Cardiovascular Disease and Digital Health
By Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech
Many of the people must have recently (September 29, 2022) celebrated the World Heart Day, with its theme: “Use heart for every heart.” Since the recent COVID-19 pandemic started in early 2020, number of deaths worldwide continues to climb towards 6.5 million as of end of August 2022 (including more than one million in the U.S.); however, cardiovascular disease (CVD) claims around 18.8 million lives (about 900,000 in the U.S.) every year. Yet the COVID-19 pandemic has accelerated the uptake of digital health, creating an opportunity to strengthen the response to CVD. With the increasing access to the internet, and through telemedicine and artificial intelligence (AI)-enabled devices, advances in digital health provide an impetus to improve access and achieve greater equity in health care for the millions of people at risk of or living with CVD, particularly those in lower-resource settings with limited access to in-person treatment. Although this digital transformation is not a magic bullet, it could help redraw the health-care landscape by improving access to care for underserved populations and by reducing pressures on overloaded health-care systems.
Digital technologies can also empower people by providing them with mote control of their well-being in sickness and health. A trial in the UK of a digital health tool for the management of hypertension is a good example. The technology facilitates self-monitoring of blood pressure and includes reminders and predetermined drug changes combined with support for behavior change. The increasing application of AI to the electrocardiogram is another example of harnessing AI in the management of CVD.
The potential of remote CVD management has been highlighted in the COVID-19 pandemic when face-to-face medical consultations have not been possible in many settings. Lessons learned – both positive and negative – from this move to digitally enabled care can facilitate the use of digital health for the prevention and management of CVD worldwide. Digital health also has a part to play in addressing health inequalities and increasing access to health-care in low-resource settings. For instance, as digital health expands, governments need to reconsider approaches to investment in medical training and in technology infrastructure and access.
The results of a digital health trial in a community hospital with limited number of doctors is an indicator of what could be achieved. Patients can be able to consult doctors and specialists online about their health, including their blood pressure. It can show that telemedicine can be effective in improving control of systolic blood pressure and give patients access to quality, affordable medicine.
There are challenges in relation to awareness, accessibility, and availability of the necessary technology that will need to be overcome on the path to increased use of digital health. Access to digital technology and network infrastructure low-income and middle-income communities is insufficient. There are people, mostly in lower-income communities who are offline. Wherever it takes place, it is crucial that advances in digital health do not exacerbate inequality in health care. Furthermore, not all technological innovation is necessarily good and it is important to understand what is the problem that needs solving and ensure that the collection of data and evidence is reliable, impactful, and secure. Much digital health research takes place in selected population in high-income communities.
Thus, AI-derived algorithms are influenced by the gender, ethnicity, age, and socioeconomic status of the sample population. If we are to make recommendations to everyone in all communities, then we need the same quality of data everywhere, representing all people. The development of digital health affords an opportunity to redress this imbalance and equalize the data framework for CVD and other diseases. Consideration also needs to be given to the impacts of digital health on the relationship between patient and doctor. Digital health solutions are not a panacea and they can only complement a fully funded and staffed health system.
Hand in hand with maintaining trust between practitioners and patients, the journey towards routine use of digital health care has already started. Let’s “Use Heart to Connect”. Digital health can help connect every heart everywhere and thus bring us one step closer to achieving cardiovascular health for everyone!