Wearables, smartphones and RPM can improve heart health — if patients can get the tech and use it

© American Heart Association

Wearable health devices, smartphone applications and remote patient monitoring all have potential to help patients reduce their risk of heart disease — if patients can get and use the technology.

Smartphones have become ubiquitous across racial, ethnic, socioeconomic, and geographic populations of the United States. But the health tech is not a panacea for heart disease, America’s leading cause of death, and it won’t overcome the social drivers of health (SDOH) that create barriers to care for some people, according to a new position paper from the American Heart Association (AHA).

“Achieving optimal cardiovascular health is challenging in the general population,” AHA Chief Science and Medical Officer Mariell Jessup, MD, FAHA, said in a statement. “However, certain communities, including people with lower socioeconomic status, individuals with disabilities, people from under-resourced racial and ethnic groups, and those living in rural or underserved or low-income communities, are disproportionately affected by adverse social drivers of health that contribute to gaps in cardiovascular health, risk factors and health outcomes.

Mariell Jessup, MD, FAHA
_{© American Heart Association}

“In this technology-driven and -dependent era, it is especially critical to develop and identify interventions to support populations most at risk for developing cardiovascular disease and to increase equitable access to resources that promote health including mobile health technologies,” Jessup said.

CVD and tech in context

Cardiovascular disease (CVD) is the leading cause of death in the United States and across the globe. It affects almost 130 million American adults, and more than 70% of the American adult population has overweight or obesity. More than half have Type 2 diabetes or prediabetes, and almost half have hypertension, which are all known risk factors for CVD, according to AHA.

To counteract those health issues, AHA focuses on Life’s Essential 8: better diet, more activity, quitting tobacco, healthy sleep, healthy weight, and control of cholesterol, blood sugar and blood pressure.

DDOH

Meanwhile, technology is part of American life. American physicians have heard about social drivers of health (SDOH). Economic stability, neighborhood and built environment, education, social and community context, and health care access and quality are the five identified by U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion.

Now physicians and other clinicians must examine SDOH for connections with digital drivers of health (DDOH), including the influence of wearables and telemedicine over health behaviors and outcomes. “DDOH are an important addition to the SDOH paradigm,” similar in influence to environmental factors and the health care system, the paper said. Additional DDOH include Internet access, device access, digital literacy and adequate computer infrastructure.

A base to build on with tech

The position paper, titled “The Role of Technology in Promoting Heart Healthy Behavior Change to Increase Equity in Optimal Cardiovascular Health,” aims at heart-healthy behaviors that can benefit from digital interventions.

AHA covered a range of studies that showed some positive results, with potential for more. For example, activity trackers, text messaging, email feedback and prompts, and mobile apps all have demonstrated success in increasing physical activity (PA) and reducing sedentary behavior for adolescents and adults.

For diet, “the physical and technology-based food environments continue to become increasingly interconnected and thus exert a great influence over diet-related behaviors and health outcomes,” at least for adults. Nutrition interventions that combine technology support, such as an app, with other support, such as nutrition education, are more effective and just tech, though additional study is needed, the paper said.

While tobacco use and smoking are declining overall, those with lower education still smoke and use tobacco generally at higher rates. DDOH can address disparities in tobacco use, and young people and adults have responded to various technology, such as participatory media production and gamified approaches to stop smoking, the AHA paper said.

For adequate rest, “interest in using wearables and apps to improve sleep is high across all sociodemographic groups,” the paper said. While more study is needed, AHA recommended avoiding smartphone-based sleep interventions due to smartphone dependence and the device being associated with worse sleep.

Community engagement

Regardless of patient condition, technology will not generate behavior change or have good effects if people don’t find it acceptable, appropriate and usable. Poor urban and rural communities have limited broadband access, and studies to assess the acceptability of technology have been limited, especially regarding trustworthiness, bias and privacy, the AHA paper said.

Technology makers should adhere to universal design principles, making devices and programs usable by all people without the need for additional adaptation. Yet tech also could be tailored to meet the needs of underserved and poor communities with human-centered design and community-based research, according to AHA. Technological advancements also develop quickly, making public-private partnerships important to deploy programs that lead to increased health equity.

“Digital health technology holds great promise for supporting people with tools to improve their cardiovascular health,” Jessup said in the AHA announcement. “The Association’s Center for Health Technology and Innovation initiative fosters the core tenets of this scientific statement: It is critical to identify and address barriers to access and develop health technologies that are scalable, effective and affordable, ensuring that people receive the best possible care regardless of their location, socioeconomic status or other involuntary factors.”