Current strategies to manage the prevalence of CVD include identifying high-risk individuals and practicing early interventions to reduce their risk of developing a disease, as well as limiting the progression in individuals who already have cardiovascular disease. Despite the availability of highly-effective treatments, there is still an urgent need to tackle CVD. Digital therapeutic (DTx) interventions hold promise to further improve the quality and experience of cardiovascular care, and The Sidebar sets out to understand how and why this is possible.
Cardiovascular Disease: Why Medication Adherence Remains a Problem
Cardiovascular disease costs the US healthcare system around $363.4 billion each year. Lifestyle changes that include increased movement and eating a balanced diet can reduce the risk of CVD significantly. Despite the importance of lifestyle changes and medication, experts report non-adherence in around 60% of patients with cardiovascular disease. Furthermore, up to 50% of individuals who are initially adherent, stop taking their drugs within six to twelve months of commencing treatment.
But why are the numbers so high? Pharmacologic and nonpharmacologic factors can negatively impact treatment adherence and include:
- Lack of understanding of the disease and the implications of skipping medicine. Patients who do not have a good understanding of their disease can have difficulty adhering to treatment. This is particularly problematic in patients who are asymptomatic and may fail to perceive the benefits of treatment or the potential risks associated with progressive disease.
- Lack of motivation. Lack of motivation is a key contributor to poor adherence and may be caused by insufficient understanding of the disease, fear of the side effects, or a failure to perceive the benefits of specific interventions.
- Complex drug regimens. Regimens made up of multiple drugs and multiple dosing are commonly associated with poor adherence. For example, when researchers retrospectively studied patients with hypertension over a two-year period, they found that adherence was better among those with fixed-dose combinations rather than single agent pills.
- Poor access to healthcare. The cost of healthcare coupled with the distance from healthcare facilities can further contribute to poor adherence. Individuals with poor socioeconomic backgrounds are predominantly impacted by this barrier.
Cardiovascular Disease: Can DTx Make a Difference?
The Digital Therapeutics Alliance defines DTx as a “new category of medicine that delivers medical interventions directly to patients using evidence-based, clinically evaluated software to treat, manage, and prevent a broad spectrum of diseases and disorders.” Because DTx solutions are promoted as a therapeutic intervention, they are subject to rigorous regulation by the U.S. Food and Drug Administration (FDA) and must be clinically validated to provide real world positive health outcomes.
The goal of DTx is to encourage positive lifestyle and behavior change and promote positive long-term health through the disease-specific programs. While basic wellness applications target general health, DTx solutions target a person’s specific medical condition such as heart failure, hypertension, coronary artery disease, etc. Depending on a person’s treatment plan, the solution might manage a specific diet or exercise routine, sleep, stress, and medication reminders. To date, the DTx arena has shown massive growth potential as Insider intelligence predicts a $56 billion global opportunity.
Research shows that DTx solutions can support self-management for people living with other health conditions, thus the potential for self-management of cardiovascular risk factors (e.g., movement, nutrition, mindfulness, etc.) is vast. Within the CVD space, digital therapeutics have the potential to have a significant impact in the following ways:
1. To facilitate behavior change
Health education requires time that clinical practices often cannot afford. With healthcare providers on a time crunch, it’s becoming increasingly difficult to include effective health education as part of consultations. DTx solutions can provide quality health education as and when the patient needs it. Education is delivered in bite-sized, digestible formats which patients can access at times convenient to them.
Traditional treatment paths encourage lifestyle changes based on the premise that people will do the right thing when they know what to do. However, this is not always the case. For example, one study revealed that although participants were aware of the importance of healthy eating, they consistently told researchers that they struggled to follow a healthy diet.
Patient education is crucial, but alone, it is not enough.
Digital solutions can support behavior change by educating patients and using daily challenges and reminders to help users maintain positive momentum. The HERB-DH1 pivotal trial demonstrates the potential of a DTx solution in this context, as patients using a solution reported lower blood pressure in the absence of antihypertensives compared to standard lifestyle changes alone.