Smart Devices Resulting in Big Effect: Can Apps Cure Heart Disease?

How Hybrid Care May Revolutionize Heart Disease Treatment

Irina Eckardt; Philip Düsing; Georg Nickenig; Felix Jansen

Disclosures

Eur Heart J. 2022;43(21):2003-2004. 

In our current world, smartphones are everywhere. Advancements in mobile technology have an impact on almost all aspects of our daily lives. As a result, people spend on average 4.2 h a day on their mobile device worldwide.

Not surprisingly, the adoption of smartphones has increased worldwide, especially among seniors. In the USA, 85% of adults have a smartphone and even in an elderly population (65–75 years), three-out-of-four are owners of a smartphone. These numbers are very similar to major European countries such as Germany and the UK.[1,2]

In combination with wearables, such as smart watches, activity trackers, or blood-pressure monitors, smartphone health apps have the potential to fundamentally change patient care for heart diseases. The increasing use of smartphones, especially in elderly people, paves the way for the development of smartphones-based disease monitoring in the future. In contrast to this exciting technological advancement, the burden of cardiovascular disease is still a major challenge for health systems worldwide, with coronary artery disease (CAD) remaining the leading cause of death. The causes are multifactorial, but insufficient behavioural changes, inadequate medication adherence and in summary, a poor risk factor management in CAD patients plays a major role (Figure 1).

Figure 1.

Technical capabilities of the smartphone (apps and device connectivity) and their wide spread in the elderly population will fundamentally change patient care for heart diseases. Traditional in-person care will be complemented by digital care in the near future. Digital care includes home monitoring, video consultations with physicians, artificial intelligence-based alerts, and patient-centred, individualized therapies. Combining in-person and digital care, a holistic hybrid care model integrating patients, physicians, devices and technological algorithms will lead to a paradigm change in heart-disease treatment.

First, in the busy environment of their day-to-day clinical practice, medical doctors often do not have enough time to emphasize the importance of lifestyle changes to their patients providing practical patient-adapted recommendations. Secondly, patients find it difficult to implement the required changes into their everyday life. This problem is further aggravated by safety concerns and incorrect performance of physical exercises. Furthermore, it has been shown that long distances to cardiac rehabilitation centres discourage patients from attending.

In summary, people are using their smartphone on average >200 min/day, but the majority of CAD patients do not follow simple lifestyle recommendations to significantly lower the probability of a future heart attack. Imagine if CAD patients would spend only 10% of their daily smartphone time on (secondary) prevention, it could most likely significantly reduce the risk of future cardiac events. Do we have any evidence of this?

Two recently published studies have tested promising health apps (Corrie and Vantis) in the field of secondary prevention in cardiovascular disease.[3,4] These apps were developed based on the American and European secondary prevention guidelines of the corresponding societies. In contrast to previous apps, Corrie and Vantis offer patients an all-in-one approach for secondary prevention in patients with CAD or after myocardial infarction.

Initial studies revealed that regular usage of the smartphone-based intervention via Vantis app leads to more physical activity, healthier dietary habits, and an increased knowledge of cardiovascular risk factors.[4] The usage of the Corrie app was associated with higher activation of patient for healthcare self-management and a lower risk of all-cause unplanned 30-day readmissions in patients after acute myocardial infarction.[3] However, further studies are needed to explore whether cardiac health apps can reduce hard endpoints, such as acute myocardial infarction or (cardiac) death.

The increasing usage of health apps for cardiac patients could be part of a broader paradigm change in heart-disease treatment. The future of treatment, in particular of chronic diseases such as CAD, will no longer take place exclusively in the doctor's office, but will rest on three major pillars: a combination of self-management (app-guided using smart devices), telemedicine (asynchronous or via a direct conversation), and in-person (practice/hospital) care. Real-world data collection in the private environment of the patient will play an increasingly important role and be valuable for many research questions. Thinking one-step further, real-world data on large scale could enable us to offer more personalized treatment options with better outcomes in the future.

To finally answer our initial question: can apps cure heart disease? Unfortunately, we are not that far yet, but they can motivate patients to follow guideline suggestions with a beneficial effect on risk factor management and rehospitalization. Furthermore, health apps that are synchronized with wearables will be indispensable for a patient-centred hybrid cardiac-care model, including home monitoring, remote monitoring, telemedicine, and in-person contact.

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