Mobile health or mHealth, defined as “the delivery of healthcare services via mobile communication devices,” promises to improve healthcare delivery. Multiple factors are driving this trend, including rising healthcare spending, the aging population, and the need to promote healthy behaviors and create innovative solutions to inefficiencies in healthcare. Increasing adoption of electronic health records and passage of the Affordable Care Act are key drivers. In addition, the concept of precision medicine is emerging. This supports tailored prevention and treatment strategies based on an individual’s genotypic and phenotypic data, including data collected via mobile devices.
Patients – including virtually all demographics and those with chronic conditions such as cardiovascular disease and diabetes – are increasingly using online sources of health information and engaging in their own care and research. Mobile phone technology has been rapidly adopted, with the proportion of Americans who owned a smartphone increasing from 35 percent to 64 percent between 2011 and 2014, according to the Pew Research Center.
Cardiovascular disease is the leading cause of death in the United States and worldwide, making this an area mHealth could provide advances from the perspectives of patients, providers, payers, and policymakers. Multiple modifiable lifestyle behaviors are related to cardiovascular risk, and many mHealth interventions promise to promote successful and sustained changes in behavior.
The wide range of mHealth tools may be patient facing, physician facing, or related to patient–physician communication. Sensors within smartphones, such as accelerometers and cameras, can be leveraged for diagnostic measurements. Wearable devices – including watches, wristbands, cutaneous patches, and clothing – also contain physiological sensors that can store and transmit data. These may be paired with a smartphone, allowing passive or active collection, analysis, and transmission of sensor data.
For cardiovascular care, relevant sensor technologies cover electrocardiography (ECG), heart rate, blood pressure, motion and exercise, and drug adherence. By collecting heart rate data, new activity trackers can offer insights into the intensity of activity, going beyond just measuring steps and distance. Mobile ECG platforms have achieved clearance from the US Food and Drug Administration for detecting atrial fibrillation. Newer wearables may offer continuous blood glucose and blood pressure monitoring. Embedding sensors in clothing could potentially enable even more comprehensive physiological monitoring. Translating such streams of continuous data into actionable information for use at decision points may improve the ability of patients and their providers to achieve health goals and manage chronic conditions.
Several challenges must be overcome to increase consumer adoption of mHealth, however. Studies suggest that after three months, only 80 percent of consumers continue to use wearables regularly, and after 18 months, this figure falls to less than one-half of consumers. Socioeconomic and demographic disparities exist in the use of mHealth applications, as with other technologies. Finally, the privacy of patient data remains a central concern.
More evidence of successful mHealth interventions is needed. To date, only few examples have undergone rigorous study, and conclusions about their effectiveness have been mixed. For example, the Tobacco, Exercise, and Diet Messages (TEXT ME project) randomized clinical trial demonstrated the simultaneous benefit of mobile phone text messaging for multiple important cardiovascular parameters, including low‐density lipoprotein cholesterol, blood pressure, body mass index, exercise frequency, and smoking status. In contrast, a randomized clinical trial showed no benefit of using smartphone‐enabled biosensors regarding healthcare costs or use among patients with hypertension, diabetes, or cardiac arrhythmias.
A common framework is needed to measure, validate, and ensure the success of mHealth solutions for the prevention and management of cardiovascular disease. One example is the American Heart Association “Life’s Simple 7” program, which focuses on elements known to impact cardiovascular risk: eating better, getting active, stopping smoking, controlling cholesterol, managing blood pressure, losing weight, and reducing blood sugar.
The evolution of mHealth is still at an early stage, but this is a burgeoning field that represents the promising convergence of healthcare and mobile technologies. To have a substantial impact on patients’ lives, developers must work closely with patients, providers, and payers to understand the pressing problems in healthcare early in the design process. These collaborations will enable developers to better integrate their products with care delivery systems and providers on which patients continue to rely. This will drive mHealth towards the large‐scale adoption needed to achieve a meaningful impact on population health.
Zubin Eapen, M.D., MHS is an Associate Professor of Medicine at Duke University, Medical Director of the Duke Heart Failure Same Day Access Clinic, Department of Medicine Director of Education IT Innovations, and Department of Medicine Director of Clinical Improvement. He is also a member of Duke Clinical Research Institute Health Services Research Group and Assistant Faculty Director for the Center for Educational Excellence. Dr. Eapen obtained his medical degree and completed his residency and Cardiology Fellowship at Duke University. He serves as Electronic Media Editor for JACC: Heart Failure, Editor for the 14th edition of Hurst’s the Heart, and Chief Medical Officer for Pattern Health Technologies. His particular interests include improving care coordination, disease management, and quality of care using digital health tools.