Heart disease in seniors is a major concern
As the #1 cause of death in adults in the United States, heart disease and hypertension, a leading factor in heart disease, are major population health concerns. In 2018, the Surgeon General and Centers for Disease Control released a Call to Action to Control Hypertension and have worked to raise awareness around the importance of hypertension management to help stem the impact of heart disease on our citizens and communities.
The impact of heart disease is even higher in older adults, as aging brings changes in hormones, the heart, and blood vessels that may increase a person's risk of developing the disease. In fact, according to the American Heart Association, the prevalence of cardiovascular disease–and its associated complications–increases with age, with about 75 percent of people aged 60-79 years old living with the disease.1
Heart disease is a prime reason for the dwindling quality of life among seniors.2
Baby boomers are going digital
The trend of older consumers adopting digital technology like smartphones isn’t new. Pew Research Center data from 2022 shows that the majority of baby boomers own a smartphone (61 percent),3 and boomer consumers are growing increasingly comfortable with digital options. Research shows that in recent years, comfort in using mobile apps to manage one’s health is increasing within the population, with 40 percent reporting they use a digital app designed to improve their health pre-Covid and 54 percent post-Covid. Pair that with the buy-online boom caused by the pandemic, and baby boomers have come to not only want but also expect digital offerings from their favorite businesses.4
If the data shows seniors are willing to use digital technology - even to help manage something as important as their health - then why do we encounter many myths and questions about digital adoption within this population? Leveraging our experience with this population and live user data, we set out to dispel some of these common myths about seniors and their relationship with digital solutions like Hello Heart.
Skeptical? Not convinced?
Today, Hello Heart supports more than 21,000 active users over the age of 65, with nearly half (47.5 percent) of the 65+ users characterized in this blog post enrolled in a Medicare Advantage Employer Group Waiver Plan (EGWP) plan versus a commercial insurance plan.5
MYTH #1: Seniors do not use digital tools
HELLO HEART REALITY: Users age 65+ use the Hello Heart app to manage their heart health and use it nearly 2x more than younger users.1
As discussed above, the data shows that seniors do use digital tools, even to manage their health, and their use of Hello Heart is no exception. In our experience, our senior users do not have problems using smartphones - or our app - compared to younger users. We see 98 percent more (about 2x) app sessions for those over the age of 65 compared to younger users.5
With a simple, intuitive, easy-to-use smartphone app like Hello Heart, there is little barrier to entry for seniors. The user simply connects their blood pressure cuff to their app using the Bluetooth connectivity they’re likely already familiar with, and the app does the rest, tracking each reading and surfacing actionable insights, trends, and flags for the user to be aware of. Beyond that, practice makes perfect. With nearly 2x the number of sessions, seniors have lots of opportunities to become expert app users.5
MYTH #2: Seniors prefer to talk to their doctor in person or on the phone instead of using digital channels
HELLO HEART REALITY: Seniors use digital channels to engage with their providers and understand the appropriate level of care they may need.
Hello Heart engagement shows a greater than 33 percent increase with our in-app clinician reporting tools (e.g., screen share, email, fax, etc.) for users age 65+ compared to their younger counterparts.5 And it's not just users in their 60s driving this pattern, we see users 75+ engaging about 19 percent more than users 65-75 years of age.5 This high engagement rate indicates that these users use the Hello Heart app and tools like the provider report to engage with their providers.
The Hello Heart app provides the right level of coaching and information at the right time to support users who seek care or to inform their conversations with their care team. By sharing their app screen or report in telehealth or in-person doctor visits, users can confirm they are managing their condition or inform a clinical discussion, such as the potential need for a medication dosing change. This proactive approach helps users avoid risky events and potential hospitalization or complications.
MYTH #3: Older users will not have the same clinical results as younger users.
HELLO HEART REALITY: Hello Heart helps its users reduce their systolic blood pressure at similar rates–regardless of age.
Users of Hello Heart reduce their systolic blood pressure within six months–regardless of age. Hello Heart users demonstrate reductions in average systolic BP that are long-lasting and exceed other digital hypertension management solutions in the marketplace.6 Hello Heart just published six-month user outcomes data in the American Heart Association’s Hypertension journal that showed no significant correlation between age and systolic blood pressure reduction.7
In Figure 1, we illustrate the overlap in average systolic blood pressure reduction after six months for Hello Heart users over 65 compared to our entire user population.
