Exploring the Use of a Digital Therapeutic Intervention to Support the Pediatric Cardiac Care Journey: Qualitative Study on Clinician Perspectives

Sahr Wali, Alliya Remtulla Tharani, Diana Balmer-Minnes, Joseph A. Cafazzo, Jessica Laks, Aamir Jeewa


Pediatric heart disease currently effects over one million infants, children, and adolescents in the United States alone. Unlike the adult population, pediatric patients face a more uncertain path with factors relating to their growth and maturation creating levels of complexity to their care management. With mobile phones increasingly being utilized amongst adolescents, digital therapeutics tools could provide a platform to help patients and families manage their condition. This study explored clinicians’ views on the use of a digital therapeutic program to support pediatric heart disease management. Using the principles from user-centered design, semi-structured interviews were conducted with 4 cardiologists, 3 nurse practitioners and 1 cardiology fellow at the Hospital for Sick Children.


Pediatric heart disease currently represents a significant cause of morbidity and mortality in childhood, effecting over one million infants, children, and adolescents in the United States alone [1,2]. The complexities associated with pediatric heart disease has been connected to a diverse range of primary, secondary, and shared pathways of disease progression [3,4]. Among children with heart failure, disease processes such as primary cardiomyopathy, rhythm disorders, congenital heart disease (CHD), and acquired heart diseases (e.g., myocarditis, rhematic heart disease, Kawasaki disease) have been linked as the causes of the condition [5–7]. These sources for HF differ substantially from the adult population, leading children with HF-related hospitalizations to have over a 20-fold increased risk of death [3,7–11]. With the advancements in medical and surgical care, improvements in life expectancy have been reported amongst children with HF [1,5].

Materials and method

The Peter Munk Cardiac Centre (PMCC) and the Centre for Digital Therapeutics at the University Health Network (UHN) in Toronto, Canada, have designed a mobile phone-based digital therapeutic, known as the Medly program (, to provide remote clinical support for patients with HF [15,19]. Medly currently operates as part of the standard of care at the UHN Heart Function Clinic in Toronto, Canada [19]. With Medly, patients can use a mobile phone with the Medly app, weight scale, and blood pressure monitor to record daily physiologic readings and symptoms [19].


During the analysis of the interview data, five themes were identified: (i) multidisciplinary model of care; (ii) patient care needs change over time; (iii) treatment burden and difficulties in care management; (iv) transition to adulthood; and (v) filling care gaps with digital health.


With the complexities of pediatric heart disease continuing to grow as children move from infancy to adolescence, integrated solutions are needed to reduce the burden of care on patients, families, and clinicians. In the adult population, digital health interventions have been widely introduced to empower remote heart disease management, however, there is minimal evidence regarding its use in the changing context of pediatric care [26,27]. With this, our study aimed to explore the clinician perspective on the applicability of DTx for pediatric heart disease.


As the number of children facing the burden of pediatric heart disease continues to grow, the level of innovative opportunities to improve patient quality of life remains promising. Unlike the adult population, pediatric patients face a more uncertain path with factors relating to their growth and maturation creating levels of complexity to their care management. Despite the limited evidence on DTx in the pediatric setting, its ability to support remote, collaborative sources of care continuity led clinicians of varying cardiac backgrounds to support its use. However, given the uniqueness of each patient’s care journey, interventions should be co-designed with families to ensure both clinical and cultural factors are incorporated within its design.

Citation: Wali S, Remtulla Tharani A, Balmer-Minnes D, Cafazzo JA, Laks J, Jeewa A (2023) Exploring the use of a digital therapeutic intervention to support the pediatric cardiac care journey: Qualitative study on clinician perspectives. PLOS Digit Health 2(12): e0000371.

Editor: Padmanesan Narasimhan, University of New South Wales, AUSTRALIA

Received: January 23, 2023; Accepted: September 19, 2023; Published: December 11, 2023

Copyright: © 2023 Wali et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data leading to this study findings is available without restriction within the manuscript and in our supplementary files.

Funding: This work was supported by the Emmet Jeffrey Foster Endowment Fund (AJ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.


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