How digital health tools shape emotional support experiences in cardiovascular care: a systematic review and thematic synthesis.

BACKGROUND: Digital health tools are increasingly integrated into cardiovascular care, yet their value is commonly assessed through clinical outcomes, adherence, and usability. Less is known about how patients experience these tools as sources of emotional support, or how digitally mediated care can instead create emotional burden. In this review, emotional support refers to patients' experiences of feeling reassured, understood, encouraged, validated, and relationally connected while managing cardiovascular illness. OBJECTIVE: To synthesize qualitative evidence on how digital health tools shape emotional support experiences among patients with cardiovascular disease or closely related cardiovascular conditions, and to identify the mechanisms and contextual factors that determine whether technology is experienced as supportive or burdensome. METHODS: This systematic review and qualitative synthesis was designed in accordance with the PRISMA 2020 and ENTREQ guidelines. PubMed, Web of Science, Embase, Scopus, CNKI, Wanfang, and VIP databases were searched from inception to December 2025. Studies reporting qualitative patient data on mobile applications, remote monitoring, telerehabilitation, conversational artificial intelligence, virtual reality, or related digital tools in cardiovascular care were included. Methodological quality was appraised using the Joanna Briggs Institute (JBI) checklist. Findings were integrated through thematic synthesis, and confidence in the evidence was assessed using GRADE-CERQual. RESULTS: Eighteen studies, representing approximately 401 patients across 14 countries or regions, were included. Five analytical themes were generated: (1) reassurance through monitored and responsive care; (2) agency through understandable and actionable information; (3) relational continuity through humanized digital connection; (4) motivation and hope through personalization, enjoyment, and encouragement; and (5) distress and disengagement through technical, informational, and ethical burden. Six cross-cutting contextual moderators shaped these pathways: human-in-the-loop support, technical reliability, personalization, cultural safety, digital and health literacy, and continuity with routine care. CONCLUSION: Emotional support is not an inherent property of a digital tool. It is an experience co-produced when technology enables credible oversight, understandable feedback, responsive relationships, and patient control. Cardiovascular digital interventions should therefore be evaluated not only for usability and clinical effectiveness, but also for reassurance, relational continuity, anxiety, trust, and digital treatment burden. SYSTEMATIC REVIEW REGISTRATION: CRD420261430511.