Cardiovascular disease (CVD) is the leading cause of death in the United States and has a tremendous economic impact with costs upward of $200 billion annually.1 Risk factors include smoking, poor diet, and lack of physical activity.
There are numerous health-related apps and digital health technologies that seek to modify these risk factors. However, there is a lack of high-level evidence on the effect of digital health technologies on actual CVD outcomes. With a shift in focus on quality and outcomes in healthcare, evidence supporting a positive effect on outcomes is needed prior to the widespread adoption of digital health tools.
Physicians from the Mayo Clinic conducted a systematic review and meta-analysis of digital health interventions for the prevention of cardiovascular disease.2
The authors lumped digital health interventions in the analysis, including telemedicine, web-based strategies, email, mobile phones, mobile applications, text messaging, and monitoring sensors. They included 51 studies in the systematic review and identified 9 studies with quantitative data on CVD outcomes (CVD events, hospitalizations, or mortality) for analysis.
- Digital health interventions have a beneficial effect on CVD risk factors and outcomes
- 6.5% absolute risk reduction overall
- Sub-group analysis identified telemedicine, web-based solutions, and SMS texting as particularly beneficial
- In primary prevention populations, there is a benefit of digital health interventions on CVD risk factors, including weight loss, body mass index, systolic blood pressure, total cholesterol, and LDL cholesterol
- No observed benefit of digital health interventions in primary prevention groups regarding CVD outcomes, but there was an observed reduction in the Framingham risk scores
- For secondary CVD prevention and heart failure, digital health interventions have a benefit on all-cause mortality and CVD morbidity
- 40% relative risk reduction in CVD outcomes with the most significant impact among secondary prevention and heart failure groups
- 7.5% absolute risk reduction in secondary prevention groups
- Pooled analysis of several different digital health interventions
- Heterogeneity of studies
- Lack of long-term follow-up in the primary prevention groups
The current study provides important evidence-based data on digital health interventions on CVD outcomes. Its important to note that the degree of risk reduction they report may be biased due to the limitations of the included studies like potential selection bias, lack of blinding, and generally low numbers of patients. That said, it does lend more support to the belief that these generally (comparatively) low cost interventions can have a significant impact on outcomes that patients care about.
Also, as the authors point out, however, we should remember that digital health interventions do not have a direct effect on CVD risk; rather they likely improve CVD outcomes via improved adherence to and utilization of evidence-based preventative measures. This is an important factor to consider when deciding on the use of digital health technologies. Physicians, nurses, hospital administrators, and insurance companies must focus on how digital health solutions can improve known and validated risk factors that affect disease outcomes. To make an indelible impact, digital health technologies increasingly need to show benefit on quality, value, and outcomes.