This study used a qualitative meta-synthesis approach [28] to synthesize the experiences, perceptions, and perspectives of patients with CHF receiving nurse-led eHealth interventions. The study was conducted in accordance with the methodological procedures for qualitative evidence synthesis developed by the Joanna Briggs Institute (JBI) to enhance the methodological rigor, transparency, and traceability of the evidence generation process [29]. This review was reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist, which is provided in Checklist 1.

A comprehensive search strategy was developed based on 4 core concepts: nurse-led care, CHF, eHealth interventions, and qualitative research or patient experiences. The search terms included, but were not limited to, the following: “nurse-led,” “nurse managed,” “nurse-directed,” “nurse-delivered,” and “nurs*” for nurse-led care; “heart failure,” “cardiac failure,” “myocardial failure,” “congestive heart failure,” “left-sided heart failure,” “right-sided heart failure,” and “heart decompensation” for CHF; “telemedicine,” “telehealth,” “telecare,” “telemonitor*,” “telecoaching,” “telenursing,” “eHealth,” “e-health,” “mHealth,” “m-health,” “gerontechnology,” “telerehabilitation,” “e-rehabilitation,” “telecommunication,” “videoconferenc*,” “teleconferenc*,” “internet,” “computer*,” “mobile,” “phone*,” “smartphone*,” “telephone*,” “tablet*,” “email,” “e-mail,” “SMS,” “app*,” “social media,” “wireless,” “virtual,” “remote,” “distant,” and “technolog*” for eHealth interventions; and “qualitative,” “focus group*,” “interview*,” “experienc*,” “attitud*,” “feel*,” “respons*,” “perspectiv*,” “opin*,” “phenomenolog*,” “lived experience*,” “narrative*,” “ethnograph*,” “grounded theory,” and “content analysis” for qualitative research and patient experiences. Search terms within each concept were combined using the Boolean operator “OR,” and the 4 concept blocks were combined using “AND.” No “NOT” operator was applied. Both controlled vocabulary terms and free-text keywords were used, and the search strategy was adapted to the indexing system of each database. Quotation marks were used consistently for all search terms, and truncation symbols (*) were applied to capture lexical variations. No start-date restriction was applied, and all databases were searched from inception to April 30, 2026, to ensure comprehensive retrieval of the available evidence. The full reproducible search strategies for each database are provided in Multimedia Appendix 1 in accordance with PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) recommendations. Two reviewers (YZ and YM) independently conducted the database searches and cross-checked the search results to ensure accuracy and consistency.

Based on the population, phenomenon of interest, context, and study design framework, this review established explicit inclusion and exclusion criteria, as detailed in Table 1.

All retrieved records were imported into EndNote (version 21; Clarivate) for reference management and deduplication. Following deduplication, 2 reviewers independently screened the titles and abstracts against the predefined eligibility criteria to identify potentially relevant studies. After excluding records that did not meet the eligibility criteria, the full texts of potentially eligible papers were independently assessed to determine final inclusion. Any disagreements arising during the selection process were resolved through discussion and consensus; when necessary, a third reviewer was consulted for arbitration.

The methodological quality of all included studies was assessed using the JBI Critical Appraisal Checklist for Qualitative Research [30]. This tool comprises 10 items evaluating key methodological domains, including philosophical underpinnings, researcher positioning and influence, participant recruitment, transparency in data collection and analysis, and ethical considerations. Each item was rated as “yes,” “no,” “unclear,” or “not applicable.”

The appraisal was independently conducted by 2 researchers (YZ and YM) with experience in systematic reviews. Any discrepancies in scoring were resolved through discussion and consensus, with arbitration by a third researcher when necessary. Based on the extent to which the appraisal items were met, the research team made an overall judgment of methodological quality. Studies that generally met the appraisal criteria and had minimal methodological limitations were rated as grade A. Studies with some reporting deficiencies that did not compromise overall credibility were rated as grade B. Studies in which most key items failed to meet the criteria, or that had evident methodological limitations or substantial concerns regarding methodological quality, were rated as grade C and excluded. Ultimately, only studies rated as grade A or grade B were included to enhance the credibility and interpretive value of the synthesized evidence.

