Da-Young Kim

Background: Examining caregiver burden subgroups in family caregivers of patients with heart failure may help identify individuals at elevated risk. Also, although caregiver burden is known to be associated with social support and depressive symptoms, how these factors interact to produce depressive symptoms is unclear. Purpose: This study was designed to investigate the distinct subgroups of caregiver burden using latent profile analysis as well as the mediating role of social support in the relationship between caregiver burden profiles and depressive symptoms among heart failure family caregivers. Methods: Two hundred nine family caregivers (age ≥18 years) of older adults with heart failure were enrolled as participants. Caregiver burden, social support, and depressive symptoms were measured using self-administered questionnaires. Data were collected at the outpatient cardiology clinics of two university hospitals in Seoul, South Korea, between July 2022 and May 2023. Latent profile and mediation analyses were conducted using Mplus and PROCESS macro models. Results: The caregiver burden profiles were categorized into two groups: “lower burden” (78.9%) and “higher burden” (21.1%). The caregiver burden domain “emotional well-being” registered the highest scores in both lower and higher burden groups. Social support was shown to significantly mediate the relationship between higher caregiver burden (reference=lower caregiver burden group) and depressive symptoms. Conclusions: The findings indicate that promoting social support can buffer the negative impact of higher caregiver burden on depressive symptoms in family caregivers of older adults with heart failure. Health care professionals should develop interventions to strengthen social support to prevent depressive symptoms of family caregivers experiencing high caregiver burden.

Background: With expansion of technology-enabled care, digital health literacy (DHL) has become integral to effective cardiovascular disease (CVD) management. However, quantitative evidence regarding determinants and health outcomes of DHL in CVD remains limited and heterogeneous, necessitating comprehensive evidence synthesis. Objective: This study aimed to (1) estimate DHL levels, (2) synthesize DHL-associated factors, and (3) examine DHL-related health outcomes in CVD. Methods: A systematic review and meta-analysis of DHL in adults with CVD was conducted per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. PubMed, Embase, Cochrane CENTRAL, CINAHL, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed studies published between 2006 and January 31, 2026. Quantitative studies enrolling adults with CVD, which reported a measure of DHL were included. Studies focusing exclusively on primary cerebrovascular disease and non–peer-reviewed articles were excluded. Risk of bias (ROB) was assessed using the Appraisal Tool for Cross-Sectional Studies tool, the Newcastle-Ottawa Scale, the Revised Cochrane Risk-of-Bias Tool for Randomized Trials, and the Risk of Bias in Nonrandomized Studies of Interventions. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Pooled mean eHealth Literacy Scale (eHEALS) scores were synthesized using a random-effects meta-analysis. Heterogeneity was quantified using the I2 statistic and 95% prediction intervals. Results: Twenty studies involving 8581 adults with CVD were included. The overall pooled mean eHEALS score was 24.26 (95% CI 21.19-27.32), with substantial heterogeneity (I2=98.4%; τ2=15.55; τ=3.94) and a wide 95% prediction interval (14.66-33.85). Lower DHL was consistently associated with older age, lower educational attainment, female sex, limited social support, and less experience with digital technologies. Higher DHL was associated with more favorable health-related outcomes, including health behaviors, better quality of life, and greater use and acceptance of digital health technologies. Subgroup analyses showed no statistically significant differences in DHL by region, disease type, or age group. The certainty of evidence was rated as low to very low, and substantial heterogeneity persisted across analyses. Conclusions: Our findings underscore DHL as a foundational capability for digitally supported self-management in CVD care and reveal disparities associated with age and socioeconomic factors. By integrating evidence on DHL levels, associated factors, and DHL-related health outcomes in CVD populations, this review provides a more comprehensive, clinically relevant understanding of DHL beyond studies relying on a single instrument (eg, eHEALS) or examining isolated domains. DHL appears to be a context-dependent competency shaped by broader structural and social determinants. From a clinical and health system perspective, digital health interventions should be accompanied by structured digital inclusion strategies, including routine assessment of DHL and care delivery to patients’ digital capacities. Further longitudinal and interventional studies are warranted to clarify the causal pathways linking DHL to health outcomes in adults with CVD and to incorporate provider- and system-level perspectives beyond individual-level assessments. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD420251068000; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251068000

