SMARTWOMAN™: Feasibility assessment of a smartphone app to control cardiovascular risk factors in vulnerable diabetic women.

BACKGROUND/HYPOTHESIS: SMARTWOMAN™ was designed to develop and assess the feasibility of a smartphone app to control cardiovascular risk factors in vulnerable diabetic women. METHODS: Fourteen African-American women with diabetes and without known cardiovascular disease were enrolled. A weight-scale, glucometer, sphygmomanometer, and FitBit were synchronized to the smartphone, and text messaging was provided. Follow-up was 6 months. RESULTS: Patients were able to follow instructions for app use and device prompts. Weekly device reporting was 85% for blood glucose, 82.5% for daily steps, and 77% for systolic blood pressure. Patient engagement levels were 85% to 100% at 1 month and 50% to 78% at month 6. The majority reported text messages to be useful, easy to understand, and appropriate in frequency. The women indicated on the exit questionnaire that study participation increased their motivation and ability to take charge of their health. CONCLUSIONS: Use of a smartphone app to control cardiovascular risk factors appears feasible in a population of vulnerable indigent African-American diabetic women, resulted in increased patient satisfaction and positive reinforcement to healthy behaviors, and warrants a larger clinical outcome trial.

Depression and cardiovascular health care costs among women with suspected myocardial ischemia: prospective results from the WISE (Women's Ischemia Syndrome Evaluation) Study.

OBJECTIVES: This study evaluated 3 novel questions in a prospective clinical cohort of women undergoing evaluation for suspected myocardial ischemia: 1) What is the relationship between depression and cardiovascular costs? 2) Does the relationship vary by definition of depression? 3) Do depression-cost relationship patterns differ among women with versus without coronary artery disease (CAD)? BACKGROUND: Comorbid depression has been linked to higher medical costs in previous studies of cardiovascular patients. METHODS: A total of 868 women presenting with suspected myocardial ischemia completed an extensive baseline examination including cardiovascular risk factor assessment and coronary angiogram. Depression was defined by: 1) current use of antidepressants; 2) a reported history of depression treatment; and 3) Beck Depression Inventory scores. Direct (hospitalizations, office visits, procedures, and medications) and indirect (out-of-pocket, lost productivity, and travel) costs were collected through 5 years of follow-up to estimate cardiovascular costs. RESULTS: Using the study criteria, 17% to 45% of the women studied met study depression criteria. Depressed women showed adjusted annual cardiovascular costs $1,550 to $3,300 higher than nondepressed groups (r = 0.08 to 0.12, p < 0.05). Depression-cost relationships also varied by CAD status, with stronger associations present among women without evidence of significant CAD. CONCLUSIONS: Depression was associated with 15% to 53% increases in 5-year cardiovascular costs, and cost differences were present using 3 definitions of depression. The results reinforce the importance of assessing depression in clinical populations and support the hypothesis that improved management of depression in women with suspected myocardial ischemia could reduce medical costs.