Data extraction was independently performed by 2 researchers after full-text review to promote a systematic and consistent extraction process. Using a prespecified data extraction form, the research team extracted information from the included studies, including author, year of publication, country or region, study setting, sample size and participant characteristics, study design, study aims, data collection methods, duration of interviews or data collection, data analysis methods, and the main findings reported in each study. For studies that included patients, caregivers, or health care professionals, only experiential data clearly attributable to patients with CHF were extracted. For mixed methods studies, only qualitative findings that could be clearly separated from the quantitative results were extracted. After the initial comparison of extracted data, discrepancies were reviewed by a third researcher to enhance data accuracy and completeness. The final extracted data were used for subsequent meta-synthesis and interpreted in conjunction with the methodological quality appraisal results.

To avoid duplicate inclusion of the same participant sample, the research team compared author groups, study settings, sample sources, recruitment periods, intervention program names, and study characteristics during full-text screening and data extraction to identify potential duplicate publications from the same research project or participant sample. If multiple papers were based on the same sample, only the report providing the most complete information and most closely aligned with the aim of this review was retained. After verification, no sample overlap was identified among the studies ultimately included, and the participant samples reported in each study were considered independent.

This study combined meta-aggregation and thematic analysis to synthesize the experiences and perspectives of patients with CHF receiving nurse-led eHealth interventions, as reported in qualitative studies and mixed methods studies with qualitative findings. Two researchers independently and repeatedly read all included studies and identified findings explicitly presented by the authors of the primary studies. The credibility of these findings was assessed in relation to the accompanying original participant quotations. On this basis, findings with similar meanings were grouped into categories and further integrated through team discussions into overarching themes to capture the core content and internal logic of patients’ experiences. Throughout the synthesis process, emphasis was placed on the relationships among findings and the clarity of the conceptual structure to support an interpretation that reflected patients’ shared experiences and practical challenges. The research team maintained analytic records during the synthesis process and used repeated comparison and team discussions to enhance the transparency, traceability, and interpretive rigor of the analytic pathway.

This study assessed the level of confidence in the evidence for the final synthesized themes using the Confidence in the Evidence from Reviews of Qualitative Research (ConQual) approach developed by the JBI [31]. This approach begins with an initial rating of “high,” followed by downgrading based on 2 core domains: the methodological dependability of the primary studies and the credibility of the study findings. The final level of confidence is then determined and categorized as high, moderate, low, or very low.

Methodological dependability was assessed using 5 critical items from the JBI Critical Appraisal Checklist for Qualitative Research, reflecting the overall rigor and methodological conduct of each included study. If 4 or 5 of these items were rated “yes,” no downgrading was applied; if 2 or 3 were rated “yes,” the confidence rating was downgraded by 1 level; and if only 1 or none was rated “yes,” the confidence rating was downgraded by 2 levels.

The credibility of findings focused on the alignment between the researchers’ interpretations and the original participant quotations across the synthesized themes. Findings were categorized as “unequivocal,” “credible,” or “unsupported.” No downgrading was applied for themes supported solely by unequivocal findings; themes supported only by credible findings were downgraded by 2 levels; and themes with unsupported findings were downgraded to very low.

Each synthesized theme was evaluated using the ConQual approach to present the strength and trustworthiness of the qualitative evidence and to support interpretation of the robustness and applicability of the review findings.

As this study is a systematic review and meta-synthesis that does not involve the collection of primary data, ethics approval was not required. All included studies had received prior ethical clearance and obtained informed consent from participants.

The database search yielded 9838 records. After deduplication and screening of titles and abstracts, 110 papers underwent full-text review. Ultimately, 23 studies [25-27,32-51] met the inclusion criteria and were included in the synthesis (Figure 1). The included studies were conducted in the United States (n=5), Sweden (n=4), China (n=3), Canada (n=3), Norway (n=2), the United Kingdom (n=1), Singapore (n=1), South Korea (n=1), Japan (n=1), Italy (n=1), and Lithuania (n=1). These studies involved a total of 424 patients with CHF. The study designs comprised 17 qualitative studies and 6 mixed methods studies. Detailed characteristics of the included studies are presented in Multimedia Appendix 2 [25-27,32-51].

