Smartphone ownership accounted for just over 50% of cardiology inpatients in both pre-COVID-19 and post-COVID-19 cohorts, and was less common among older adults, patients with comorbidities, and those with markers of lower socioeconomic status.
Key Findings
Results
Smartphone ownership among cardiology inpatients was approximately 51% in both the pre-COVID-19 and post-COVID-19 cohorts.
In the pre-COVID-19 cohort (N=377), 194 (51.5%) patients owned smartphones.
In the post-COVID-19 cohort (N=718), 366 (51%) patients owned smartphones.
These rates are substantially lower than the estimated ~90% smartphone ownership rate in the general Australian adult population.
International studies suggest smartphone ownership in patient populations ranges from 34% to 91%, and this study falls at the lower end for a cardiovascular disease population.
Results
A substantial proportion of cardiology inpatients owned no mobile phone at all, and this proportion increased in the post-COVID-19 cohort.
In the pre-COVID-19 cohort, 104 (27.6%) patients did not own any mobile phone.
In the post-COVID-19 cohort, 246 (34.3%) patients did not own any mobile phone.
In the pre-COVID-19 cohort, 79 (21%) owned phones that were incompatible with the mHealth intervention.
In the post-COVID-19 cohort, 106 (14.8%) owned incompatible phones.
Results
Younger age was associated with higher smartphone ownership in both cohorts.
In both the pre-COVID-19 and post-COVID-19 cohorts, younger patients were more likely to own smartphones (P<.001 in both cohorts).
Older adults were identified as a group less likely to own smartphones, raising concerns about digital exclusion in mHealth delivery.
Results
Male sex and private health insurance were associated with smartphone ownership in the pre-COVID-19 cohort.
Smartphone owners in the pre-COVID-19 cohort were predominantly male (P<.001).
Smartphone owners in the pre-COVID-19 cohort more often had private health insurance (P=.002).
Private health insurance was used as a marker of higher socioeconomic status.
Lower socioeconomic status was identified as a factor associated with lower smartphone ownership.
Results
Multiple comorbidities were associated with not owning a mobile phone.
This finding was observed across both cohorts of cardiology inpatients.
The study population included patients admitted with coronary artery disease or heart failure.
The association between comorbidity burden and lack of phone ownership has implications for mHealth interventions targeting high-risk patients who may stand to benefit most.
Methods
The study used prescreening logs from two multicenter randomized controlled trials as its data source.
TCC-Pilot recruited patients between February 2019 and March 2020, forming the pre-COVID-19 cohort with 377 eligible patients screened in Sydney.
TCC-Cardiac recruited patients from July 2021 to February 2023, forming the post-COVID-19 cohort with 718 eligible patients.
Supplemental patient demographic and medical history data were collected from the electronic medical record.
Inclusion criteria required a qualifying hospital admission, residence in Sydney, and recorded phone ownership status.
Background
This study represents the first examination of smartphone ownership specifically in patients with cardiovascular disease.
The authors note that 'smartphone ownership in patients with cardiovascular disease has not previously been examined.'
Prior international studies in general patient populations report smartphone ownership ranging from 34% to 91%.
The ~51% ownership rate found in this cardiovascular population is notably lower than general population estimates of ~90% in Australia.
What This Means
This research suggests that among patients hospitalized with heart disease in Sydney, Australia, only about half owned a smartphone — far fewer than in the general Australian population where roughly 90% of adults are estimated to own one. This finding held true both before the COVID-19 pandemic (2019–2020) and after it (2021–2023), with smartphone ownership rates of 51.5% and 51% respectively. Notably, more than a quarter to a third of patients in these groups did not own any mobile phone at all.
The research also found that smartphone ownership was unequally distributed even within this patient group. Older patients, those with more health conditions (comorbidities), and those with markers of lower socioeconomic status — such as lacking private health insurance — were significantly less likely to own a smartphone. In the pre-pandemic group, men were also more likely to be smartphone owners than women.
These findings matter because 'mobile health' (mHealth) apps and remote monitoring tools for heart conditions — such as apps to track symptoms or send data to doctors — are increasingly being developed and promoted. However, this research suggests that if such tools rely on patients owning a smartphone, they may systematically exclude the patients who are often at highest risk: older adults and those with multiple health problems. Designers and providers of these digital health tools need to account for the reality that a large portion of their intended patient population may not have the technology needed to participate.