A $2.5 million grant from the American Heart Association will help establish a new wearable health technology research center and national research collaboration, and a supplemental $200K grant will be used to track cardiovascular consequences of COVID-19.

As heart disease and stroke remain the leading causes of death worldwide, a new University of Michigan research initiative aims to investigate how mobile health (mHealth) technology, such as smartwatches and smartphones, can be used to study and improve health behaviors among hypertensive populations.

“Mobile technology has changed nearly all aspects of our lives. There is great hope that mHealth through smartphones and wearables could also transform how we practice clinical care and ultimately help people lead healthier lives. But a lot of the evidence for how this could or should happen remains unknown,” says Brahmajee Nallamothu, MD, MPH, professor of cardiovascular medicine at U-M Medical School and leader of Precision Health’s Data Analytics & IT Workgroup.

The potential to improve hypertensive patient care inspired a multidisciplinary team of researchers to seek funding from the American Health Association (AHA) to establish a new mHealth technology research center at U-M, where studies can be performed to help scientists and doctors understand how to use smartphones and wearables to improve lifestyle behaviors.

“Hypertension can be particularly challenging for people to manage because it requires sustained changes in diet, exercise, and other health behaviors in addition to drug therapies. Being able to track patients’ behaviors through wearables offers the unprecedented opportunity to understand disease trajectories and provide interventions in real-time,” Nallamothu added.

The AHA awarded the U-M team $2.5 million in early April to establish the center, housed within the Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP) and operating in partnership with Precision Health at U-M. Another $4 million will be available to support the center’s research in collaboration with investigators from Cincinnati Children’s Hospital, Johns Hopkins University, and Stanford University School of Medicine, as part of the AHA’s new Strategically Focused Research Network on Health Technologies and Innovation.

Known as the Wearables In Reducing Risk and Enhancing Daily Lifestyle Center — or WIRED-L, for short — the center will build and test mHealth apps that leverage wearables to improve physical activity and nutrition in hypertensive patients, particularly those in underserved communities.

On April 30, the team received an additional $200K in AHA funding for the COVID-19 Health Evaluation & Cardiovascular Complications (CHECC) Study: a supplemental, short-term project that will use the new center’s mHealth technology to track the physiological and cardiovascular consequences of the COVID-19 pandemic.

“We’re excited that the American Heart Association can support projects that are breaking new ground in the health technology field, developing tools that can ultimately make it easier for patients and their providers to work together in achieving longer, healthier lives for all,” said James A. Weyhenmeyer, PhD, chair of the AHA’s peer review team for the selection of new grant recipients, in the AHA press release.

Impact with an equity-first lens

An overarching objective of the AHA’s new research network and the WIRED-L center at U-M is to leverage health technology with an “equity-first lens” to study and address racial and socioeconomic health disparities.

Within the first six months, and in partnership with U-M Flint, WIRED-L researchers will conduct interviews with study cohorts of hypertensive patients from Flint and Ann Arbor, Mich., including African Americans and older adults of lower socioeconomic status, to understand their unique needs and strive to design an mHealth app that can help meet those needs.

“Hypertension is a leading cause of disability and death in the US that disproportionately affects African Americans and older adults. We are committed to promoting health equity through our work,” says Lesli Skolarus, MD, MS, an associate professor of neurology who has worked closely with community partners in Flint on stroke prevention and preparedness for the past 11 years. She is one of the center’s principal investigators and focused on health equity.

“The promise of mHealth will be achieved by partnering with underserved communities from the beginning so that the interventions are created with the community rather than delivered in a community,” says Skolarus.

Innovative interventions 

After conducting participatory research, the WIRED-L team will develop an mHealth app that leverages health behavior change theory and real-time contextual information to create tailored, just-in-time-adaptive-interventions (JITAIs). These interventions deliver notifications to users when they are most likely to be responsive using contextual information obtained from their devices.

“JITAIs are an essential part of what makes our mHealth apps unique and most effective,” says Mark Newman, PhD, MS, professor of information and electrical engineering and computer science at U-M and co-principal investigator of WIRED-L. “Instead of regularly timed notifications to, for instance, take a walk or make healthy dietary choices, JITAIs use contextual data to try to understand when app users are able to engage in healthy behaviors and when a prompt will be most helpful.”

For example, LowSalt4Life, an mHealth app built by WIRED-L Center co-principal investigator, Mike Dorsch, PharmD, MS, helps patients develop better dietary behaviors. Dorsch is an assistant professor in the U-M College of Pharmacy and has studied the LowSalt4Life application in patients with hypertension. LowSalt4Life uses contextual information to make dynamic, tailored suggestions for nutrition when patients are at home, in a restaurant, and at grocery stores to encourage lower salt intake.

A similar mHealth app for encouraging physical activity – HeartSteps – has been designed and tested by Newman and fellow WIRED-L researcher, Pedja Klasjna, PhD, an assistant professor of information.

“People often focus on the ABC’s of cardiovascular disease prevention—aspirin therapy, blood pressure control, and cholesterol—but many forget the D and E: diet and exercise. This grant will allow our research team to focus on two interventions for diet and exercise, the most forgotten and difficult areas of cardiovascular disease prevention,” says Dorsch. “By tailoring the interventions, or JITAIs, of our mHealth apps to the specific needs of hypertensive patients, and eventually other clinical groups, we hope to see long-term changes in patients’ health behaviors.”

Building a reusable platform

The researchers aim to develop the WIRED-L platform to allow distinct clinical areas and patient needs beyond hypertensive care to share an integrated mHealth application with a reusable set of customization options, user interface elements, and participant notification mechanisms.

“Our patients don’t want to download ten different apps from ten different U-M researchers. With a cohort of more than 6,500 mHealth research participants in Precision Health, we have learned that sharing our experiences, technology platforms, and engagement mechanisms across researchers is key to providing our valuable research volunteers with a positive, long-term relationship,” states WIRED-L technology director, Sachin Kheterpal MD, MBA, Precision Health Co-Director and professor of anesthesiology.

To expand its commitment to health technology innovation even further, the team plans to train future leaders in mHealth through an integrated program that focuses on key and complementary areas of clinical trials, data science, and health equity research.

Nallamothu says, “By developing an app that can be easily modified for other clinical purposes and by training future mHealth innovators, we hope our center’s work can have a long-lasting impact in the field of clinical health technology and make a significant difference in the care of our patients.”

WIRED-L is led by center director Brahmajee Nallamothu, MD, MPH. He is joined by co-principal investigators, Lesli Skolarus, MD, Michael Dorsch, PharmD, MS, and Mark Newman, PhD, MS.  Co-investigators for the center include Sachin Kheterpal, MD, MBA,  Bhramar Mukherjee, PhD, MS, MStat, and Karandeep Singh, MD, MMSc.