Revolutionizing access to cardiovascular care for 1.4 billion people - How mobile health apps and services evolved from 2016-2020 in China and its implications

Abstract

Background Cardiovascular diseases (CVDs) create a large disease burden in China. The country’s large population and land mass make access to CVD care difficult. The virtual model of care provided through mobile health (mHealth) can improve access to care and management of chronic CVDs on a population level. The article aims to examine the evolution of mHealth coverage, patient usage, and service development and delivery for CVD on a national level and describe its potential to impact access to cardiovascular care in developing countries. Methods We collected data on mHealth platforms for telemedicine of CVDs in the Chinese market in 2016, 2017, 2019 and 2020 from platforms available to the general public. Factors affecting access to CVD care were analyzed including 1) longitudinal changes of mHealth services provided per region; 2) medical facility coverage rate per province by mHealth apps; 3) distribution of specific cardiovascular conditions being sought on mHealth apps; and 4) the flow of patients across geographies to receive telemedicine. Descriptive statistics were used. Findings 45.8% of tertiary hospitals were accessible by mHealth apps in 2016, this grew at an average annual growth rate of 10.7% between 2016 to 2020. Regions with a higher economic level, population, percentage of elderly, and internet penetration, rather than CVD burden, had better mHealth coverage. 34% and 67% of patients consulted doctors outside of their own provinces in 2016 and 2020, respectively. Wealthiest areas of Beijing, Shanghai and Guangdong were the preferred destinations (57.1% in 2016, 38.4% in 2020) for patients seeking interprovincial care. The top 3 disease types were the common chronic CVDs of hypertension, coronary artery disease and arrhythmia. Interpretation The uniform functionality available across provinces and apps suggest a mature technological and health service infrastructure across Mainland China, where the widespread adoption of service delivery and offerings (such as payment, tracking, telemedicine, etc.) via mHealth apps show a step toward democratizing access to care across the country. The inter-provincial flow of patients to HCPs suggests poorer and resource-scarce areas are poised to benefit more while the burden on major cities can be ameliorated; We found regions that are traditionally underdeveloped and lacking in access to care had the most increase in services available. However, adequate technological infrastructure needs to be available and mobile technology widely adopted by patients and medical facilities. Funding None of the authors were paid by a company or other agency for the writing of this manuscript. This study was supported by the National High Level Hospital Clinical Research Funding grant awarded by the Chinese Academy of Medical Sciences to Wei Chen (grant nos.: 2022-PUMCH-B-0252 and 2022-PUMCH-C-069) for data analysis and interpretation.