Statement Highlights:
- Mobile health technologies, such as wearable devices, mobile health apps and telehealth or remote coaching, have shown potential to help people start and maintain heart-healthy behaviors, such as eating a healthy diet, increasing physical activity, quitting smoking, monitoring sleep and more.
- People impacted by adverse social drivers of health, such as lower socioeconomic status, insufficient health care access, housing instability and/or low-income communities, may face barriers accessing cost-effective health technologies.
- Addressing barriers, such as digital and health literacy, internet access, affordability, language barriers, cultural relevance and privacy concerns, is critical to ensuring equitable access to health care technologies and improving health outcomes for people at high risk of developing cardiovascular disease.
DALLAS, April 7, 2025 — The use of technology-based health solutions, such as fitness trackers, smartwatches and mobile health apps, has shown potential to help people improve management of their cardiovascular health. However, people affected by adverse social drivers of health face barriers in accessing health care including these new technologies, and interventions are needed to broaden access and improve cardiovascular health for all, according to a new scientific statement published today in the American Heart Association’s flagship, peer-reviewed journal Circulation.
The new scientific statement, “The Role of Technology in Promoting Heart Healthy Behavior Change to Increase Equity in Optimal Cardiovascular Health,” examines how technology-enabled, mobile devices and interventions (wearable devices, apps and telehealth or remote coaching) can help improve cardiovascular health behaviors. It also highlights barriers that need to be addressed to make these technologies more accessible to more people, particularly those affected by adverse social drivers of health.
Social drivers of health that negatively impact cardiovascular and overall health outcomes include lower socioeconomic status, insufficient health care access, housing instability, underserved or under-resourced neighborhood environments, and psychosocial stressors. These factors directly determine access to resources and opportunities for healthy lifestyle and behaviors.
According to the Association’s 2025 Heart Disease and Stroke statistics, nearly 130 million adults in the U.S. have some form of cardiovascular disease (CVD), and CVD is the number one cause of death in the U.S. and worldwide. More than 70% of U.S. adults have overweight or obesity, over half have Type 2 diabetes or prediabetes and nearly half have hypertension, all known risk factors for CVD.
“Achieving optimal cardiovascular health is challenging in the general population. However, certain communities, including people with lower socioeconomic status, individuals with disabilities, people from under-resourced racial and ethnic groups, and those living in rural or underserved or low-income communities, are disproportionately affected by adverse social drivers of health that contribute to gaps in cardiovascular health, risk factors and health outcomes,” said Mariell Jessup, M.D., FAHA, chief science and medical officer of the American Heart Association. “In this technology-driven and -dependent era, it is especially critical to develop and identify interventions to support populations most at risk for developing cardiovascular disease and to increase equitable access to resources that promote health including mobile health technologies.”
Leveraging Mobile Technology to Support Healthy Behaviors
The scientific statement writing group focused on digital solutions that target heart healthy behaviors aligned with the American Heart Association’s Life's Essential 8 measures for improving and maintaining heart health, such as eating healthy, managing healthy body weight, being more physically active, quitting tobacco and getting healthy sleep. The Life’s Essential 8 metrics are incorporated into the Association’s My Life Check tool to calculate a cardiovascular health score ranging from 0-100, with higher scores indicating better cardiovascular health. As detailed in a 2022 study, only 1 in 5 people in the U.S. has optimal heart health (defined as scores of 80 or above). Recent research indicates that populations most affected by adverse social drivers of health have lower cardiovascular health scores (or fewer healthy behaviors) as measured by Life’s Essential 8 compared to people with higher socioeconomic status or those not affected by adverse social drivers.
The scientific statement highlights several health behaviors that can be positively impacted through the use of mobile health technologies:
- Physical activity: Studies have shown that technologies aimed at increasing physical activity, such as activity trackers, text messages or mobile apps with goal-setting and self-monitoring, were effective for adults with higher socioeconomic status, yet in contrast not among people with lower socioeconomic status. Since some neighborhood environments may not be conducive or safe to engage in outdoor physical activity, the scientific statement suggests the tailored development of health behavior technologies to better meet the needs of people in under-resourced communities.
