Digital health interventions (DHIs), such as apps, text messages, and wearables, often fail to significantly lower heart attack risk or improve clinical outcomes like mortality in studies, despite promoting positive behavior changes in diet and activity. While effective for intermediate, short-term improvements (weight, BP), they do not reduce long-term cardiovascular events.
Key findings regarding digital health and heart attack risk include:
- Minimal Clinical Impact: A 12-month study (the “TEXT ME” trial style) showed no significant reduction in cardiovascular risk scores among high-risk individuals.
- Minimal Effect on Events: A major study found that digital health interventions (telemedicine/apps) for patients with existing coronary heart disease provided minimal benefits, suggesting they do not replace direct medical care.
- Short-Term vs. Long-Term: While apps can help with 6-month improvements, these effects often fade by 12 months.
- High-Risk vs. General Population: Some studies suggest that while DHIs are not highly effective in the general population for risk reduction, they might be useful for monitoring, but not for reducing, major cardiovascular events like heart attacks.
- Evidence suggests these tools are most effective when used in combination with traditional in-person care.
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Introduction
Cardiovascular disease is the leading cause of mortality worldwide, with an estimated 17.9 million deaths (32% of all global deaths) in 2019.1 Guidelines from the European Society of Cardiology and American Heart Association place adherence to medication and healthy lifestyle behaviors at the core of cardiovascular disease primary and secondary prevention strategies.2,3 In practice, an exceedingly small proportion of patients achieve target goals across all measures, suggesting there is a critical unmet need for patient behavioral change to optimize modifiable risk factors such as hypertension, dyslipidemia, tobacco use, inactivity, obesity, and medication nonadherence. The growing collective burden of disease, particularly of heart failure (HF), is likely to eventually outgrow the available resources allocated for traditional care provision, such as nurse-led HF outreach services. Novel strategies are required to address this growing need.
Telemedicine refers to the provision of healthcare by means of any telecommunication technology. Traditionally, telemedicine required the provision of home-based specialized monitoring equipment to patients. However, smartphones, mobile phones, and wearable technology offer tremendous potential for monitoring health through phone calls, text messages, data recording, and activity monitoring.4 This technology is at the heart of digital health, which is defined as the use of digital, mobile, and wireless technologies to support the achievement of health objectives.5 mHealth is a branch of digital health that is specific to the use of mobile devices such as smartphones and tablets.
The potential of digital health has become even more relevant during the COVID-19 pandemic, in which social isolation has boosted the need for rapid proliferation of digital medicine.6 Worldwide, more than 6.5 billion people own smartphones and opportunities to deliver healthcare digitally for patients with cardiac conditions are expanding exponentially.7
Multiple studies have underlined several advantages of using digital health to reduce inequalities in cardiovascular outcomes8 and improve care for patients with HF and coronary artery disease.9 Several of these novel models of healthcare delivery are cost-effective, accessible, patient-centric, and focused on patient behavior change.10
The importance of digital health solutions during the recent COVID-19 pandemic has been reflected by an increase in publications on this important topic; however, many studies are underpowered with short follow-up owing to difficulty sourcing funding and the relative short lifespan of digital health interventions as technology advances. This narrative review will critically analyze large, adequately powered pivotal randomized controlled trials (RCTs) (summarized in Table 1) and discuss examples of successfully deployed noninvasive mobile digital technology in the prevention of HF hospitalizations, and in the primary and secondary prevention of coronary artery disease.
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