Pub Date: Thursday, Apr 01, 2021
Author: Ruth Masterson Creber, PhD, MSc, RN, FAHA
Affiliation: Assistant Professor, Department of Population Health Sciences, Division of Health Informatics, Weill Cornell Medicine
Adults over 60 are at highest risk of cardiovascular disease (CVD),1 and are also the fastest growing global demographic.2 Effective secondary prevention of CVD is needed for older adults who bear the majority of disease burden.1 Concurrent with the rise of CVD is the rapid growth in use of mobile health (mHealth) technologies among older adults.3 Over 30% of adults report using a smartphone app to manage an aspect of their health.4 Smartphone ownership varies among older adults, with about 42% ages 65 and older owning smartphones, though the majority (59%) are under 70.3 With increased availability of mHealth tools, the question is whether mHealth tools can be effective among older adults for secondary prevention of CVD.
In this Scientific Statement, “Harnessing Mobile Health (mHealth) Technology for Secondary Cardiovascular Disease Prevention in Older Adults,” Schorr and colleagues conducted a systematic literature review of 26 studies that evaluated secondary prevention of CVD (heart failure, hypertension, atrial fibrillation, and peripheral arterial disease) among adults over 60 years using mHealth technologies.5 Three forms of secondary CVD prevention were evaluated: behavior change (exercise, weight management, diet), medication adherence, and perceived ease of use and patient satisfaction. Results of the study indicate that features of mHealth apps that hold the most promise include continuous monitoring, real-time feedback on physical activity, diet, and medication adherence for self-management. Specifically, including a text message component to the intervention improved health behaviors and medication adherence.5
A limitation of the available studies in this systematic review includes heterogeneity of the outcomes measured in the included studies. In addition, a number of different technologies were evaluated, including mHealth apps, implantable devices, and remote monitoring. As such, the unique contributions of specific technologies and features within those technologies could not be independently evaluated for independent contributions to the prevention of CVD.
One of the challenges that mHealth tools need to directly address is usability of apps for older adults.6 Most apps do not account for limitations in visual acuity, finger dexterity, hearing loss and technology experience. Typically, older adult end users are often not involved in the development and the heuristic evaluations of apps. As such, apps should be designed for older adults using inclusive design principles7 to ensure that they are accessible and able to be used by people with a wide range of abilities. Other challenges to widespread use of mHealth apps among older adults include affordability, usability, privacy, and security.5 Another challenge with mHealth apps is sustained engagement over time--many users start using an app and then stop before seeing the full benefit.
Most apps include multiple features, making it challenging to tease out which features and functions of apps benefit the reduction of specific CVD risk factors. An area for future research includes conducting rigorous longitudinal evaluations of specific apps and their features to differentiate which features impact clinical outcomes. Knowledge gaps exist both for app developers and healthcare professionals who can recommend these apps to their patients.
This Scientific Statement provides important information about opportunities and challenges for using mHealth apps to support secondary CVD prevention among older adults. It will serve as a reference for healthcare professionals who want to use specific mHealth tools to support secondary CVD prevention, and for researchers who want to evaluate how apps can be used to reduce CVD risk burden, and identify beneficial features of technologies. As concluded in this Statement, mHealth tools for older adults hold potential for helping to yield major improvements for the secondary prevention of CVD.
Schorr EN, Gepner AD, Dolansky MA, Forman DE, Park LG, Petersen KS, Still CH, Wang TY, Wenger NK; on behalf of the American Heart Association Cardiovascular Disease in Older Populations Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing; Council on Arteriosclerosis, Thrombosis and Vascular Biology; and Council on Lifestyle and Cardiometabolic Health. Harnessing mobile health technology for secondary cardiovascular disease prevention in older adults: a scientific statement from the American Heart Association. Circ Cardiovasc Qual Outcomes. 2021;14:e000103. doi: 10.1161/HCQ.0000000000000103
- Virani SS, Alonso A, Benjamin EJ, et al. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation. 2020;141(9):e139-e596.
- Nations U. World Population Ageing 2019 Highlights. World population ageing. Published online 2019.
- Anderson M, Perrin A. Tech adoption climbs among older adults. Pew research center. 2017;2017:1-22.
- Fox S, Duggan M. Main Findings. Pew Research Center Internet & Technology. Published November 8, 2012. https://www.pewresearch.org/internet/2012/11/08/main-findings-6/
- Schorr EN, Gepner AD, Dolansky MA, Forman DE, Park LG, Petersen KS, Still CH, Wang TY, Wenger NK; on behalf of the American Heart Association Cardiovascular Disease in Older Populations Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing; Council on Arteriosclerosis, Thrombosis and Vascular Biology; and Council on Lifestyle and Cardiometabolic Health. Harnessing mobile health technology (mHealth) for secondary cardiovascular disease prevention in older adults: a scientific statement from the American Heart Association. Circ Cardiovasc Qual Outcomes. 2021;14:e000103. doi: 10.1161/HCQ.0000000000000103
- Masterson Creber RM, Hickey KT, Maurer MS. Gerontechnologies for Older Patients with Heart Failure: What is the Role of Smartphones, Tablets, and Remote Monitoring Devices in Improving Symptom Monitoring and Self-Care Management? Curr Cardiovasc Risk Rep. 2016;10(10). doi:10.1007/s12170-016-0511-8
- Reading Turchioe M, Grossman LV, Baik D, et al. Older Adults Can Successfully Monitor Symptoms Using an Inclusively Designed Mobile Application. J Am Geriatr Soc. 2020;68(6):1313-1318.
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-- The opinions expressed in this commentary are not necessarily those of the editors or of the American Heart Association --