Digital health RCT interventions for cardiovascular disease risk reduction: a systematic review and meta-analysis

Problem

Cardiovascular disease (CVD) continues to be a significant cause of mortality in the UK. Evaluation of modern digital health technologies and their efficacy in reducing risk factors is a priority for health systems worldwide. This systematic review and meta-analysis examined whether RCTs for digital health interventions (DHIs) can reduce CVD risk, and prevent rehospitalisation of individuals with CVD.

Approach

We undertook a systematic review and meta-analysis, based on Cochrane guidelines, using a PICO framework and PRISMA guidelines for digital health RCT interventions in reducing CVD risk. PubMed, Medline, Web of Science, the Cochrane systematic review and Cochrane trials database were systematically searched, and 450 abstracts of relevant articles screened, prior to selection of full text articles for review. CVD risk reduction was the primary outcome, and secondary outcomes considered included factors such as rehospitalisation of individuals with CVD, blood pressure reduction, lipid optimisation, weight loss/BMI reduction, smoking cessation, and CVD risk scores such as QRISK3. Evidence from 01/01/2010 onwards was considered – due to the technological advances of DHI since this time period. Risk of bias was assessed by the Cochrane Risk of Bias 2 Tool (RoB-2), and STATA 16 used for meta-analysis.

Findings

Preliminary results indicate DHIs are effective in reducing CVD risk, compared with usual care. Trials evaluated to date suggest that DHIs are effective in reducing weight and BMI, and increasing smoking cessation rates.

Consequences

DHIs offer opportunities to reduce CVD risk as the technology and resultant uptake increases over the next decade. However barriers to effective DHI implementation include lack of access to technology and inequalities in digital literacy.