Purpose The digital transformation of healthcare is creating new opportunities to enhance access, engagement, and outcomes in exercise, fitness, cardiovascular disease (CVD) prevention, and rehabilitation. This review synthesizes current evidence on digital health technologies across the cardiovascular care continuum, emphasizing their role in promoting physical activity in both primary and secondary prevention. Methods A narrative review was conducted examining mobile health applications, wearable devices, artificial intelligence, remote monitoring platforms, and emerging technologies including virtual reality, 5G connectivity, and large language models. Applications were evaluated in the context of CVD prevention, rehabilitation, and behavior change. Results Digital tools can personalize exercise prescriptions, monitor physiologic metrics, and support remote supervision in clinical and community settings. Wearables and mobile platforms demonstrate utility in improving adherence, fitness, and CVD risk. AI-driven systems enable adaptive programming, patient monitoring, and predictive modeling, while virtual and augmented reality offer immersive options for home-based rehabilitation. Persistent barriers include digital literacy, inequitable access, and data privacy concerns. Conclusion Digital health technologies are reshaping exercise-based cardiovascular care. When coupled with behavior change strategies and ethical implementation, they can extend the reach and impact of physical activity interventions. Further research is needed to guide clinical integration, long-term evaluation, and equitable adoption.

Artificial intelligence (AI) is now embedded across many aspects of healthcare, yet most implementations remain fragmented, task-specific, and layered onto legacy workflows. This paper does not review AI applications in healthcare per se; instead, it examines what an AI-first healthcare system would look like, one in which AI functions as a foundational organizing principle of care delivery rather than an adjunct technology. We synthesize evidence across ambulatory, inpatient, diagnostic, post-acute, and population health settings to assess where AI capabilities are sufficiently mature to support system-level integration and where critical gaps remain. Across domains, the literature demonstrates strong performance for narrowly defined tasks such as imaging interpretation, documentation support, predictive surveillance, and remote monitoring. However, evidence for longitudinal orchestration, cross-setting integration, and sustained impact on outcomes, costs, and equity remains limited. Key barriers include data fragmentation, workflow misalignment, algorithmic bias, insufficient governance, and lack of prospective, multi-site evaluations. We argue that advancing toward AI-first healthcare requires shifting evaluation from accuracy-centric metrics to system-level outcomes, emphasizing human-enabled AI, interoperability, continuous learning, and equity-aware design. Using hypertension management and patient journey exemplars, we illustrate how AI-first systems can enable proactive risk stratification, coordinated intervention, and continuous support across the care continuum. We further outline architectural and governance requirements, including cloud-enabled infrastructure, interoperability, operational machine learning practices, and accountability frameworks-necessary to operationalize AI-first care safely and at scale, subject to prospective validation, regulatory oversight, and post-deployment surveillance. This review contributes a system-level framework for understanding AI-first healthcare, identifies priority research and implementation gaps, and offers practical considerations for clinicians, health systems, researchers, and policymakers. By reframing AI as infrastructure rather than isolated tools, the AI-first approach provides a pathway toward more proactive, coordinated, and equitable healthcare delivery while preserving the central role of human judgment and trust.

Background: One-size-fits-all counseling often underperforms in long-term cardiovascular prevention where sustained activation is required. We developed Signatures, a practical framework that maps individuals to four communication archetypes—Listener, Motivator, Director, with an Expert overlay—to guide message tone, structure, and shared decision-making at the point of care. The framework operationalizes psychographic segmentation into an implementable taxonomy. Methods: Classification uses three complementary pathways: (1) a 20-item self-assessment that summarizes activation and support-need domains; (2) a clinician 10-domain binary grid scored 0–10; and (3) a supervised NLP classifier that ingests de-identified narrative to estimate archetype probabilities. Discordance is resolved by conservative tie-breaking and barrier-domain overrides (health literacy, trust, access, food security). Intervention (Chatbot): We prototyped a rules-plus-NLP chatbot to (a) administer the self-assessment, (b) collect short narratives for NLP pre-labeling, and (c) deliver Signature-specific counseling (e.g., plain-language, one-step plans for Listeners; option sets and SMART weekly goals for Motivators; concise, data-driven progressions for Directors; synthesis and trade-offs for Experts). Example phrase templates were derived from our library of Signature-aligned responses for common health questions. Results: Formative testing established face validity of the three-pathway workflow and usability of chatbot dialogues. The system consistently generated actionable outputs: an assigned archetype, domain-level flags, and a message kit (tone, structure, and SDM cues) that clinicians can use or edit in real time. The chatbot supported weekly goal-setting, reminders, and teach-back prompts aligned to the assigned Signature. Conclusions: A triaged, multi-method classification combined with chatbot delivery is a feasible approach to precision communication in cardiovascular prevention, offering a practical bridge from psychographic theory to routine encounters and remote interactions. Prospective validation will assess concordance among pathways, equity, and effects on engagement, lifestyle habits, condition management and clinical proxies.

