Stroke cases are on the rise worldwide, particularly in developing countries, and primary prevention measures are crucial to stem this trend. Thanks to the advancement of digital technology, including smartphones, there is a growing opportunity to enhance individual-level primary stroke prevention.
The American Heart Association recently conducted a systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to shed light on the current knowledge, challenges, and opportunities of digital health in primary stroke prevention.
Despite robust evidence for the benefits of primary prevention, participation and access are low, especially in low- to middle-income countries.
Digital technology and prevention services
Digital tech, like smartphones, is now a big part of our lives and could make it easier and cheaper for people to get access to primary stroke and heart disease prevention services.
Mobile health technologies have enormous potential to enhance lifestyle changes and prevent cardiovascular diseases. However, several barriers must be addressed to fully realize this promising strategy.
Studies have revealed gaps in individual primary stroke prevention, such as lack of awareness, false perception of low risk, inadequate treatment for high blood pressure and cholesterol, failure to recognize critical stroke risk factors, ineffective prediction algorithms, and ineffective screening of stroke-risk patients.
Effective primary stroke prevention needs to focus on all levels of cardiovascular risk, not just high-risk individuals, and must include awareness of risk factors and early life interventions. To be effective, preventative measures must motivate individuals to reduce their exposure to risk factors and maintain a low-risk level throughout their lives.
Digital health technologies offer a promising solution to enhance primary stroke/cardiovascular prevention strategies. They should be integrated into healthcare systems for use by both medical professionals and the general public.
Early prevention through healthy diet and behaviour has been shown to be effective in reducing the prevalence of metabolic syndrome and improving risk factors later in life.
The potential of mobile apps
There is limited evidence on the use of digital technologies for stroke/cardiovascular prevention, but technologies such as smartwatches, mobile apps, and activity trackers have shown potential. There is an expanding body of evidence on the acceptability, feasibility, and efficacy of digital technologies for managing stroke risk factors and preventing strokes and cardiovascular diseases.
These interventions have been shown to reduce weight, BMI, blood pressure, cholesterol, and glucose levels. They can also be supported by other methods such as coaching, telephone calls, peer groups, or lifestyle programs. The use of digital health technologies for primary stroke prevention holds promise.
It has the potential to be accessible, educational, and affordable for both health professionals and the general public.
Available tools
A search for digital technologies to prevent strokes revealed 2,369 options, but only 20 met the American Heart Association’s standards.
Most of the apps (18 out of 20) simply informed users of their risk of stroke/heart disease, but only three met the criteria for being effective stroke prevention tools. One app was tested in a study and proved to be useful, easy to use, and acceptable. Only two of the apps were designed to prevent both first and second strokes and used a motivational approach for all users, not just high-risk individuals.
In 2019, the World Health Organization released guidelines for digital health, stating also: “To achieve the goal of reducing stroke burden, digital technologies for primary stroke prevention have to be proven clinically effective, scalable to reach a global population, and are affordable.”
Digital tools for primary stroke prevention offer several advantages, including widespread availability and affordability and increasing use by the general public.
However, there are limitations to the current digital tools, such as a lack of motivation and engagement, lack of scientifically accurate and valid tools for primary stroke prevention, and poor quality among some tools.
In addition, there are challenges for digital tools to be used by elderly people and those in low socio-economic groups. There are also ethical and legal concerns for privacy protection, and limited regulation by health care authorities.
Conclusions
In simpler terms, digital health tools are becoming a popular and effective way to prevent strokes and cardiovascular diseases.
With widespread availability and usage, these tools can improve communication and relationships between patients and doctors, increase productivity, and make preventative measures more accessible.
But there are also challenges to overcome. To fully realize the benefits of digital health, doctors need to be educated on how to use these tools effectively, and regulations need to be improved.
