Data lacking on using mobile technologies to improve cardiovascular disease risk

With approximately 20 percent of U.S. adults using technology to track health data, the American Heart Association (AHA) sought to examine the current research related to mobile health in cardiovascular disease prevention.

Although the number of smartphone applications and wearable sensors has increased significantly in recent years, a group convened by the AHA found that research was lacking in terms of whether the applications or devices helped reduce the risk of heart disease and stroke.

Lead author Lora E. Burke, PhD, MPH, a professor of nursing and epidemiology at the University of Pittsburgh, and colleagues published their findings online in Circulation on Aug. 13.

The researchers searched the iTunes and Android app stores for the following terms: weight loss, physical activity/exercise, smoking, diabetes, hypertension/blood pressure, cholesterol and medication adherence. They found nearly 4,000 applications in iTunes and 250 in the Android store pertaining to weight loss. There were also 6,312 applications in iTunes related to physical activity and exercise compared with 120 in the Android store. The smallest number of applications had to due with lowering cholesterol.

Burke said the applications were diverse and included information delivery, education, motivation, self-monitoring, lifestyle, drug therapies, reminders or alerts and alternative therapies. Still, the efficacy of the applications was unknown.

The FDA does not regulate applications unless they have to do with the diagnosis or treatment of diseases.

“There’s not a strong evidence base for all these apps that they develop for phones,” Burke told Cardiovascular Business. “These companies develop these apps, but they’re not using the existing evidence or the existing theoretical basis for behavior change. What we really advocate is that there needs to be a shared responsibility. Researchers and developers need to work together.”

The researchers also conducted a literature search and included 69 studies from 2004 to 2014 that evaluated the use of mobile technologies to reduce cardiovascular risk behaviors. Ten trials targeted weight loss, 14 focused on increasing physical activity, 14 aimed to improve smoking cessation, 15 examined blood glucose management, 13 evaluated hypertension management and three targeted lipid management. The researchers included randomized controlled trials as well as systematic reviews and meta-analyses.

Burke said most of the trials for smoking, diabetes, hypertension and dyslipidemia were conducted outside the U.S. She added that the data was lacking for males, minorities and underserved populations.

Burke recommended that developers incorporate evidence-based data in their applications and that groups such as the AHA, along with researchers, work with developers to provide the most reliable information. She added that studies should examine the sustainability of the applications and how long people use them.

“The healthcare providers are not totally on board with this yet, partly because they don’t know [about the applications] and they don’t know what to recommend to their patients,” Burke said. “Part of that is because there’s such a lack of evidence on specific apps…We’re recommending that healthcare providers start looking at these [applications] and using the information that’s provided, but at the same time the healthcare providers say, ‘Is this information reliable? Can I count on the accuracy of this information?’ Everybody on the team needs to be working together more because there’s tremendous potential with the use of these.”