BACKGROUND:Digital health technologies provide a scalable, efficient approach to implementing guideline-recommended risk factor modification in the care of patients with atrial fibrillation (AF). OBJECTIVES:This study aimed to evaluate the feasibility of a 12-week, multicomponent, virtual AF management program using a smartphone application, connected devices, and virtual coaching calls for risk factor modification. METHODS:Patients with AF were enrolled from outpatient clinics. Patients were randomized in a 1:1 ratio to either usual care only or the virtual program. The study objectives were to assess feasibility, with the goal of achieving at least 60% participant retention at 12 weeks, intervention engagement, and participant satisfaction. RESULTS:Among 61 patients enrolled (76% of those approached), the mean age was 65 ± 8 years, and 36% were women. A total of 89% of all participants were retained by 12-week follow-up. In the intervention group, at 12-weeks, 88% continued using the smartphone application, 73% continued participation in virtual coaching calls, and 80% reported being satisfied with the program. CONCLUSIONS:The mTECH Afib (Patient Centered mobile health TECHnology Enabled Atrial Fibrillation Management) trial demonstrates feasibility of conducting a randomized controlled trial using an innovative digital health technology-enabled intervention with broad patient engagement and acceptance of the program components. Large-scale clinical trials powered for health outcomes will be necessary to establish intervention efficacy.

Background: Stroke continues to be a major cause of morbidity mortality in the United States. In this study, we determined if the food insecurity status interacted with a history of stroke to influence the overall mortality risk. Methods: Data from the 2015–2018 National Health and Nutrition Examination Survey, a nationally representative survey among the non-institutionalized population that is published in two-year cycles, with a mortality follow-up through 31 December 2019 was analyzed in this investigation. Results: In stroke survivors, upon follow-up, a higher proportion of those with food insecurity died (38.1% vs. 31.6%, p < 0.05) than food-secure individuals. For overall mortality, the crude hazard ratio (HR) for stroke survivors was 5.87 (95% confidence interval [CI], 3.18–10.86, p < 0.01). After adjustment for multiple variables, the HR was significantly elevated, 3.66 (CI 1.64–8.14, p < 0.01), among stroke survivors with food insecurity, but among those with stroke only or just food insecurity, the HR was not significantly elevated. Similar interactions were seen among females but not among males. Conclusions: Food insecurity substantially increases mortality from all causes among stroke survivors. When considering various chronic diseases, such as stroke, the role of social problems must be taken into consideration.

Background: The interconnectedness between Cardiovascular Kidney and Metabolic(CKM) diseases has been increasing in its importance, morbidity, mortality, and economic burden. There is sparse data on the impact of AI/ML based intervention to improve outcomes Methods: This is a randomized controlled study to assess safety and efficacy of CHAPERONE Device based intervention compared with standard of care. Inclusion criteria: 18 yrs. or older with recent discharge from hospital due to acute decompensated heart failure or acute kidney failure or metabolic complication. Enrollment at 10 sites over 3 years. Randomization to SOC or Intervention arm (to receive the CHAPERONE Kit that includes monitoring and tracking of demographics cBP, blood tests ,CGM, 6 lead EKG, fluid status, CO, SVR, TFC, and HRV.) Treatment target to an A1c of 6.0, LDL <50, SBP 110- 130mm Hg, Triglyceride <150, eGFR >15, BMI < 25 and GDMT. Primary Outcome is to assess the efficacy and safety of patient empowerment, outcomes of CHF readmissions, worsening kidney disease, diabetes complications mortality through 30 days,90 days and 180 days. Secondary outcomes include LE-8 score, modified PREVENT score, Wellbeing score, KCCQ, NYHA class and technology enabled score. Sample size of 1444 subjects will be enrolled to have approximately 90% power and an alpha value of 0.05 to detect 28 % between the two groups. The primary endpoint will be a WIN RATIO based on magnitude and hierarchy of hard events to QOL Results: Study is IRB approved. Preliminary validation of the chatbot and copilot has been performed and revealed a high level of correlation between HCP and AI based technology. Number of study subjects at the start and end of study will be reported along with demographics, number of subjects randomized, and number analyzed, frequency of the primary outcome and Win Ratio for each arm, along with 95% confidence interval and p values. All secondary and tertiary endpoints will be reported Conclusions: The message coming out of this project will involve Best Patient outcomes in the CKM space with intensive management using user friendly technology to add value to healthcare provider as an additional tool to be utilized at low cost. This project will be able to add capacity and efficiency across multiple health systems in multiple states while providing novelty, clinical impact, sustainability , intuitiveness and accomplishing our goals to reduce disparities in care as it pertains to SDOH