BACKGROUND With expansion of technology-enabled care, digital health literacy (DHL) has become integral to effective cardiovascular disease (CVD) management. However, quantitative evidence regarding determinants and health outcomes of DHL in CVD remains limited and heterogeneous, necessitating comprehensive evidence synthesis. OBJECTIVE This study aimed to (1) estimate DHL levels, (2) synthesize DHL-associated factors, and (3) examine DHL-related health outcomes in CVD. METHODS A systematic review and meta-analysis of DHL in adults with CVD was conducted per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. PubMed, Embase, Cochrane CENTRAL, CINAHL, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed studies published between 2006 and January 31, 2026. Quantitative studies enrolling adults with CVD, which reported a measure of DHL were included. Studies focusing exclusively on primary cerebrovascular disease and non–peer-reviewed articles were excluded. Risk of bias (ROB) was assessed using the Appraisal Tool for Cross-Sectional Studies tool, the Newcastle-Ottawa Scale, the Revised Cochrane Risk-of-Bias Tool for Randomized Trials, and the Risk of Bias in Nonrandomized Studies of Interventions. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Pooled mean eHealth Literacy Scale (eHEALS) scores were synthesized using a random-effects meta-analysis. Heterogeneity was quantified using the I2 statistic and 95% prediction intervals. RESULTS Twenty studies involving 8581 adults with CVD were included. The overall pooled mean eHEALS score was 24.26 (95% CI 21.19-27.32), with substantial heterogeneity (I2=98.4%; τ2=15.55; τ=3.94) and a wide 95% prediction interval (14.66-33.85). Lower DHL was consistently associated with older age, lower educational attainment, female sex, limited social support, and less experience with digital technologies. Higher DHL was associated with more favorable health-related outcomes, including health behaviors, better quality of life, and greater use and acceptance of digital health technologies. Subgroup analyses showed no statistically significant differences in DHL by region, disease type, or age group. The certainty of evidence was rated as low to very low, and substantial heterogeneity persisted across analyses. CONCLUSIONS Our findings underscore DHL as a foundational capability for digitally supported self-management in CVD care and reveal disparities associated with age and socioeconomic factors. By integrating evidence on DHL levels, associated factors, and DHL-related health outcomes in CVD populations, this review provides a more comprehensive, clinically relevant understanding of DHL beyond studies relying on a single instrument (eg, eHEALS) or examining isolated domains. DHL appears to be a context-dependent competency shaped by broader structural and social determinants. From a clinical and health system perspective, digital health interventions should be accompanied by structured digital inclusion strategies, including routine assessment of DHL and care delivery to patients’ digital capacities. Further longitudinal and interventional studies are warranted to clarify the causal pathways linking DHL to health outcomes in adults with CVD and to incorporate provider- and system-level perspectives beyond individual-level assessments. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD420251068000; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251068000

Heart failure (HF) can limit the capacity of patients to perform daily activities, increasing their dependence on caregivers and contributing to significant caregiver burden. Accurate assessment of this burden is crucial for elucidating its impact and guiding the development of evidence-based strategies to support both patients and their caregivers. This study aims to translate, culturally adapt, and evaluate the psychometric properties of the heart failure caregiver burden questionnaire (HF-CQ) for application among Korean caregivers of individuals with HF. The HF-CQ was translated into Korean and culturally adapted in accordance with the World Health Organization guidelines. A total of 328 caregivers of patients with HF were enrolled between June 2021 and December 2023. To evaluate construct validity, a confirmatory factor analysis was used, including the assessments of convergent and discriminant validity of the instrument. Criterion validity and known-group validity were also examined. Reliability was determined by calculating Cronbach’s α for internal consistency and the intraclass correlation coefficient (ICC) for test–retest stability. The Korean version of the HF-CQ confirmed a three-factor structure—physical wellbeing, emotional wellbeing, and lifestyle—comprising 20 items. The instrument demonstrated excellent content validity. Construct validity was supported using acceptable model fit, standardized factor loadings and average variance extracted values > 0.50, composite reliability values > 0.70, and heterotrait–monotrait ratios < 0.85. Criterion validity was verified via significant correlations with depressive symptoms (r = 0.44, p < 0.001) and with health-related quality of life (r = -0.23, p < 0.001). Known-group validity was not demonstrated, with no significant differences in caregiver burden scores caregivers of patients in NYHA Class II and those in Class III/IV (t = -1.680, p = 0.094). Internal consistency was excellent (Cronbach’s α = 0.95), and test–retest reliability was good (ICC = 0.73). The 20-item Korean HF-CQ demonstrated sound psychometric properties, offering a culturally adapted tool for evaluating caregiver burden in HF. Implementation in clinical and community settings can facilitate early detection of caregivers experiencing high levels of burden, thereby allowing prompt recognition and the development of individualized support strategies.

