Researchers have found that the majority (>80%) of high-risk participants using Hello Heart reduced blood pressure and total cholesterol across key social determinants of health. The findings, which were published in Circulation and presented at the American Heart Association 2023 Scientific Sessions, highlight the potential use of this technology to support health equity.
Social determinants of health (SDOH) are environmental factors that have an impact on health, outcomes, and quality of life. Examples include language, income, access to nearby healthcare facilities, race, ethnicity, and neighborhood characteristics.
SDOH factors can manifest in inequalities in cardiovascular disease (CVD) and its risk factors, resulting in inequitable CVD-related morbidity and mortality. Despite the potentially adverse impact on a large number of people, limited data is available on the effects of SDOH on CVD risk factor control among users of digital health technology.
To address this knowledge gap, Hello Heart conducted a study on the impact of SDOH factors on blood pressure (BP) and total cholesterol (TC) control in participants of Hello Heart’s smartphone-based cardiovascular risk self-management program with AI-based digital coaching.
The study authors include Edo Paz, MD, SVP Medical Affairs at Hello Heart; Vedant Pargaonkar, MD, Clinical Research Scientist at the Stanford University School of Medicine; and Brian Roach, MS, Data Analytics Team Lead at Hello Heart.
About the study
The researchers assessed data from 27,553 Hello Heart users and matched them with the Agency for Healthcare Research and Quality’s 2020 SDOH database by ZIP code. Changes in systolic BP (SBP), diastolic BP (DBP) and TC were evaluated from baseline to six months follow up.
Four SDOH factors – primary language, median household income, distance to healthcare facility and urban/rural residential type – were used to predict changes in BP and TC via regression models. The models were adjusted for age, gender and baseline BP/TC.
Researchers selected these specific social determinants to further complement research in the American Heart Association’s Hypertension journal that previously found equitable outcomes for Hello Heart users across gender, race, age, and preferred language.
What researchers found
Across the pool of participants, an overall reduction in BP and TC was observed. Of those participants with baseline stage 2 hypertension, 80.5% reduced SBP at follow up, and 82.9% of those with baseline high TC (≥240 mg/dL) reduced TC at follow up.
No difference in BP or TC change was found based on primary language, distance to healthcare facility, and urban or rural residential type.
Median household income was associated with change in SBP and DBP, but not TC. This association was not clinically significant, as each $62,535 increase in the median household income was associated with an additional 1 mm Hg in BP reduction.
Digital health’s potential to close gaps
Over six months, the majority (>80%) of Hello Heart users with increased cardiovascular risk were able to reduce their BP and TC regardless of their language, income, residence, and distance to healthcare facilities. These results further highlight the potential use of Hello Heart’s technology to bridge health inequity gaps in prevention and control of CVD risk.
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.)
