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Meta-Analysis
. 2015 Apr;90(4):469-80.
doi: 10.1016/j.mayocp.2014.12.026.

Digital health interventions for the prevention of cardiovascular disease: a systematic review and meta-analysis

R Jay Widmer  1 , Nerissa M Collins  2 , C Scott Collins  2 , Colin P West  3 , Lilach O Lerman  4 , Amir Lerman  5
Affiliations
Meta-Analysis

Digital health interventions for the prevention of cardiovascular disease: a systematic review and meta-analysis

R Jay Widmer et al. Mayo Clin Proc. 2015 Apr.

Abstract

Objective: To assess the potential benefit of digital health interventions (DHIs) on cardiovascular disease (CVD) outcomes (CVD events, all-cause mortality, hospitalizations) and risk factors compared with non-DHIs.

Patients and methods: We conducted a systematic search of PubMed, MEDLINE, EMBASE, Web of Science, Ovid, CINHAL, ERIC, PsychINFO, Cochrane, and Cochrane Central Register of Controlled Trials for articles published from January 1, 1990, through January 21, 2014. Included studies examined any element of DHI (telemedicine, Web-based strategies, e-mail, mobile phones, mobile applications, text messaging, and monitoring sensors) and CVD outcomes or risk factors. Two reviewers independently evaluated study quality utilizing a modified version of the Cochrane Collaboration risk assessment tool. Authors extracted CVD outcomes and risk factors for CVD such as weight, body mass index, blood pressure, and lipid levels from 51 full-text articles that met validity and inclusion criteria.

Results: Digital health interventions significantly reduced CVD outcomes (relative risk, 0.61; 95% CI, 0.46-0.80; P<.001; I(2)=22%). Concomitant reductions in weight (-2.77 lb [95% CI, -4.49 to -1.05 lb]; P<.002; I(2)=97%) and body mass index (-0.17 kg/m(2) [95% CI, -0.32 kg/m(2) to -0.01 kg/m(2)]; P=.03; I(2)=97%) but not blood pressure (-1.18 mm Hg [95% CI, -2.93 mm Hg to 0.57 mm Hg]; P=.19; I(2)=100%) were found in these DHI trials compared with usual care. In the 6 studies reporting Framingham risk score, 10-year risk percentages were also significantly improved (-1.24%; 95% CI, -1.73% to -0.76%; P<.001; I(2)=94%). Results were limited by heterogeneity not fully explained by study population (primary or secondary prevention) or DHI modality.

Conclusion: Overall, these aggregations of data provide evidence that DHIs can reduce CVD outcomes and have a positive impact on risk factors for CVD.

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Conflict of interest statement

All authors contributed to the work, and have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
PRISMA schematic for study selection.
Figure 2
Figure 2
CVD Outcomes and DHI.
Figure 3
Figure 3
Figure 3a: Weight and DHI. Figure 3b: BMI and DHI.
Figure 4
Figure 4
Figure 4a: Web-based DHI and weight loss: Figure 4b: Telehealth-based DHI and weight loss: Figure 4c: SMS Text-based DHI and weight loss: Figure 4d: Email-based DHI and weight loss:
See this image and copyright information in PMC

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