Digital literacy of patients with chronic heart failure using telemedicine in france: a national observational cohort study

Abstract Introduction Remote patient monitoring (RPM) is increasingly considered for chronic care management. However, several challenges exist for its implementation such as funding resources, lack of standardizations and gaps in digital literacy. Objective The aim of this study was to describe patients using RPM to manage chronic heart failure (CHF) according to their digital literacy at a national scale in France. Methods A national retrospective study was conducted using a remote monitoring system for the management and therapeutic guidance of patients with CHF. Patients were categorized according to their digital literacy (digitally literate vs poor digital literacy). The latter were identified as requiring nurse assistance in medical data entry. Data collection included baseline characteristics, comorbidities, RPM status, heart failure-related hospitalizations and mortality. Results Of the 12,072 patients with CHF enrolled for RPM follow-ups (male: 65.4%, mean age: 74.2±13.1 years), 43.3% had poor digital literacy. These patients were older (79.4±10.2 vs 70.2±13.6 years) and were less among males (39.7% vs 60.3%). Overall, digitally literate patients had more comorbidities, including diabetes (61.8%) and obesity (69.4%). Over a third of all patients withdrew from RPM (37.0%). Continued use of RPM was higher in digitally literate patients (60.1% vs 39.9%, p<0.001). Mortality was higher in patients with poor digital literacy (OR: 0.71, 95%CI: 0.66 to 0.78, p<0.0001). Poor digital literacy was linked to increased occurrences of HF episodes in contrast to digitally literate patients (34.1% vs 25.8%) who had an uHR of 0.66 (95%CI: 0.62 to 0.71, p<0.0001), and an aHR of 0.68 (95%CI: 0.64 to 0.73, p<0.0001). Conclusion Patients with poor digital literacy form a sizable subgroup in heart failure management and may require specialized tools tailored to their needs. Prevalence of poor digital literacy may increase the risk of HF hospitalization and mortality and reduce RPM adherence.