{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T07:08:01Z","timestamp":1789369681214,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Heart failure (HF) is a major public-health burden, and sustained patient education and self-management support are central to long-term care. Digital health technologies provide additional channels for education, monitoring and post-discharge follow-up, but review-level evidence is heterogeneous across intervention models, intensity, feedback mechanisms and outcomes. This study aimed to synthesise review-level evidence on digital health education and digitally supported self-management for adults with HF and to develop practice-oriented evidence statements. We conducted a narrative best-evidence synthesis of review-level evidence, informed by JBI evidence-summary principles and reported according to PRISMA 2020 where applicable. The protocol was registered with the Fudan University Centre for Evidence-Based Nursing (ES20259435). Eight English and Chinese bibliographic databases were searched from inception to 1 December 2025. Eligible evidence included systematic reviews, meta-analyses, network meta-analyses, umbrella reviews, systematic metareviews and scoping reviews indexed in the searched databases. Two reviewers independently screened sources, extracted data and appraised methodological quality using AMSTAR 2 or PRISMA-ScR\/JBI-informed criteria. Evidence statements were developed using review quality, directness, consistency, feasibility and likely overlap among primary studies; no recommendation grade was assigned. Of 8,698 records identified, 5,331 were screened after de-duplication, 37 full-text reports were assessed and 27 review-level evidence sources were included. Evidence varied substantially in quality, directness and intervention type. The final synthesis generated 27 practice-oriented statements organised into three tiers: essential core components, conditional implementation components, and emerging or outcome-related statements. Review-level evidence suggests that digitally supported education and self-management may complement routine HF care, particularly when linked to structured clinical feedback, clearly assigned responsibility and escalation pathways. However, the evidence statements should be interpreted conditionally because of methodological limitations, indirectness, intervention heterogeneity and likely overlap among reviews.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1926335","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T06:53:06Z","timestamp":1789368786000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Digital health education and self-management support for adults with heart failure: a best-evidence summary of review-level evidence"],"prefix":"10.3389","volume":"14","author":[{"given":"Huan","family":"Dong","sequence":"first","affiliation":[{"name":"Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhankun","family":"Jia","sequence":"additional","affiliation":[{"name":"Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Wang","sequence":"additional","affiliation":[{"name":"Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiling","family":"Yang","sequence":"additional","affiliation":[{"name":"Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global burden of heart failure: a comprehensive and updated review of epidemiology","volume":"118","author":"Savarese","year":"2022","journal-title":"Cardiovasc Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1306","DOI":"10.1002\/ejhf.1594","article-title":"Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis","volume":"21","author":"Jones","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.cardfail.2024.07.001","article-title":"HF STATS 2024: heart failure epidemiology and outcomes statistics: an updated 2024 report from the Heart Failure Society of America","volume":"31","author":"Bozkurt","year":"2025","journal-title":"J Card Fail"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e895","DOI":"10.1161\/CIR.0000000000001063","article-title":"AHA\/ACC\/HFSA guideline for the management of heart failure","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref6","volume-title":"Global Strategy on Digital Health 2020\u20132025","year":"2021"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"CD002098","DOI":"10.1002\/14651858.CD002098.pub2","article-title":"Interactive telemedicine: effects on professional practice and health care outcomes","volume":"2016","author":"Flodgren","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"CD011845","DOI":"10.1002\/14651858.CD011845.pub2","article-title":"mHealth education interventions in heart failure","volume":"2020","author":"Allida","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"CD007228","DOI":"10.1002\/14651858.CD007228.pub3","article-title":"Structured telephone support or non-invasive telemonitoring for patients with heart failure","volume":"2015","author":"Inglis","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e33839","DOI":"10.2196\/33839","article-title":"The use of mobile apps for heart failure self-management: systematic review of experimental and qualitative studies","volume":"6","author":"Bezerra Giordan","year":"2022","journal-title":"JMIR Cardio"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"108277","DOI":"10.1016\/j.pec.2024.108277","article-title":"Comparative effectiveness of eHealth self-management interventions for patients with heart failure: a Bayesian network meta-analysis","volume":"124","author":"Li","year":"2024","journal-title":"Patient Educ Couns"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"E133","DOI":"10.1097\/JCN.0000000000001253","article-title":"Effectiveness of interventions to improve heart failure self-care: an umbrella review of systematic reviews","volume":"41","author":"da Costa Ferreira Oberfrank","year":"2026","journal-title":"J Cardiovasc Nurs"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e172","DOI":"10.2196\/jmir.6688","article-title":"Telehealth interventions to support self-management of long-term conditions: a systematic metareview of diabetes, heart failure, asthma, chronic obstructive pulmonary disease, and cancer","volume":"19","author":"Hanlon","year":"2017","journal-title":"J Med Internet Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"422","DOI":"10.3390\/jcdd12110422","article-title":"ChatGPT applications in heart failure: patient education, readability enhancement, and clinical utility","volume":"12","author":"Doyle","year":"2025","journal-title":"J Cardiovasc Dev