mHealth and cardiovascular diseases self-management: There is still a long way ahead of us

Cardiovascular disease (CVD) has a high prevalence in the population worldwide and represents a huge economic and human burden. There is a strong evidencebased assumption that reducing modifiable CVD risk factors decreases the incidence, morbidity and mortality due to CVD. However, there is low long-term adherence to treatments and recommendations aimed to prevent CVD or to prevent events after CVD has already developed. Interventions to promote and enhance patient empowerment are essential components for effective self-care behaviour and risk factor control for chronic diseases and believed to increase adherence to medical treatments and preventive strategies. Telemedicine is the utilization of medical information transferred remotely via digital communication to improve or promote the health of patients, and is progressively becoming common practice of medicine in many areas of the world. The usual model of care for people with CVD includes regular visits to the doctor and emergency services, involving high healthcare costs. However, new methods to deliver healthcare using mobile digital communication devices, mobile health (mHealth), may increase the number of patients treated while facilitating patient self-management and saving costs. According to the systematic review by Coorey et al., several risk factors and lifestyle habits might be modifiable with the utilization of mobile apps, like high blood pressure, obesity, smoking, dyslipidaemia, and sedentarism, with improvement of medication adherence, quality of life and psychosocial well-being. Although the overall results show encouraging results supporting the idea that mHealth could represent a new paradigm in the delivery of preventive strategies, there are few things that remain unclear. For example, no studies included in the systematic review reported analyses of subgroups based on sex, age or other factors that may help to identify the ideal target population for mHealth interventions. Most of the participants were men, which is different from recent studies where women seem to get a higher benefit when using smartphone-based models. Identification of a patient’s profile who might potentially benefit the most through the use of mobile applications would be a desirable outcome in future studies addressing the effectiveness of mHealth in cardiovascular disease prevention. The maximum follow-up reported in the studies included in this review was six months, with a high participant drop-out rate in most of the studies. This is a troubling finding considering that secondary prevention is a lifelong intervention, underscoring the need for studies with longer follow-up. Assessing the longterm effectiveness of mHealth interventions proves the value of mHealth in clinical practice. Currently mHealth features may include tracking lifestyle habits, self-monitoring, disease information and other aspects of patient education, all of them with customizable options. Additional research is needed to determine what makes health mobile applications more appealing to users to promote adherence to a healthy lifestyle. In only one study of the metaanalysis by Coorey cardiac rehabilitation patients reported that the use of the mHealth intervention allowed themselves to identify personal lifestyle challenges and set future goals. A key question to be answered is whether the health literacy of the participants plays a role in these outcomes. While a recent review states the need for an appropriate health literacy level to guarantee the development of skill self-management by patients, no studies targeting secondary prevention of CVD have reported health literacy level as a variable that may affect the outcomes.