Digital Health Interventions for Atherosclerotic Cardiovascular Disease: The Current Impact and Future Directions for Prevention and Management

Abstract

Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality worldwide, including in Japan, where the aging population intensifies its impact. This review evaluated the potential impact of digital healthcare on the prevention and management of ASCVD, covering both primary and secondary prevention strategies. Digital health tools, such as risk assessment applications remote monitoring, lifestyle modification support, and remote rehabilitation, have shown promise in improving patient engagement, adherence, and outcomes. However, while digital health interventions demonstrate significant benefits, challenges persist, including interoperability issues, privacy concerns, low digital literacy among older adults, and limited health insurance coverage for digital interventions. Through an analysis of recent advancements and case studies, this review demonstrates the need for user-centered design, enhanced regulatory frameworks, and expanded insurance support to facilitate the effective integration of digital health in ASCVD care. Furthermore, emerging technologies such as personalized healthcare modules offer promising directions for tailored and impactful care. Addressing these barriers is critical to unleashing the full potential of digital healthcare to reduce the burden of ASCVD and enhance patient outcomes.

Introduction

Atherosclerotic cardiovascular disease (ASCVD) is characterized by the buildup of atherosclerotic plaques in the arterial walls, leading to cardiovascular events, such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease¹⁾. It is a leading cause of morbidity and mortality worldwide, particularly among individuals with diabetes and other risk factors. ASCVD is also a significant health concern in Japan, affecting various segments of the population²⁾. The review provides an overview of the prevalence, risk factors, and economic burden of ASCVD in Japan based on recent research findings. Based on a retrospective study using the Japan Medical Data Center (JMDC) database conducted between 2006 and 2011, the prevalence of ASCVD in Japan was 1,869 per 100,000, and total 5-year costs were estimated at $8.2 billion among employed individuals, with the prevalence specifically estimated during 2008-2009 ³⁾. ASCVD, including myocardial infarction (MI) and stroke, results in significant premature mortality in Japan. Estimating the years of life lost (YLL) has been highlighted as a key measure of the total population burden for diseases⁴⁾. The total YLL for ASCVD was estimated to be 2,703,711 in 2017, with an average of 11.99 person-YLL (PYLL) for MI and 9.39 PYLL for stroke⁵⁾. The prevention and management of ASCVD are critical issues both domestically and internationally⁶⁾. In Japan, the risk of ASCVD is expected to increase further with the progression of its societal aging.

As of 2023, the global smartphone penetration rate is estimated to have reached 69%, with some countries and regions showing penetration rates exceeding 100%⁷⁾. The mobile health (mHealth) sector is rapidly expanding, with over 100,000 health applications (apps) available across various app stores⁸⁾. These apps offer various functionalities, from tracking physical activity and diet to providing personalized health recommendations. Most of these apps focus on weight management, physical activity, and diet tracking, but the COVID-19 pandemic accelerated the development of health and fitness apps⁹⁾.

With the rapid advancement of digital technologies, such as smartphones and wearable devices, the potential utility of digital healthcare for the prevention and management of ASCVD has garnered attention in recent years. This review summarizes the latest insights into digital healthcare for ASCVD from the perspectives of primary and secondary prevention.

Primary Prevention of ASCVD with Digital Healthcare

Primary prevention of ASCVD aims to prevent the onset of the disease through risk factor management and lifestyle improvements before cardiovascular events occur. Risk factors for ASCVD include lifestyle-related diseases, such as hypertension, dyslipidemia, and diabetes, as well as lifestyle habits, such as smoking, lack of exercise, and an unbalanced diet^{10, 11)}. Practical applications of digital healthcare apps in primary prevention include risk screening and assessment, support for lifestyle improvement, and patient education. These potential applications are further outlined in the subsequent sections.

