Despite the benefits of digital healthcare, there are signs of a digital divide along the demographic, socioeconomic and regional lines that influence healthcare outcomes5. This digital divide could potentially amplify healthcare disparities, but can be managed by adopting a health equity framework and thoughtful interventions to bridge gaps in digital care.
The social determinants of health, including cardiovascular health, have been well established. Across the world, there are regional differences in the age-adjusted prevalence of heart disease, access to specialty care and mortality rates, as well as socioeconomic differences in cardiovascular risk factors, the incidence of cardiovascular disease, quality of hospital care and outcomes. There are sex and race disparities in preventive care, prescription of guideline-directed medical therapy, coronary revascularization, surgical intervention and referral for advanced healthcare services across cardiovascular conditions. There are knowledge gaps created by the under-representation of women, minority ethnic groups and large geographic regions in clinical trials. These disparities were seen during the COVID-19 pandemic, which disproportionately affected those with cardiovascular diseases and placed the greatest burden of death and severe illness on minoritized individuals and those facing socioeconomic deprivation.
Digital health technologies include mobile apps, wearable or implanted sensors, gamification, electronic health records (EHRs), artificial intelligence (AI) algorithms and telemedicine; each have the potential to improve healthcare, particularly among those who have faced historic disparities (Fig. 1). In healthcare systems, wearable and remote monitoring technologies can facilitate disease surveillance and screening for risk factors, allowing early diagnosis of disease and optimization of evidence-based therapies. For clinicians, decision support within EHRs can guide the initiation and titration of therapies, digital messaging within records can enhance communication between team members and AI analysis of diagnostic imaging can shorten interpretation time for clinicians. Clinicians can consult each other and deliver services virtually using telehealth tools. For patients, digital health interventions can enhance self-monitoring of health, self-care and self-management of disease, engagement in healthcare decisions, remote participation in interventions such as cardiac rehabilitation and adherence to medical therapies. For research, digital health technology can allow the remote recruitment, obtaining of patient consent (understanding of and agreement to trial procedures) and execution of clinical trials in a manner that reaches under-represented groups and regions and enhances representation in health system data. Digital technology has the potential to expand the reach of healthcare and research to patients who many not wish to use, or have access to, traditional brick-and-mortar clinics.
