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Fall 2026

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Digital Health Interventions for Cardiovascular Disease: A Behavioral Medicine Perspective

Joyline Chepkorir, PhD, MSc, BSN, RN1; Biswadeep Dhar, PhD, M.Ed, MS2; Azuka Amaka Ngige, MBBS, MPH3; Katie Edwards, PhD4; MinKyoung Song, PhD, RN, FNP, FAHA5; Abbey N. Collins, PhD6; Hailey Miller, PhD, RN1 - Cardiovascular Disease SIG

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality ​​worldwide, accounting for one-third of global deaths.​1​ The rapid evolution of digital health technologies has transformed CVD prevention and management by expanding access to supporting self-management and enabling personalized health beh​​avior change.​(2,3)​ Digital health interventions (DHIs) range from low-intensity approaches that provide information or reminders (e.g., text messaging and web-based educational programs) to interactive technologies that support self-monitoring (e.g., mobile applications and wearable devices), and to higher-intensity interventions that facilitate ongoing clinical management and decision-making (e.g., remote monitoring systems and telemedicine).​(2,4)​ 

Digital Health Interventions for CVD Prevention and Managemen​​​​t 

​​​Evidence supporting DHIs for CVD continues to expand, demonstrating benefits for health behavior change, self-management support, and care coordination. A recent systematic review and meta-analysis of 52 randomized controlled trials (n=15,430) found that DHIs significantly reduced systolic blood pressure (mean difference: -3.74 mmHg), LDL cholesterol (-7.00 mg/dL), and body mass index (-0.86 kg/m²) compared to usual care, with hybrid interventions combining digital tools and human support showing the lar​​​​gest effects.​2​​​ However, the effectiveness of DHIs depends largely on their integration of behavioral medicine principles, such as goal setting, self-monitoring, feedback, motivational strategies, and social support, rather than technology features ​​​​alone​​.​5​ Behavioral medicine provides the foundation for addressing the complex lifestyle and psychosocial determinants of CVD, including diet, physical activity, stress, depression, anxiety, and soci​​​​al isolatio​​n. By embedding theory-driven, evidence-based behavioral approaches into digital platforms, DHIs can enhance engagement, personalization, adherence, and ultimately cardiovascular outcomes.​6​​​ 

Emerging Innovations

Emerging innovations in artificial intelligence, machine learning, ​​remote monitoring, and ​​adaptive ​​interventions are​​​​ ​​advancing personalized cardiovascula​​​​r care. ​Just-In-Time Adaptive Interventions (JITAIs) tailor the timing, intensity, and content of support in response to an individual's changing behaviors, needs, and context to promote sustained behavior change.​7​ Applied in the context of CVD care to address physical inactivity, diet and medication adherence, JITAIs can be optimized via microrandomized ​trials​ (MRTs) to maximize user engagement while minimizing user ​​​​​​fatigue. Additionally, co-design approaches and hybrid models combining digital tools alongside human support ensure scalable user-centered technological interventions.​​​​ ​For example, the REHEARSE-AF trial demonstrated that smartphone-based ECG screening combined with clinical follow-up significantly increased atrial fibrillation detection compared to​​​​ routine car​​e,​8​ while the TIM-HF2 study showed that remote patient monitoring integrated with telemedical center support reduced mortality and hospitalizations among heart failure p​​​​atients​​.​​​9​ These advances underscore the potential for technology-supported, human-centered interventions to enhance cardiovascular disease prevention and management.

​​​​I​​mplementation Challe​​nges​​

Despite significant progress, persistent implementation challenges limit widespread adoption of DHIs. Barriers include digital literacy gaps, inequitable access, fragmented technology platforms, privacy concerns, limited interoperability, inconsistent reimbursement models, and difficulties maintaining long-term user​​​​​​ engagemen​​t.​10​ Successful implementation requires provider training, integration into clinical workflows, stakeholder engagement (e.g., patient and family members), and equity-focused design to ensure digital innovations reduce rather than widen health disparities.