Risk Assessment and Screening

The development of risk assessment tools and screening apps for ASCVD has significantly advanced with the integration of digital technology, and several reports have highlighted the advancements. There are specific ASCVD risk assessment apps designed for healthcare professionals as well as apps aimed at the general public for ASCVD risk assessment and preventive information.

In the systematic review conducted by Fabian et al., the quality and functionality of mHealth apps used by healthcare professionals for cardiovascular risk assessments were evaluated¹²⁾. By inputting information such as the patient’s age, gender, blood pressure, and cholesterol levels, these apps assess ASCVD risk and provide preventive information. Many of these apps are free, with some being accessible to the general public. The review included 18 apps, with the European Society of Cardiology (ESC) CVD Risk Calculation by the ESC and ASCVD Risk Estimator Plus by the American Heart Association scoring the highest in quality and functionality assessments¹²⁾.

Several apps have been developed for the general public, as introduced below (Table 1). According to the Healthy Heart Nutritional Approach (DAHNA), a mobile app was developed based on the expertise of Romanian cardiologists, nutritionists, and diabetes specialists to support heart health. It was designed for screening and personalized management of ASCVD risk. It combines the 2021 ESC SCORE2/SCORE2-OP scores^13-15) and the AHA Framingham score¹⁶⁾ to assess ASCVD risk. It is not limited to healthy individuals and includes features of patients with diabetes, chronic kidney disease, or existing ASCVD. Based on the ASCVD risk score, the DAHNA offers personalized health menus, including elements of the Mediterranean diet, periodic follow-ups, and various educational resources. The app also provides notifications, reminders, and rewards to encourage healthy lifestyle changes. HerzFit, developed in Germany, integrates multiple internationally recommended risk scores (e.g. Framingham¹⁶⁾, SCORE2 ^{14, 15)}) to provide a comprehensive CVD risk assessment for a broad age range recalibrated for specific populations¹⁷⁾. This tool enables individuals to self-assess their cardiovascular risk, and it has been widely adopted in public campaigns. HerzFit’s “Heart Age” feature estimates an individual’s cardiovascular health by comparing their risk factors to the average levels for different ages. The implementation of the “heart age” concept has shown the potential to enhance risk awareness and motivate healthier behaviors.

Table 1.mHealth Apps for ASCVD prevention

Country	App name	Developer Company	icon	primary prevention	secondary prevention	Fee	Website
Romania	DAHNA	CARDIOSCIENCE srl		yes	yes	Free (some features may require payment)	https://dahnapp.com/?lang=en
Germany	HerzFit	Deutsche Herzstiftung eV		yes	yes	Free (some features may require payment)	https://herzstiftung.de/service-und-aktuelles/podcasts/herzfit-gesund-mit-smartphone
Japan	Cholerisukun	Japan Atherosclerosis Society		yes	no	Free	https://www.j-athero.org/jp/general/ge_tool/
Japan	Kencom	DeSC Healthcare,Inc.		yes	no	Free (limited to specific insurance policyholders or residents of certain municipalities)	https://kencom.jp/login

In Japan, the atherosclerotic disease onset prediction app Cholerisukun has been developed by the Japan Atherosclerosis Society for primary prevention¹⁸⁾. This app utilizes an ASCVD risk scoring system modified based on the 2022 Hisayama Study to assess the ASCVD onset risk¹⁹⁾. Its simple user interface aims to facilitate communication between doctors and patients, allowing individuals to evaluate their cardiovascular disease risk and assist in ASCVD prevention. Kencom, developed by Japan’s DeSC Healthcare, is a digital health platform that provides personalized health management services through features such as visualization of health checkup results, daily step counting, and customized health information delivery. The platform integrate with health insurance providers to offer comprehensive health monitoring and lifestyle improvement support²⁰⁾. These tools provide accessible, user-friendly, and effective methods for individuals to monitor and manage their cardiovascular health, potentially reducing the burden on healthcare systems and improving patient outcomes.