On average, users 65+ years old with stage 2 hypertension reduced their systolic blood pressure by 17.1 mmHg within six months compared to an average reduction of 16.6 mmHg for the entire user group during the same timeframe (Figure 1).5 In addition to a similar average reduction, the percentage of stage 2 hypertension Hello Heart users who reduced their systolic blood pressure is virtually identical at 83.7 percent (Users <65 in the Hypertension study) vs. 83.6 percent (Users 65+), with highly overlapping confidence intervals of 95 percent (Figure 2).5
When we look at how our Medicare Advantage users perform next to a similar cohort enrolled in a commercial plan, our data shows that Medicare users participate in ~10 percent more sessions than the average 65+ commercial user, and engage with reporting features ~5 percent more often.5
As discussed, Figures 1 and 2 demonstrate that clinical outcomes of the 65+ Medicare user cohort align closely with the Hello Heart book of business and 65+ commercial insurance users and show no statistically significant difference in results.
MYTH #4: Hypertension affects everyone, so the same approach will work for men and women
HELLO HEART REALITY: While hypertension does affect both men and women, the genders have unique needs. We designed Hello Heart to address the unique heart health needs of everyone.
While the prevalence of hypertension is very high in both males and females, with 7 out of 10 individuals aged 65+ living with the condition, contrary to popular brief, in older adults, the prevalence of hypertension is higher in women, with 71.9 percent of 65-year-old women and 71.7 percent of 65-year-old men living with the condition according to the CDC.8 By age 75, 83.9 percent of women are estimated to have hypertension as opposed to 80.5% of men, due in part to post-menopausal hormonal changes.9 Typically, people with hypertension do not experience symptoms. This is one of the reasons why it’s referred to as “the silent killer”.10 However, hypertension can lead to heart disease, heart disease can lead to a heart attack, and common symptoms of heart disease and heart attacks do differ based on born gender.11
Regarding user engagement, we see an almost equal split between male (51 percent) and female (49 percent) Hello Heart users in the 65+ age group. In addition to equal engagement across the genders, we also see a clinically similar reduction in systolic blood pressure in both cohorts. This indicates that while hypertension might be more common in women over the age of 65, gender doesn’t impact one’s ability to reduce their systolic blood pressure with Hello Heart.12
Hello Heart can help support individuals aged 65 and older regarding their heart health by providing personalized digital coaching with actionable lifestyle insights and tips while also providing born gender-specific user flows for heart attack symptoms and cholesterol management.
MYTH #5: People with lower social determinants of health don’t benefit as much from digital health solutions
HELLO HEART REALITY: Hello Heart results in equitable outcomes among populations impacted by common social determinants of health.
Social determinants of health, such as socioeconomic status, are known to impact clinical outcomes significantly, and one might expect differences in outcomes between individuals covered by commercial insurance compared to those covered by Medicare. However, in addition to Hello Heart achieving statistically similar clinical outcomes across age, race, sex, and preferred language groups,12 Hello Heart’s active user data also shows no impact of plan type on clinical outcomes.5
Our demonstrations of parity in outcomes between populations impacted by SDoH are exciting, but they reflect a point-in-time view of how our program performs and meets the needs of our users today. But the journey to health equity doesn’t end there. By exploring our user data and continually checking these patterns, we strive to ensure that Hello Heart does not exacerbate the problem of healthcare inequity and instead contributes to closing the gap and reducing the impact of SDoH on our users. Read more about how Hello Heart could drive equitable outcomes here.
As more Medicare beneficiaries adopt digital technology and a willingness or preference to engage with digital solutions, health plans that haven’t factored these consumers into their digital health strategy may find themselves lagging behind the industry and, more importantly, their beneficiaries. Let’s work to create a healthier digital future for seniors – Together.
1 American Heart Association News. Chronic stress can cause heart trouble. American Heart Association Website. https://www.heart.org/en/news/2020/02/04/chronic-stress-can-cause-heart-trouble. Published February 4, 2020. Accessed December 16, 2022.
2 National Poll on Healthy Aging, December 2021/January 2022, https://dx.doi.org/10.7302/3749. Accessed December 16, 2022.
