Smartphone-based mobile health impact on oral anticoagulation adherence, quality of life, and healthcare utilization in adult atrial fibrillation

BACKGROUND Atrial fibrillation (AF) is a prevalent arrhythmia associated with increased stroke risk, morbidity, and healthcare burden. Oral anticoagulation (OAC) is essential for stroke prevention, but adherence is often suboptimal. Smartphone-based mobile health (mHealth) applications offer potential to enhance adherence, quality of life (QoL), and reduce healthcare utilization. AIM To systematically review randomized controlled trials (RCTs) evaluating the impact of smartphone-based mHealth interventions on OAC adherence, health-related QoL, and healthcare utilization in adults with AF. METHODS Following PRISMA guidelines and a PROSPERO-registered protocol (CRD420251169904), databases (PubMed, Scopus, Web of Science, EMBASE, Cochrane CENTRAL, CINAHL, ClinicalTrials.gov) were searched from January 1, 2000, to July 30, 2025. Eligible studies were RCTs of mHealth apps for AF management in adults (≥ 18 years). Two reviewers screened records, extracted data, and assessed risk of bias using Cochrane risk of bias 2. Narrative synthesis was used due to heterogeneity. RESULTS Of 968 records, 16 RCTs (n = 209-3324 participants) were included, primarily from China, United States, Taiwan, and South Korea. Integrated interventions (e.g. , mAFA-II aligning with AF better care pathway) improved OAC adherence (e.g. , higher self-reported scores, P < 0.05; increased OAC persistence, P < 0.001), enhanced QoL (e.g. , EQ-5D improvements, P < 0.001), and reduced healthcare utilization (e.g. , rehospitalizations hazard ratio = 0.32, P < 0.001) without increasing bleeding risks. Simpler apps showed inconsistent benefits. Heterogeneity in designs, adherence measures, and follow-up (3 months to 2 years) limited generalizability. Risk of bias was high in 10 studies due to open-label designs and post-hoc analyses. CONCLUSION mHealth apps, especially comprehensive ones, can improve OAC adherence, QoL, and reduce utilization in AF patients. Future research should focus on long-term efficacy, cost-effectiveness, and equitable implementation for diverse populations.