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Researchers at 911½ñÈÕºÚÁÏ’s National Heart and Lung Institute have teamed up with colleagues at Stanford University to run a study, conducted through a mobile app: My Heart Counts. The aim is to help users track and improve their heart health, with a grant from the British Heart Foundation supporting an additional plan to provide a user experience designed to directly benefit people living with pulmonary arterial hypertension (PAH).

Cardiovascular disease is the leading cause of death globally, responsible for nearly a third of deaths each year. Familiarising the general population with their individual risk, based on their diet, lifestyle and general health, is a powerful tool in the effort to reduce the prevalence of cardiovascular disease.

A team of researchers at NHLI have joined forces with fellow UK collaborators and the US-based team behind , an app which takes data from participants’ smartphones and wearables to give them real-time insights into their heart health, and tips on how they can better protect it. Those who participate in the study through the app, with their consent, generate data for researchers who can then utilise this comprehensive digital biobank when looking into the relationship between physical activity and cardiovascular health.

, Chair of Pulmonary Vascular Diseases at NHLI, is the principal investigator for the UK-based wing of the project. He first became involved with My Heart Counts in 2019; a combination of professional and personal interest drew him to the project. “I’ve always been interested in how we can use technology to give people more information about their own health”, Professor Lawrie said. “I used to take medication to manage high blood pressure and was not especially active. I have always been an early adopter of technology and had a wearable, and the data from my own devices helped inform and empower me to track my own exercise and health”, he continued, adding, “Over time, and with medical advice, I now no longer need blood pressure medication. This experience validated the power of educating people with their own health data and information.”

My Heart Counts and Pulmonary Arterial Hypertension (PAH)

Since the My Heart Counts app was launched by Apple in partnership with Stanford University in 2015, over 50,000 people have participated in the study. Now, thanks to a grant from the British Heart Foundation, the contingent from NHLI is working to deliver an in-app experience that can benefit anyone, but that has been tailored to provide additional benefit to people living with pulmonary arterial hypertension (PAH).

Pulmonary arterial hypertension is a serious, progressive condition, where the blood pressure in the pulmonary arteries is too high due to a narrowing and thickening of small arteries in the lungs. Because of this, the right side of the heart works harder to compensate for reduced blood flow through the pulmonary arteries, often resulting in damage – damage which eventually leads to heart failure. The My Heart Counts UK team’s focus is on early detection of PAH, improving remote monitoring, and encouraging gradual and appropriate increases in physical activity.

Professor Lawrie discussed how the My Heart Counts app could benefit people living with pulmonary arterial hypertension now and in future, saying, “Providing a tailored pathway in the app for people with PAH will give patients the chance to not only monitor their own health more closely, but also to become citizen scientists, whose data will be used to give researchers valuable insights into how lifestyle changes affect the rate of disease progression.”

The app could also help clinicians to treat people living with pulmonary arterial hypertension more effectively. Patients will typically only see a clinician two or three times a year, often travelling many hours to do so, which can aggravate their symptoms. As Professor Lawrie explained, “These appointments only provide snapshots of the patient’s health and wellbeing, which are not always conducive to a precise evaluation of their disease progression, or its impact on everyday life.” If patients have access to their daily data, as My Heart Counts provides, this could prove advantageous when clinicians are conducting their assessments.

AI: Challenges and Opportunities

With a project as data-rich as My Heart Counts, the use of AI-powered large language models (LLMs) could prove beneficial. Speaking about the potential uses of LLMs, Professor Lawrie said, “We see AI as a potential tool to both assist in the management of the large amounts of data that we receive from the study’s participants, which is one of the biggest challenges we face, and providing more personalised motivation back to the participants.”

However, integrating AI is a process that must be managed carefully, as Professor Lawrie explained: “Any introduction of LLM-generated messaging must be done within strict guardrails, and it is our responsibility to the app’s users to ensure that the relevant checks and balances are in place.”

The future of My Heart Counts

After seeing success in its first decade, the My Heart Counts study – and the international team behind it – have no plans to slow down. Not only do the UK contingent want to provide a tailored experience for users with PAH, but collectively, the international team have ambitions to do the same for those living with other cardiovascular conditions, starting by working with patient groups to understand their specific needs. In doing so, the team are aiming to collect an international biobank of digital data to both focus on supporting participants living with disease and provide tools for people to reduce their risk of developing cardiovascular disease.

Furthermore, part of the project’s future is tied to the much-discussed question of how the kind of health data that the My Heart Counts app provides is best used. In regard to external organisations, like the NHS, utilising the study’s data, Professor Lawrie was hopeful but cautious, stating there is “a lot to learn before large-scale data integration can happen”. For instance, the project’s data could, in future, be integrated into the NHS’s clinical records (in line with the technological goals set out in the NHS Ten Year Health Plan, Fit for the Future). However, to make this possible, the MHC team must first solve the problem of how to precisely compare data from different devices that use different sensors and metrics, so it can become transferable across populations.

But despite the challenges, Professor Lawrie is optimistic about the potential of My Heart Counts: “Bringing together cardiovascular researchers, like myself, with computer scientists, behavioural scientists, and exercise and sport scientists is what has made this project possible. I have learnt so much by working alongside people with such a wide range of skillsets. And for our users, I think that our work is giving people the chance to understand the health data that smartphones and wearables provide more deeply, empowering them to use it to make a real difference to their heart health and, as a result, their general wellbeing.”