Am J Prev Med"},{"issue":"283","key":"2024121616132756600_ocae221-B17","doi-asserted-by":"publisher","first-page":"283rv3","DOI":"10.1126\/SCITRANSLMED.AAA3487\/ASSET\/385AA314-F48E-4CAD-B39C-9E8F775D8D0B\/ASSETS\/GRAPHIC\/7-283RV3-F2.JPEG","article-title":"The emerging field of mobile health","volume":"7","author":"Steinhubl","year":"2015","journal-title":"Sci Transl Med"},{"issue":"7","key":"2024121616132756600_ocae221-B18","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1002\/clc.22968","article-title":"Harnessing mHealth technologies to increase physical activity and prevent cardiovascular disease","volume":"41","author":"Feldman","year":"2018","journal-title":"Clin Cardiol"},{"issue":"2","key":"2024121616132756600_ocae221-B19","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1111\/J.1471-6712.2000.TB00571.X","article-title":"Self-care behaviour of patients with heart failure","volume":"14","author":"Jaarsma","year":"2000","journal-title":"Scand J Caring Sci"},{"issue":"5","key":"2024121616132756600_ocae221-B20","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1007\/S10916-011-9733-Y","article-title":"A remote patient monitoring system for congestive heart failure","volume":"35","author":"Suh","year":"2011","journal-title":"J Med Syst"},{"issue":"1","key":"2024121616132756600_ocae221-B21","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1258\/JTT.2008.080701\/FORMAT\/EPUB","article-title":"Outcomes of a home telehealth intervention for patients with heart failure","volume":"15","author":"Wakefield","year":"2009","journal-title":"J Telemed Telecare"},{"issue":"2","key":"2024121616132756600_ocae221-B22","doi-asserted-by":"publisher","first-page":"E33","DOI":"10.2196\/MHEALTH.3789","article-title":"Patient engagement with a mobile web-based telemonitoring system for heart failure self-management: a pilot study","volume":"3","author":"Zan","year":"2015","journal-title":"JMIR Mhealth Uhealth"},{"issue":"24","key":"2024121616132756600_ocae221-B23","doi-asserted-by":"publisher","first-page":"2301","DOI":"10.1056\/NEJMoa1010029","article-title":"Telemonitoring in patients with heart failure","volume":"363","author":"Chaudhry","year":"2013","journal-title":"N Engl J Med"},{"issue":"2","key":"2024121616132756600_ocae221-B24","doi-asserted-by":"publisher","first-page":"116","DOI":"10.15420\/CFR.2017:6:2","article-title":"Value of telemonitoring and telemedicine in heart failure management","volume":"3","author":"Gensini","year":"2017","journal-title":"Card Fail Rev"},{"issue":"3","key":"2024121616132756600_ocae221-B25","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1001\/JAMAINTERNMED.2015.7712","article-title":"Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure: the better effectiveness after transition\u2013heart failure (BEAT-HF) randomized clinical trial","volume":"176","author":"Ong","year":"2016","journal-title":"JAMA Intern Med"},{"issue":"2","key":"2024121616132756600_ocae221-B26","doi-asserted-by":"publisher","first-page":"E13259","DOI":"10.2196\/13259","article-title":"Patient adherence to a mobile phone\u2013based heart failure telemonitoring program: a longitudinal mixed-methods study","volume":"7","author":"Ware","year":"2019","journal-title":"JMIR Mhealth Uhealth"},{"issue":"2","key":"2024121616132756600_ocae221-B27","doi-asserted-by":"publisher","first-page":"e30671","DOI":"10.2196\/30671","article-title":"The use of gamification and incentives in mobile health apps to improve medication adherence: scoping review","volume":"10","author":"Tran","year":"2022","journal-title":"JMIR Mhealth Uhealth"},{"issue":"4","key":"2024121616132756600_ocae221-B28","first-page":"323","article-title":"Medication reminder applications to improve adherence in coronary heart disease: a randomised clinical trial","volume":"105","author":"Santo","year":"2019","journal-title":"Heart (British Cardiac Society)"},{"issue":"1","key":"2024121616132756600_ocae221-B29","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12955-016-0425-7","article-title":"The Minnesota Living with Heart Failure Questionnaire: comparison of different factor structures","volume":"14","author":"Bilbao","year":"2016","journal-title":"Health Qual Life Out"},{"issue":"5 Suppl 1","key":"2024121616132756600_ocae221-B30","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1097\/01.mlr.0000258615.42478.55","article-title":"The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap Cooperative Group during its first two years","volume":"45","author":"Cella","year":"2007","journal-title":"Med Care"},{"issue":"7","key":"2024121616132756600_ocae221-B31","doi-asserted-by":"crossref","first-page":"e17559","DOI":"10.2196\/17559","article-title":"The effects of telemonitoring on patient compliance with self-management recommendations and outcomes of the innovative telemonitoring enhanced care program for chronic heart failure: randomized controlled trial","volume":"22","author":"Ding","year":"2020","journal-title":"J Med Internet Res"},{"key":"2024121616132756600_ocae221-B32","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.ahj.2023.02.014","article-title":"A randomized controlled trial of gamification, financial incentives, or both to increase physical activity among patients with elevated risk for cardiovascular disease: rationale and design of the Be Active study","volume":"260","author":"Fanaroff","year":"2023","journal-title":"Am Heart J"},{"issue":"2","key":"2024121616132756600_ocae221-B33","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1093\/eurjhf\/hfr168","article-title":"Heart failure and socioeconomic status: accumulating evidence of inequality","volume":"14","author":"Hawkins","year":"2012","journal-title":"Eur J Heart Fail"},{"issue":"3","key":"2024121616132756600_ocae221-B34","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1097\/HCO.0000000000000855","article-title":"Racial and ethnic disparities in heart failure: current state and future directions","volume":"36","author":"Lewsey","year":"2021","journal-title":"Curr Opin Cardiol"},{"issue":"2","key":"2024121616132756600_ocae221-B35","doi-asserted-by":"publisher","first-page":"176","DOI":"10.29011\/2475-5605.000076","article-title":"Health disparities in patients with congestive heart failure exacerbations in Los Angeles County","volume":"6","author":"Lam","year":"2018","journal-title":"Emerg Med Investig"},{"issue":"10","key":"2024121616132756600_ocae221-B36","doi-asserted-by":"publisher","first-page":"1412","DOI":"10.1016\/j.cardfail.2023.07.006","article-title":"Heart failure epidemiology and outcomes statistics: a report of the Heart Failure Society of America","volume":"29","author":"Bozkurt","year":"2023","journal-title":"J Card Fail"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/32\/1\/181\/61202156\/ocae221.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/32\/1\/181\/61202156\/ocae221.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T16:13:40Z","timestamp":1734365620000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/32\/1\/181\/7738853"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,22]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,8,22]]},"published-print":{"date-parts":[[2025,1,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocae221","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,1]]},"published":{"date-parts":[[2024,8,22]]}}}