Dis"},{"key":"ref15","volume-title":"JBI Manual for Evidence Synthesis","author":"Aromataris","year":"2020"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"j4008","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both","volume":"358","author":"Shea","year":"2017","journal-title":"BMJ"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e32946","DOI":"10.2196\/32946","article-title":"Posthospitalization follow-up of patients with heart failure using eHealth solutions: restricted systematic review","volume":"24","author":"Morken","year":"2022","journal-title":"J Med Internet Res"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.3969\/j.issn.1672-1756.2022.11.020","article-title":"Mobile health management among chronic heart failure patients: a scoping review","volume":"22","author":"Chen","year":"2022","journal-title":"Chin J Nurs Manag"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"100151","DOI":"10.1016\/j.ijnsa.2023.100151","article-title":"The effects on rehospitalization rate of transitional care using information communication technology in patients with heart failure: a scoping review","volume":"5","author":"Qi","year":"2023","journal-title":"Int J Nurs Stud Adv"},{"key":"ref21","first-page":"1183","article-title":"Meta-analysis of the impact of an \u201cinternet+\u201d-based nursing intervention model on the prognosis of patients with chronic heart failure","volume":"50","author":"Yan","year":"2022","journal-title":"Mod Med J"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1053765","DOI":"10.3389\/fcvm.2022.1053765","article-title":"Effect of e-health intervention on disease management in patients with chronic heart failure: a meta-analysis","volume":"9","author":"Ding","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"104630","DOI":"10.1016\/j.ijnurstu.2023.104630","article-title":"Effectiveness of nurse-led electronic health interventions on illness management in patients with chronic heart failure: a systematic review and meta-analysis","volume":"150","author":"Zhang","year":"2024","journal-title":"Int J Nurs Stud"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1111\/jocn.16025","article-title":"Outcomes of nurse-led telecoaching intervention for patients with heart failure: a systematic review and meta-analysis of randomised controlled trials","volume":"31","author":"Imanuel Tonapa","year":"2022","journal-title":"J Clin Nurs"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1002\/ehf2.14207","article-title":"Multicomponent integrated care for patients with chronic heart failure: systematic review and meta-analysis","volume":"10","author":"Yang","year":"2023","journal-title":"ESC Heart Fail"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.1016\/j.cjca.2021.02.015","article-title":"Effectiveness of mobile health technology interventions for patients with heart failure: systematic review and meta-analysis","volume":"37","author":"Kitsiou","year":"2021","journal-title":"Can J Cardiol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1093\/eurjhf\/hfr039","article-title":"Which components of heart failure programmes are effective? A systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8,323 patients: abridged Cochrane review","volume":"13","author":"Inglis","year":"2011","journal-title":"Eur J Heart Fail"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"587","DOI":"10.2459\/JCM.0000000000001631","article-title":"A meta-analysis of effectiveness of mobile health interventions on health-related outcomes in patients with heart failure","volume":"25","author":"Zhang","year":"2024","journal-title":"J Cardiovasc Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"6859795","DOI":"10.1155\/2024\/6859795","article-title":"Mobile application-based interventions for people with heart failure: a systematic review and meta-analysis","volume":"2024","author":"Ni","year":"2024","journal-title":"J Nurs Manag"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/JCN.0000000000001083","article-title":"The effect of distance education on self-care in patients with heart failure in the chronic or stable phase: a systematic review and meta-analysis","volume":"40","author":"Sun","year":"2025","journal-title":"J Cardiovasc Nurs"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e38697","DOI":"10.2196\/38697","article-title":"Effectiveness of eHealth self-management interventions in patients with heart failure: systematic review and meta-analysis","volume":"24","author":"Liu","year":"2022","journal-title":"J Med Internet Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1002\/ejhf.3568","article-title":"Remote patient monitoring in heart failure: a comprehensive meta-analysis of effective programme components for hospitalization and mortality reduction","volume":"27","author":"De Lathauwer","year":"2025","journal-title":"Eur J Heart Fail"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.hjc.2023.11.001","article-title":"The role of patient-oriented mHealth interventions in improving heart failure outcomes: a systematic review of the literature","volume":"77","author":"Mouselimis","year":"2024","journal-title":"Hell J Cardiol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"102734","DOI":"10.1016\/j.aprim.2023.102734","article-title":"Education interventions in heart failure using m-health: systematic review","volume":"55","author":"Camino Ortega","year":"2023","journal-title":"Aten Primaria"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e19","DOI":"10.2196\/jmir.3000","article-title":"The effects on health behavior and health outcomes of internet-based asynchronous communication between health providers and patients with a chronic condition: a systematic review","volume":"16","author":"de Jong","year":"2014","journal-title":"J Med Internet Res"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e030956","DOI":"10.1161\/JAHA.123.030956","article-title":"Digital health interventions for heart failure management in underserved rural areas of the United States: a systematic review of randomized trials","volume":"13","author":"Azizi","year":"2024","journal-title":"J Am Heart Assoc"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1926335\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T06:53:08Z","timestamp":1789368788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1926335\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":36,"alternative-id":["10.3389\/fpubh.2026.1926335"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1926335","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]},"article-number":"1926335"}}