According to the JBI Critical Appraisal Checklist for Qualitative Research, the included studies generally demonstrated good methodological quality. Two studies were rated as grade A [42,45], and 21 studies were rated as grade B [25-27,32-41,43,44,46-51]. However, reporting deficiencies remained in several appraisal items. Specifically, 7 studies [26,32,40,41,44,46,48] did not clearly report the congruity between the stated philosophical perspective and the research methodology; 3 studies [32,40,46] did not clearly describe the researchers’ cultural or theoretical positioning; and 20 studies [25-27,32-39,41,43,44,46-51] did not describe the influence of the researchers on the research or the influence of the research on the researchers. The remaining appraisal items were generally adequately reported. Overall, the included studies demonstrated good congruity in terms of research questions or objectives, research methodology, data collection, data analysis, presentation of findings, interpretation of results, ethics approval, and derivation of conclusions. The complete methodological quality appraisal results are presented in Multimedia Appendix 3 [25-27,32-51].

Through iterative reading and comparative analysis, four overarching themes and twelve subthemes were synthesized (Textbox 1): (1) patient empowerment and enhanced self-management, (2) sense of security and continuity of care under professional support, (3) variations in acceptance and emotional responses, and (4) barriers and challenges in implementing eHealth interventions. The correspondence between each theme and subtheme and the included studies is presented in Multimedia Appendix 4 [25-27,32-51].

To further clarify the trustworthiness and interpretive value of the synthesized findings, this study used the JBI ConQual approach to assess the level of confidence in the evidence for each synthesized theme and subtheme. The ConQual assessment was based primarily on 2 domains: methodological dependability, which was assessed according to the methodological quality of the corresponding included studies, and credibility of findings, which reflected the extent to which the original participant quotations supported the synthesized findings. Overall, the level of confidence in the evidence was rated as moderate for all 4 synthesized themes and ranged from moderate to high for the 12 subthemes. Downgrading was mainly attributable to limitations in the credibility of some findings, as several synthesized findings were supported by both unequivocal and credible findings rather than solely by unequivocal findings. In addition, although the overall methodological quality of the included studies was acceptable, several studies insufficiently reported researcher reflexivity and the reciprocal influence between the researchers and the research process. The ConQual assessment results for the 4 synthesized themes are presented in Table 2, and the complete results for each synthesized theme and subtheme are provided in Multimedia Appendix 5 [25-27,32-51].

This qualitative systematic review and meta-synthesis integrated patients’ experiences of nurse-led eHealth interventions for CHF. The findings were reflected in 4 main aspects. Nurse-led eHealth interventions were perceived as supporting disease-related knowledge, self-efficacy, and adjustments in daily self-management behaviors; continuous monitoring, remote follow-up, and timely feedback were associated with patients’ sense of security and perceived continuity of care; willingness to engage varied across individuals and technological modalities; and usability, technical barriers, and concerns about long-term sustainability remained important constraints during implementation. These findings indicate that patients’ experiences encompassed not only empowerment and support but also technological adaptation and implementation burden.

This review first showed that nurse-led eHealth interventions were perceived as supporting patients’ understanding of CHF and its daily management. Patients not only received more information on symptom recognition, dietary control, medication use, and responses to abnormal signs or changes in condition but also gradually translated this information into practical knowledge relevant to their own life contexts [25,26,48,51]. This suggests that the value of such interventions lies not merely in information provision but also in helping patients transform disease-related knowledge into understandable and applicable management experience. Previous studies have emphasized the foundational role of health education in chronic disease management [52,53], and this review further shows, from the perspective of patients’ experience, that nurse-led eHealth interventions may improve both the comprehensibility and practical usefulness of disease-related information.

On this basis, some patients developed a more positive perception of their disease management capacity, as reflected in a stronger sense of control over their health condition and greater confidence in self-monitoring and sustained management [25,26,48]. This finding indicates that the experiential value of nurse-led eHealth interventions extends beyond supporting patients’ understanding of disease-related information to helping them gradually develop trust in their own management capacity. Previous chronic disease management research has identified self-efficacy as an important factor influencing long-term engagement and sustained self-management [54,55]. The findings of this review are broadly consistent with this view, suggesting that whether patients can incorporate these interventions into daily life depends not only on whether they know how to manage their condition but also on whether they believe they are capable of implementing these behaviors. Patients reported greater regularity and initiative in dietary control, symptom and sign monitoring, medication management, and daily activity planning [25,37], and some perceived symptom relief, improved activity tolerance, and better overall condition [43,44,51]. However, because this review focused on patients’ subjective experiences rather than intervention effectiveness, these findings should be interpreted as perceived changes rather than evidence of objective clinical outcomes.