- Dietary intake: Using technology such as mobile health apps to track food intake has been shown to improve short-term dietary intake, weight loss and cardiometabolic disease including Type 2 diabetes. However, there is limited evidence of long-term engagement and effectiveness for technology-based nutrition programs. Multifaceted nutrition interventions, including those that pair technology with other clinic-based programs, like nutrition education or counseling, appear to be more effective than technology-only programs. Lower-income, non-Hispanic Black and Hispanic households experience higher rates of food and nutrition insecurity, which pose additional barriers to adopting healthy eating habits.
- Tobacco cessation: Although the overall prevalence of cigarette smoking has decreased in the U.S., data show that among all racial and ethnic groups, people with less than a high school education are more likely to be current smokers compared to adults who have completed college. Smoking cessation programs that combine technology with pharmacotherapy (such as nicotine replacement products or medications to help people quit smoking), have been shown to be more effective than pharmacotherapy alone. One digital health program using a gamification approach, including motivational text messaging, challenge quizzes, goal setting, an app for cravings management and reward points for participation, integrated with nicotine replacement therapy, resulted in greater six-month abstinence in the treatment group compared with the control group. Future research is needed to assess the outcomes from technology-based interventions – whether they are effective in reducing tobacco use in both the short- and long-term.
- Sleep: Significant gaps in sleep health exist for people in under-resourced racial and ethnic groups and low-income communities due to various factors, such as neighborhood noise and suboptimal sleep environments. Although the use of wearable devices and apps to improve sleep is high across all sociodemographic groups, technology-based, sleep health interventions are not equally effective among people in all racial and ethnic groups. Many wearable devices rely on light absorption to measure heart rate and blood oxygen levels. Because light absorption varies by skin tone, some devices may not be able to measure some health information accurately in people with darker skin tones.
Barriers to Equitable Access
“Digital health technology holds great promise for supporting people with tools to improve their cardiovascular health. The Association’s Center for Health Technology and Innovation initiative fosters the core tenets of this scientific statement: It is critical to identify and address barriers to access and develop health technologies that are scalable, effective and affordable, ensuring that people receive the best possible care regardless of their location, socioeconomic status or other involuntary factors,” Jessup said.
The scientific statement identifies several barriers limiting the access and use of health technologies among people in underserved or under-resourced communities. For example, the cost of smartwatches, fitness trackers and mobile app subscriptions may be a barrier for people with limited financial resources. In addition, challenges to successfully using technology-based interventions include low digital literacy and/or no access or unreliable internet access. People may also have privacy concerns about how their personal health information will be used.
Language barriers and cultural relevance are also factors to consider when developing and testing digital health technologies for people in different racial and ethnic groups. Interventions that use personalized messaging and culturally tailored content have been more successful in achieving higher participant engagement and more behavioral changes. The statement authors emphasize that more research including people in diverse populations is needed to help identify effective and scalable digital health interventions to promote cardiovascular health behaviors and increase equitable access to care.
This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Council on Lifestyle and Cardiometabolic Health; the Council on Cardiovascular and Stroke Nursing; the Council on Peripheral Vascular Disease; and the Council on Quality of Care and Outcomes Research. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.
The scientific statement writing group members/co-authors include Chair Tiffany M. Powell-Wiley, M.D., M.P.H., FAHA; Vice-Chair Gerald J. Jerome, Ph.D., FAHA; LaPrincess C. Brewer, M.D., M.P.H., FAHA; Lora E. Burke, Ph.D., M.P.H., FAHA; Rosalba Hernandez, Ph.D., FAHA; Jill Landsbaugh Kaar, Ph.D., FAHA; Maura Kepper, Ph.D.; Christopher E. Kline, Ph.D.; Keila N. Lopez, M.D., M.P.H.; Shamarial Roberson, D.P.H.; and Colleen K. Spees, Ph.D., R.D., FAHA. Authors’ disclosures are listed in the manuscript.
The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content. Overall financial information is available here.