Mobile Health Devices as Tools for Worldwide Cardiovascular Risk Reduction and Disease Management

Abstract

We examined evidence on whether mobile health (mHealth) tools, including Interactive Voice Response (IVR) calls, short message service (SMS) or text messaging, and smartphones, can improve lifestyle behaviors and management related to cardiovascular diseases throughout the world. We conducted a state-of-the-art review and literature synthesis of peer-reviewed and grey literature published since 2004. The review prioritized randomized trials and studies focused on cardiovascular diseases and risk factors, but included other reports when they represented the best available evidence. The search emphasized reports on the potential benefits of mHealth interventions implemented in low- and middle-income countries (LMICs). IVR and SMS interventions can improve cardiovascular preventive care in developed countries by addressing risk factors including weight, smoking, and physical activity. IVR and SMS-based interventions for cardiovascular disease management also have shown benefits with respect to hypertension management, hospital readmissions, and diabetic glycemic control. Multi-modal interventions including web-based communication with clinicians and mHealth-enabled clinical monitoring with feedback also have shown benefits. The evidence regarding the potential benefits of interventions using smartphones and social media is still developing. Studies of mHealth interventions have been conducted in more than 30 LMICs, and evidence to date suggests that programs are feasible and may improve medication adherence and disease outcomes. Emerging evidence suggests that mHealth interventions may improve cardiovascular-related lifestyle behaviors and disease management. Next generation mHealth programs developed worldwide should be based on evidence-based behavioral theories and incorporate advances in artificial intelligence for adapting systems automatically to patients’ unique and changing needs.

Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country

“…6 Mobile health (m-health) tools are part of a comprehensive plan to improve chronic illness care in LMICs. [7][8][9] Trials indicate that interactive voice response (IVR)-based interventions effectively address diabetes risk factors such as poor diet and sedentary behavior, [10][11][12] and IVR-supported nurse follow-up can improve glycemic control and self-care after diabetes is diagnosed. [12][13][14] In Honduras, weekly IVR self-management support calls were associated with improved diabetes self-management and A1c levels, 15 and in Honduras and Mexico, a similar IVR-based intervention resulted in better blood pressure control and improved self-care among hypertensive patients.…”

Development and Evaluation of a Mobile Decision Support System for Hypertension Management in the Primary Care Setting in Brazil: Mixed-Methods Field Study on Usability, Feasibility, and Utility (Preprint)

“…Problems in telecommunication structures that limit the dissemination of mHealth services in LMIC are similar to those seen in LMIC medical care, like services limited in scope, unevenly distributed across geographic areas and of variable quality when available [28]. This issue was mitigated because the TeleHAS was designed to function without Internet connection, but it is still required for data transmission and system update.…”

Mobile health in cardiology: a review of currently available medical apps and equipment for remote monitoring

“…A recent review by Piette et al [72]. identified studies that involved mHealth in weight management, physical activity, or smoking cessation.…”

“…identified studies that involved mHealth in weight management, physical activity, or smoking cessation. They found that there were numerous trials positively correlating an mHealth intervention and lower BP, lower BMI, higher physical activity, and more smoking cessation [72].…”