Gerotechnology for Older Adults With Cardiovascular Diseases: JACC State-of-the-Art Review

Abstract

The growing population of older adults (age ≥65 years) is expected to lead to higher rates of cardiovascular disease. The expansion of digital health (encompassing telehealth, telemedicine, mobile health, and remote patient monitoring), Internet access, and cellular technologies provides an opportunity to enhance patient care and improve health outcomes-opportunities that are particularly relevant during the current coronavirus disease-2019 pandemic. Insufficient dexterity, visual impairment, and cognitive dysfunction, found commonly in older adults should be taken into consideration in the development and utilization of existing technologies. If not implemented strategically and appropriately, these can lead to inequities propagating digital divides among older adults, across disease severities and socioeconomic distributions. A systematic approach, therefore, is needed to study and implement digital health strategies in older adults. This review will focus on current knowledge of the benefits, barriers, and use of digital health in older adults for cardiovascular disease management.

Keywords: arrhythmia; barriers; cardiac rehabilitation; clinical trials; diabetes mellitus; digital health; dyslipidemia; gerotechnology; heart failure; hypertension; obesity; older adults; palliative care; telehealth.

FIGURE 1

Temporal Trend in U.S. Mobile Technology Use (A) Mobile cellular subscriptions (131); (B) Internet usage (131).

FIGURE 2. Real-World Examples of Remote Patient Monitoring With Digital Health Technologies in Hypertension and Atrial Fibrillation

(A and B) A 86-year-old woman with a history of sick sinus syndrome, pacemaker implantation, and hypertension on an angiotensin-converting enzyme (ACE) inhibitor and calcium-channel blocker with uncontrolled blood pressure (BP) enrolled in remote patient monitoring in January 2019. Collection and transmission of patient-generated BP data on a daily basis, entered on a smartphone application, and direct upload to her electronic medical record. Monthly review of digital data with titration and initiation of antihypertensive therapy (blue arrows) between February 2019 and May 2019 (A) achieving sustained BP reduction to February 2020 (B). (C and D) A 78-year-old man with a history of paroxysmal atrial fibrillation and hypertensive heart disease. Enrolled in remote patient monitoring in February 2019 with the smartphone ECG. Symptomatic recurrence of PAF (red circles) captured in November 2019 (C) and medication initiation with conversion to sinus rhythm (blue circles). Recurrence in April 2020 (D, red arrow) that coincided with an upper respiratory tract infection. Both examples highlight long-term digital engagement in older adult patients.

CENTRAL ILLUSTRATION

Identify goals of care: Includes disease-based and overarching goals of care. Consider patient-centered outcome sought as a function of treatment burden. Assess barriers to digital health use: Engineering, decision support, and human barriers (physical, cognitive, other age-related barriers, privacy, “tech” anxiety, motivational inertia, decreased trust in individual abilities, accessibility, family member integration, socioeconomic). See Table 2. Optimize patient technology match: Matching “what matters most,” individual preference, individual barriers to specific technology. Support participant and caregiver(s): Easy to read/understand instructions, ensure HELP-line available, in-person and virtually. Reassess impact: On patient-centered, disease-based, and overarching goals of care and quality of life. Adapted with permission from (75).