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

Table 2 Oral anticoagulant adherence

Ref.	Intervention/trial name	Adherence metric	Follow-up	Key finding	Interpretation
Studies reporting a positive effect on adherence
Yoon et al[32], 2024	ADHERE-app (Alerts + monitoring)	Pill count (≥ 95% threshold)	6 months	Proportion with adequate adherence (≥ 95%) significantly higher in intervention (73.9% vs 61.0%; P = 0.007)	Intervention increased the likelihood of achieving high adherence
Hsieh et al[35], 2021	Web-based integrated program	MARS (self-report scale)	6 months	Significantly greater improvement in adherence vs control over time (GEE analysis, P = 0.001)	Sustained improvement in self-reported adherence
Xu et al[36], 2024	Alfalfa app (education + consultation)	MMAS-8 (self-report scale)	3 months	Medication compliance significantly higher at 1 and 3 months (all P < 0.05)	Short-term improvement in self-reported adherence
Guo et al[31], 2017	mAFA pilot (mAF app)	3-item adherence estimator	3 months	Drug adherence significantly better at 1 and 3 months (all P < 0.05)	Early improvement in adherence with integrated app
Magnani et al[37], 2025	Rural AF intervention (agent + monitor)	3-item self-report instrument	4 and 8 months	Self-reported adherence significantly higher (OR = 1.89)	Positive subjective effect, despite no objective difference
Guo et al[30], 2020	mAFA-II (dynamic management)	OAC usage/uptake	12 months	OAC use increased in intervention (63.4% to 70.2%) but decreased in control (P < 0.001)	Intervention improved OAC persistence at a population level
Studies reporting no significant difference in objective adherence
Yoon et al[32], 2024	ADHERE-app (alerts + monitoring)	Pill count (continuous median)	6 months	No difference in median adherence (98% vs 97.5%; P = 0.15).	High baseline adherence in both groups limited improvement
Turakhia et al[33], 2021	SmartADHERE (blended support)	PDC	6 months	No difference in mean PDC (0.86 vs 0.88; P = 0.62) or PDC ≥ 80%	Exceptionally high adherence in control group (“ceiling effect”)
Tran et al[38], 2022	BOAT-OAR (ECG + organizer)	Pill Count (median)	5.9 months	No difference in median compliance (100% vs 99.7%; P = 0.247)	Near-perfect adherence in both groups
Magnani et al[37], 2025	Rural AF intervention (agent + monitor)	PDC	12 months	No difference in 12-month PDC (median 0.97 both groups)	Objective measure did not confirm self-reported benefits

ADHERE: Smartphone-based adherence to anticoagulation and heart rhythm education; MMAS-8: 8-item morisky medication adherence scale; AF: Atrial fibrillation; OR: Odds ratio: ADHERE-app: Application-driven heart rhythm education and empowerment; BOAT-OAR: Bleeding outcomes and thromboembolism in oral anticoagulant-related; PDC: Proportion of days covered; ECG: Electrocardiogram; MARS: Medication adherence report scale; GEE: Generalized estimating equations.