Research projects aim to develop breakthrough digital technology for improving heart and brain health

A special issue of the Journal of the American Heart Association spotlights the progress of ongoing projects aimed at developing breakthrough digital technology solutions to improve heart and brain health on a global scale. The projects were funded in 2020 by more than $14 million in scientific grants through the American Heart Association's Strategically Focused Health Technologies and Innovation Research Network.

Improving health care for all will require technology-based solutions, however, many people avoid technology solutions for a variety of reasons including lack of trust, relevance or ease of use, according to American Heart Association volunteer and author of the issue's Editor's Page James A. Weyhenmeyer, Ph.D.

"These gaps presented an opportunity for the research community to validate or create scalable, engaging health-tech solutions up and down the health continuum with the potential to improve health for people across the socioeconomic spectrum," said Weyhenmeyer, former vice president for research and economic development at Auburn University and chair of the Association's peer review team for the selection of the new grant recipients.

"This Strategically Focused Research Network provides the American Heart Association with a mechanism to enhance the understanding of the ability for digital technology to improve health metrics and lower health care costs by engaging patients in self-care and self-prevention."

This issue represents the first published collection of work from the Network's funding, which went to collaborative and multidisciplinary research teams at Boston University, Cincinnati Children's Hospital, Johns Hopkins University, Stanford University School of Medicine and University of Michigan.

These initial findings are promising. They represent an important step toward our goal -; the validation of scalable digital solutions for cardiovascular disease. Research projects underway and featured in this special journal issue look at creating digital solutions and making them evidence-based, accessible and user-friendly -; whether health care professionals or patients use them."

James A. Weyhenmeyer, Ph.D.

Highlights of some of the research include:

• Quantifying Induced Nystagmus Using a Smartphone Eye Tracking Application (EyePhone) - Ali Saber Tehrani, M.D., et al.; The Johns Hopkins University School of Medicine

This research team developed "EyePhone," a smartphone application to help diagnose stroke in people with nonspecific symptoms by detecting a type of rapid, uncontrollable eye movement, called nystagmus, that is associated with stroke. The technology performed well with similar accuracy to currently used standard devices, like video-oculography goggles.

• Acceptability of a Text Message Based Mobile Health Intervention to Promote Physical Activity in Cardiac Rehabilitation Enrollees: A Qualitative Sub-Study of Participant Perspectives - Namratha Atluri, M.D., et al.; University of Michigan

Recognizing the challenges associated with recruitment and retention of patients for cardiac rehabilitation programs, this team looked at ways to improve communications. People undergoing cardiac rehabilitation found the mobile text message-based intervention simple and motivating. However, researchers noted the need for more personalization and inclusion of clinical and social support to increase the text messages' usefulness.

• Comparing Cognitive Tests and Smartphone-Based Assessment in Two U.S. Community-Based Cohorts - Ileana De Anda-Duran, M.D., M.P.H. et al.; Tulane University School of Public Health and Tropical Medicine

This team compared traditional written cognitive testing to smartphone-based cognitive assessments to help identify dementia. The smartphone app performed similarly to traditional neuropsychological tests, without the invasive nature and expense associated with traditional tests. This supports the use of smartphone-based assessments in cognitive screening for Alzheimer's disease and related dementias across diverse populations.

• Deployment of Point-of-care Echocardiography to Improve Cardiac Diagnostic Access among American Indians - Sarah de Loizaga, M.D., et al.; Cincinnati Children's Hospital

Researchers developed a point-of-care approach to echocardiography to improve access to the cardiac screening for American Indian populations in remote settings. When they studied the approach's use in primary care clinics in the Indian Health Service, researchers found that clinicians unfamiliar with echocardiography could be successfully trained to provide point-of-care screening echocardiograms. Almost 6% of American Indians screened in the study had a new, clinically significant abnormal finding.

• Utilizing Artificial Intelligence for Rheumatic Heart Disease Detection by Echocardiography: Focus on Mitral Regurgitation - Kelsey Brown, M.D., et al. Children's National Hospital, Washington, DC

Echocardiography is the gold standard for detecting early rheumatic heart disease, and using this technology in children with latent rheumatic heart disease before they have symptoms is an opportunity to prevent disease progression. Researchers studied using machine learning to detect and analyze mitral regurgitation to detect rheumatic heart disease on standard portable echocardiograms. They found the artificial intelligence (AI) approach has the potential to detect rheumatic heart disease as accurately as expert cardiologists, which suggests it is a promising tool to increase access to echocardiography screening by working with non-physician healthcare workers in larger populations.

