Original articleDigital Health Interventions for the Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis
Section snippets
Data Sources and Searches
This systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.14 We included all RCTs and observational/cohort studies published between January 1, 1990, and January 21, 2014, that examined any element of DHI (telemedicine, Web-based strategies, e-mail, mobile phones, mobile applications, text messaging, and monitoring sensors) and impact on CVD. We intentionally and broadly included any studies of adult patients
Results
Fifty-one studies met criteria for full-text review and were included in the systematic review, with 9 studies providing analyzable CVD outcome data. A summary of studies reporting CVD outcomes is presented in the Table.20, 21, 22, 23, 24, 25, 26, 27, 28 Risk of bias among studies reporting CVD outcomes was predominantly low apart from a consistent lack of participant blinding (Figure 2) with a funnel plot included (Supplemental Figure 2, available online at http://www.mayoclinicproceedings.org
Discussion
This systematic review and meta-analysis reveals that DHI has a beneficial effect on CVD risk factors and outcomes. Applying an inclusive definition of DHI broadly applied to studies ranging from 2 to 36 months, we found a CVD morbidity and all-cause mortality benefit for secondary CVD prevention and HF groups, with primary prevention populations having benefit with regard to weight loss, BMI, SBP, total cholesterol, and LDL cholesterol. However, there was no clear benefit of DHI in primary
Conclusion
The data synthesized and analyzed in this systematic review show a net benefit of DHI on overall CVD outcomes (CVD events, hospitalizations, and all-cause mortality) compared with usual care. These gains are largely driven by improvements in CVD outcomes among higher-risk populations such as patients with HF or those targeting secondary CVD prevention. Digital health interventions were also associated with improvement in risk factors for CVD in primary prevention studies, suggesting the
Acknowledgments
There was no direct role of the funding agencies in this study or article. The views expressed are those of the authors and do not necessarily reflect those of the National Institutes of Health. All authors contributed to the work.
We thank the Clinial and Translational Science program of Mayo Clinic including the faculty and staff of course CTSC 5740 (Dr M. Hassan Murad, Dr Victor Montori, and Ms Jesse Welsh) for their guidance. We greatly appreciate the 28 authors who responded to our request
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