HeartMan is a personal health system to help congestive heart failure patients manage their disease. Its decision support system provides personalised advice. It features advanced devices and monitoring methods to understand the patients' physical and psychological state, and standard-based data management for wide interoperability.
1%–2% of people in the developed world suffer from congestive heart failure (CHF), which costs the society around 100 billion USD per year. While the improvements in treatment have lately decreased, the number of hospitalizations and deaths due to CHF remains high: around half the patients with CHF are expected to die within five years, and CHF is the most frequent cause of hospitalization in people aged over 65. There is currently no cure available, which makes better management of CHF of paramount importance: both to improve the patients’ quality of life and to reduce the economic costs to society.
In the European project CHIRON, heart failing patients in two countries were telemonitored to gather a unique dataset consisting of 17 parameters characterizing HF patients' short-term health and environment. Due to the reluctance of severely sick patients (among whom deaths and hospitalizations are likely) to participate in the study, patient-reported outcomes were used instead – specifically how the patients perceive their health. This is very much in line with the recent trends in medicine that stress the importance of patient participation and their quality of life. The CHIRON data was used to build models that can predict how a patient will perceive his/her health based on parameters such as daily exercise, humidity, heart rate, etc. Many of these parameters can be controlled, so the CHIRON predictive model is suitable as a basis for a Decision Support System (DSS) that can provide day-to-day advice to patients.
In the HeartMan project we developed a personal health system for CHF that features a DSS based on predictive computer models. The user – a CHF patient – is monitored with the sensors in his/her smartphone, health devices that may be wearable (e.g. ECG monitor), used occasionally (e.g. scales) or placed in the apartment (e.g. temperature and humidity sensor). The devices are connected to a mobile phone through a framework capable of intelligently managing a wide range of devices and ensuring the right devices are sampled with the right frequency at the right time. The framework also interprets the sensor data to extract parameters describing the patient’s physical and psychological state. These parameters, together with the user’s feedback entered through a mobile application, are fed into a DSS.
The DSS first uses predictive computer models for CHF and other decision models to suggest the appropriate intervention for the patient in his/her current state. Next, the patient’s psychological profile and state is used to select the most appropriate presentation of the intervention, as well as select psychological interventions aiming to increase the receptiveness to medical advice and help cope with the disease. The interventions are finally presented to the user through the mobile application. The data generated by the system is stored in the cloud, taking into account privacy and security concerns. It is available to the treating physician through a web interface, and he/she is also be able to modify the advice provided by the DSS if necessary. Anonymized data is available to medical researchers, who can be able to gain new insights into the CHF and its management.
The HeartMan system achieves improved self-management of CHF by using a DSS based on predictive models intended for the patients. The HeartMan DSS is designed as a patient-oriented system, promoting self-care management in an individualized fashion. The users are educated and assisted in the monitoring procedures required by the system, and provided with personalized advice together with explanations appropriate for their understanding. As a result, they are closely involved in their disease management. From the available evidence, these features are expected to increase the level of patient participation.
The HeartMan system is a major step forward in the technology for self-management of CHF. It provides considerably more value to the patients than the current devices that only monitor the patients’ physiological signals and at best provide basic interpretations.
The HeartMan system provides decision support through cognitive behavioral therapy using an approach based on cognitive dissonance and mindfulness exercises. From the available evidence, these features are expected to enhance the level of patient empowerment and self-control.