Lifestyle Improvement Support and Patient Education/Awareness

Assessing risks and encouraging lifestyle improvements are essential for improving patient outcomes. In a prospective, single-center randomized intervention trial conducted in Turkey, patients with a high cardiovascular risk (ASCVD risk score ≥ 7.5%) were evaluated for changes in their ASCVD risk score following mobile technology-based lifestyle interventions²¹⁾. Participants randomly assigned to the intervention group received a set of smart devices and entered data, such as diet and blood pressure, daily into the Mediup app. These data were managed on a central server with automated messages prompting outpatient visits for non-compliant patients when necessary. As a result, the mobile technology-based intervention significantly reduced ASCVD risk scores in high-risk patients over a one-year period. Recent clinical trials have demonstrated the effectiveness of digital health interventions for the management of hypertension. A randomized controlled trial in China evaluated the Blood Pressure Assistant mHealth app, showing significant improvements in blood pressure after six months. The intervention group achieved a mean reduction of 25.83 mmHg in systolic blood pressure and 14.28 mmHg in diastolic blood pressure, with a blood pressure control rate of 90.1%. In comparison, the control group showed reductions of 21.83 mmHg and 8.87 mmHg in systolic and diastolic blood pressure, respectively, with a control rate of 65.2%. The intervention group also demonstrated significant improvements in hypertension knowledge and lifestyle behaviors, including medication adherence, low salt intake, and physical exercise²²⁾. In another study, a WeChat-based multimodal digital management model was evaluated in 175 patients newly diagnosed with mild to moderate hypertension. This comprehensive intervention incorporated educational tools, including text messages and videos, enabling patients to record their blood pressure and lifestyle data while receiving feedback from healthcare providers. After 6 months, the intervention group demonstrated significant blood pressure reductions (systolic, 25.55 mmHg and diastolic, 12.45 mmHg) compared to controls, with 72.7% achieving blood pressure control below 140/90 mmHg. Furthermore, the patients reported improvements in their anxiety, depression, and sleep quality²³⁾.

These findings suggest that digital health interventions can effectively bridge the gap between physician guidance and patient implementation, ultimately leading to improved disease management and improved health outcomes.

Secondary Prevention for ASCVD with Digital Healthcare

Secondary prevention of ASCVD aims to prevent recurrence and complications in patients who have already experienced cardiovascular events or are at high risk. Digital technology contributes to secondary prevention by improving medication adherence, preventing hospital readmission, supporting remote rehabilitation, and enhancing support for self-monitoring/management.

Medication Adherence Enhancement

Secondary prevention, aimed at preventing recurrent cardiovascular events, often requires long-term medication. However, adherence to these medications remains frequently suboptimal²⁴⁾. To address this challenge, digital healthcare interventions, such as telemedicine and mobile phone-based messaging, have demonstrated effectiveness in improving medication adherence^{25, 26)}. Apps employing behavior change techniques, such as reminders and educational content, show association with better medication adherence²⁷⁾, although the specific behavior change techniques contributing to efficacy remain incompletely understood^{28, 29)}.

Several studies have demonstrated that text messaging through mobile phones can improve medication adherence in patients with ASCVD. A systematic review and meta-analysis reported in 2018 included 27 studies conducted between 1950 and 2016 ³⁰⁾. Due to the study period, interventions via applications were limited because of the study period, with most interventions utilizing text messaging through mobile phones. Compared to the usual care group, the mHealth group showed improvements in medication adherence, achievement of blood pressure and exercise targets, dietary and exercise awareness, and reduced anxiety. However, no significant differences were observed in smoking cessation, achievement of target low-density lipoprotein (LDL) cholesterol levels, or hospital readmission.

A systematic review and meta-analysis conducted in 2020 examined the effectiveness of mobile phone interventions in cardiovascular disease management. Among the included studies, six randomized control trials (RCTs) focused on patients with ischemic heart disease, showing that app-based messages and short message services improved medication adherence³¹⁾.