Objective:The purpose of this study was to determine if patients with hypertension could better self-manage their disease by using automated mHealth including health coaching. Background:A mobile health (mHealth) coaching app called HyperCoach was developed to help patients self-manage their hypertension. Method:Participants with hypertension were provided a blood pressure monitor and weight scale that communicated with an mHealth app via Bluetooth to deliver health coaching for hypertension. The first 30 days of the study involved a health awareness phase that informed the participants of the daily status of their hypertension. The second 30-day phase initiated an automated health coaching plan developed in collaboration with the American Heart Association. Blood pressure, heart rate, weight, health-related quality of life and health literacy were measured. Results:Thirty-four participants completed the study. Results showed no significant improvements in outcomes during the health awareness phase; however, during the health coaching phase there was a significant reduction of systolic blood pressure from 85.1 to 81.2 mmHg as well as diastolic blood pressure from 85.1 to 81.2 mmHg. Participants' quality of life score significantly increased from 68.4 to 74.6, and hypertension health literacy score increased from 74.7% to 85.2%. Conclusion:Our study found that providing health coaching information in conjunction with daily blood pressure values may encourage individuals with hypertension to change their health-related behaviors. Despite the potential positive impact of digital coaching on global hypertension management, more work is warranted to account for varied cultural and demographic variables. Application:mHealth apps may assist patients with hypertension in self-managing their disease.

Background Involving patient and community stakeholders in clinical trials adds value by ensuring research prioritizes patient goals both in conduct of the study and application of the research. The use of stakeholder committees and their impact on the conduct of a multicenter clinical trial have been underreported clinically and academically. The aim of this study is to describe how Study Advisory Committee (SAC) recommendations were implemented throughout the Emergency Medicine Palliative Care Access (EMPallA) trial. EMPallA is a multi-center, pragmatic two-arm randomized controlled trial (RCT) comparing the effectiveness of nurse-led telephonic case management and specialty, outpatient palliative care of older adults with advanced illness. Methods A SAC consisting of 18 individuals, including patients with palliative care experience, members of healthcare organizations, and payers was convened for the EMPallA trial. The SAC engaged in community-based participatory research and assisted in all aspects from study design to dissemination. The SAC met with the research team quarterly and annually from project inception to dissemination. Using meeting notes and recordings we completed a qualitative thematic analysis using an iterative process to develop themes and subthemes to summarize SAC recommendations throughout the project’s duration. Results The SAC convened 16 times between 2017 and 2020. Over the course of the project, the SAC provided 41 unique recommendations. Twenty-six of the 41 (63%) recommendations were adapted into formal Institutional Review Board (IRB) study modifications. Recommendations were coded into four major themes: Scientific, Pragmatic, Resource and Dissemination. A majority of the recommendations were related to either the Scientific (46%) or Pragmatic (29%) themes. Recommendations were not mutually exclusive across three study phases: Preparatory, execution and translational. A vast majority (94%) of the recommendations made were related to the execution phase. Major IRB study modifications were made based on their recommendations including data collection of novel dependent variables and expanding recruitment to Spanish-speaking patients. Conclusions Our study provides an example of successful integration of a SAC in the conduct of a pragmatic, multi-center RCT. Future trials should engage with SACs in all study phases to ensure trials are relevant, inclusive, patient-focused, and attentive to gaps between health care and patient and family needs. Trial Registration : Clinicaltrials.gov Identifier: NCT03325985, 10/30/2017.

Study advisory committees (SACs) provide critical value to clinical trials by providing unique perspectives that pull from personal and professional experiences related to the trial's healthcare topic. The Emergency Medicine Palliative Care Access (EMPallA) study had the privilege of convening a 16-person SAC from the project's inception to completion. The study team wanted to understand the impact this project had on the SAC members. In this narrative, we use reflective dialogue to share SAC members' lived experiences and the impact the EMPallA study has had on members both personally and professionally. We detail the (1) benefits SAC members, specifically patients, and caregivers, have had through working on this project. (2) The importance of recruiting diverse SAC members with different lived experiences and leveraging their feedback in clinical research. (3) Value of community capacity building to ensure the common vision of the clinical trial is promoted.

