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Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
Published on: September 26, 2018
Reciprocal Relationship Between Cardiovascular Risk and Attainment of Blood Pressure and Cholesterol Targets in Users
Fabian Starnecker1,2, Johannes Krefting3,4, Leon Nissen5
1Department of Cardiovascular Diseases, School of Medicine and Health, German Heart Centre Munich, TUM University Hospital, Technical University of Munich, Lazarettstr. 36, 80636, Munich, Germany. fabian.starnecker@tum.de.
Insights
Mobile health app users interested in lowering cardiovascular disease risk often do not meet blood pressure and cholesterol targets. Higher-risk individuals showed poorer control despite more frequent treatment, indicating underutilization of effective therapies.
Area of Science:
- Cardiology
- Digital Health
- Public Health
Background:
- Mobile health (mHealth) apps are increasingly used by individuals seeking to reduce cardiovascular disease (CVD) risk.
- However, the extent to which these users achieve guideline-recommended blood pressure (BP) and cholesterol treatment targets remains unclear.
Purpose of the Study:
- To assess the attainment of BP and cholesterol treatment goals in mHealth app users across different CVD risk strata.
- To identify potential gaps in treatment and control among users of the HerzFit application.
Main Methods:
- 1,230 users of the German mHealth app HerzFit without pre-existing CVD were categorized into low-to-moderate, high, and very high CVD risk groups.
- Risk factor control was evaluated based on the use of antihypertensive and cholesterol-lowering medications and achievement of guideline-recommended BP and lipid targets.
Main Results:
- Higher CVD risk groups (high and very high) reported more frequent antihypertensive and cholesterol-lowering treatment compared to the low-to-moderate risk group.
- Despite increased treatment frequency, BP control rates were significantly lower in high-risk (65.4%) and very high-risk (48.2%) individuals versus low-risk (79.0%).
- Cholesterol control rates were also substantially poorer in high-risk (12.8%) and very high-risk (11.0%) individuals compared to low-risk (30.4%) users. Use of advanced therapies like high-intensity statins was low.
Conclusions:
- Individuals at high and very high CVD risk using mHealth apps achieve suboptimal BP and cholesterol control, even when receiving more frequent treatment.
- There is a notable underutilization of effective medications and therapies in high-risk populations, highlighting a critical need for improved management strategies.
- The findings underscore the importance of optimizing treatment protocols for high-risk individuals who actively engage with digital health tools for cardiovascular health management.
Introduction:
Voluntary users of mobile health (mHealth) apps indicate an interest in lowering cardiovascular disease (CVD) risk. It is unclear by which extent blood pressure (BP) or cholesterol treatment targets are achieved in such individuals.
Aim:
This study aimed to evaluate the attainment of guideline-recommended BP and cholesterol targets across different CVD risk categories among mHealth app users.
Methods:
We grouped users of the publicly available German mHealth app HerzFit, who donated their data for scientific evaluations, into individuals with "low-to-moderate risk", "high risk" and "very high risk" of future CVD events. Risk factor control was assessed according to presence of antihypertensive or cholesterol-lowering treatment and achievement of guideline-recommended BP and cholesterol treatment targets.
Results:
Individual data sets from 1,230 HerzFit users without CVD who provided BP and cholesterol levels were used for the analysis. 471 users were categorized as low (-to-moderate) risk (38.3%), 595 as high risk (48.4%), and 164 as very high risk (13.3%). Antihypertensive treatment was reported in 36.9% of low-risk individuals, 58.2% of high-risk individuals (p<0.001 vs. low), and 59.1% of very high-risk individuals (p<0.001 vs. low). Cholesterol-lowering therapy was present in 29.3%, 41.7% (p<0.001 vs. low), and 40.9% (p=0.01 vs. low), respectively. Use of high-intensity statins (9%) and statin-ezetimibe combinations (5%) was low across all risk groups. BP control was achieved in 79.0% of low-risk individuals, 65.4% of high-risk individuals (P<0.001 vs. low) and 48.2% of very high-risk individuals (p<0.001 vs. low). Respective numbers for cholesterol control were 30.4%, 12.8% (p<0.001 vs. low) and 11.0% (p<0.001 vs. low).
Conclusions:
Despite being treated more frequently, individuals at high or very-high risk achieved poorer BP and cholesterol control compared to individuals at low-to-moderate risk. Thus, effective medications are particularly underutilized in individuals at high risk for future CVD events, despite an expressed interest in management of cardiovascular health.
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