Subsequently, a 2021 systematic review and meta-analysis was conducted to evaluate the impact of mHealth apps on medication adherence and health-related outcomes in patients with CVD³²⁾. This systematic review included 16 RCTs, 6 of which were included in the meta-analysis of medication-adherence outcomes. Nine of the RCTs demonstrated significant improvement in medication adherence in the intervention group. While the meta-analysis of the six above-mentioned trials confirmed a significant positive effect of app interventions on medication adherence, there was no statistically significant effect related to the duration of use³²⁾. The variation in results could be attributed to diverse mHealth app functionalities as well as differences in intervention methods, content, and delivery, , including the involvement of specialized teams. Furthermore, half of the included trials were small-scale pilot or feasibility studies, which resulted in limited evidence. In addition, large-scale studies are needed to determine the effectiveness of mHealth apps in improving medication adherence in patients with CVD.

Preventing Hospital Readmission

The transition from hospital to home is a critical period for patients with cardiac diseases, such as acute coronary syndrome (ACS) and heart failure (HF)³³⁾. High readmission rates during this period highlight the need for effective post-discharge care models. Smartphone-based care models, such as TeleClinical Care (TCC), have been developed to support these patients through telemonitoring and educational interventions³⁴⁾.

In a pioneering mHealth randomized trial targeting patients with ACS or HF, TCC was provided to the intervention group along with usual care. The participants used Bluetooth-enabled devices to transmit data to their smartphones and a central server, with the medical team receiving notifications when preset thresholds were exceeded. Although no significant difference was found in 30-day readmission rates, the intervention group showed significant improvements over the 6-month follow-up period, including reduced overall readmissions, enhanced medication adherence, and increased rehabilitation completion rates³⁵⁾.

Remote Rehabilitation

Despite strong evidence that cardiac rehabilitation (CR) reduces mortality and morbidity in patients with CVD, CR utilization rates remain low^36-38). This underutilization is attributed to patient-related factors (resistance to group rehabilitation, a lack of individualized exercise programs, work-related barriers, and decreased motivation) and system-related factors (shortage of specialized facilities and geographic accessibility). Remote rehabilitation systems have emerged as a promising solution for the secondary prevention of ASCVD.

A systematic review and meta-analysis demonstrated that telemedicine interventions significantly improved risk factors, including the body mass index (BMI) and blood pressure³⁹⁾. The study also showed improvements in physical activity and exercise metrics, such as the maximal oxygen uptake (peak VO₂) and 6-minute walk test scores³⁹⁾. Another review confirmed that telerehabilitation programs were as effective as traditional center-based cardiac rehabilitation programs in managing cardiac risk factors while providing additional benefits in increasing physical activity and functional capacity through self-monitoring and motivational feedback⁴⁰⁾.

The Care Assessment Platform of Cardiac Rehabilitation (CAP-CR) in Australia demonstrated superior completion rates (80%) compared to traditional center-based cardiac rehabilitation (47%)⁴¹⁾. The platform utilized smartphones for health and exercise monitoring, providing motivational support through text messages and educational videos. The participants received comprehensive monitoring equipment, including a smartphone with a health diary and activity monitoring apps, blood pressure monitoring, and weight scale. Participants received weekly 15-minute phone consultations with personalized feedback, achieving equivalent health outcomes to traditional rehabilitation in areas such as 6-minute walk test results, dietary habits, and depression reduction. Similarly, the HeartHab app, developed in Belgium, covers various modules for cardiac rehabilitation, including risk factor monitoring (blood pressure, weight, glucose, cholesterol), medication management, physical activity training, video-based education, and symptom monitoring⁴²⁾. In the crossover study of 32 CAD patients, 75% (21/28) found the app motivating and felt encouraged to achieve their rehabilitation targets. The study demonstrated significant improvements in clinical outcomes, including a mean decrease in glycated hemoglobin of 1.5 mg/dL and a mean increase in high-density lipoprotein (HDL) cholesterol of 0.61 mg/dL⁴²⁾.

