Smartphone-Based Digital Health Interventions: A Comprehensive Systematic Review of Efficacy for Cardiovascular and Cerebrovascular Outcomes.

Digital health interventions (DHIs) have the potential to transform the management of cardiovascular disease (CVD) and cerebrovascular disease (CeVD) by addressing their risk factors, including hypertension, diabetes, obesity, dyslipidemia, and physical inactivity. Despite this potential, there remains a need for a comprehensive understanding of their clinical efficacy, implementation challenges, and usability features to integrate them effectively into healthcare frameworks. This systematic review aims to evaluate the clinical efficacy, functionalities, and barriers associated with smartphone-based DHIs for managing CVD and CeVD. The protocol was first registered in PROSPERO, with the registration number CRD42024570866. A comprehensive search was conducted across PubMed, ScienceDirect, Web of Science, and DOAJ. The study selection adhered to the PICO framework, and methodological quality was assessed using Cochrane's RoB 2 tool for randomized controlled trials (RCTs) and ROBINS-I for non-RCTs. A total of 35 studies were included, primarily consisting of 2-arm RCTs (57%). The studies were largely conducted in high-income countries, with limited representation from low- and middle-income regions. Significant improvements in physical activity were observed, while clinical outcomes like blood pressure, glucose levels, lipid profiles, and body weight showed mixed results, with several changes not reaching statistical significance. This review underscores the potential of DHIs in managing CVD and CeVD risk factors. However, the variability in clinical outcomes highlights the need for tailored, personalized interventions, longer study durations, and strategies to improve retention and engagement for optimizing efficacy and scalability.