Top 20 Cardiovascular Disease Digital Health Intervention Apps: Innovations Driving Improved Outcomes

In April 2015, Mayo Clinic Proceedings published a meta-analysis report.The analysis indicated that digital health interventions are highly beneficial for improving cardiovascular disease outcomes. This finding was reached by researchers at the Mayo Clinic after systematically reviewing previous studies. From research outputs over the past 25 years, they identified 588 reports and ultimately selected 51 studies meeting their criteria, including randomized controlled trials and cohort studies, encompassing a total of 24,000 cases.The meta-analysis was conducted by a research team led by Dr. Jay Widmer. They stated in the report:“Although previous studies have demonstrated that digital health interventions are effective in specific areas such as smoking cessation, behavioral pattern monitoring, physical activity monitoring, glycated hemoglobin (HbA1c) monitoring, blood pressure monitoring, and weight loss, there has been insufficient evidence to prove that digital health interventions play a role in the prevention and control of cardiovascular disease risk factors, let alone evidence showing their benefit in improving cardiovascular disease outcomes, such as reducing incidence, hospitalization rates, and all-cause mortality. However, with approximately 50,000 healthcare-related apps currently available for download and countless internet-based digital health intervention programs, it is worthwhile to re-examine the primary and secondary roles that digital health interventions can play in strengthening the prevention and treatment of cardiovascular diseases and improving outcomes.”Researchers involved in this meta-analysis found that, on average, digital health interventions (including telemedicine, web-based therapies, email reminders, text message reminders, mobile app monitoring, and data tracking) reduced the relative risk of factors influencing cardiovascular disease outcomes by 40%—a effect substantially greater than that of statins, antihypertensive medications, or aspirin.They also found that,Broadly speaking, digital health interventions can reduce weight loss, lower body mass index, blood pressure, and low-density lipoprotein cholesterol; however, the magnitude of reduction in these indicators does not always correspond to the degree of reduction in cardiovascular disease risk.After these researchers conducted separate studies on various digital health interventions,They found that not all interventions achieved the aforementioned effects. Web-based therapies, text message reminders, and telemedicine demonstrated the best efficacy, whereas email reminders and data monitoring showed the poorest outcomes.However, this is not entirely the case; data monitoring is an exception in terms of its efficacy in lowering diastolic blood pressure, as it can effectively help reduce diastolic pressure.The researchers caution that although this meta-analysis has yielded positive conclusions, it does not address all aspects of the issue.The report also shows:“Because the use of digital health interventions (DHIs) does not directly reduce the risk of cardiovascular disease, the effects observed with these interventions likely reflect only increasing patient adherence to evidence-based therapies such as statins, aspirin, or beta-blockers. Furthermore, this analysis did not assess behavior change and incentive mechanisms, either of which could influence trial outcomes or the efficacy of DHIs. In the future, it will be crucial for researchers to effectively evaluate these two aspects in their work.”For FDA-cleared applications with more advanced functionalities, the next step is integration with existing hospital electronic health record (EHR) and imaging systems. Some applications have already embarked on this path; for example, Mobile MIM and ResolutionMD allow users to remotely view radiological images, MRI scans, neuroimaging, and cardiac imaging on smartphones and tablets. Because most image processing occurs outside the mobile device, sensitive patient information is not transmitted, thereby ensuring that the entire image-viewing process is fundamentally secure.Another example is AirStrip One, an application that enables users to integrate patients’ telemetry data, historical and recent electrocardiograms (ECGs), laboratory test results, and EHR data into a single, real-time view on mobile devices. Additionally, during emergency medical response, it can transmit ECGs to physicians before the patient arrives at the hospital, thereby reducing door-to-balloon time.Several other applications are particularly useful for the prevention and management of valvular heart disease.EuroSCORE II is the latest application for risk assessment in valvular heart disease. CardioValve, launched by Digital Medical Networks, serves as a compendium of measurement metrics, covering most mechanical and bioprosthetic valves currently used in hospitals. Valve In Valve, introduced by UBQO Ltd, identifies most surgically implanted valves and provides relevant information to inform users about which valves are suitable for transcatheter aortic valve replacement (TAVR). EchoCalc, developed by the British Society of Echocardiography, incorporates multiple equations, enabling it to process any conceivable information derived from echocardiographic data.To identify commonly used health intervention applications for cardiovascular disease, we conducted an informal survey among our cardiology colleagues while preparing this article. The survey indicated that most respondents had used the aforementioned applications. They also reported using several other applications, which are briefly described below.AnticoagEvaluatorAnticoagEvaluator, launched by the American College of Cardiology, is a risk assessment application that integrates the CHADS2, CHA2DS2-VASc, and HAS-BLED scoring systems. It calculates a patient’s risk of stroke and bleeding associated with atrial fibrillation, thereby assisting physicians in determining the appropriate treatment strategy.I recently encountered this application while leading residents on ward rounds. During these rounds, an intern demonstrated a typical patient consultation process. Her patient was an elderly woman with newly diagnosed atrial fibrillation. After completing the consultation, the intern mentally weighed the risks and benefits of anticoagulation therapy and reached her conclusion. She recommended rate control therapy rather than anticoagulation. Anticipating my inevitable question about her rationale, she handed me her smartphone before I could ask, showing me the risk assessment generated by the app. The results were compelling and convincingly supported her decision.

