Although mobile health technology could have the answers to preventing and managing heart disease, there are still questions on how to utilize the technology effectively and maintain patient engagement, according to a review published in the Canadian Journal of Cardiology.
Mobile health (mHealth) technology has been a key tool in finding a way to improve attention on cardiovascular prevention by targeting modifiable risk factors in a more affordable way, according to Eurek Alert!.
“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,” said lead investigator Clara Chow. “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 the study, researchers reviewed evidence on mHealth interventions for multiple risk factor reduction in both smartphone applications and test messaging.
The largest prevention text messaging study was conducted in China for 12-months. It consisted of text messages and phone calls to almost 600 Chinese workers who received an annual medical examination and did not have cardiovascular disease. The intervention group received personalized text messages measuring lifestyle habits that could reduce cardiovascular disease risks. Additionally, the workers received a computerized risk evaluation that consisted of a 15-minute in-person risk counselling session with follow-up phone calls, an educational handbook and medical examination.
The control group only received an annual medical exam and report of their results.
At 12 months, there was a lower mean 10-year cardiovascular disease risk score in the intervention group compared to the control group. Systolic blood pressure, total cholesterol, waist-to-hip ratio and body mass index were also lower at 12 months for the intervention group.
A text-message based prevention program delivered on a smartphone (left) and a standard cellular phone (right). The TEXT ME program sends regular text messages to encourage participants to lead healthier lifestyles. Credit: TEXT ME
Investigators also evaluated different text messages approaches using: TEXT ME and Text4Heart. After 6 months, TEXT ME trial provided evidence that text message support for heart attack survivors could help improve health risk factors such as cholesterol, blood pressure and weight. Those who received TEXT ME were twice as likely to reach guideline goals. The text messages provided advice, motivation and different dietary support on smoking and exercise.
The intervention group that received Text4Heart received one text per day that slowly decreased to five messages per week. The study identified positive effects to healthy lifestyle behaviors at three months but not at six months.
An app-based secondary prevention program targeting individuals who have known ischemic heart disease. The ‘My Heart, My Life’ app from the Australian Heart Foundation includes educational videos on acute coronary syndromes, and a personal health tracker. Credit: National Heart Foundation of Australia
“mHealth has great potential to prevent heart disease, but there are unanswered questions about how to optimize it and maintain engagement with patients,” said 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.”
