An international study is using smartphones and wearables to improve digital heart monitoring, with an additional pathway planned for people with pulmonary arterial hypertension (PAH).
Researchers from Imperial College London’s National Heart and Lung Institute have joined UK collaborators and the Stanford University team behind the My Heart Counts app.
The study aims to help users track and improve their heart health. British Heart Foundation funding will also support an app experience tailored to people with pulmonary arterial hypertension, or PAH.
Professor Allan Lawrie, chair of pulmonary vascular diseases at the National Heart and Lung Institute, is the principal investigator for the UK arm of the project.
He joined My Heart Counts in 2019, driven by both professional and personal interest.
“I’ve always been interested in how we can use technology to give people more information about their own health,” Professor Lawrie said.
“I used to take medication to manage high blood pressure and was not especially active. I have always been an early adopter of technology and had a wearable, and the data from my own devices helped inform and empower me to track my own exercise and health.
“Over time, and with medical advice, I now no longer need blood pressure medication.
“This experience validated the power of educating people with their own health data and information.”
Cardiovascular disease is the world’s leading cause of death and accounts for nearly a third of deaths each year.
The researchers said helping people understand how diet, lifestyle and general health affect their individual risk could support efforts to reduce cardiovascular disease.
The app collects information from participants’ smartphones and wearable devices, giving them real-time insights into their heart health and guidance on how to protect it.
With their consent, participants also contribute data that researchers can use to study links between physical activity and cardiovascular health.
This information forms a digital biobank, which is a collection of health data gathered electronically for research rather than a traditional store of physical samples such as blood or tissue.
My Heart Counts was launched by Apple in partnership with Stanford University in 2015. More than 50,000 people have since taken part in the study.
British Heart Foundation funding will support an additional in-app experience that can benefit any user but is tailored to provide extra support to people living with PAH.
PAH is a serious, progressive condition in which blood pressure in the pulmonary arteries becomes too high because small arteries in the lungs narrow and thicken.
This makes the right side of the heart work harder to compensate for reduced blood flow, often causing damage that can eventually lead to heart failure.
The UK team will focus on identifying PAH earlier, improving remote monitoring and encouraging gradual, appropriate increases in physical activity.
“Providing a tailored pathway in the app for people with PAH will give patients the chance to not only monitor their own health more closely, but also to become citizen scientists, whose data will be used to give researchers valuable insights into how lifestyle changes affect the rate of disease progression,” Professor Lawrie said.
The app could also help clinicians treat people with PAH more effectively.
Patients typically see a clinician only two or three times a year and may travel for several hours to attend appointments, which can aggravate their symptoms.
“These appointments only provide snapshots of the patient’s health and wellbeing, which are not always conducive to a precise evaluation of their disease progression, or its impact on everyday life,” Professor Lawrie said.
Access to the daily information collected by My Heart Counts could give clinicians a fuller picture when assessing patients.
The research team is also looking at how artificial intelligence could help manage the large amount of information generated by participants.
Large language models, or LLMs, are AI systems trained on large amounts of data to understand and generate language.
“We see AI as a potential tool to both assist in the management of the large amounts of data that we receive from the study’s participants, which is one of the biggest challenges we face, and providing more personalised motivation back to the participants,” Professor Lawrie said.
However, he said careful controls would be needed before AI-generated messages could be used to communicate with participants.
“Any introduction of LLM-generated messaging must be done within strict guardrails, and it is our responsibility to the app’s users to ensure that the relevant checks and balances are in place.”
After its first decade, the international team plans to develop tailored app experiences for people living with other cardiovascular conditions.
It will begin by working with patient groups to understand their specific needs.
The longer-term aim is to build an international digital biobank that supports participants living with cardiovascular disease and helps others reduce their risk of developing it.
Researchers are also looking at whether information generated through the app could eventually be added to NHS clinical records, in line with the technology goals of the NHS 10-Year Health Plan.
Professor Lawrie said there is “a lot to learn before large-scale data integration can happen”.
One challenge is ensuring that information gathered by devices using different sensors and measurements can be compared accurately and used across different patient populations.
“Bringing together cardiovascular researchers, like myself, with computer scientists, behavioural scientists, and exercise and sport scientists is what has made this project possible.
“I have learnt so much by working alongside people with such a wide range of skillsets. And for our users, I think that our work is giving people the chance to understand the health data that smartphones and wearables provide more deeply, empowering them to use it to make a real difference to their heart health and, as a result, their general wellbeing.”