Beyond empowerment, another important finding was patients’ emphasis on a sense of security and continuity of care. Patients repeatedly reported that continuous data transmission, remote monitoring, and timely feedback gave them a sense of ongoing professional oversight after discharge and were perceived as reducing uncertainty about changes in their condition [33,34,47]. This suggests that patients’ sense of security arose less from the technology itself than from the perceived presence of continued professional support [56]. Previous studies on remote care have similarly shown that patients value technology not because it is advanced, but because it can reduce the perceived distance between patients and professional support [57,58]. The present findings further support this view.

At the same time, nurse-led remote follow-up, home visits, and individualized feedback were perceived as extending traditional care across time and space [37,38,42]. Compared with brief outpatient encounters with limited opportunities to express concerns [25,56,59], these interventions were perceived as providing patients with ongoing opportunities to report problems, receive symptom assessment, and obtain timely recommendations. The continuity perceived by patients was reflected not only in uninterrupted service but also in the continuous receipt, interpretation, and response to patient information. In addition, this review showed that technological involvement did not necessarily weaken the nurse-patient relationship; under certain conditions, it could support trust and relational continuity [47,50]. Patients placed particular value on timely, individualized, and respectful communication, viewing it as a key basis for accepting and sustaining engagement with the intervention [60]. This suggests that, in the eHealth context, technology does not necessarily replace the nurse-patient relationship but can extend it into the postdischarge setting by enabling ongoing communication and professional responsiveness [61].

Regarding willingness to accept the intervention, this study showed variation in patients’ attitudes toward nurse-led eHealth interventions. Some patients perceived these interventions as beneficial support and were willing to learn and remain engaged [27,35,36], whereas others expressed reservations or resistance [35,39-41]. This variation was not determined solely by patients’ ability to use technology but was associated with multiple factors, including age, educational level, health literacy, cognitive status, prior technological experience, and understanding of disease management approaches [59]. These findings indicate that patients’ acceptance of eHealth interventions is a process shaped by cognitive, emotional, and contextual attributes rather than merely a matter of technology adoption [62,63]. This result is broadly consistent with existing digital health research showing that acceptance is influenced by multiple factors while further revealing how such variation is manifested among people with CHF from the perspective of patient experience.

This study further showed that different forms of eHealth technology served distinct nursing functions and were associated with differences in patient experience [35,40,41,49]. Apps and web-based platforms relied more heavily on patients’ active reading, recording, and feedback, and were therefore more likely to reveal differences in learning ability, operational competence, and sustained engagement. Telemonitoring primarily supported patients’ perception that their condition was being attended to through data uploading and professional feedback, with its value mainly reflected in a sense of security and the experience of continuous monitoring. Telephone and video follow-up, as well as home-based support, were more closely aligned with an extension of conventional nursing relationships, from which patients mainly obtained convenient communication, individualized explanations, and relational continuity [25,33,36,50,64,65]. These findings suggest that patients’ acceptance or resistance should be understood in relation to the specific technological modality. The design of nurse-led eHealth interventions should not assume a single uniform model but should instead align patients’ capabilities and support needs with the nursing functions performed by different technological modalities.

This review also revealed multiple barriers during implementation. Usability was closely related to patients’ willingness to initiate and sustain engagement [25,34,35,43]. Patients repeatedly referred to interface simplicity, clarity of procedural steps, ease of remembering how to operate the system, and flexibility in timing [25,43], indicating that for patients with CHF, particularly older adults, usability is a key prerequisite for effective implementation and sustained use [66]. Technical problems also varied across intervention forms. App- and web-based platforms were more likely to involve login difficulties, challenges in understanding information, and frustration caused by interface complexity [32,34,39,43,67], whereas remote monitoring interventions more often involved problems related to device functioning, data transmission, timely feedback, and technical support [32,44,45,47,68]. Beyond these immediate challenges, patients also expressed concerns about long-term sustainability [69]. Cost, the possibility of future charges, the availability of ongoing technical support, and the credibility of information sources all shaped patients’ judgments about the long-term value of eHealth interventions [70,71]. These findings suggest that eHealth interventions should focus not only on initial acceptance but also on long-term affordability, sustained support, and the maintenance of trust.