• Resource Requirements for Participant Enrollment from a University Health System and a Federally Qualified Health Center Network In a Mobile Health Study: The myBPmyLife Trial - Lesli Skolarus, M.D., M.S., et al.; Northwestern University

To better understand the resources needed to overcome barriers for enrolling racially and economically diverse participants to research trials (in this case a study looking at a mobile health intervention for lowering high blood pressure), researchers set out to recruit people from a university clinic versus a Federally Qualified Health Center (FQHC). They found recruiting and enrolling FQHC patients required more telephone calls to potential participants to achieve similar enrollment rates, suggesting that a tailored approach to recruitment, including text messages and additional staffing, may help overcome some barriers.

• Patient Representativeness with Virtual Enrollment in the Patient-Reported Outcome Measurement in Heart Failure Clinic (PRO-HF) Trial - Alexander Sandhu, M.D., M.S., et al.; Stanford University

People with heart failure who are elderly, female, Black or Hispanic are historically underrepresented in clinical trials. To overcome one of the known barriers to trial participation, which is in-person recruitment, researchers studied virtual enrollment (via email, text message and phone calls). Among their findings, all non-white patients enrolled in greater proportions by phone than by email. They concluded that virtual clinical trials enable efficient enrollment of large populations, however, using multiple recruitment avenues is key for achieving diverse representation in clinical trials.

Other papers in this spotlight issue include:

• A Physical Activity and Diet Just-in-time Adaptive Intervention to Reduce Blood Pressure: The myBPmyLife Study Rationale and Design - Michael Dorsch Pharm.D., M.S., et al.; University of Michigan
• Design and Feasibility Analysis of a Smartphone-based Digital Cognitive Assessment Study in the Framingham Heart Study - Preeti Sunderaraman, Ph.D., et al; Boston University Chobanian & Avedisian School of Medicine School of Medicine
• Digital Health Interventions for Heart Failure Management in Underserved Rural Areas of the United States: A Systematic Review of Randomized Trials - Zahra Azizi, M.D., M.Sc., et al.; Stanford University
• User-centered Design to Develop Automated SMS Messaging for Patient Support of Rheumatic Heart Disease Secondary Antibiotic Prophylaxis – Ndate Fall, Ph.D., et al.; Cincinnati Children's Hospital Medical Center
• Design and implementation of an electronic health record integrated hypertension management application - Mario Funes Hernandez, M.D., et al.; Stanford University School of Medicine)
• Rationale and Design of the Impact of a Mobile Technology Enabled Corrie Cardiac Rehabilitation Program on Functional Status and Cardiovascular Health (mTECH-Rehab) Randomized Controlled Trial - Lena Mathews M.D., M.H.S., et al.; Johns Hopkins University School of Medicine
• Shifting from Active to Passive Monitoring of Alzheimer's Disease: The State of the Research - Zachary Popp, B.S., M.P.H., et al.; Boston University
• The Challenge of Optimizing Medical Therapy in Heart Failure: Unlocking the Potential of Digital Health and Patient Engagement - Zahra Azizi, M.D., M.Sc., et al.; Stanford University
• Advancing Cardiovascular Health Equity Globally through Digital Technologies – Yvonne Commodore-Mensah, Ph.D., M.H.S., R.N., et al.; Johns Hopkins University
• Cardiac Rehabilitation Enabled with Health Technology: Innovative Models of Care Delivery and Policy to Enhance Health Equity - Francoise Marvel, M.D., et al.; Johns Hopkins University

"A final marker of success for these programs will be their ability to sustain and scale the solutions beyond the projects' funding periods," Weyhenmeyer said. "While it is still relatively early to assess just how much new intellectual property and how many new commercial products will come from this Strategically Focused Research Network, at least one group -; Johns Hopkins University -; has already created a digital start-up and currently is in its first round of capitalization,"

The American Heart Association has now invested more than $263 million to establish a total of 15 Strategically Focused Research Networks, providing an opportunity to address key strategic issues that were identified by the Association's volunteer Board of Directors. Networks have already been studying cardiovascular disease and stroke prevention; hypertension; disparities in cardiovascular disease and stroke; women's health; heart failure; obesity; vascular disease; atrial fibrillation; arrhythmias/sudden cardiac death; cardiometabolic health – including Type 2 diabetes; health technology; cardio-oncology; and diversity in clinical trials. Each network centers around the scientific knowledge and knowledge gaps, prevention, diagnosis and treatment of the key research topic. Four to six research centers make up each network, bringing together investigators with expertise in basic, clinical and population/behavioral health science to find new ways to diagnose, treat and prevent heart disease and stroke.

Authors' disclosures and funding sources for all studies in the special issue are listed in the individual manuscripts.