Table 2.

Selected studies for mobile health technologies in secondary prevention of cardiovascular disease

Targeted disease	Study name/ authors	Study design	Sample size (RCT no. enrolled, or sys. review studies included)	Intervention	Outcomes	Findings
Atherosclerotic disease	Varnfield et al. [32]	RCT	120 enrolled	Smartphone-based home CR vs.traditional center-based CR	Primary: 6MWT Secondary: CR uptake and completion	mHealth CR and traditional CR both showed improved 6MWT; mHealth improved CR uptake and completion compared with traditional
	HEARTSTRONG [34]	RCT	1509 enrolled	mHealth-based medication reminders, social support, and lottery incentives vs. usual care in post-Acute Myocardial Infarction patients	Primary: time to first vascular rehospitalization or death Secondary: time to first all-cause rehospitalization, total number of repeated hospitalizations, medication adherence, and total medical costs	No significant improvement in vascular readmissions or medication adherence
	HONOR [35]	RCT	200 enrolled	Home-based exercise intervention with wearable activity monitor and telephone coaching compared with usual care for patients with peripheral artery disease	Primary: 6MWT Secondary: pain, functional capacity, social satisfaction scores	Home-based mHealth exercise intervention failed to demonstrate improvement in 6MWT or other secondary outcomes
	Wongvibulsin et al. [33]	Systematic review	31 studies	mHealth-based CR strategies	Exercise capacity, rehospitalizations, lipid profile, weight, nutrition, program, adherence, satisfaction, psychosocial wellbeing	mHealth-based CR as effective as traditional CR in improving outcomes, whether as adjunct or alternative, with potential to increase access and participation in CR
	MiCORE (ongoing) [36]	Non-RCT with propensity matched control	200 enrolled	Corrie Health App-based home CR with integrated smart BP monitor and apple watch vs. traditional CR	Primary: readmissions within 30 days Secondary: death, ED visits, and hospital observations within 30 days of discharge, med adherence, attendance at followup, program engagement, satisfaction, cost-effectiveness	Study ongoing
Heart failure	CardioMEMS [37]	RCT	550 enrolled	Daily wireless PAP monitoring and standard of care vs. standard of care alone in NYHA symptom class III heart failure (HF) patients with implanted wireless hemodynamic monitor	Primary: HF-related hospitalizations at 6 months Secondary: days alive outside hospital at 6 months, change in baseline PAP, functional capacity score	Wireless monitoring was associated with significant reduction in hospitalizations as well as mean PAP, more days alive outside hospital, and better quality of life compared with control
	Cajita et al. [38]	Systematic review	10 studies	mHealth-based management strategies in HF	Mortality, hospitalizations, length of stay, functional capacity, quality of life, self-care	Inconsistent results failed to demonstrate significant benefit
	Allida et al. [39]	Systematic review (Cochrane)	5 studies	mHealth education interventions in HF	HF knowledge, hospitalization rates, quality of life, self-efficacy, and self-care	Very low quality of evidence with inconsistent results across all outcomes
Arrhythmia	Apple Heart Study [42]	Large-scale siteless study	Up to 500,000	Detection of AF in patients using Apple Watch Series 4 or later	Primary: detection of AF Secondary: self-reporting to clinicians, concordant AF with app notification	Achieved primary outcome with FDA approval of the Apple Watch for AF detection
	Heartline Study (ongoing, clinical trial NCT04276441)	Observational prospective cohort	Actively enrolling as of 2020	Apple Watch-based AF detection	Primary: early detection of AF, days on anticoagulation Secondary: time to major adverse cardiac event, AMI, stroke, and thromboembolic events	Study ongoing

6MWT, 6-min walk test; AF, atrial fibrillation; AMI, acute myocardial infarction; CR, cardiac rehab; ED, emergency department; FDA, Food and Drug Administration; HF, heart failure; mHealth, mobile health technologies; NYHA, New York Heart Association; PAP, pulmonary artery pressure; RCT, randomized controlled trial.