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Recurrence of cardiovascular events is common and yet traditional cardiac rehabilitation programmes, which have proven benefits in secondary prevention, are underused. A dedicated symposium on Friday will look at the role of digital technologies in secondary-prevention strategies.
One of the experts leading the session is ACNAP President-Elect, Professor Lis Neubeck from Edinburgh Napier University (Edinburgh, UK). Prof. Neubeck explained that the uptake of traditional cardiac rehabilitation programmes is only around 30% due to well-known barriers, such as a dislike of face-to-face or group programmes, inconvenient timing, geographical distance and conflicting demands.
She also said that there is not the capacity to deliver face-to-face cardiac rehabilitation to all those who need it. With the increasing role of digital technology in people’s lives, she believes that it is timely to consider how digital health tools are used to enhance diagnostics, management and longer-term support of patients with cardiovascular disease. Prof. Neubeck and colleagues recently conducted a systematic review of randomised controlled trials evaluating telehealth intervention in patients with coronary heart disease.1 Despite wide variations in the types of interventions analysed, patients using telehealth were found to have significantly improved cardiovascular risk factors. Telehealth was not significantly associated with lower all-cause mortality but there were significantly fewer rehospitalisations or cardiac events compared with non-intervention groups.
Prof. Neubeck explained that people are engaged with health in different ways and that digital health presents opportunities and diversity—mobile technologies enable a creative and imaginative approach that might engage people who may not respond well to more traditional programmes. Prof. Neubeck believes that the value of these tools and also their limitations need to be understood by healthcare professionals. She said, “There isn’t going to be a single app that will be a silver-bullet fix and we don’t know what is going to be available around the corner, so we have to be aware and responsive. Tele- and mobile-health interventions are not all equal and, in Friday’s session, we will touch on the differences between the various types and how we can evaluate them, for example, what makes a good intervention and what makes an intervention likely to be able to help patients.”
Professor Robyn Gallagher (University of Sydney, Sydney, Australia), who has worked with Prof. Neubeck and others on numerous projects related to tele- and mobile-health interventions, provided her insight: “We must act to close the gap and improve access to secondary-prevention strategies. One of the key reasons that digital health options are so attractive is that phones are now ubiquitous and can be used in many different ways to reach people. Another key reason is that interventions related to devices can be fitted into people’s lives as it suits them. We can use mobiles for simple one-on-one conversations, and we can also use social media platforms to allow patients to keep in touch with known health professionals and support groups. Smartphone apps can be developed as we have done at the University of Sydney where a randomised trial is underway to investigate if the MyHeartMate app can improve risk factors.2 There are also lots of health apps available that anyone can buy—some are quite effective and even non-cardiac apps may be useful too. For improving exercise, we can link smartphones to activity trackers, and help patients to set goals and see patterns in their activity levels.”
Prof. Gallagher explained that healthcare professionals need to recognise that patients are already using devices for health and cardiac health. She suggested that healthcare professionals engage in conversations with patients about what devices can do, where they can find good products and find out what types of interventions patients need to help them. “We can reach out to individuals, but we also need to think about how we can make interventions scaleable so we can engage even more people in need of effective secondary prevention,” she said.
‘Revolutionising cardiovascular care: e-health and telemedicine’
Friday: 09:00 – 10:00; Green 2–3
Our mission: To reduce the burden of cardiovascular disease
© 2019 European Society of Cardiology. All rights reserved