Patient trust and readiness for digital health-enabled precision care after heart transplantation: a real-world survey

Background:Digital health may support continuous, personalized follow-up after heart transplantation; however, successful implementation depends on patient trust, digital confidence, and acceptable data-governance arrangements. Objective: To characterize digital access, perceived usefulness, trust, privacy concerns, and implementation readiness among adult heart transplant recipients, and to explore differences across demographic and technology-use subgroups. Methods:In this cross-sectional study, consecutive adult heart transplant recipients attending routine follow-up at a tertiary center completed a 43-item questionnaire developed through literature-informed item generation, multidisciplinary expert review, and pilot testing in 5 transplant recipients. Responses were summarized descriptively. Exploratory subgroup comparisons used Pearson chi-square or Fisher exact tests, as appropriate. As multiple comparisons were exploratory, p-values were interpreted as hypothesis-generating. Results:Ninety-three recipients participated; 61 (65.6%) were male and 74 (79.6%) were older than 45 years. Smartphone use was common (85/93, 91.4%), whereas wearable use remained limited (18/93, 19.4%). Most respondents agreed that technology could improve health monitoring (69/92, 75.0%), and 69/93 (74.2%) considered digital tools more useful and reliable when incorporating guidance from their treating clinicians. Nevertheless, 29/93 (31.2%) expressed discomfort with device-led monitoring, and 49/92 (53.3%) preferred physician advice over app-based guidance. Concerns about data misuse were reported by 44/93 (47.3%), although 72/93 (77.4%) supported data use for clinical research and 69/ 93 (74.2%) valued revocable consent. Perceived usefulness differed significantly by sex (males 83.3% vs. females 59.4%, p = 0.023). Medication-related insecurity and preference for physician advice varied across age groups (p = 0.029 and p = 0.030, respectively). Greater daily technology use was associated with less medication-related insecurity and less discomfort with monitoring (p = 0.009 and p = 0.022). Conclusions: Heart transplant recipients demonstrate substantial but conditional readiness for digital health adoption. Successful implementation appears to depend not only on access, but also on clinician integration, task- specific confidence, and transparent, patient-controlled data governance. These findings support a staged, human-centered implementation approach rather than technology substitution for established clinical relationships.