Mobile Health Applications in Cardiac Care

Abstract and Introduction

Abstract

Rapid advances in mobile health technologies and their ubiquitous communication capacity have invigorated remote healthcare delivery. Mobile health applications can help counter the mounting pressure on cardiac services. Patients are increasingly using health and well-being applications, including those for chronic disease monitoring. Population-screening applications are becoming widely used and can have a significant impact on early detection in future. Studies show that cardiology services are using mobile technologies to provide earlier diagnosis through remote transmission and interpretation of ECG, leading to more accurate triage and shorter door-to-balloon time in myocardial infarction. Arrhythmias can be monitored in real time, supported by automated detection algorithms, and implantable device status checks can efficiently and safely be carried out remotely. Ongoing monitoring for and early detection of deterioration in heart failure can also be achieved through mobile applications. Cardiac rehabilitation has been delivered remotely utilizing mobile technologies. Mobile health offers significant potential in providing effective, efficient and appropriately personalized care; however, further studies are required to confirm this. The objective of this review is to explore and describe studies of mobile health applications in cardiac care, including the implications for interventional cardiology, with a focus on clinical outcomes.

Introduction

There is mounting pressure on cardiac services to find novel and accessible ways of delivering services due to increasing cardiac disease prevalence and escalating costs. Although cardiology has been one of the leading disciplines in embracing telehealth, normalization of telecardiology services has been slow to develop,^[1] with challenges in geographical connectivity, affordability, technology maturity and patient uptake often being cited as causes. The focus has mostly been on teletriage and telemonitoring in long-term care. In-hospital and face-to-face care remains a mainstay of acute cardiac management. The wide adoption of ever-more sophisticated mobile applications (apps) and devices provides mobile health with the opportunity to build on telecardiology's aims to reduce costs while delivering safe, effective and personalized care at all stages of the patient's journey.

Mobile phones are playing an increasingly important and creative role in supporting patients in their well-being and healthcare journey. Health improvement apps, including weight management, smoking cessation, fitness and stress reduction, are common and widely used. While these apps may play a role in prevention of cardiac disease, smartphones also have the potential to be a viable tool for wide community cardiac disease screening through apps such as those for arrhythmia diagnosis, and mobile monitoring devices for blood pressure (BP) measurement, which are available to the public at low cost.

Clinicians are turning to mobile devices, including mobile phones and tablet PCs, to support training and continued development, with educational apps and professional publications increasingly being available on handheld devices. Professional networking and sharing of best practice are some of the ways doctors are using mobile technologies. Clinicians can also access medical records whenever required, and studies have shown that, when clinicians read ECGs and CT scans on mobile devices, they respond more promptly, have improved data management and record-keeping practices, and fewer medication prescribing and discharge from hospital errors.^[2]

Acute care is often confined to hospital and/or clinical settings because it often requires specialized clinicians and a controlled environment to ensure patients are safely managed following medical interventions. Cardiac interventions, varying from revascularization, and pacemaker (PM) and cardiac defibrillator implants, to ventricular assist device surgery, are often followed by intensive care in a hospital environment. However, hospital stays beyond intensive care frequently involve monitoring and medical management, which could feasibly be shifted to the home environment and supported through mobile health.

Uptake and completion rates for cardiac rehabilitation (CR), which is known to reduce secondary events and long-term healthcare costs, are notoriously poor. Smartphones can help address these issues by enabling remote delivery of appropriately monitored rehabilitation programs,^[3] while also extending care services to remote areas that traditional services are not able to reach. Similarly, mobile health can support safer and more personalized care in the long-term management of chronic disease, with real-time smart monitoring opening up new possibilities for appropriate early intervention and active risk factor management. Mobile technologies can also support patients in their self-care and medication management, and, with patients also able to access electronic health records on their mobile devices, they are enabled and empowered to better participate in their own healthcare and management of their long-term condition.

This review will first outline the general capabilities and features of mobile health that enable medical, and in particular cardiac, interventions. Secondly, it will review the clinical studies that have applied mobile health technologies in cardiac care. Through these studies, we will outline how mobile health can assist cardiac clinicians and how it has influenced patient outcomes. Finally, we will discuss the limitations and future perspectives of mobile health in cardiology.

Sidebar

Mobile health features & functions

Mobile health uses the internet, medical workstations, mobile connectivity and wireless portable health-monitoring devices to deliver healthcare in patients' environment.

Mobile health in cardiac intervention & management

Mobile medical applications (apps) for smartphones have the potential to be a viable tool for community screening of cardiac disease such as arrhythmia and hypertension.
Mobile health has the potential to play a role in aspects of the acute care, rehabilitation and long-term management of patients with cardiac disease.
Organizations and professionals using mobile applications need to have appropriate policies and procedures in place to ensure patient privacy and safety, and patients need to be educated on risks and safe usage of their mobile devices.

Cardiac arrest

Application of mobile heath in cardiac arrest has shown improvements in: self-directed cardiopulmonary resuscitation through training apps; and assisting in bystander cardiopulmonary resuscitation through dispatch instructions accompanied by smartphone video communication or mobile app animation.

Arrhythmia

Real-time mobile transmission of ECG has the potential for cardiologists to detect cardiac arrhythmia early.
Automatic arrhythmia detection algorithms in mobile medical apps have shown to enable remote diagnosis of atrial fibrillation and other arrhythmias.
Remote monitoring of cardiovascular implantable electronic devices through mobile communication has aided physicians in responding to cardiac abnormalities and reduces requirements for face-to-face device status checks.

Myocardial infarction

Mobile transmitted ECGs of myocardial infarction patients have enabled appropriate triage for coronary intervention and shown outcomes of significant reductions in door-to-balloon time, appropriate utilization of specialist facilities and maintenance of cardiac function.
Mobile devices and apps have potential to offer new opportunities in delivering cardiac rehabilitation to patients at home.

Heart failure

Weight monitoring and fluid management of heart failure through mobile health monitoring have demonstrated improved self care.
Intelligent decision-support mobile medical apps in telemonitoring have demonstrated improved efficacy to predict clinical deterioration and improved quality of life in patients.

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