Mobile Questionnaires in Heart Failure Clinics
In one South Korean cardiology outpatient clinic, a mobile previsit questionnaire with direct electronic medical record integration was feasible and was associated with more complete documentation among heart-failure follow-up responders, but the study does not establish clinical benefit or causation.
> Research explainer: This briefing examines verified primary research published 57 days before the briefing date. It is not a same-day research update and does not provide medical advice.
Evidence
The study evaluated Miri-Alimi, a mobile social-networking-service-based system that sent previsit questionnaires and automatically transferred structured responses into the electronic medical record (EMR). It was conducted as a single-center prospective observational study in a cardiology outpatient clinic in South Korea from August through November 2024.
The enrolled population comprised 751 consecutive cardiology outpatients: 282 first-visit patients and 469 patients attending follow-up visits for heart failure. All eligible patients received a questionnaire link before their scheduled visit through KakaoTalk or multimedia messaging service. The overall response rate was 38.5% (289 of 751). Response was 48.9% (138 of 282) among first-visit patients and 32.2% (151 of 469) among follow-up patients with heart failure.
Participation was not evenly distributed by age. Responders had a mean age of 62.0 years, compared with 69.8 years among nonresponders; the reported difference was statistically significant (P<.001). This difference matters for interpreting both uptake and comparisons between people who did and did not respond.
For follow-up patients with heart failure, the investigators assessed documentation of three prespecified routine-care parameters: dyspnea, peripheral edema, and medication-adherence status. They expressed this as an EMR completeness score from 0 to 3. Responders had a median score of 3 (IQR 3-3), whereas nonresponders had a median score of 0 (IQR 0-1), with P<.001. The study also reports use of Firth penalized logistic regression to examine the association between response status and documentation completeness with adjustment for age and sex.
Satisfaction findings came from a subset of 76 surveyed patients. Across the reported items, 82.9% (63 of 76) to 92.1% (70 of 76) agreed that the system was appropriate, easy to use, and helpful. In the same surveyed group, 78.9% (60 of 76) reported completing the questionnaire in under 10 minutes. Both cardiologists and 7 of 8 participating nurses supported continued use and cited workflow-efficiency gains.
Analysis — Documentation workflow
This study is best read as an implementation and documentation-workflow explainer, rather than evidence that a digital questionnaire improves heart-failure outcomes. Its central operational feature was not simply electronic symptom collection: structured responses were transferred directly into the EMR. The marked difference in completeness scores shows that documented information on the three selected parameters was more complete among questionnaire responders. That is compatible with the system helping make previsit information available in a usable format during clinic workflow.
At the same time, response status is not an assigned treatment. People who responded were younger, and a 38.5% overall response rate means most enrolled patients did not submit a questionnaire. Even with the study’s age- and sex-adjusted analysis, observational comparisons cannot isolate the effect of the system from participation differences, clinical workflow differences, or other unmeasured factors. The findings therefore support feasibility and an association with documentation completeness among responders, while leaving effectiveness, reach, and equity open questions.
The satisfaction results add a narrower signal: surveyed participants and most participating nurses reported favorable views, and many surveyed patients reported short completion time. These results describe experience among respondents and staff involved in this clinic; they do not establish acceptability for all eligible patients or for other settings.
Limitations
The study took place in one cardiology outpatient clinic in South Korea, so its results may not transfer to other health systems, messaging platforms, patient populations, or EMR configurations. It was observational rather than randomized, and the responder–nonresponder comparison cannot demonstrate that Miri-Alimi caused the documentation difference. The younger mean age among responders is direct evidence of a participation difference that could affect interpretation.
The response rate was 38.5%, including 32.2% among the heart-failure follow-up group used for the documentation comparison. Consequently, the results do not describe universal uptake among eligible patients. Satisfaction was assessed in 76 patients, not the full cohort of 751, which further narrows what can be inferred about user experience.
Finally, the measured documentation score covered dyspnea, peripheral edema, and medication adherence, not morbidity, mortality, hospitalization, or long-term outcomes. The source itself states that further studies are needed to assess sustainability and associations with long-term clinical outcomes across diverse care settings. This briefing therefore makes no claim about clinical effectiveness, prognosis, or decisions for any individual.