Impact of the MonCœur smartphone application on self-care and quality of life in heart failure: The APPLIMONCOEUR randomized trial

• We evaluated the impact of the MonCœur app versus usual care in patients with HF. • At 6 months, no significant differences were observed in self-care or quality of life. • Exploratory analyses at 12 months showed increased physical activity among app users. • Medication adherence tended to improve in the app group, suggesting a potential benefit. • Patient engagement with the app was moderate, highlighting a need for integration into usual care. Background. – The MonCœur smartphone application (app) was developed to meet the specific needs of individuals living with heart failure (HF). Aims. – To evaluate whether the MonCœur smartphone app improves self-care at 6 months in patients with HF, and to assess effects on quality of life, physical activity and medication adherence. Methods. − APPLIMONCOEUR was a prospective, multicentre, randomized, controlled, open-label trial conducted in 12 HF centres in France. Adults with HF (left ventricular ejection fraction ≤ 40%) hospitalized for de novo or decompensated HF, or within 3 months of discharge, were randomized 1:1 to usual care or usual care plus MonCœur mobile app. Follow-up occurred at baseline, 3, 6 (primary timepoint) and 12 months. The primary endpoint was change in self-care (European Heart Failure Self-care Behaviour Scale [EHFSCB] score) at 6 months. Secondary endpoints included health-related quality of life (Minnesota Living with Heart Failure Questionnaire [MLWHFQ] score), weekly physical activity (minutes/week per World Health Organization categories) and medication adherence (Girerd questionnaire). Analyses were performed on the intention-to-treat population with multiple imputation; between-group differences at follow-up were assessed using analysis of covariance adjusted for baseline values. Results. − Among 123 randomized patients (control n = 64; app n = 59), baseline characteristics and therapies were well balanced. At 6 months, no significant difference was found for self-care (EHFScB total P = 0.23). Quality of life improved similarly in both groups (MLWHFQ total P = 0.87). Physical activity increased in both groups, with no between-group differences at 6 months (intensive P = 0.92; moderate-to-intensive P = 0.63), but exploratory 12-month analyses favoured the app (P = 0.002 and P = 0.008, respectively). Medication adherence increased modestly in both groups (P = 0.12). Only 25/59 (42.4%) of app users were active (i.e. used the app at least 3 times during the study). Conclusion. − The MonCœur randomized trial suggests that a mobile app dedicated to HF management may contribute to behavioural changes, particularly in physical activity, although patient engagement with the app was moderate. ClinicalTrials.gov. – NCT04198779.