The image above shows the scoring interface of AnticoagEvaluator.

AliveCorAliveCor enables smartphones to acquire a new capability: recording single-lead electrocardiograms (ECGs). To enable this feature, users need only complete the following three steps:First, attach the specially designed AliveCor monitoring device to the smartphone or insert it into a purpose-built phone case.

Next, install the companion app AliveECG for the monitoring device on your mobile phone.

Finally, press the device against the skin around the heart area, and the smartphone can begin generating an electrocardiogram (ECG).

This device has gained widespread recognition for its portability and ability to detect arrhythmias early, and it is compatible with both Android and iOS. AliveCor has currently received FDA clearance.AliveCor users in the United States {who wish to have their recorded ECGs analyzed by professionals} can send these ECGs to their physicians through a direct-to-consumer marketing service called AliveInsights, or they may choose to transmit them to remote cardiologists or remote cardiac electrophysiology technicians. However, users are required to pay a fee each time they use this transmission service to obtain medical analysis. The purchase price of the AliveCor monitor is $199.

The image below shows the AliveCor monitor embedded in a specially designed phone case.

It has been reported that Dr. Eric Topol, a renowned cardiologist, diagnosed myocardial infarction and atrial fibrillation using the AliveCor device on two separate flights.PDR® 2015Patients often identify medications by their size, shape, and color, as they are more familiar with the physical appearance of drugs than with pharmacological details. Conversely, many physicians have a thorough understanding of drug pharmacology and properties but may not recognize the actual appearance of the medications they routinely prescribe. Despite this, few people keep a reference book such as the Physician's Desk Reference on hand for drug information queries, likely due to the inconvenience of looking it up. However, this issue has now been resolved with the availability of convenient search tools. PDR Network has launched several paid and free drug information applications, including the app named PDR® 2015, which contains the complete content of the Physician's Desk Reference.iCathWhether it involves selecting appropriate treatment methods for patients or providing them with adequate compensation, the Guidelines for Percutaneous Coronary Intervention have become an increasingly unavoidable reality for practicing interventional cardiologists in both respects. However, fully mastering these guidelines is by no means easy. A mere glance reveals the extensive and complex scope of their content, which includes indications, stress testing, pharmacological therapy, and anatomical considerations (covering 166 indications for coronary catheterization and 180 clinical scenarios suitable for coronary angioplasty).Faced with such a vast amount of information, how can interventional cardiologists make sense of it all and adhere to the guidelines to provide appropriate patient care? Several applications currently available on the market aim to help interventional cardiologists address this challenge. iCath is one such application. Developed by Weston Hickey, a cardiology fellow at the University of Oklahoma Health Sciences Center, it is currently available exclusively on iOS. The app features not only an intuitive user interface but also comprehensive functionality. The following is an introduction to some of iCath’s features.

