Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology

Abstract

Objective There is rising interest in digital health in preventive cardiology, particularly for blood pressure (BP) management. In a digital health study of early BP assessment following acute myocardial infarction (AMI), we sought to examine feasibility and the (1) proportion of post-AMI patients with controlled BP and hypotension, and (2) association between prior cardiovascular disease (CVD) and BP post-AMI. Methods In this substudy of the parent Myocardial infarction, COmbined-device, Recovery Enhancement (MiCORE) study, type 1 AMI patients were enrolled between October 2017 and April 2019. Participants self-monitored their BP through 30 days after hospital discharge using an FDA-approved wireless BP monitor connected with a smartphone application. Linear mixed-effects models assessed the association between prior CVD and BP trajectory post-discharge, adjusting for antihypertensive medications and a propensity score inclusive of CVD risk factors. Results Sixty-eight AMI patients (mean age 58±10 years, 75% male, 68% white race, 68% history of hypertension, 24% prior CVD) provided 2,638 measurements over 30 days. The percentage of BP control <130/80 mmHg was 59.6% (95% CI: 54.3 - 64.9%) and <140/90 mmHg was 83.7% (95% CI: 80.3-87.2%). The percentage of systolic BP <90 mmHg was 1.1% (95% CI: 0.17-2.0%) and the percentage of diastolic BP <60 mmHg was 3.9% (95% CI: 2.6-5.2%). Prior CVD was associated with 12.2 mmHg higher mean daily systolic BP during admission (95% CI: 3.5-20.9 mmHg), which persisted over follow-up. There was no association between prior CVD and diastolic BP. Conclusion The digital health program was feasible and ∼40% of post-AMI patients who engaged in it had uncontrolled BP according to recent guideline cutpoints, while hypotension occurred rarely. The gap in BP control was especially large in patients in whom AMI represented recurrent CVD. These data suggest an opportunity for more aggressive secondary prevention early after MI as care models integrate digital health.

The emerging role of digital health in the management of asthma

“…Beyond diabetes, DHT and DT are increasingly being integrated into clinical practice for many other chronic conditions, such as cardiovascular disease, 90–93 chronic kidney disease, 94 ophthalmology, 95,96 and mental health. 97,98 DHT is also able to improve healthcare in developing nations.…”

“…Randomized trials and real-world studies have shown that smart insulin pens are associated with improvements in glycemic control, adherence, life expectancy, and increased confidence in the ability to self-manage among patients with T1DM and T2DM. [86][87][88][89] Beyond diabetes, DHT and DT are increasingly being integrated into clinical practice for many other chronic conditions, such as cardiovascular disease, [90][91][92][93] chronic kidney disease, 94 ophthalmology, 95,96 and mental health. 97,98 DHT is also able to improve healthcare in developing nations.…”

The role of digital health in the cardiovascular learning healthcare system

“…Preventive cardiology continues to be bolstered by the influx of integrative digital health technologies aimed to improve medical monitoring and risk management. Feasibility studies on blood pressure management have shown improvements in patient engagement with BP monitoring in those with acute myocardial infarctions (AMI), as well as those with previous cardiovascular disease and hypertension management post-AMI ( 50 ). Validation studies are crucial in not only evaluating the integration of digital health technologies into standard care, but also in assessing the intrinsic validity of measurement tools such as blood pressure and heart rate monitoring devices, where high correlation between manual measurements and wearables shows promising potential particularly in ambulatory medical management ( 51 ).…”