Digital Health Technologies for Risk Factor Management and Secondary Prevention After Stroke: A Systematic Review and...

Digital health interventions are increasingly used in medicine to manage chronic conditions. However, the effectiveness, feasibility, and consistency of these interventions in poststroke risk factor management and secondary prevention remain uncertain. We conducted a systematic review and meta-analysis to evaluate the effect of digital health-supported interventions on vascular risk factor control among stroke survivors. We systematically searched MEDLINE, Embase, and Cochrane CENTRAL from inception through September 2025 for randomized, single-arm, and observational studies evaluating digital health interventions, defined as mobile health applications, wearable devices, or combined platforms, among adults with ischemic stroke, hemorrhagic stroke, or transient ischemic attack. Outcomes of interest included systolic and diastolic blood pressure, lipid levels, weight, physical activity, medication adherence, quality of life, and clinical events. Random-effects meta-analyses were performed for outcomes reported by ≥ 3 studies. Feasibility outcomes, including recruitment, retention, adherence, and usability were synthesized qualitatively.

Twenty-nine studies encompassing 8,389 participants were included. Digital health interventions were associated with modest reductions in systolic blood pressure compared with control conditions, including usual care and minimal-intervention comparators (pooled between-group mean difference, -5.8 mm Hg; 95% CI -9.9 to -1.6). However, prediction intervals crossed the null value, and between-study heterogeneity was substantial. No consistent effects were observed for diastolic blood pressure, lipid levels, or weight. Reporting of physical activity, medication adherence, and quality-of-life outcomes was heterogeneous, precluding quantitative pooling, although most studies reported favorable trends. Overall feasibility was high, with an aggregate dropout rate of 3.6% (95% CI 3.2%-4.0%) and high user acceptability across studies. Most trials enrolled participants with mild functional impairment and short follow-up durations (median ≈3 months). Few studies were powered to assess recurrent stroke or mortality.

Digital health-supported interventions for secondary stroke prevention seem feasible and acceptable, with evidence of modest short-term improvements in blood pressure. However, clinical effectiveness across other vascular risk factors remains inconsistent. In addition, substantial heterogeneity, short follow-up, and limited high-quality evidence constrain causal inference and preclude conclusions regarding sustained clinical benefit.