In the toolbar at the bottom of the left image, the names and functions of the buttons from left to right are as follows:“Diagnostic” button: Click it, and the application will ask users a series of questions based on the guideline content, ultimately helping them determine whether the current patient is suitable for coronary catheterization;“Revascularization” button: It functions similarly to the “Diagnostic” button, but differs in the assessment criteria. Click it when determining whether the current patient is suitable for coronary angioplasty;“Appendix” button: This allows access to other useful tools and enables users to look up definitions of all terms appearing in the guidelines.Calculate by QxMdCalculate by QxMd is a data calculation application and a clinical decision support tool. It is available on iPhone, iPad, Android devices, and BlackBerry smartphones. The application is completely free for the medical community.Currently, Calculate is dedicated to providing healthcare professionals with practical tools for clinical practice, thereby assisting them in diagnosis, treatment, and prognosis. Users can customize Calculate according to their specific needs, enabling it to function effectively within specialized fields.Calculate incorporates multiple tools that aid in the management of cardiovascular diseases. It can be used to assess cardiovascular risk, guide lipid-lowering therapy, and calculate CHADS2 and CHA2DS2-VASc scores for the management of atrial fibrillation. Additionally, it supports invasive hemodynamic monitoring and shunt fraction monitoring, guides the treatment of coronary artery disease (incorporating the Canadian Cardiovascular Society classification, TIMI risk score, and Killip classification), and assists in preoperative patient assessment. Furthermore, the application includes other data calculation tools for computing various medical metrics, such as Body Mass Index (BMI) and dehydration indices.

ep Toolsep Tools is a free, universal application available for iPad, iPhone, and iPod Touch. It incorporates multiple computational algorithms designed to localize the substrates of cardiac arrhythmias, provide reference standards, and assist in the clinical diagnosis of various conditions. Users can easily access these algorithms through an intuitive user interface. Additional features of the application include diagnostic localization for accessory pathways, atrial tachycardia, ischemic ventricular tachycardia, idiopathic ventricular tachycardia, and premature ventricular contractions, as well as tools to help differentiate between supraventricular and ventricular abnormalities.DoximityAs one of the largest healthcare websites, Doximity has launched a companion app bearing the same name. Currently, more than half of all licensed physicians in the United States are members of the Doximity network, meaning that over half of board-certified doctors use this app.The app enables users to engage in instant messaging with other physicians and collaborate securely on patient care. It also helps users expand their practices and discover new job opportunities. The Doximity app provides a searchable directory of contact information for 700,000 physicians across the country and offers HIPAA-compliant opportunities for clinical collaboration and physician-to-physician communication. Users can also earn or track Continuing Medical Education (CME) credits through the app. The public can search for and view Doximity user profiles on the website, although users have the option to leave their profile information blank.

The image below shows the profile of a Doximity user.

HeartWise Blood Pressure TrackerHeartWise Blood Pressure Tracker, developed by SwEng LLC, is a monitoring application. It visually monitors patients' blood pressure, and users can send the collected data to their healthcare providers.The application is very easy to use. For instance, when users need to input existing blood pressure readings, they simply open the app to access the main interface and import their data there. Users can also add notes to these imported entries. Once imported, the data are displayed in tabular format within the app. To view the imported data, users need only tap the "Charts" or "Statistics" button located at the bottom of the main interface. Additionally, users can share the data from the app with others for analysis and review.

The figure below shows the data visualization from HeartWise Blood Pressure Tracker.

Features of this application:

• Intuitive data entry interface;

• Track systolic blood pressure, diastolic blood pressure, heart rate, and weight;

• Capable of automatically calculating mean arterial pressure and body mass index;

• Capable of exporting formatted reports via email, such as in spreadsheet or plain text format;

• - Capable of importing existing records or data from other applications;

• Features reminder functionality to alert users for measurements or medication intake;

• News and Announcements;

• Detailed statistical reports can display changes in a user's blood pressure over a period of time;

• Supports multiple units, such as pounds or kilograms;

• Quickly take screenshots and save charts to the user's photo album;

• Multilingual support;

The app is solely an information recording tool and is not intended for the diagnosis, prevention, or treatment of any diseases. For relevant medical advice, please consult a physician.BHF PocketCPRCardiopulmonary resuscitation (CPR) is a critical skill, yet bystanders often lack confidence or fear causing harm to the victim. This application, designed for use in conjunction with the PocketCPR device, aims to boost bystander confidence and reinforce CPR training. It guides rescuers on pre-CPR actions and provides real-time feedback to instruct proper CPR technique.

