Comparative Efficacy of Digital Health Intervention Delivery Modalities on Quality of Life, Anxiety, and Depression in Coronary Heart Disease: A Systematic Review and Network Meta-Analysis

Abstract

Background:Nonadherence to traditional cardiac rehabilitation and persistent psychological distress among patients with coronary heart disease(CHD)severely undermine desired therapeutic outcomes.Digital health interventions(DHIs)emerge as promising strategies to effectively tackle this adherence and mental health issue remotely. Objective:The aim of this study was to conduct a network meta-analysis(NMA)to compare and rank the comparative efficacy of various DHI delivery modalities in improving quality of life(QoL),anxiety, and depression among patients with CHD. Methods:A systematic search strategy was conducted in PubMed,Embase,Web of Science,Cochrane,CNKI,VIP,WanFang,and SinoMed databases to search for randomized controlled trials(RCTs)published from their inception to February 1,2026.We carried out a frequentist NMA using Stata 18.0to compare the efficacy of various DHIs against standard care.The quality of literature was assessed using the Cochrane Risk of Bias tool(version2.0).The certainty of evidence was evaluated using the Confidence in Network Meta-Analysis(CINeMA)framework,and interventions were ranked utilizing the surface under the cumulative ranking(SUCRA)curve. Results:A total of44RCTs involving8,495patients were enrolled.The NMA revealed that for improving QoL,telephone follow-up(standardized mean difference2.98,95%CI 1.75-4.20)and social media(SMD 1.13,95%CI 0.42-1.84)were statistically superior to usual care. Notably,telephone follow-up,with a SUCRA of99.5%,appeared to be the most effective option.Regarding psychological outcomes,web-based platforms demonstrated the highest probability of being the best intervention for reducing both anxiety(SMD -1.56,95%CI-2.34 to -0.79;SUCRA 98.6%)and depression(SMD-1.07,95%CI-1.94to-0.20;SUCRA 91.4%).Safety analyses showed interactive modalities significantly reduced adverse events,whereas one-way SMS carried a significantly higher risk than interactive telephone support(OR 3.38,95%CI 1.13-10.13). Conclusions:The research suggests that telephone follow-up ranked highest among the included studies for improving short-term QoL,while web-based platforms showed a high probability of being effective for alleviating long-term anxiety and depression.However, these rankings should be interpreted cautiously,as intervention content,duration,and patient populations varied considerably across trials,and the small number of studies for certain modalities limits the robustness of direct comparisons.Social media interventions also emerged as a versatile option with benefits across all three outcomes,though their modest effect sizes warrant further optimization of engagement strategies.Passive SMS interventions present potential safety concerns,as their unidirectional nature may attenuate timely symptom recognition and delay appropriate care-seeking—a hypothesis supported by their significantly higher adverse event rates compared with interactive modalities.These results provide crucial evidence-based support for healthcare providers to tailor specific DHIs to individual patient needs.