Patterns of adherence and predictors of engagement with digital vs paper weight monitoring methods or measures in heart failure
N Caples, F O'brien, M MooneyAbstract
Background
Daily weight monitoring is a cornerstone of heart failure (HF) self-care, yet most centres continue to rely on paper logbooks, which are inconsistently used 1. Digital applications may improve adherence 2; however, sustaining long-term engagement remains challenging. The Fluid Heart Tracker App was designed as a simple, single-function tool providing automated weight-gain alerts, but patterns of engagement over time remain unclear.
Purpose
To compare adherence to daily weight monitoring using a logbook versus the App, and to determine whether engagement over time was associated with sex, NYHA class or hospitalisations.
Methods
In this within-subject, quasi-experimental study, patients with HF (n=136) completed two consecutive 12-month weight-monitoring phases: logbook use followed by App use. Adherence was defined as the proportion of days with recorded weights. Engagement trajectories were examined over time. Multiple linear regression analyses evaluated whether sex, age, NYHA class and hospitalisation predicted total days of use in each phase.
Results
Adherence was significantly higher during the App phase compared with the logbook phase (median 346.5 vs 315 days; p<0.001). App engagement was high initially (98.5%) but declined to 30.1% in the final three months. Female patients demonstrated lower initial App uptake (OR 0.46; p=0.046); however, among those who engaged, sex did not influence total App-use days. In regression analyses, sex (p=0.49), age (p=0.80), and NYHA class (p=0.59) were not associated with App-use days, whereas older age was associated with greater logbook use (β=2.35 days/year; p=0.044). App engagement was not associated with hospitalisations (p = 0.279).
Conclusions
Although App-based monitoring improved adherence compared with logbooks, engagement declined substantially over time and was not related to HF severity or hospitalisation. Lower initial uptake among female patients suggests targeted onboarding may be required. Sustaining long-term digital self-care likely requires behavioural or motivational strategies beyond automated alerts alone.