Mobile Health Technology can Potentially Transform How Patients Manage Heart Disease Risk

Mobile health technology has the potential to transform the way we prevent and manage heart disease, but there are unanswered questions about how to optimize this technology and maintain engagement with patients, according to a review of randomized clinical trials published in the Canadian Journal of Cardiology. Cardiovascular disease is the leading cause of death worldwide. Recently, mobile health (mHealth) technology has been the focus of increasing interest as a means to improve the delivery of cardiovascular prevention targeting a combination of modifiable risk factors which account for the majority of global risk factors for cardiovascular disease - in a scalable and affordable way.

According to lead investigator Clara Chow, MBBS, FRACP, PhD, Professor of Medicine, University of Sydney, Program Director, Community Based Cardiac Services, Westmead Hospital, and Professorial Fellow, The George Institute for Global Health, Sydney, NSW, Australia, "mHealth interventions are a novel, exciting, and expanding field in medicine that will potentially transform healthcare delivery by improving access to treatments that would otherwise require frequent clinic or hospital visits. There are already an overwhelming number of cardiovascular mHealth options available to consumers. However, the utility of applications to improve health outcomes has been poorly evaluated. There is limited research evidence for their effectiveness in modifying objective measures of health, and app development and provision are largely unregulated."

In this study, investigators review the evidence on mHealth interventions for simultaneous multiple risk factor reduction in both primary and secondary prevention settings, using smartphone applications (apps) and text messaging (short messaging service - or SMS).

In the primary setting investigators found only a few randomized controlled trials (RCTs) that assessed mHealth approaches using text messaging and could not identify any RCTs assessing the effect of mHealth smartphone apps on total cardiovascular risk.

The largest primary prevention text messaging study was an RCT conducted in China of a 12-month intervention comprising text messaging and phone calls performed among 589 Chinese workers who had been allocated to receive an annual medical examination, who were without cardiovascular disease, and between 45 and 75 years of age.

The intervention group received personalized text messages targeting lifestyle measures to reduce cardiovascular disease risk (frequency determined by risk assessment) in addition to a computerized risk evaluation, an initial 15-minute face-to-face risk counselling session, follow-up phone calls, an educational handbook, and a medical examination. Electronic health prescription software was developed to prescribe the program to the intervention group. The control group received only the annual medical examination and report detailing their results.

At 12 months, there was a significantly lower mean 10-year cardiovascular disease (CVD) risk score in the intervention group compared to the control group. However, there was no significant reduction in the mean cardiovascular disease risk at 12 months compared to baseline for the intervention group. The investigators concluded that the study was underpowered to detect differences in overall 10-year CVD risk, despite showing significant differences in the individual components of the risk score. Systolic blood pressure, total cholesterol, waist-to-hip ratio, and body mass index were all significantly lower at 12 months compared to baseline in the intervention versus controls.

There have been several mHealth interventions designed to deliver secondary prevention to patients with cardiovascular disease and which target multiple risk factors simultaneously. Investigators evaluated the approach and the results of trials using text messages: TEXT ME and Text4Heart.

After six months, the TEXT ME trial, the largest secondary prevention texting study, provided objective evidence that text message support for heart attack survivors could improve key health risk factors of cholesterol, blood pressure, weight, exercise, diet, and smoking. Patients who received TEXT ME were more than twice as likely to reach guideline targets in their risk factors. The TEXT ME messages provided advice, motivation, and support on diet, quitting smoking, exercise, and general heart health.

By contrast the intervention group in the Text4Heart trial received one message per day that decreased to five messages each week from week 13. The study identified positive effects of adherence to healthy lifestyle behaviors at three months but not at six months, raising the question about the durability of mHealth interventions, as well as the optimal frequency of text messages.

Another two-month single-blind RCT of 203 patients with prior acute coronary syndrome evaluated personalized text messages based on cardiovascular data sent via mobile phone. The intervention group was significantly more likely to have an improved cardiovascular risk profile than the control group.

