We live in an era of incredible advancements in modern medicine and healthcare. Many conditions with life-altering or life-threatening consequences a few decades ago, are now treated safely and effectively. There is much to be impressed with and inspired about. But there is much more work to do, especially when it comes to the number one killer in the U.S.: cardiovascular disease.
Across the country, cardiovascular disease is responsible for one death every 34 seconds and costs the United States about $219 billion each year. Yet 80% of cardiovascular disease is preventable, caused by risk factors like high blood pressure and high cholesterol for which we have effective treatments. And so, why doesn’t the medical community focus on patients with these risk factors before they suffer severe and potentially fatal consequences like heart attack and stroke?
In theory, this makes sense. But in practice, this approach has challenges that cannot be solved entirely by the traditional tools used by doctors.
An Ounce of Prevention is Worth a Pound Ton of Cure
As I mentioned earlier, in the last several decades we have seen significant advances in medications, surgeries, and diagnostics for cardiovascular conditions. I first learned how to use these while completing my training in cardiology at New York - Presbyterian Hospital/Columbia University Medical Center, one of the best hospitals in the country for cardiology. While there, I treated extremely sick cardiac patients with heart attacks, congestive heart failure, dangerous arrhythmias, and other problems that needed aggressive treatment just to survive another day.
Treating these patients was immensely fulfilling. But I couldn't help but notice that these critical events were often preceded by years of missed opportunities - chances to treat high blood pressure, high cholesterol, and other known risk factors for heart disease. Naturally, I asked the same question that all of you would: Why don’t we allocate more attention and resources on preventing cardiovascular disease, instead of on trying — and in many cases, ultimately failing — to treat it?
A Taste of My Own Medicine: When the Doctor Becomes the Patient
Towards the end of my cardiology training, I decided to take some of the tests that I ask my patients to complete. The first one was an exercise stress test, which involves walking and then running on a treadmill while connected to a cardiac monitor. This test looks for evidence that parts of the heart muscle are not getting enough blood due to blockages in the heart’s arteries. I passed the test without a hitch.
Next on the roster of diagnostics was a coronary calcium score. This is a specialized X-ray that measures calcium-containing plaque in the arteries that feed the heart muscle. Even if no significant blockage is present, the coronary calcium score can detect the precursors to those blockages. A perfect coronary calcium score is zero, indicating that no calcium is present. My score was higher than zero.
I was surprised, and even a little shocked by this result. At the time, I was a 34-year-old with normal blood pressure and healthy body weight, and who didn’t smoke or drink alcohol in excess. Granted, I hadn’t checked my cholesterol in some time. But when I did, it was in normal range. Was it due to my diet and exercise habits, which I knew could be better? Was it my family history of heart problems?
Regardless of the cause (or causes), I vowed to double down on my own heart health, changing my diet and exercising more frequently. I even started taking medication that improves cholesterol levels and lowers heart risk. But like a New Year’s Resolution, my new and improved lifestyle was short-lived, and pushed aside by the stressors and pressures of everyday life.
Making Smarter, Better Decisions About Our Health
My story here is hardly the exception — rather, it is more like the rule. Every day, we all make decisions that impact our heart health: from taking our prescription medications, to monitoring our blood pressure, to eating better, to exercising more. Consistently making the right decisions is hard! And so, the questions that we need to answer are:
- How can we make it easier for people to make the decisions that bolster their heart health?
- How can we avoid the decades of missed opportunities that invariably come before a heart attack?
In my view, the answer lies in technology, which is why I have always focused on using technology to improve patient outcomes. That is also why at the beginning of this year, I joined the Hello Heart team as SVP of Medical Affairs.
Using Technology to Prevent and Manage Heart Disease
At Hello Heart, we don’t just use technology to improve the delivery of care. The technology, itself, is the care. The digital coaching available through the app includes:
- Cholesterol, blood pressure, and medication tracking
- AI-driven actionable lifestyle insights; and
- Shareable physician reports
It is all delivered to patients in a personalized, easy, and fun-to-use platform that is highly engaging. In effect, the Hello Heart app could be there with my patients all year round, reinforcing healthy habits, encouraging them to follow their care plans, and directing them back to me at the right times.
This digital coaching is also associated with clinically-relevant improvements. In a study published in the Journal of the American Medical Association Network Open in 2021, researchers looked at over 28,000 participants who used the Hello Heart app. For patients with stage two hypertension (defined as blood pressure above 140/90 mm Hg), 84% reduced their blood pressure and sustained this improvement up to three years. Those in this group that remained in the program for more than three years saw an average reduction in systolic blood pressure of 21 mm Hg. These numbers are striking! And the digital coaching benefits for hypertension could also apply to other areas of heart health, such as elevated levels of cholesterol.
Final Thoughts
Cardiovascular disease is potentially catastrophic and deadly, and places an enormous financial burden on an already-strained healthcare system — including stakeholders such as self-insured employers who enable more than 181 million members to access healthcare. We need to use every tool in our arsenal to deal with this. I feel certain that leveraging digital therapeutics like Hello Heart to complement conventional treatments will enable more people to identify, learn about, and track cardiovascular disease well in advance of experiencing a catastrophic heart event. I am delighted, proud, and enthusiastic to be part of the Hello Heart team that is committed to making this happen!
1. Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open. 2021;4(10):e2127008, https://doi.org/10.1001/jamanetworkopen.2021.27008. Accessed October 19, 2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. See additional important study limitations in the publication. This study showed that 108 participants with baseline blood pressure over 140/90 who had been enrolled in the program for 3 years and had application activity during weeks 148-163 were able to reduce their blood pressure by 21 mmHg using the Hello Heart program.) (2) Livongo Health, Inc. Form S-1 Registration Statement. https:/www.sec.gov/Archives/edgar/data/1639225/000119312519185159/d731249ds1.htm. Published June 28, 2019. Accessed October 19, 2022. (In a pilot study that lasted six weeks, individuals starting with a blood pressure of greater than 140/90 mmHg, on average, had a 10 mmHG reduction.) NOTE: This comparison is not based on a head-to-head study, and the difference in results may be due in part to different study protocols.
2. Validation Institute. 2021 Validation Report (Valid Through October 2022). https://validationinstitute.com/wp-content/uploads/2021/10/Hello_Heart-Savings-2021- Final.pdf. Published October 2021. Accessed October 19, 2022. (This analysis was commissioned by Hello Heart, which provided a summary report of self-fundedemployer client medical claims data for 203 Hello Heart users and 200 non-users from 2017-2020. Findings have not been subjected to peer review.)
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