Despite these proven benefits, however, the implementation of telerehabilitation in routine clinical practice has several challenges. A systematic review found that while participants highly valued cardiac telerehabilitation interventions, technical challenges, particularly reliable Internet connectivity, could impact feasibility⁴³⁾. Future research should focus on long-term outcomes, cost-effectiveness, and healthcare providers’ perspectives to ensure sustainable integration into clinical practice.

Self-Management Support

Self-management support in secondary prevention using digital healthcare for ASCVD involves various strategies and tools designed to help patients effectively manage their condition and reduce the risk of further cardiovascular events.

The Corrie Health Digital Platform (Corrie), developed at Johns Hopkins, represents a comprehensive digital health intervention designed for patients recovering from acute myocardial infarction⁴⁴⁾. Corrie includes a cardiology Apple CareKit smartphone application paired with an Apple Watch and iHealth Bluetooth-enabled blood pressure cuff. The platform targets the self-management of cardiac medications, self-tracking of vital signs, education on cardiovascular disease through articles and animated videos, and care coordination, including outpatient follow-up appointments. In Phase 2 of the myocardial infarction, Combined-device, Recovery Enhancement (MiCORE) study, the feasibility of deploying the Corrie in an acute-care setting was established among 60 patients with acute myocardial infarction⁴⁴⁾.

A single-blinded randomized clinical trial conducted in Canada evaluated patients with multiple chronic diseases from primary care clinics in small urban and rural areas⁴⁵⁾. The study compared an internet-based self-management and symptom monitoring program for patients with two or more chronic diseases with usual care on hospitalizations. Participants routinely completed symptom reports, including disease-specific symptoms, biometric data (e.g. weight, blood pressure, and blood glucose), and free-text comments. The intervention reduced hospitalizations and improved self-management and social support⁴⁵⁾.

Similarly, a pilot study in China evaluated a mobile app-based self-management digital therapeutic (DTx) platform for patients with coronary heart disease. The system integrated three portals (physician, patient, and health manager) on a cloud platform featuring modules for discharge management, home monitoring, and follow-up care. Over 12 months, the intervention demonstrated significant improvements in medication adherence, blood pressure control, and lipid profile management compared with conventional care⁴⁶⁾.

Challenges in Digital Healthcare

Digital healthcare shows significant promise in improving ASCVD outcomes, although several challenges hinder its large-scale implementation. Key implementation barriers include technical integration issues, such as the lack of shared platforms and connectivity between systems, and data privacy and security concerns, particularly with big data and cloud computing applications. In addition, engagement of stakeholders, namely healthcare professionals and patients, remains inadequate, as development often prioritizes technical capabilities over healthcare professionals’ and patients’ needs^{47, 48)}. The Dutch Coronary ARtery disease: Risk estimations and Interventions for prevention and EaRly detection (CARRIER) consortium proposed the following four solutions to address these challenges⁴⁹⁾: (1) the development of an eHealth solution that will include design thinking and co-creation with relevant stakeholders; (2) a modeling approach for two clinical prediction models (CPMs) to identify people at risk of developing ASCVD and to guide interventions; (3) the description of a federated data infrastructure to train the CPMs and provide eHealth solutions using relevant data; and (4) the discussion of an ethical and legal framework for responsible data handling in health care⁴⁹⁾.