The investigators also evaluated the results of three RCTs for secondary prevention using smartphone apps. They generally found no or small improvements in cardiovascular risk factors but concluded that the small trial sizes meant they were unlikely to be powered to detect small improvements in cardiovascular risk factors. They suggest that there is potential for reducing health service utilization and hospitalization, but that further research is required to clarify this.

"mHealth has great potential to prevent heart disease, but there are unanswered questions about how to optimize it and maintain engagement with patients," commented lead author Harry Klimis, MBBS, University of Sydney, Department of Cardiology, Westmead Hospital, and The George Institute for Global Health, Sydney, NSW, Australia. "Select studies such as TEXT ME, show that mHealth can improve overall heart disease risk. However, our goal needs to be high quality and effective mHealth interventions. Importantly, future mHealth producers should collaborate with clinicians and regulatory agencies to ensure the interventions are safe and effective and outcome measures standardized."

The article is "Breaking Barriers: Mobile Health Interventions for Cardiovascular Disease," by Harry Klimis, MBBS, Jay Thakkar, MBBS, MD (INT MEDICINE), FRACP, and Clara K. Chow, MBBS, FRACP, PhD (https://doi.org/10.1016/j.cjca.2018.02.012). It will appear in the Canadian Journal of Cardiology, volume 34, issue 7 (July 2018) published by Elsevier.

Most Popular Now

Researchers Capture First Images of Oxyg…

Oxygen in cancer tumors is known to be a major factor that helps radiation therapy be successful. Hypoxia, or starvation of oxygen, in solid tumors is also thought to be...

VTT Makes New Investments in Digital Hea…

VTT is launching new research activities in the area of digital health as part of the growing wellbeing and health technology ecosystem in Kuopio. The new initiative aims to create...

A New Method of Artificial Intelligence …

Despite the immense progress in the field of AI in recent years, we are still very far from human intelligence. Indeed, if current AI techniques allow to train computer agents...

FDA Informs Health Care Providers, Facil…

Today, the U.S. Food and Drug Administration is issuing a safety communication informing health care providers, facilities and patients about cybersecurity vulnerabilities identified for certain GE Healthcare Clinical Information Central...

eHealthWeek 2020 Croatia - Trusted Infor…

15 - 17 April 2020, Rovinj, Croatia. In its capacity of hosting the upcoming Presidency of the Council of the European Union, the Croatian Ministry of Health is in preparations to...

Siemens Healthineers Presents Solutions …

CT scanners with intelligent user guidance, AI-based software assistants for MRI and a lab system that revolutionizes workflows: Siemens Healthineers is showcasing its products and solutions according to the motto...

NHS IT Chiefs Set the Stage for a Year o…

3 - 4 March 2019, London, United Kingdom. NHS technology leaders are to kick off the second-ever Digital Health Rewired Conference and Exhibition on 3 - 4 March at the Olympia...

PatchAi Startup has Arrived in the Marke…

PatchAi - a startup that offers, thanks to Artificial Intelligence and Machine Learning, an empathic virtual assistant to patients participating in clinical trials - announced that it has closed two...

Digital Health App Medicus AI Earns CE C…

Medicus AI, the Vienna-based health tech company, has received a ​Class I Medical Device CE Mark for its mobile application. The CE certification mark confirms that Medicus AI conforms to...

FDA Authorizes Marketing of First Cardia…

Today, the U.S. Food and Drug Administration authorized marketing of software to assist medical professionals in the acquisition of cardiac ultrasound, or echocardiography, images. The software, called Caption Guidance, is...

Human Body-on-Chip Platform Enables In V…

Drug development is an extremely arduous and costly process, and failure rates in clinical trials that test new drugs for their safety and efficacy in humans remain very high. According...

AI in Drug Discovery Conference 2020

16 - 17 March 2020, London, UK. SMi group presents the launch of the inaugural AI in Drug Discovery conference taking place in London. AI-empowered machine learning technologies hold the potential...