Recommendations for Researchers, Clinicians, and Policymakers

Future efforts should focus on developing equitable, scalable, sustainable, and​ personalized​ DHIs that complement traditional cardiovascu​​lar care.​(11,12)​ Priorities include rigorous evaluation of long-term outcomes, implementation strategies that address technological and social barriers, investment in digital literacy and infrastructure, interoperability standards, ​​sustainable funding and reimbursement models for DHI delivery, ​​and policies supporting sustainable del​​ivery.​(10,11)​ Collaborative efforts among researchers, clinicians, technology developers, policymakers, ​funders ​and communities will be essential to maximize the impact of digital health while advancing cardiovascular health equity.

Affiliations:

  1. School of Nursing, Johns Hopkins University  
  2. Department of Health Sciences, James Madison University  
  3. School of Medicine, Johns Hopkins University  
  4. Psychiatry and Behavioral Sciences, Stanford University 
  5. School of Nursing, Oregon Health ​&​ Science University 
  6. Department of Psychology, North Carolina State University 

References: 

  1. Di Cesare M, Perel P, Taylor S, et al. The Heart of the World. Glob Heart. 2024;19(1). doi:10.5334/gh.1288 
  2. Widmer RJ, Collins NM, Collins CS, West CP, Lerman LO, Lerman A. Digital Health Interventions for the Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis. Mayo Clin Proc. 2015;90(4):469-480. doi:10.1016/j.mayocp.2014.12.026 
  3. Park LG, Kariuki JK, Hendriks JM, Gallagher R, Burke LE. A review and promise of digital health technologies to promote global cardiovascular health. European Journal of Cardiovascular Nursing. 2026;25(1):31-39. doi:10.1093/eurjcn/zvaf242 
  4. Gupta K, Junaid V, Qureshi MA, et al. Health Data Sciences and Cardiovascular Diseases in South Asia: Innovations and Challenges in Digital Health. Curr Atheroscler Rep. 2024;26(11):639-648. doi:10.1007/s11883-024-01233-3 
  5. Mair JL, Salamanca-Sanabria A, Augsburger M, et al. Effective Behavior Change Techniques in Digital Health Interventions for the Prevention or Management of Noncommunicable Diseases: An Umbrella Review. Annals of Behavioral Medicine. 2023;57(10):817-835. doi:10.1093/abm/kaad041 
  6. Chen X, Zheng H, Han Y, et al. Best evidence summary of digital health interventions for self-management in patients with coronary artery disease. Front Public Health. 2026;14. doi:10.3389/fpubh.2026.1833261 
  7. Golbus JR, Dempsey W, Jackson EA, Nallamothu BK, Klasnja P. Microrandomized Trial Design for Evaluating Just-in-Time Adaptive Interventions Through Mobile Health Technologies for Cardiovascular Disease. Circ Cardiovasc Qual Outcomes. 2021;14(2). doi:10.1161/CIRCOUTCOMES.120.006760 
  8. Halcox JPJ, Wareham K, Cardew A, et al. Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation. Circulation. 2017;136(19):1784-1794. doi:10.1161/CIRCULATIONAHA.117.030583 
  9. Sandhu AT, Zheng J, Kalwani NM, et al. Impact of Patient-Reported Outcome Measurement in Heart Failure Clinic on Clinician Health Status Assessment and Patient Experience: A Substudy of the PRO-HF Trial. Circ Heart Fail. 2023;16(2). doi:10.1161/CIRCHEARTFAILURE.122.010280 
  10. Badr J, Motulsky A, Denis JL. Digital health technologies and inequalities: A scoping review of potential impacts and policy recommendations. Health Policy (New York). 2024;146:105122. doi:10.1016/j.healthpol.2024.105122 
  11. Park LG, Kariuki JK, Hendriks JM, Gallagher R, Burke LE. A review and promise of digital health technologies to promote global cardiovascular health. European Journal of Cardiovascular Nursing. 2026;25(1):31-39. doi:10.1093/eurjcn/zvaf242 
  12. Burg MM, Stewart JC, Gaffey AE, Särnholm J, Vela AM, Kovacs RJ. Behavioral Medicine Can Tackle Cardiovascular Disease Risk and Burden: A Call for New Priorities. Policy Insights Behav Brain Sci. 2025;12(1):28-36. doi:10.1177/23727322241306071