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Cardiovascular Disease: Mobile Health (mHealth) Interventions for Treatment Adherence among Newly Diagnosed Patients

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What the CPSTF Found

About The Systematic Review

The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to cardiovascular disease prevention.

Gandhi S, Chen S, Hong L, Sun K, Gong E, Li C, et al. Effect of mobile health interventions on the secondary prevention of cardiovascular disease: systematic review and meta-analysis. Canadian Journal of Cardiology 2017; 33:219-31.

The systematic review and meta-analysis included 27 randomized controlled trials (search period through January 2016). The team examined a subset of 12 studies from the systematic review that were conducted in high-income countries and abstracted supplemental information about study, intervention, and population characteristics.

The CPSTF finding is based on results from the published review, additional information from the subset of studies, and expert input from team members and the CPSTF.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review and meta-analysis included 27 studies.

  • Adherence to medications improved significantly (9 studies).
  • Adherence to treatment (i.e., one or more medications, clinical care follow-up, or risk factor management recommendations) improved significantly (15 studies).
  • Conclusions about intervention effects on additional outcomes related to changes for cardiovascular disease risk factors (i.e., blood pressure, lipids, smoking cessation), morbidity, and mortality were limited by the small numbers of studies and mixed, or inconsistent, results.

The CPSTF examined results from a subset of 12 trials conducted in high-income countries.

  • Adherence to medications improved significantly (3 studies).
  • Adherence to treatment (i.e., one or more medications, clinical care follow-up, or risk factor management recommendations) improved significantly (6 studies).
  • Two additional studies reported improvements in medication adherence using objective measures (1 study) or self-reported outcomes (1 study). A third study reported improvements in treatment adherence.

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

While additional research is warranted, the CPSTF finding is likely applicable to the use of these interventions in U.S. healthcare settings for adults recently diagnosed with cardiovascular disease.

Evidence Gaps

Gandhi et al. suggested additional research and evaluation be completed to answer the following questions and fill existing gaps in the evidence base.

  • Are interventions based on smartphone apps more or less effective than interventions based on text messaging?
  • Are mobile health interventions effective when used for older patients (>65 years), who may have less familiarity with mobile devices and content?
  • Are mobile health interventions, especially smartphones, effective for patients of lower socioeconomic status, given potential limitations in access to data or current technologies?

The CPSTF further identified the following evidence gaps as areas for future research (What are evidence gaps?):

  • Do studies that use objective measures report outcomes equal to or greater than studies that use self-reported data?
  • Are interventions effective in helping patients adhere to medications and self-management goals over longer periods of time (1-2 years)?
  • Are interventions effective in reducing morbidity, mortality, and healthcare use associated with cardiovascular disease?
  • What factors influence intervention effectiveness?
    • Use with or without in-person counseling or contact?
    • Patients’ gender, race, ethnicity, or socioeconomic status?
    • Length of time since cardiovascular disease diagnosis?
    • Use of current smartphone capabilities such as access to social support?

Study Characteristics

  • Following are characteristics of studies from the subset of 12 studies from high-income countries.
    • Studies were of short duration (median 6 months).
    • Interventions used mobile phones (10 studies) or smartphones (2 studies).
    • Studies provided web-based content that was accessible through smartphones (2 studies) or served as a supplement to text messages (2 studies).
    • Studies used text messages for information or motivation (4 studies), as reminders (4 studies), or both (2 studies).
    • Mobile content was tailored based on patient inputs (2 studies), or personalized without patient inputs (4 studies).
    • Three studies offered contact or appropriate follow-up with a healthcare provider.
    • Studies were conducted in the United States (4 studies), Australia (2 studies), New Zealand (2 studies), Norway (1 study), Spain (1 study), France (1 study), and Canada (1 study).
  • All 12 of the subset studies (and 25 of the 27 studies in the full meta-analysis) were conducted among patients with a recent diagnosis of cardiovascular disease.
  • Patients were recruited at the time of initial hospitalization (6 studies), or when they were referred to an outpatient cardiac rehabilitation program (6 studies).
  • Four U.S. studies provided limited information on patient demographic characteristics, and none provided stratified analyses of effectiveness by socioeconomic status, or race/ethnicity. None of the studies evaluated intervention effectiveness among older patients (>65 years).

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