Around 15 million people across Europe suffer from congestive heart failure, a chronic condition where the heart is not able to pump enough blood around the body, but according to Sofia Marchã, a senior policy officer for patients and research at the European Heart Network in Brussels, Belgium, a new health app could make living with the condition easier.
Who is at risk of developing heart failure?
‘High blood pressure, raised cholesterol and diabetes are risk factors for heart failure, while genetics, age and family history also play a role.
‘However, behaviour also has an effect. Smoking and an unhealthy diet, for example, increase the chance of developing heart diseases in general and certainly don't help someone who has been diagnosed with heart failure.’
What is it like to live with the condition?
‘It is physically debilitating as well as socially and psychologically overwhelming. It causes shortness of breath, fatigue and swelling of the ankles, for example, which can reduce mobility. If you are walking you can get the sensation that your heart is racing and even simple activities like vacuuming around the house can be a struggle. It’s a challenge for people that have to go to work every day.
‘The physical limitations can cause a great deal of anxiety and stress in patients. They receive a lot of advice but don’t always find it easy to translate it into their daily lives. Patients have to take a lot of medication throughout the day, they have to regularly track their heart rate and weight. It significantly affects a person's quality of life - you can't just get on with your day.’
How is the EU-funded HeartMan project aiming to help?
‘We are developing a virtual coach to support heart failure patients so they can better manage their disease on a day-to-day basis. The system consists of a wristband that can monitor heart rate, acceleration and skin temperature, for example, that transmits the information to a smartphone app. The software sends patients reminders and can alert them when they need to take medication or measure their blood pressure or weight, which they can record directly in the system.
‘It is meant to be tailored to individual patients as much as possible. Some people may only need a few reminders a day whereas others may prefer to be sent notifications more often.
‘HeartMan is designed to give heart failure patients extra support in everyday tasks and routine, so it will hopefully contribute to improving patients’ overall quality of life.’
Sofia Marchã, European Heart Network, Belgium
‘The app also gives personalised advice on physical exercise and nutrition which is continuously monitored by the treating physicians or caregiver. The exercise programme is adapted to a patient's physical capabilities and they can choose which exercises they want to perform and when. The dietary suggestions are based on their knowledge of appropriate nutrition, their prescribed diet and what they are actually eating.’
Can the app help with the psychological impact of the condition as well?
'Yes, it also offers psychological support, cognitive behavioural therapy and mindfulness exercises. If a patient's heart rate is elevated because they are experiencing a moment of high anxiety, there is the option to play mindfulness games to calm them and refocus attention. The cognitive behavioural therapy mostly consists of pop-up messages that aim to reduce unhealthy behaviour and improve adherence to the therapeutic routine.’
Will the system also be of use to doctors?
‘Treating physicians often do not see patients for two or three months between consultations. It is difficult for anybody to remember what they have done over the course of a month or more. So doctors will have access to data collected about the patient between consultations.
‘By accessing the information on the server, doctors will have an overview of whether a patient is adhering to therapy, variations in heart rate and weight, changes in physical endurance, and if they have been following dietary recommendations. All of this data is key to inform treatment decisions.’
Were patients involved in designing the app?
‘HeartMan follows a human-centred design approach, which means that patients and caregivers informed the design and initial mock-ups were evaluated by potential users. In 2018 we will also have a group of patients testing a trial version of the app and system, so it is continuously being improved based on feedback we get.
‘It is important to note that heart failure occurs predominantly in the older population, so the app needs to be very user-friendly for people who are not adept at using technology. We need to make sure that it’s not too overwhelming in terms of features and reminders, and that it displays the most important features prominently and accessibly.
‘A working prototype is currently in development, but the wristband is already available while the mobile app is still being tweaked.’
Apart from helping people with heart failure, could the system have other applications in the future?
'Although it is specifically designed to help manage heart failure, many of the components could easily be adapted to create apps that help prevent or manage other chronic diseases. There is a lot of discussion about how being physically active and having an appropriate diet can not only help prevent many conditions, but also influence how patients respond to medication.
‘Using wristbands, apps and smartwatches to help people make healthy choices is becoming increasingly popular. If the trial is successful, a reduction in hospital stays and other healthcare-related costs could also be expected. HeartMan, however, is designed to give heart failure patients extra support in everyday tasks and routine, so it will hopefully contribute to improving patients’ overall quality of life.’
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