Digital interventions help corral heart disease in meta-analysis

Digital health tools may be the ticket for preventing cardiovascular disease or improving outcomes in at-risk patients. A meta-analysis gave digital health interventions an overall thumbs up for primary and secondary prevention.

R. Jay Widmer, MD, PhD, and colleagues at the Mayo Clinic in Rochester, Minn., reviewed randomized, controlled clinical trials and cohort studies that focused in preventing cardiovascular disease outcomes or modifying risk factors. They defined digital health interventions as tools that used telemedicine, web-based approaches, email, mobile phones, mobile apps, text messaging and monitoring sensors.

After searching PubMed, MEDLINE, Web of Science, Ovid and other resources between 1990 and 2014, they identified 51 studies. Nine studies provided cardiovascular disease outcomes data; 39 focused on primary prevention and 13 mostly on secondary prevention.

In their meta-analysis, they found these interventions significantly reduced the risk of adverse cardiovascular disease outcomes. Of the six studies with Framingham scores, the interventions provided 1.24 percent reduction in the 10-year risk. They found that compared with usual care, interventions were associated with weight reductions of 2.77 pounds and decreases in body mass index.

Overall, the secondary prevention and heart failure groups saw benefits for cardiovascular morbidity and all-cause mortality. Widmer et al found improvements in risk factors such as weight, body mass index, blood pressure and low-density lipoprotein cholesterol for primary prevention groups but they did not detect improvements in cardiovascular outcomes.  

Web-based interventions, telemedicine and text messaging but not email appeared to be effective for weight loss interventions. Web-based interventions also were associated with reductions in systolic blood pressure and data monitoring approaches with reductions in diastolic blood pressure.  

“However, the observed level of heterogeneity precludes definitive conclusions regarding specific [digital health interventions] that should be clinically applied to [cardiovascular disease] prevention at the present time,” they wrote.

They concluded that the interventions showed a net benefit on overall outcomes, especially in high-risk populations, and may help improve risk factors. But they added that more research needs to be done to identify which approach was most effective and why.

The meta-analysis was published in the April issue of the Mayo Clinic Proceedings.