Centennial Collection: Health Applications of Digital Technologies

As the AHA enters its second century, health applications of digital technologies are a source of hope. Digital technologies are transforming how we communicate, learn, shop, and conduct so many aspects of our modern lives, and a digital transformation is also underway in healthcare. The numerous cardiovascular applications of digital technologies span the healthcare continuum from maintenance of well-being to the pre-acute, acute, post-acute, and chronic phases of the patient journey (Figure). Further extending our reach beyond traditional brick and mortar hospitals and health systems into the homes and communities of the people we serve, digital technologies can strengthen clinician-patient partnership and enable a more continuous, proactive, and equitable patient-centered care model.

Figure: Cardiovascular Health Applications of Digital Technologies Across the Healthcare Journey.

Selected technologies are highlighted, which may be used alone or in combination for a multitude of cardiovascular health applications such as those listed. Potential applications span the healthcare continuum from maintenance of well-being to pre-acute, acute, post-acute, and home care. Technologies may reach patients directly or via institutions. Modified with permission from the American Heart Association’s Center for Health Technology and Innovation. BP = blood pressure; SMS = short messaging service.

Today’s technologies for practicing medicine at a distance open up new possibilities compared with the 20^th century’s telephone, radio, television, and computer technologies. Not only can we offer telehealth via synchronous audio and visual communication technologies, the broad adoption of modern smartphone and wearable technologies in the 2000–2010s opened up a realm of intimate, personal power to learn about and engage with one’s health continuously and asynchronously. From the sensors embedded in modern digital technology, we have an unprecedented breadth and depth of health data, such as step counts, heart rate, heart rhythm, blood pressure, and sleep time, that can help guide clinical management in cardiometabolic risk factor modification, coronary disease, atrial fibrillation, heart failure, valve disease, and more. Over time, technologies have become progressively smaller and more mobile, and yet paired with greater computing power and potential for incorporation of artificial intelligence into digital health interventions. Furthermore, digital technologies have enormous potential to scale and advance health equity considering there are more mobile subscriptions than people on Earth according to the International Telecommunication Union (ITU), with >8.58 billion active mobile subscriptions worldwide in 2022.¹

This rapidly evolving intersection of computer science and technology with medical science is often labeled “digital health” or “mobile health”. The field is experiencing not only a rapid evolution in the technologies but in the evidence for their use. A PubMed search as of 1/15/24 for “digital health” or “mobile health” reveals 26,864 articles of which the vast majority (22,995) are from 2015 and beyond. There are 2,939 articles categorized as clinical trials, randomized controlled trials, systematic reviews, or meta-analyses. Adding the search term “cardiovascular” narrows this list to 307 publications, the bulk of which has been published since 2020. Within this digital health evidence base, one finds a multitude of favorable outcomes such as improved patient engagement/activation, positive behavior change (e.g., increased physical activity), better risk factor control (e.g., BP, LDL-C, A1c, smoking, weight), and reduction in readmissions after cardiac events.

A notable example in the diagnostic realm of digital health is the use of smartwatches and other devices for rhythm assessment, in particular for detection of atrial fibrillation, which has already made its way into clinical practice guideline recommendations. The 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation includes a IIa recommendation in favor of using consumer-accessible electrocardiographic devices for rhythm monitoring.² This is just the start of the impact that digital health is likely to have in shaping cardiovascular guidelines in the years to come.

Through the growing body of digital health science, we are better understanding the accuracy and effectiveness of digital health tools while addressing key challenges such as the digital divide, privacy risks, clinical workflow integration, and reimbursement models that will be essential to digital health avoiding unintended consequences and fulfilling its promise. Contributing to rigorous digital health research, the AHA’s Strategically Focused Research Network on Health Technologies and Innovation recently published 19 papers in JAHA spotlight issue examining opportunities in U.S. and globally to advance cardiovascular health.³ Topics ranged from artificial intelligence guided echocardiography to detect rheumatic heart disease, to smartphone based cognitive assessment and stroke diagnosis, to digital health interventions for hypertension control, heart failure management, and cardiac rehabilitation.

But will the emerging digital health solutions scale to have an impact that is sustained and large enough to impact major cardiovascular events including cardiovascular mortality? That remains an unanswered but important question as cardiovascular disease continues as the leading cause of death in the U.S. and globally, accounting for 19.9 million global deaths in 2021.⁴ Due to innovation over the decades, we know a lot about what works to mitigate cardiovascular risk and improve survival. Similar advances in understanding how we deliver what we know to everyone, everywhere, powered by digital technologies, would be transformative.

Digital health may be capable of delivering transformative impact because of its ‘outside the box’ frame of reference. This leads to a natural questioning of conventional thinking, digging deep to understand problems, and then inventing innovative solutions. A scientific framework for this approach is human centered design, which is a widely used methodology in engineering and social sciences but not in healthcare. In 2020, an iDesign framework was introduced to apply human centered design to development of equitable digital health interventions and used in creating an atrial fibrillation intervention.⁵ The iDesign process involves asking how might we questions to facilitate collaborative creativity between patients, health partners, clinicians, researchers, designers, and engineers to co-ideate and co-create innovative solutions. The arising solutions can be piloted, iterated upon, and then tested in clinical trials which themselves can use digital platforms.

Therefore, as the AHA and its partners look into the next century, health applications of digital technologies are poised to play a leading role in building a world of longer, healthier lives. Throughout the patient journey, the idea is to meet people where they are by embracing the technologies in our hands and on our wrists that are increasingly integrated into our daily lives. Technology will augment but not replace us, and the master clinician of tomorrow will learn to balance technology with human touch. Together, we can harness our collaborative creativity across academia, industry, communities, non-profit organizations, patient advocacy groups, and government to build the digitally powered future of cardiovascular care, and advance health and hope for everyone, everywhere.