Table 1.
Selected studies on mHealth in CVD
| Author, name of study/technology (if applicable), year | Patient population, location | mHealth technology used | Key findings |
|---|---|---|---|
| Cardiac rehabilitation | |||
| Worringham, CardioMobile, 201134 | 6 patients, mean age 53, Australia | Smartphone application with single‐lead ECG and GPS‐tracking technology | This feasibility study offered an mHealth‐based CR program to a small group of patients who were unable to participate in traditional CR (following hospitalization for ACS or PCI). Participants showed improvement in 6‐minute‐walk test, reduced levels of depression, and improved QoL. |
| Antypas, 201439 | 69 patients, mean age 59, Norway | Automated text messages to mobile phone, educational website | Intervention group received “tailored” mHealth approach involving automated text messages to mobile phone, questionnaires, and access to educational website that provided feedback based on patient responses. Compared to control group (traditional CR without text reminders), the mHealth group reported higher levels of physical activity 3 months after discharge from CR; there were no differences in self‐efficacy, social support, anxiety, or depression. |
| Forman, Heart Coach, 201421 | 26 patients, mean age 59, USA | Mobile phone application | Mobile application prompted patients to complete a daily “task list” (including physical activity, medication reminders), provided educational material, tracked patient activity, and allowed CR providers to monitor patient progress. The app had favorable impact on adherence to CR, and older adults had no difficulty using the technology. |
| Varnfield, Care Assessment Platform, 201420 | 120 patients, mean age 56, Australia | Mobile phone application with health diary, activity monitor, BP monitor, and scale | Patients randomized to smartphone‐based home CR program had significantly higher uptake, adherence, and completion than traditional CR. Both mHealth‐augmented and traditional groups showed similar improvements in 6‐minute walk assessment. |
| Maddison, HEART, 201538 | 171 patients, mean age 60, New Zealand | Automated text messages to mobile phone, educational website | mHealth application used automated text messages multiple times per week to encourage home exercise and leisure‐time activity. Patients with IHD were randomized to mHealth‐augmented home CR vs usual community‐based CR; while there was no difference in peak oxygen uptake between groups, the mHealth group reported more leisure‐time physical activity and walking than the control group. |
| Prescott, EU‐CaRE, 201637 | 1958 patients, age ≥65, Europe (Denmark, Netherlands, Italy, Germany) | Smartphone, HR monitor | Study ongoing; will enroll older patients who have declined traditional CR into an mHealth‐augmented home‐based CR and assess functional status and CR uptake at 12 months. |
| Widmer, 201740 | 80 patients, mean age 63, USA | Online and smartphone‐based application | Patients randomized to mHealth‐augmented CR group (which provided educational materials and allowed for reporting of exercise and dietary habits) had significant improvements in weight loss and QoL; a nonsignificant reduction in CV‐related hospitalizations and ED visits (8.1% vs 26.6%, P = .054) was also seen. |
| Dodson, RESILIENT, 201936 | 400 patients, age ≥70, USA | Tablet, eFitBit pedometer | Study ongoing; will randomize older patients to mHealth‐augmented CR and assess functional outcomes and health status at 3 months. |
| Heart failure | |||
| Scherr, MOBITEL, 200916 | 120 patients, mean age 66, Austria | Mobile phone application, internet program | Patients randomized to mHealth group had routine physiologic metrics (BP, weight) transferred to monitoring center for evaluation by physicians. In the per‐protocol analysis, patients in the mHealth group had fewer hospitalizations than usual care group (this difference was not seen in the intention‐to‐treat analysis). |
| Seto, 201227 | 100 patients, mean age 54, Canada | Mobile phone application with Bluetooth connection to BP monitor, scale, ECG leads | Patients randomized to mHealth telemonitoring group (encouraged to record daily physiologic metrics through home vital sign measurements) reported improved QoL and self‐care scores; adherence was high in older patients. No difference between groups in mortality, ED visits, or hospitalization rates. |
| Layton, Wellframe, 201413 | 16 patients, mean age 55, USA | Mobile phone application | Wellframe application provided medication reminders, educational materials (including information regarding smoking cessation), and tracked patient activity using phone pedometer; patients who were medically stable were more likely to use the application. |
| Vuorinen, Heart at Home, 201414 | 94 patients with HFrEF, mean age 57, Finland | Mobile phone application | mHealth application allowed patients to self‐report physiologic metrics (weight, BP, HR) and answer questions regarding symptoms. There was no difference in number of HF‐related hospital days between usual care and mHealth group; mHealth group had more unplanned visits to nurses. |