PURPOSE:Personal activity intelligence (PAI) translates heart rate during physical activity (PA) into a weekly score, which credits vigorous over low- and moderate-intensity PA. We prospectively investigated the association between PAI and fatal and nonfatal coronary heart disease (CHD) in self-reported healthy participants from Norway, with specific reference to improving the accuracy of conventional coronary risk assessment. METHODS:We studied 40,961 healthy adults (56% women) from the population-based Trøndelag Health Study (the HUNT study). Individual data were linked to hospital and cause of death registries. The weekly PAI score of each participant was divided into four groups (PAI scores of 0, ≤50, 51-99, or ≥100). Adjusted hazard ratios and 95% confidence intervals for fatal and nonfatal CHD related to PAI were estimated using Cox proportional hazard regression analyses. RESULTS:During a median follow-up period of 13.1 yr (interquartile range, 12.7-13.6), 3303 (3109 nonfatal, 194 fatal) CHD events occurred. Compared with the inactive group (0 PAI), weekly PAI scores at baseline of 51-99 and ≥100 were associated with a lower risk of CHD [0.80 (0.71-0.91) and 0.86 (0.78-0.95), respectively]. By adding PAI to traditional risk factors, the net reclassification improvement of CHD was 0.472 ( P < 0.001). CONCLUSIONS:PAI was inversely associated with CHD risk among healthy participants at baseline, and its cardioprotective effect persisted across diverse risk factor profiles. A PAI score >50 was substantially associated with a reduced risk of CHD. These findings have implications for improving the accuracy of conventional coronary risk assessments with PAI.

Currently, assessing physical activity (PA) and cardiorespiratory fitness in healthcare settings and supporting patients on their journey toward active living is not a standard of practice in the US, although significant progress is underway. This paper summarizes the foundational as well as supporting public policies necessary to make PA assessment, prescription, and referral a standard of care in the US healthcare system to support active living for all. Measure standardization and healthcare integration will be supported by digital health and public private partnerships, as well as payer strategies and quality and performance incentives. The policy and systems change effort, currently being led by the Physical Activity Alliance's "It's Time to Move" initiative, will improve patient care and the ability to monitor PA levels across the US population, filling in gaps in current national public health surveillance systems. Having patient data available will also allow for additional research that elucidates the relationship between PA and overall health and well-being.

Study advisory committees (SACs) provide critical value to clinical trials by providing unique perspectives that pull from personal and professional experiences related to the trial's healthcare topic. The Emergency Medicine Palliative Care Access (EMPallA) study had the privilege of convening a 16-person SAC from the project's inception to completion. The study team wanted to understand the impact this project had on the SAC members. In this narrative, we use reflective dialogue to share SAC members’ lived experiences and the impact the EMPallA study has had on members both personally and professionally. We detail the (1) benefits SAC members, specifically patients, and caregivers, have had through working on this project. (2) The importance of recruiting diverse SAC members with different lived experiences and leveraging their feedback in clinical research. (3) Value of community capacity building to ensure the common vision of the clinical trial is promoted.

Study advisory committees (SACs) provide critical value to clinical trials by providing unique perspectives that pull from personal and professional experiences related to the trial's healthcare topic. The Emergency Medicine Palliative Care Access (EMPallA) study had the privilege of convening a 16-person SAC from the project's inception to completion. The study team wanted to understand the impact this project had on the SAC members. In this narrative, we use reflective dialogue to share SAC members’ lived experiences and the impact the EMPallA study has had on members both personally and professionally. We detail the (1) benefits SAC members, specifically patients, and caregivers, have had through working on this project. (2) The importance of recruiting diverse SAC members with different lived experiences and leveraging their feedback in clinical research. (3) Value of community capacity building to ensure the common vision of the clinical trial is promoted.