Background and Objectives: The Sarcopenia and Calf Circumference (SARC-CalF) tool has been proposed to enhance the detection of sarcopenia. A comprehensive systematic review evaluating the diagnostic performance of the SARC-CalF could support its broader adoption as a valid screening instrument. Thus, this study aimed to assess the diagnostic accuracy of the SARC-CalF in detecting sarcopenia risk among older adults. Research Design and Methods: A systemic review was conducted in six electronic databases and Google Scholar. The values of sensitivity, specificity, and area under the curve were estimated simultaneously using a bivariate model. Evaluation of the quality of individual studies included in this review was conducted with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results: Our systematic review included 18 studies, with 10,367 older adults. The pooled sensitivity and specificity of the SARC-CalF were 53.3% (95% confidence interval [CI]: 0.46–0.60) and 87.3% (95% CI: 0.84–0.90), respectively. The pooled diagnostic odds ratio was 7.34 (95% CI: 5.87–9.19), and the area under the curve was 0.78 (95% CI: 0.73–0.81), indicating moderate diagnostic accuracy. Subgroup analyses revealed variations based on reference standards and calf circumference cutoff values. Discussion and Implications: This study highlights the SARC-CalF as a practical, cost-effective screening scale for sarcopenia of older people in community settings. Further research is required to establish optimal calf circumference cutoff values and validate its utility in various clinical environments. Combining the SARC-CalF scale with other functional measures may be useful and optimal tools for sarcopenia among older adults.

Background: A patient–family caregiver dyad approach is necessary to improve adherence to self-care behaviors by patients with heart failure (HF). However, there is a lack of mobile health (mHealth) interventions that engage both patients and their family caregivers to promote HF self-care. Objective: The purpose of this quasi-experimental study was to develop and confirm the feasibility and effectiveness of a novel mHealth intervention based on patient–family caregiver dyads for promoting adherence to self-care by patients with HF. Methods: We developed a dyadic mHealth program with 2 main features: a basic feature app and an interactive text-based chatbot. The intervention group (35 of 70 HF patient–family caregiver dyads; 50%) underwent a dyadic mHealth program for 24 weeks, while the control group (35 of 70 dyads; 50%) received usual care. Adherence to self-care behaviors, family caregivers’ contributions to self-care behaviors, and health-related quality of life were evaluated. Data were collected using self-administered questionnaires at baseline and at 1 month, 3 months, and 6 months post enrollment. The outcomes were analyzed using intention-to-treat analysis. Results: The intervention group had significantly better adherence to self-care behaviors (β=4.68, 95% CI 0.99-8.37) and family caregivers’ contributions to self-care behaviors (β=8.76, 95% CI 4.63-12.88) over 6 months compared with the control group. The 6-month follow-up health-related quality of life scores for patients (β=0.07, 95% CI 0.00-0.13) and family caregivers (β=0.08, 95% CI 0.03-0.13) were significantly greater in the intervention group than in the control group. The 1-month follow-up disease knowledge scores for patients (β=0.16, 95% CI 0.03-0.29) and family caregivers (β=0.12, 95% CI 0.00-0.25) were significantly greater in the intervention group than in the control group. The intervention also had a significant effect on mutuality at the 1-month follow-up for patients (β=0.11, 95% CI 0.00-0.21) and family caregivers (β=0.15, 95% CI 0.01-0.30). However, health literacy was significantly higher in the intervention group than in the control group only for patients at 1 month (β=0.14, 95% CI 0.04-0.25). The intervention had no significant effects on depressive symptoms, social support with patient and family caregivers, and caregiver burden with family caregivers. Conclusions: This study found that the dyadic mHealth intervention was beneficial for improving patients’ adherence to self-care behaviors and family caregivers’ contributions to self-care behaviors by providing information and motivation and improving health-related quality of life for patients with HF and family caregivers. Further studies should confirm the generalizability, feasibility, and long-term health outcomes of this intervention. Trial Registration: Clinical Research Information Service (CRIS) KCT0008786; https://tinyurl.com/3684ur4r

