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The Future of Cardiovascular Research

Trial shows mobile devices may be useful in future health studies.

Close to 50,000 people participated in a clinical trial that lasted for seven days via a smartphone app where they were asked about their well-being. This trial demonstrated a way to quickly get data from thousands of people at a very low cost. There were no transportation or postage costs, calls, or other things that can significantly raise the cost of doing a survey.

Participants downloaded the MyHeart Counts app to their iPhones and agreed to enter the MyHeart Counts Cardiovascular Health Study during 6 months in 2015. The preliminary findings were published December 14, 2016 in JAMA Cardiology.

Dr. Michael V McConnell (Stanford University, CA), chief investigator, and colleagues concluded that the trial showed “large-scale, real-world assessment of physical activity, fitness, and sleep using mobile devices may be a useful addition to future population-health studies.”

Senior author Dr Euan A Ashley (Stanford University) added that, this is a new way to perform population-health research “that we haven’t yet fully embraced….One of the main findings is just to say that it is feasible and possible to take a large population and do consent entirely on a smartphone app and get the data from the device.”

The study showed that mobile devices can quickly gather huge amounts of physical activity and questionnaire data in real time, which can be identified and shared securely with researchers and participants.

It also identified gaps between perceived and actual physical activity and cardiovascular risk; showed that “most people are not that active for much of the day;” and, as has been observed before, found that frequent transitioning from being inactive to active (e.g., going from sitting to standing to walking) and vice versa was associated with having less self-reported disease, Ashley added.

In this case, the trial succeeded as proof of concept that it works, and can be used for many types of surveys and for some studies.

However, they urge caution when interpreting the findings. In this case, for example, people may not have been keeping their phones on them, so the app would not be accurately reflecting their activity; however, in the future, Fitbits and smartphones could provide more reliable data.

And although the observation period was brief, 91% of enrollees did not complete all 7 days, and only a few completed the 6-minute-walk test at the study end, they pointed out.

Even for this study there was low retention. They announced that it had developed a software framework for clinical research, the “ResearchKit,” and people could join five types of research studies (for asthma, Parkinson’s disease, breast cancer, diabetes, and cardiovascular disease) conducted by five groups of researchers in the US, by downloading free apps.

From March to October 2015, 48,968 adults age 18 and older from all 50 states downloaded the MyHeart Counts app, which was developed by scientists at Stanford University, and consented to enroll in this study. The participants had a median age of 36, and 82% were men.

They were asked to fill in daily activity-level surveys for 7 days, reply to health questionnaires at the beginning and end of the study, and do a 6-minute-walk test at the end.  They were also asked to wear their mobile phones as much as possible to track their movements. Based on time and distance traveled, the phone could determine whether the person was stationary, walking, running, cycling, or driving, and people could add in activity they did when they were not wearing the phone (such as swimming), Ashley explained.

From the 42% of study participants who reported motion data for 2 weekend and 2 week days, four patterns of physical activity emerged: inactive, drivers, weekend warriors, or active.

Weekend warrior or active participants were less likely to report chest pain, type 2 diabetes, heart disease, or joint pain than participants who were mainly inactive or drivers.

In the subset of 1,334 participants who were 40 to 79 years old, 2.7% completed the heart-age questionnaire and provided a lipid value. This showed that four in 10 participants (38%) underestimated their 10-year risk of stroke and MI and six in 10 overestimated this risk.

Previous investigations that established the importance of physical activity for cardiovascular health were based on time-consuming, in-person measurements and participant recall, at a large expense.

They are actively working to recruit segments of the population who were underrepresented, and future trials will give participants more feedback to try to encourage them to stay in the study, Ashley said.

Practice Pearls:

  • New technologies will change the way we do future studies.
  • Using the smartphone capabilities can improve the outcomes for our studies.
  • The future for studies will change forever how we conduct them.

 

McConnell MV, Shcherbina A, Pavlovic A, et al. Feasibility of obtaining measures of lifestyle from a smartphone app: The MyHeart Counts Cardiovascular Health Study. JAMA Cardiol 2016; DOI:10.1001 /jamacardio.2016.4395. Article.

Spring B, Pfammatter A, Alshurafa N. First steps into the brave new transdiscipline of mobile health. JAMA Cardiol 2016; DOI:10.1001/jamacardio.2016.4440. Editorial