This review has several limitations. First, although a systematic search of multiple databases and gray literature was conducted, the included studies were restricted to published papers in Chinese and English, which may have introduced publication and language bias and affected the comprehensiveness of the evidence. Second, the participants in the included studies were predominantly patients with CHF who had basic cognitive and communication abilities; therefore, the representation of the oldest-old population, patients with severe cognitive impairment, or patients with strong resistance to technology was limited, which may constrain the applicability of the findings to these specific populations. Third, most of the included studies were conducted in high- and middle-income countries or regions, particularly in Europe, North America, and East Asia, while evidence from lower-income regions and culturally diverse contexts remained relatively scarce, which may limit the cross-cultural transferability of the findings to some extent. Fourth, the forms of eHealth intervention and their application contexts varied across studies. Although this review identified shared experiential patterns through thematic synthesis, subtle differences across intervention modalities may have been attenuated during the process of integration. Fifth, some primary studies showed limitations in reporting their philosophical stance, researcher positioning, and reflexivity, which may have affected the transparency of interpretation in the primary findings and, in turn, the robustness of the synthesized evidence. Finally, this review focused on patients’ experiences rather than intervention effectiveness. Therefore, the findings should be interpreted as reflecting how patients perceived and interpreted nurse-led eHealth interventions and should not be directly extrapolated to clinical or patient-reported outcomes such as rehospitalization, disease progression, or quality of life.

This review suggests that nurse-led eHealth interventions may have practical value in CHF management, but their implementation requires attention to patient characteristics, technological suitability, and nursing system support. For clinical practice, intervention tools should be designed with simple and user-friendly interfaces, adequate training, and individualized adjustments to reduce barriers for older patients and support sustained engagement. In remote care delivery, nurses should emphasize sustained supportive presence and individualized responsiveness. Relatively consistent follow-up teams, proactive feedback, and respectful communication may support patients’ trust and their perception of continuity of care. At the organizational level, adequate staffing, training, and institutional support should be provided. Nurses’ responsibilities in data monitoring, symptom feedback, health education, and psychological support should be clearly defined, and mechanisms for interdisciplinary collaboration and data security should be strengthened to support the sustainable operation of nurse-led models.

Future research should further clarify the fit among different technological modalities, patient characteristics, and care contexts, with particular attention to adaptation strategies for the oldest-old population, individuals with low digital literacy, and patients with multimorbidity. In addition, future studies could build on qualitative research by adopting mixed methods designs to examine the relationship between patients’ subjective experiences and objective clinical indicators. For example, patient-reported measures such as technology acceptability, use burden, self-efficacy, or satisfaction could be analyzed alongside readmission, emergency department visits, mortality, and adherence-related outcomes. Such work could provide a more comprehensive understanding of the role of patient experience in shaping both intervention implementation and clinical outcomes. Such research could help move beyond purely descriptive accounts of experience or isolated evaluations of effectiveness and support the optimization and application of patient-centered, nurse-led eHealth interventions.

This review systematically synthesized the experiences of patients with CHF receiving nurse-led eHealth interventions from the patient perspective. The findings showed that such interventions could enhance disease understanding, strengthen self-efficacy, support adjustments in daily self-management behaviors, and improve patients’ sense of security and perceived continuity of care in postdischarge settings. At the same time, patients’ acceptance and sustained engagement were jointly influenced by individual characteristics, technological modalities, usability barriers, and concerns about long-term sustainability. These findings indicate that the significance of nurse-led eHealth interventions lies not only in extending the temporal and spatial reach of nursing services but also in maintaining patients’ perceived access to professional support, timely responses, and the nurse-patient relationship during out-of-hospital management. Future practice and research should place greater emphasis on the heterogeneity of patient experiences and develop more appropriate matching pathways between different technological modalities and patient characteristics, thereby improving the adaptability and sustainability of nurse-led eHealth interventions in CHF management.