Digital Health Literacy and Accessibility

Introducing digital health tools presents unique challenges for older adults and patients with ASCVD who have limited technological literacy. Many older adults require assistance with digital skills, including seeking, understanding, and using health information from electronic sources^{50, 51)}. Studies have shown that older adults generally demonstrate lower levels of digital literacy than younger adults, complicated by physical limitations, poor vision, a lack of confidence, and limited exposure to technology^{52, 53)}. Furthermore, concerns about data security, a lack of personalization, and limited awareness of the value of digital health tools represent additional barriers⁵²⁾. Digital health literacy interventions have demonstrated positive outcomes. A notable example is programs like Project Wire Up in Singapore, which provided one-on-one digital literacy training and significantly improved digital literacy among older adults of low socioeconomic status^{52, 54)}. The program’s success was attributed to its personalized approach, including home-based training sessions and the provision of necessary devices and Internet connectivity⁵²⁾. Research indicates that developing user-friendly digital health tools tailored to older adults’ needs and involving users in the design process is essential for successful adoption and implementation^{51, 54)}.

Digital Therapeutics: Global Implementation and Insurance Coverage

The integration of digital health tools into healthcare systems varies by country but is expanding rapidly under the framework of “digital therapeutics,” particularly in the United States and Europe. Once their effectiveness has been confirmed in clinical trials, these therapeutic applications have been approved for use by regulatory authorities. They are expected to optimize personal lifestyle management and help prevent disease progression⁵⁵⁾.

Germany leads the digital health field, having established the Digital Healthcare Act, which enables digital health apps (Digitale Gesundheitsanwendungen; DiGA) to receive medical device certification. DiGA apps undergo FastTrack approval through the Federal Institute for Drugs and Medical Devices (BfArM), enabling physician prescription and public health insurance coverage. Currently, 56 DiGA apps have received approval, with Zanadio⁵⁶⁾ (obesity management) being the only ASCVD prevention-related application.

In Japan, the 2014 Medical Regulation Amendment permitted the classification of medical devices, facilitating the development of digital therapeutics. As of November 2024, two types of DTx useful for the prevention of ASCVD (for nicotine addiction [CureApp SC^TM] and for hypertension [CureApp HT^TM]) were approved and reimbursed by the MHLW in Japan⁵⁷⁾. The CureApp SC^TM DTx for nicotine dependence is a therapeutic system that aims to provide intervention and support for psychological dependence to quit smoking, in addition to the 12-week standard smoking cessation program in Japan⁵⁸⁾. A multicenter RCT assessed the usefulness of DTx for nicotine dependence⁵⁹⁾, and on its heels, the CureApp SC^TM DTx system was approved and reimbursed by the Ministry of Health, Labour, and Welfare (MHLW) in Japan in 2020 as the first DTx in Asia. The CureApp HT^TM DTx for hypertension is a medical device (SaMD) therapeutic app that aims to provide continuous treatment for high blood pressure during intermittent clinic visits and daily life. Clinical trials (HERB-DH1) have validated its effectiveness in blood pressure reduction and safety⁶⁰⁾. Its purchase was reimbursed by the MHLW in Japan as the world’s first hypertension therapeutic app, receiving insurance coverage in 2022 ⁶¹⁾.

In France, a fast-track system for digital therapeutics is under development following Germany’s model. The UK is also advancing its digital health implementation for medical and in vitro diagnostic devices, referencing the German approach. The United States maintains a complex regulatory and reimbursement landscape with limited insurance coverage. The COVID-19 pandemic has contributed to the increased use of telemedicine; however, challenges remain in expanding digital treatment. Private insurance plans cover programs such as Livongo⁶²⁾ (hypertension management) and Omada Health⁶³⁾ (diabetes prevention); however, coverage remains restricted to specific employers and health plans (Table 2).

Table 2.ASCVD Risk Management Apps with Insurance Coverage Worldwide

Country	App Name	Developer Company	Target Condition/Use	Insurance Coverage Status
Japan	CureApp SC	CureApp, Inc.	Smoking cessation support	Covered by insurance
	CureApp HT	CureApp, Inc.	Hypertension treatment support	Covered by insurance
Germany	Zanadio	SidekickHealth GmbH	Obesity management	Listed in DiGA directory, covered by insurance
USA	Livongo for Hypertension	Teladoc Health, Inc.	Hypertension management	Covered by some insurance plans, not FDA-approved
	Diabetes Prevention Program	Omada Health, Inc.	Diabetes prevention	Covered by many insurance plans, not FDA-approved

Future Perspective in Japan

Further development of digital health plays an essential role in both the primary and secondary prevention of ASCVD in Japan.