PocketCPR also reminds users to call for emergency assistance, check responsiveness, and perform cardiopulmonary resuscitation (CPR) at the correct rate and depth. The device’s algorithm is fully compliant with the guidelines of the American Heart Association and the International Liaison Committee on Resuscitation (ILCOR).

Its features include: clear visual and audio step-by-step instructions for CPR, including initial steps; an option to skip the initial steps and proceed directly to chest compressions; a precise metronome to calculate chest compression rate; accurate detection capability to monitor actual compression rate and provide voice feedback on whether compressions are too fast or too slow; industry-recognized technology to detect chest compression depth; reminders for rescue breaths after detecting 30 compressions; and prompts to initiate CPR when chest compressions cease.This application is currently intended for training and personal practice only and has not yet received FDA approval for use in actual resuscitation.Grace 2.0 ACS Risk CalculatorA risk calculator utilizing the GRACE algorithm to predict death or myocardial infarction in patients with initial acute coronary syndrome (ACS). Given that one in five patients is likely to die within the first five years following a heart attack, this application enables rapid assessment of disease severity. It provides mortality probability estimates for patients hospitalized for ACS within the past three years, aiming to assist physicians in formulating appropriate treatment plans for ACS patients. This application helps clinicians easily identify high-risk cardiac patients.

The application also provides more precise nonlinear calculations and a mobile device interface, enabling rapid and intuitive risk assessment. The probability of adverse events is calculated primarily based on the following clinical risk factors: age, heart rate, systolic blood pressure, creatinine level, Killip class, ST-segment deviation, troponin or other cardiac biomarkers, and cardiac arrest.GRACE 2.0 incorporates the Mini-GRACE algorithm, which facilitates new 1-year and 3-year calculations and allows direct computation of probabilities without requiring intermediate scores; population histograms include markers for high, moderate, and low risk. The application is currently classified as a medical device under the Medical Devices Directive (MDD) 93/42/EEC and is CE-marked for compliance. It helps determine the most appropriate immediate or long-term treatment strategies. The application is supported by the British Heart Foundation and sponsored by AstraZeneca.Although the GRACE risk score has undergone extensive and independent validation, any medical decision must be based on a comprehensive clinical assessment rather than relying solely on such risk calculators.JBS 3 Risk CalculatorAn application designed for physicians and other healthcare professionals to estimate patients’ cardiovascular disease risk, such as heart attack or stroke. The risk assessment is based on user-inputted measurement data, including blood pressure, cholesterol levels, and other relevant metrics. The app presents patient risk through various formats, such as Heart Age (indicating the patient’s cardiac age) and Health Years (showing the patient’s expected years of healthy life). These data can be used to guide lifestyle modifications or medication adjustments, thereby reducing patients’ cardiovascular disease risk.

Named one of the Top 10 Health Apps by TIME magazine, it is regarded as physicians’ favorite application for assisting in providing health recommendations to their patients.EchocardiographyA Pocket Guide to Heart Disease. Content edited by Dr. Scott D. Solomon of Brigham and Women’s Hospital and Harvard Medical School. This app supports viewing normal and abnormal echocardiograms, providing access to 250 annotated images and 189 videos that cover a broad spectrum of cardiac pathology. It allows zooming and panning of echocardiographic images and enables offline search for specific conditions.

Each chapter of this application includes images and videos of the most common cardiovascular diseases, covering: routine examinations, aortic valve disease, mitral valve disease, tricuspid and pulmonary valve diseases, myocardial infarction, cardiomyopathy, aortic and pericardial diseases, atrial diseases, adult congenital heart disease, right ventricular diseases, infective endocarditis, and echocardiography.It can serve as an introductory learning tool for students and as a reference for cardiologists, cardiac surgeons, internists, and other physicians.SecuraFone HealthAn application that notifies doctors, family members, and friends via SMS or email in the event of an unexpected sudden cardiac arrest. It integrates GPS technology with real-time wireless health monitoring sensor technology. The app requires pairing with a wearable sensor placed on the chest or back and is primarily designed for patients at risk of sudden cardiac events, capable of detecting hazardous abnormalities in heart rate, respiration, and skin temperature.

