Digital health interventions for older adults with heart failure: A scoping review of participant representation, engagement, and equity considerations

Objective To examine participant representation, engagement, and equity considerations in randomized controlled trials of digital health interventions for older adults living with heart failure, using the PROGRESS-Plus framework to assess reporting across key social determinants of health. Methods We conducted a scoping review following Joanna Briggs Institute methodology. Randomized controlled trials evaluating digital health interventions for older adults with heart failure were identified through systematic database searches. Data were extracted on participant characteristics, intervention features, engagement outcomes, and reporting across PROGRESS-Plus domains, including place of residence, race/ethnicity, occupation, gender/sex, religion, education, socioeconomic status, social capital, age, disability, sexual orientation, and health literacy. Results Fourteen studies (n = 5,959 participants) were included. Interventions commonly involved remote monitoring, telehealth, wearable devices, and web-based platforms. While overall engagement among enrolled older adults was generally high, reporting of equity-relevant characteristics was inconsistent. Race/ethnicity and education were variably reported, while socioeconomic status and rurality were often minimally described. Cognitive impairment was frequently an exclusion criterion, and digital literacy was rarely assessed using standardized measures. Sexual orientation and health literacy were not reported in any study. These gaps limit understanding of how digital health interventions reach and benefit socially and clinically diverse older adults. Conclusions Digital health interventions for older adults with heart failure demonstrate promising engagement but are characterized by limited and inconsistent reporting of equity-related factors. Greater attention to inclusive recruitment, standardized reporting across PROGRESS-Plus domains, and equity-informed intervention design is needed to ensure that digital innovations support diverse older adults living with heart failure.