Background Cardiac rehabilitation (CR) is an evidence‐based, guideline‐recommended intervention for patients recovering from a cardiac event, surgery or procedure that improves morbidity, mortality, and functional status. CR is traditionally provided in‐center, which limits access and engagement, most notably among underrepresented racial and ethnic groups due to barriers including cost, scheduling, and transportation access. This study is designed to evaluate the Corrie Hybrid CR, a technology‐based, multicomponent health equity‐focused intervention as an alternative to traditional in‐center CR among patients recovering from a cardiac event, surgery, or procedure compared with usual care alone. Methods The mTECH‐Rehab (Impact of a Mobile Technology Enabled Corrie CR Program) trial will randomize 200 patients who either have a diagnosis of type 1 myocardial infarction or who undergo coronary artery bypass grafting surgery, percutaneous coronary intervention, heart valve repair, or replacement presenting to 4 hospitals in a large academic health system in Maryland, United States, to the Corrie Hybrid CR program combined with usual care CR (intervention group) or usual care CR alone (control group) in a parallel arm, randomized controlled trial. The Corrie Hybrid CR program leverages 5 components: (1) a patient‐facing mobile application that encourages behavior change, patient empowerment, and engagement with guideline‐directed therapy; (2) Food and Drug Administration‐approved smart devices that collect health metrics; (3) 2 upfront in‐center CR sessions to facilitate personalization, self‐efficacy, and evaluation for the safety of home exercise, followed by a combination of in‐center and home‐based sessions per participant preference; (4) a clinician dashboard to track health data; and (5) weekly virtual coaching sessions delivered over 12 weeks for education, encouragement, and risk factor modification. The primary outcome is the mean difference between the intervention versus control groups in distance walked on the 6‐minute walk test (ie, functional capacity) at 12 weeks post randomization. Key secondary and exploratory outcomes include improvement in a composite cardiovascular health metric, CR engagement, quality of life, health factors (including low‐density lipoprotein‐cholesterol, hemoglobin A1c, weight, diet, smoking cessation, blood pressure), and psychosocial factors. Approval for the study was granted by the local institutional review board. Results of the trial will be published once data collection and analysis have been completed. Conclusions The Corrie Hybrid CR program has the potential to improve functional status, cardiovascular health, and CR engagement and advance equity in access to cardiac rehabilitation. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05238103.

Study advisory committees (SACs) provide critical value to clinical trials by providing unique perspectives that pull from personal and professional experiences related to the trial's healthcare topic. The Emergency Medicine Palliative Care Access (EMPallA) study had the privilege of convening a 16-person SAC from the project's inception to completion. The study team wanted to understand the impact this project had on the SAC members. In this narrative, we use reflective dialogue to share SAC members' lived experiences and the impact the EMPallA study has had on members both personally and professionally. We detail the (1) benefits SAC members, specifically patients, and caregivers, have had through working on this project. (2) The importance of recruiting diverse SAC members with different lived experiences and leveraging their feedback in clinical research. (3) Value of community capacity building to ensure the common vision of the clinical trial is promoted.

Recent breakthroughs in artificial intelligence (AI) have caught the attention of many fields, including health care. The vision for AI is that a computer model can process information and provide output that is indistinguishable from that of a human and, in specific repetitive tasks, outperform a human’s capability. The 2 critical underlying technologies in AI are used for supervised and unsupervised machine learning. Machine learning uses neural networks and deep learning modeled after the human brain from structured or unstructured data sets to learn, make decisions, and continuously improve the model. Natural language processing, used for supervised learning, is understanding, interpreting, and generating information using human language in chatbots and generative and conversational AI. These breakthroughs result from increased computing power and access to large data sets, setting the stage for releasing large language models, such as ChatGPT and others, and new imaging models using computer vision. Hypertension management involves using blood pressure and other biometric data from connected devices and generative AI to communicate with patients and health care professionals. AI can potentially improve hypertension diagnosis and treatment through remote patient monitoring and digital therapeutics.

Background Mobile health technologies have shown promise as delivery platforms for digital health coaching for chronic conditions. However, the impacts of such strategies on users’ health beliefs, intentions and ultimately clinical outcomes are understudied. Objective This study sought (1) to evaluate the effects of a digital health coaching intervention on participants’ belief constructs; and (2) to assess relationships between these belief constructs and intentions to utilize the technological intervention, actual adherence metrics and clinical outcomes related to hypertension. Methods Thirty-four participants with hypertension were recruited from a university community from January to May 2021. They self-measured weight and blood pressure (BP) for 30 days followed by digital coaching delivered via a mobile application for 30 days. Surveys assessed constructs from the Health Belief Model and Technology Acceptance Model, compared to intention, health belief, BP self-monitoring adherence and BP outcomes. A path analysis model was used to assess the relationships between constructs and intention, adherence metrics and clinical outcomes. A Kruskal–Wallis test was used to identify changes in beliefs. Results Participant health beliefs significantly improved after coaching, including self-efficacy ( H (1) = 15.12, p < 0.001), cues to action ( H (1) = 5.33, p = 0.02), attitude ( H (1) = 10.35, p = 0.002), perceived usefulness ( H (1) = 15.02, p < 0.001) and decreased resistance to change ( H (1) = 4.05, p = 0.04). Adherence to BP measurements positively correlated with perceived health threat ( β = .033, p = 0.007) and perceived ease of use ( β = .0277, p < 0.001). Self-efficacy ( β = −2.92, p = 0.02) and perceived usefulness ( β = −3.75, p = 0.01) were linked with a decrease in diastolic BP. Conclusions A mobile health coaching intervention may help participants improve beliefs regarding hypertension self-management.