Through this application, users can press and hold the SOS button for three seconds to place a call to a 24/7 monitoring center, 911, or any designated contact for assistance. The application also allows users to view historical health data, including real-time heart rate for up to five minutes, as well as heart rate information from the past hour or the previous 24 hours. This information can be remotely accessed by authorized caregivers, physicians, and other permitted parties.Data collected by sensors can be stored and analyzed directly within the application or transmitted to the cloud for further analysis. In the event of an emergency, the application can send notifications to the patient’s physician and friends. Physicians can configure notification recipients and set emergency thresholds via a secure portal.Instant Heart RateAn app that measures heart rate without the need for any auxiliary measurement devices. It currently has 35 million users. Ranked as the most-downloaded heart rate app in multiple countries, it has been consecutively rated as the world’s best heart rate measurement application and has been used by cardiologists at Stanford University in clinical trials.

To use the app, simply place your finger over the camera. The software will intelligently record your heart rate within ten seconds using its algorithm. By default, if only minor fluctuations are detected, the measurement will stop within 15 seconds. The application also offers convenient data analysis features. After each heart rate measurement, users are prompted to categorize the current data for future analysis. The software automatically determines your expected health status based on age and displays your heart rate curve during the test. Additionally, it provides a function to plot heart rhythm distribution charts, allowing users to choose whether to graph based on the average, maximum, or minimum heart rhythm values.The application is available for iOS, Android, and Windows Phone. The iOS version offers a paid subscription at $4.99 per month or $29.99 per year, which unlocks access to heart rate reports, heart rate trend tracking, high-definition videos, audio content, and more.

Its official website provides reference standard heart rate ranges for different ages and conditions.Heart Failure TrialsA heart disease education application. Its primary content focuses on heart failure trials, providing the latest medical evidence for the research and management of heart failure. The app’s content was designed and authored by Dr. David Majure, who studied at the University of San Francisco and Johns Hopkins Hospital. Dr. Majure is currently a heart failure specialist and a member of the international community dedicated to education in heart failure and transplantation medicine. The application currently mainly includes clinical trials, expert opinions, and clinical guidelines. Topics cover pharmacotherapy and surgical treatment trials.

Stress Check ProA Stress Measurement App. Obtain your stress index by measuring your heart rate within two minutes. Simply place your finger on the camera as prompted by the app. The data in this application is calculated based on recommendations from the European Society of Cardiology (ESC) and the North American Society of Pacing and Electrophysiology (NASPE), ensuring considerable accuracy. Users can use this application to assess their physical condition and monitor changes over time through recorded data.

Key Features:

• Quantify heart rate data;

• Assess stress conditions using Biocom technology;

• Data were estimated based on the recommendations of the European Society of Cardiology (ESC) and the North American Society of Pacing and Electrophysiology (NASPE);

• Records all stress indices;

• Built-in pressure index chart;

The app is available for both iOS and Android. The iOS version is a paid application that offers additional features, including unlimited data storage and access to historical data charts.By detecting abnormal measurements through this software, users can take timely measures to alleviate stress or reduce the risk of heart disease.However, the conclusions provided are for reference only. For further needs, users should seek assistance from professional physicians or psychological therapists.Postscript:Mobile health applications were once considered novelties, but today an increasing number of physicians and patients have integrated them into their daily routines. Nevertheless, mobile health apps have not yet entered the mainstream of healthcare delivery. This outcome is partly attributable to the fact that, for a long time, most mobile health apps faced relatively strict limitations, offered only basic functionalities, and lacked effective regulatory oversight.By simply considering the powerful and advanced features of newly launched mobile health applications, one can recognize their bright development prospects. Although the efficacy of these applications remains to be fully demonstrated, this has not hindered the steady growth of the digital health intervention industry, given its promising potential in both health promotion and the improvement of patient care. Undoubtedly, we will continue to witness the rapid development of mobile health applications and experience the growing importance of mobile devices within the healthcare service sector. In the future, mobile health applications are certain to achieve widespread adoption.Original Authors | Justin P. Levisay, Michael H. Salinger, Ted E. FeldmanCompiled by Zi Junwei, Li YingEditor: Mo Renying