The main primary prevention targets are lifestyle management to control lifestyle-related diseases, such as hypertension, dyslipidemia, and smoking cessation guidance. Utilizing wearable devices linked to digital platforms and mobile apps for target patients will enable the continuous monitoring of diet, exercise patterns, and vital signs. This will lead to not only the promotion of a healthy lifestyle but also more precise treatment.

The main secondary prevention targets are medication adherence management to achieve the control target of ASCVD risk factors, avoiding rehospitalization through follow-up, and cardiac rehabilitation interventions with digital health services. In addition, digital healthcare services that allow healthcare providers to comply with appropriate guideline-directed medical therapy are expected in the future. These efforts are expected to reduce the risk of recurrence of ASCVD. In Japan, several manufacturers, including venture and pharmaceutical companies, continuously develop DTx and conduct clinical studies to obtain approval. More than 30 DTx apps are currently being development in Japan⁵⁷⁾.

The government, academic societies, and private sector must work together to overcome some of the abovementioned barriers and effectively implement these digital health technologies in Japan. In the 2021 Organization for Economic Co-operation and Development (OECD) survey, Japan was listed as a country that has made significant progress in implementing and maturing electronic health record (eHR) systems⁶⁴⁾. This is mainly because of the May 2022 proposal, “Medical DX 2021 Vision 2030,” to promote healthcare’s digital transformation (DX) and the effective use of medical information. In particular, the standardization of national medical information platforms and electronic medical record information is a core pillar in promoting the introduction of digital health technology. In terms of introducing electronic medical records to medical institutions, the adoption of electronic medical records increased to 91.2% in general hospitals with more than 400 beds in 2020 ⁶⁵⁾. Conversely, the introduction rate of electronic medical records in primary care clinics is relatively low by international comparison, with the average rate in OECD countries being 93% in 2021, while the rate in Japan is 42%⁶⁶⁾. Factors interfering with the widespread use of electronic medical records in primary care clinics include the large number of elderly physicians with low digital literacy who cannot move away from paper-based medical records as well as the high costs involved in the introduction, operation, and maintenance of electronic medical records⁶⁷⁾.

To resolve these issues, it is essential to reduce introduction and maintenance costs, strengthen incentives, such as subsidy support, and provide digital education to elderly healthcare professionals. In addition, the medical device approval process for digital health tools requires several steps that may take several months or even a year or more to complete, so this process needs to be shortened. As mentioned above, Germany introduced a fast-track system. In response to this, the MHLW in Japan has formulated “DASH (DX Action Strategies in Healthcare) for SaMD” to promote the early commercialization of programmed medical devices⁶⁸⁾. Furthermore, medical insurance coverage for digital tools is limited. If insurance coverage is not expanded, patient burden will be high and not conducive to widespread use. Finally, as healthcare professionals, we often lack sufficient awareness to understand the usefulness of digital health and to utilize it efficiently in our medical practices, so it is essential that we educate ourselves through academic conferences.

Conclusion

Digital healthcare demonstrates significant potential for enhancing ASCVD prevention and management, particularly through patient engagement and adherence, utilizing digital tools for risk assessment, remote monitoring, lifestyle improvements, and rehabilitation. However, widespread adoption faces challenges, including interoperability issues, privacy concerns, low digital literacy among older adults, and insufficient health insurance coverage. Successful implementation requires user-centered, accessible designs, and appropriate regulatory and insurance frameworks. As technologies such as personalized modules continue to advance, digital healthcare is likely to transform ASCVD care once these implementation barriers are addressed.

Conflict of Interest

None.

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