BACKGROUND A patient–family caregiver dyad approach is necessary to improve adherence to self-care behaviors by patients with heart failure (HF). However, there is a lack of mobile health (mHealth) interventions that engage both patients and their family caregivers to promote HF self-care. OBJECTIVE The purpose of this quasi-experimental study was to develop and confirm the feasibility and effectiveness of a novel mHealth intervention based on patient–family caregiver dyads for promoting adherence to self-care by patients with HF. METHODS We developed a dyadic mHealth program with 2 main features: a basic feature app and an interactive text-based chatbot. The intervention group (35 of 70 HF patient–family caregiver dyads; 50%) underwent a dyadic mHealth program for 24 weeks, while the control group (35 of 70 dyads; 50%) received usual care. Adherence to self-care behaviors, family caregivers’ contributions to self-care behaviors, and health-related quality of life were evaluated. Data were collected using self-administered questionnaires at baseline and at 1 month, 3 months, and 6 months post enrollment. The outcomes were analyzed using intention-to-treat analysis. RESULTS The intervention group had significantly better adherence to self-care behaviors (β=4.68, 95% CI 0.99-8.37) and family caregivers’ contributions to self-care behaviors (β=8.76, 95% CI 4.63-12.88) over 6 months compared with the control group. The 6-month follow-up health-related quality of life scores for patients (β=0.07, 95% CI 0.00-0.13) and family caregivers (β=0.08, 95% CI 0.03-0.13) were significantly greater in the intervention group than in the control group. The 1-month follow-up disease knowledge scores for patients (β=0.16, 95% CI 0.03-0.29) and family caregivers (β=0.12, 95% CI 0.00-0.25) were significantly greater in the intervention group than in the control group. The intervention also had a significant effect on mutuality at the 1-month follow-up for patients (β=0.11, 95% CI 0.00-0.21) and family caregivers (β=0.15, 95% CI 0.01-0.30). However, health literacy was significantly higher in the intervention group than in the control group only for patients at 1 month (β=0.14, 95% CI 0.04-0.25). The intervention had no significant effects on depressive symptoms, social support with patient and family caregivers, and caregiver burden with family caregivers. CONCLUSIONS This study found that the dyadic mHealth intervention was beneficial for improving patients’ adherence to self-care behaviors and family caregivers’ contributions to self-care behaviors by providing information and motivation and improving health-related quality of life for patients with HF and family caregivers. Further studies should confirm the generalizability, feasibility, and long-term health outcomes of this intervention. CLINICALTRIAL Clinical Research Information Service (CRIS) KCT0008786; https://tinyurl.com/3684ur4r

This cross‐sectional study aimed to identify the impact of multimorbidity on self‐reported sarcopenia and compare the differences in the prevalence and associated factors of sarcopenia in community‐dwelling older adults with and without multimorbidity. We enrolled 876 community‐dwelling older adults in South Korea. Multimorbidity was defined as the coexistence of two or more chronic diseases, and sarcopenia was evaluated using the Strength, Assistance in walking, Rising from a chair, Climbing stairs, and Falling Questionnaire. Binomial logistic regression analyses were performed. Our study revealed that the prevalence of sarcopenia was significantly higher (43.5%) in older adults with multimorbidity than in those without multimorbidity (20.8%). This finding underscores the significant impact of multimorbidity on sarcopenia. We also found that poor perceived health status was the strongest predictor of sarcopenia in older adults with multimorbidity, while oldest‐old age (≥ 85 years) was the strongest predictor of sarcopenia in those without multimorbidity. Large prospective cohort studies using objective sarcopenia screening tools are needed to demonstrate the synergistic effects of multimorbidity and sarcopenia on health outcomes among community‐dwelling older adults.

Purpose: This study aims to identify longitudinal patterns and predictors of cognitive function trajectories among Korean older adults with cardiovascular diseases.Design: This study is a longitudinal panel analysis based on secondary data. Data from the the Korean Longitudinal Study of Ageing (KLoSA) were used for analysis.Methods: The KLoSA is a representative panel survey of older Koreans. We analyzed responses from 301 participants aged ≥65 years who completed the same survey more than three times out of five waves between 2012 and 2020.Findings: Latent class growth modeling identified two trajectories of cognitive function in older people with cardiovascular diseases: “low and declining” (n = 81, 26.9%) and “high and declining” (n = 220, 73.1%). Participants in “the low and declining trajectory group” were more likely to have a low educational level, weak handgrip strength, depression, and low social participation at baseline than those in “the high and declining trajectory group.”Conclusions: Our results indicate a need to develop community‐based tailored interventions for improving handgrip strength, mental health, and social participation in delaying cognitive decline in older people with cardiovascular diseases considering their educational level.Clinical Relevance: Healthcare providers should be more concerned about older people with a weaker handgrip, depression, and low social activities as a high‐risk group for cognitive decline over time in cardiovascular care. Therefore, it is necessary to evaluate them early with standardized tools and make subsequent strategies for the older population with cardiovascular diseases.