3 Faverio, Michelle. Share of those 65 and older who are tech users has grown in the past decade. Pew Research Center. https://www.pewresearch.org/fact-tank/2022/01/13/share-of-those-65-and-older-who-are-tech-users-has-grown-in-the-past-decade/. Published Januarty 13, 2022. Accessed December 16, 2022.
4 NCR. Baby Boomers are going digital - here’s what that means for business. https://www.ncr.com/blogs/baby-boomers-going-digital. Published February 3, 2021. Accessed December 16, 2022.
5 Based on data on file at Hello Heart analyzed by Hello Heart researchers. The analysis has not been subject to peer review.
6 Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open. 2021;4(10):e2127008, https://doi.org/10.1001/jamanetworkopen.2021.27008. Accessed December 16, 2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. There were 108 participants with baseline blood pressure over 140/90 who had been enrolled in the program for 3 years and had application activity during weeks 148-163. See additional important study limitations in the publication.)
7 Roberts J, Roach B, Gazit T, Mark S, Aggarwal S. Abstract P302: Efficacy of a Digital Hypertension Self-Management and Lifestyle Coaching Program in Reducing Blood Pressure Across Sex, Language and Racial Groups. Hypertension. 2022;79:AP302. https://www.ahajournals.org/doi/10.1161/hyp.79.suppl_1.P302. Accessed December 16, 2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. See additional important study limitations in the publication. Findings have not been subjected to peer review.)
8 Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2017-2018. https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/overview.aspx?BeginYear=2017. Accessed December 16, 2022.
9 Reckelhoff, J. Gender Differences in the Regulation of Blood Pressure. Originally published 1 May 2001, https://doi.org/10.1161/01.HYP.37.5.1199 Hypertension. 2001;37:1199–1208. Accessed December 16, 2022.
10 American Heart Association. Go Red for Women: High Blood Pressure and Heart Disease in Women website. https://www.goredforwomen.org/en/know-your-risk/risk-factors/high-blood-pressure-and-heart-disease. Last Reviewed June 28, 2021. Accessed December 12, 2022.
11 Barouch MD, Lili. Heart Disease: Differences in Men and Women. Johns Hopkins Medicine website. https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-disease-differences-in-men-and-women#:~:text=%22So%20while%20the%20classical%20symptoms,absence%20of%20obvious%20chest%20discomfort.%22. Accessed December 20, 2022.
12 Roberts J, Roach B, Gazit T, Mark S, Aggarwal S. Abstract P302: Efficacy of a Digital Hypertension Self-Management and Lifestyle Coaching Program in Reducing Blood Pressure Across Sex, Language and Racial Groups. Hypertension. 2022;79:AP302. https://www.ahajournals.org/doi/10.1161/hyp.79.suppl_1.P302. Accessed December 16, 2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. See additional important study limitations in the publication. Findings have not been subjected to peer review.)
Hello Heart is not a substitute for professional medical advice, diagnosis, and treatment. You should always consult with your doctor about your individual care.
1. Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open. 2021;4(10):e2127008, https://doi.org/10.1001/jamanetworkopen.2021.27008. Accessed October 19, 2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. See additional important study limitations in the publication. This study showed that 108 participants with baseline blood pressure over 140/90 who had been enrolled in the program for 3 years and had application activity during weeks 148-163 were able to reduce their blood pressure by 21 mmHg using the Hello Heart program.) (2) Livongo Health, Inc. Form S-1 Registration Statement. https:/www.sec.gov/Archives/edgar/data/1639225/000119312519185159/d731249ds1.htm. Published June 28, 2019. Accessed October 19, 2022. (In a pilot study that lasted six weeks, individuals starting with a blood pressure of greater than 140/90 mmHg, on average, had a 10 mmHG reduction.) NOTE: This comparison is not based on a head-to-head study, and the difference in results may be due in part to different study protocols.
2. Validation Institute. 2021 Validation Report (Valid Through October 2022). https://validationinstitute.com/wp-content/uploads/2021/10/Hello_Heart-Savings-2021- Final.pdf. Published October 2021. Accessed October 19, 2022. (This analysis was commissioned by Hello Heart, which provided a summary report of self-fundedemployer client medical claims data for 203 Hello Heart users and 200 non-users from 2017-2020. Findings have not been subjected to peer review.)