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Mobile health technology may improve secondary CVD prevention in older adults

April 06, 2021

3 min read

Disclosures:
Schorr reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Implementing effective mobile health technology will be key for secondary CVD prevention in older adults in the future, according to a scientific statement from the American Heart Association.

Published in Circulation: Cardiovascular Quality and Outcomes, the review document outlines how mobile health technology, such as text messaging, wearable technology and telehealth interventions, could improve health behaviors and medication adherence among older patients with CVD.

Doctor and Patient Practicing Telemedicine
Source: Adobe Stock

“Over the last decade, mobile health technology, especially the wearable technology and mobile health application markets, has grown substantially,” Erica N. Schorr, PhD, BSBA, RN, FAHA, associate professor in the Adult and Gerontological Health Cooperative at the University of Minnesota School of Nursing and chair of the statement writing committee, said in a press release. “There is, however, a common misperception that mobile health technology use is lower among older adults, when in fact most Americans aged 60 years and older own a cellphone and spend a significant amount of leisure time in front of a screen. This statement highlights the potential benefits that mobile health interventions can provide for monitoring, prompting, encouraging and educating older adults with cardiovascular disease.”

Improving physical activity, medication adherence

Physical inactivity is highest among individuals aged 65 years or older, especially among those with CVD. According to the statement, challenges associated with initiating and maintaining physical activity in this population may be associated with heterogeneity in perceived barriers and motivators based on older age categories and sex.

Schorr and colleagues wrote that targeted mobile health strategies have improved health behaviors in older adults with CVD.

For example, in the Text4Heart study, bidirectional text messaging plus a website-based intervention improved behavior such as smoking cessation, fruit and vegetable consumption, alcohol consumption and physical activity compared with a control group (adjusted OR = 2.55; 95{41490b4d0cf0dbc5ec3f65e11fff509c7d6ed2a53a838ebf7adf43f0908f07f3} CI, 1.12-5.84); however, the between group difference was no longer significant at 6 months (aOR = 1.93; 95{41490b4d0cf0dbc5ec3f65e11fff509c7d6ed2a53a838ebf7adf43f0908f07f3} CI, 0.83-4.53).

In the HEART study, three to five text messages per week plus a website-based intervention increased leisure-time physical activity (110 minutes per week) and walking (151 minutes per week) compared with usual care.

In two other trials that included wearables technology, researchers observed improvements in peak maximal oxygen consumption (VO2) and increased moderate to vigorous physical activity among patients with peripheral artery disease and after cardiac rehabilitation. In both studies, the intervention included self-monitoring and personalized coaching via telephone or mobile app, with feedback.

“Nonadherence to medical therapy is a significant barrier to CVD risk factor optimization,” the researchers wrote. “Using mHealth technology significantly improves medication adherence.”

The statement highlighted eight trials that examined the effect of mobile health interventions on medication adherence.

According to the statement, all trials that involved text message-based interventions increased self-reported medication adherence, and two of three app-based intervention studies improved adherence, suggesting that similarly styled intervention may improve noncompliance associated with forgetfulness or cognitive impairment.

Another trial that assessed standardized educational text messages for patients with decompensated congestive HF reduced hospital readmissions and improved event-free survival.

Ease of use, patient satisfaction

Among all intervention studies that documented outcomes related to patient experience included in this review, usability, satisfaction and acceptance of mobile health interventions were generally high.

The committee reported that studies with app-only interventions, the more than 60{41490b4d0cf0dbc5ec3f65e11fff509c7d6ed2a53a838ebf7adf43f0908f07f3} of participants reported ease of use and found the app helpful; however, many of the apps were intended for a specific subset of patients, of which there were too few, limiting the external validity.

A cross-sectional study of older patients with HF demonstrated that perceived ease of use and usefulness were associated with greater intention to use mobile health technology, according to the statement.

Moreover, interventions with text messaging tended to report high-user engagement.

“We know that controlling blood pressure, blood sugar and cholesterol are essential secondary prevention strategies and often require medication management,” Schorr said in the release. “Reducing sedentary time, increasing physical activity, maintaining an optimal body weight and adopting a healthy diet are other significant lifestyle strategies to optimize the health of individuals with cardiovascular disease. Wearable devices and mobile devices and applications play an important role because they can assist individuals in monitoring and tracking health behaviors and heart disease risk factors, referred to as the AHA’s Life’s Simple 7, to reduce their risk of a cardiac event and achieve ideal cardiovascular health.”