| Comín‐Colet, iCor, 201515 | 178 patients, mean age 77, Spain | Tablet with Bluetooth connection to BP monitor, scale; video conferencing | Patients randomized to mHealth group (with daily recording of symptoms, measurements of weight and BP, and scheduled videoconferencing with specialized HF program nurses) had reduced nonfatal HF events, HF readmissions, and CV readmissions. There was a 45% relative reduction in cost compared to usual care group. |
| Piette, CarePartner, 201528 | 331 patients, mean age 68, USA | Interactive automated voice response calls, automated e‐mails | Patients were randomized to mHealth only vs mHealth with CarePartner groups. All patients received regular automated calls where they could self‐report HF symptoms, and reports would be sent to a clinician (all groups) as well as patient's self‐identified CarePartner (intervention group). Patients with a CarePartner reported increased medication adherence, and patients with baseline depressive symptoms were more likely to report positive assessments about their health. |
| Arrhythmia monitoring | |||
| Skobel, HeartCycle, 201433 | 50 patients, mean age 69, Germany | Shirt with ECG sensors | This validation study showed that a wearable ECG technology (shirt with ECG leads that measured HR, RR, and allowed for real‐time data reporting to physicians), had acceptable comparability for measurement of HR when compared to standard conventional cardiac exercise testing recordings. |
| Guo, mAFA, 201730 | 209 patients, mean age 67, China | Mobile phone application | mHealth application provided clinical decision support tools and educational materials for patients. Patients who were randomized to mHealth intervention reported increased AF‐related knowledge, drug adherence, and anticoagulant satisfaction. |
| Mant, 201832 | 120 000 patients age ≥65, England | Handheld single‐lead ECG device | This planned trial will randomize clinics across England to home AF screening vs no home screening, and follow outcomes (stroke, MI) over 5 years. |
| Steinhubl, mSTOPS, 201831 | 2659 patients, mean age 72, USA | Portable ECG (iRhythm Zio) self‐applied patch | AF was diagnosed more frequently in the actively monitored group; anticoagulation was also prescribed more frequently in the actively monitored group. There was no significant difference in the number of AF‐related hospitalizations between groups. |
| Soni, SMART‐India, 201923 | 2100 patients, mean age 61, India | Kardia AliveCor single‐lead ECG device | Population‐based AF screening study in rural India (Anand district, Gujarat) identified 1.6% of population with AF (three times higher than previously reported), with significantly higher rates of AF in older adults |
| Hypertension | |||
| Kim, 201618 | 95 patients, mean age 58, USA | Mobile phone, BP monitor | Patients randomized to mHealth group (wireless self‐monitoring of health behaviors, medication adherence, and BP monitoring) did not show a significant reduction in systolic BP. |
| Wijsman, iVitality, 201611 | 151 patients, mean age 57, Netherlands | Mobile phone application, website, BP monitor | The iVitality application offered mobile reminders for patients to check and record their home BP; based on readings, patients were referred to an in‐person visit with their physician. Referred participants had a significant reduction in systolic blood pressure. |
| Morawski, MediSAFE‐BP, 201817 | 412 patients, mean age 52, USA | Smartphone application | mHealth application included medication reminder alerts, adherence reports, and optional peer support. Patients randomized to mHealth group self‐reported higher medication adherence, though there was no difference in systolic BP compared to controls. |
| Medication adherence; self‐management | |||
| Brath, mAMS, 201324 | 53 patients, mean age 69, Vienna | Mobile phone application, e‐blisters | Through an mHealth application, patients could record when they were taking medications, and e‐blisters (packages that send an electronic signal once opened) recorded medication compliance. Patients randomized to mHealth group had increased adherence to oral diabetes medication (metformin); otherwise, no significant improvement in adherence was found. |
| Anglada‐Martínez, 201635 | 48 patients, mean age 60, Spain | Mobile phone application, telemedicine | Older adults commonly refused an mHealth/telemedicine intervention (mobile application with educational materials aimed to improve adherence and patients' knowledge of their medication). |
| Richard, HATICE, 201626 | 2600 patients, mean age ≥65, Netherlands, Finland, France | Interactive internet platform | Final results not yet reported. Intervention group provided with interactive internet platform providing educational materials and communication with a coach to facilitate self‐management of CV risk factors with follow‐up of 18 months. Primary outcome is composite of change in systolic BP, LDL, and BMI. |
Abbreviations: ACS, acute coronary syndrome; ADL, activities of daily living; AF, atrial fibrillation; BMI, body mass index; BP, blood pressure; CR, cardiac rehabilitation; CV, cardiovascular disease; ECG, electrocardiogram; ED, emergency department; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; HR, heart rate; IHD, ischemic heart disease; LDL, low density lipoprotein; mHealth, mobile health; MI, myocardial infarction; PCI, percutaneous coronary intervention; QoL, quality of life; RR, respiratory rate.