{"id":6881,"date":"2021-09-23T11:11:15","date_gmt":"2021-09-23T11:11:15","guid":{"rendered":"https:\/\/kauveryhospital.com\/blog\/?p=6881"},"modified":"2023-04-28T04:40:44","modified_gmt":"2023-04-28T04:40:44","slug":"digital-health-integration-for-cardiac-rehabilitation","status":"publish","type":"post","link":"https:\/\/www.kauveryhospital.com\/blog\/heart-health\/digital-health-integration-for-cardiac-rehabilitation\/","title":{"rendered":"Digital Health Integration for Cardiac Rehabilitation"},"content":{"rendered":"<p class=\"caps\">People who have recently suffered a heart-attack or have had a heart surgery, or been admitted for <a href=\"https:\/\/kauveryhospital.com\/blog\/heart-health\/causes-and-types-of-congestive-heart-failure\/\">heart failure<\/a>, need to be inducted into a cardiac rehabilitation program to assist them to gradually return to a normal life in due course of time. The hope and intention is also to prevent a recurrence or worsening of the problem (called Secondary Prevention).<\/p>\n<p>The process of achieving the above objectives is called Cardiac Rehabilitation (CR).<\/p>\n<p>CR is a specialized area and involves a wide range of activities such as:<\/p>\n<ul>\n<li>Patient assessment: 24&#215;7 monitoring of vital parameters of the patient<\/li>\n<li>Risk stratification and risk factor control: Assessing the various risks for secondary incidence, classifying and managing them<\/li>\n<li>Patient education: Needless to say, the patient must be educated and involved at every step<\/li>\n<li>Optimalization of pharmacologic therapy: Changing, augmenting, stepping up and stepping down of medication as required<\/li>\n<li>Increasing physical activity: independent of exercising<\/li>\n<li>Exercise training: the best exercises and the right way of doing them<\/li>\n<li>Dietary and nutritional counselling: self-explanatory<\/li>\n<li>Weight-control and weight-management: This includes lipid management and other measures<\/li>\n<\/ul>\n<div class=\"also-read\">Also Read: <a href=\"https:\/\/kauveryhospital.com\/blog\/heart-health\/faqs-on-lipid-profile-test\/\">FAQs on Lipid Profile Test<\/a><\/div>\n<ul>\n<li>Blood Pressure management: with and without medication<\/li>\n<li>Diabetes Management: In <a href=\"https:\/\/www.kauveryhospital.com\/Centers-of-Excellence-and-Specialties\/Diabetology\">diabetics<\/a> undergoing CR<\/li>\n<li>Smoking cessation: This can be difficult if the person is a heavy smoker; involves both counselling and de-addiction measures<\/li>\n<li>Psychosocial guidance and counselling: Overcoming the emotional burden of adjusting to a new lifestyle<\/li>\n<\/ul>\n<h2><strong>CR in the past\u00a0<\/strong><\/h2>\n<p>Till a few decades ago, CR was a complex process that involved innumerable <a href=\"https:\/\/www.kauveryhospital.com\/doctors\/chennai\">doctors<\/a>, specialists, nurses and the family members of the patient. Compliance with secondary prevention measures and proactive participation, by the patient, were low. Then came Tele-rehabilitation and Tele-Medicine in the early 2000s. These aimed at remote consultation with the patient, however they have not been found to be effective in CR.<\/p>\n<h2><strong>Digital Health Integration (DHI)\u00a0<\/strong><\/h2>\n<p><strong>\u00a0<\/strong>In the last decade- and-a-half, advances in sensor technology and mobile applications have been able to automate many of the above activities. This has led to a plethora of wearable devices and cardiac implantable electronic devices (CIEDs) that capture real-time data and relay it to concerned specialists who will then suggest the required intervention.<\/p>\n<p>The sensors can be invasive or non-invasive and can be used to monitor parameters such as heart rate, pulmonary artery pressure, blood pressure, thoracic wall impedance, weight and physical activity. They can also monitor behavioural aspects such as adherence to medication and movements that reflect active smoking. Smart tools then make sure that data capture is automatic in order to increase patient comfort. Further, many of these devices and platforms are interoperable (able to exchange and make use of information) which ensures that the healthcare provider (such as the hospital managing the CR) finds the system user-friendly.<\/p>\n<p>Further, all these data are being integrated into an Artificial Intelligence based software system.<\/p>\n<p>AI-driven algorithms can simplify decision making regarding physical activities to be undertaken by the person, and medication, and can be as autonomous as possible. Secondary prevention is achieved through a partially-automated, personalized, AI-based VHC or Virtual Health Coach that is basically a smartphone application but is also integrated to all hardware worn by the person. All these are then integrated in to a system that is supervised by a team of healthcare professionals involved in the CR.<\/p>\n<p>The sum-total of all this is &#8211; a highly personalized CR program, which goes a long way in reducing the burden on the <a href=\"https:\/\/www.kauveryhospital.com\/Patients-Visitors\/Preventive-Health-Care\">healthcare<\/a> system. Further, it has moved the playing field from clinics and hospitals to the patient\u2019s home. This increases patient comfort, reduces the hassles associated with CR and improves CR outcomes.<\/p>\n<h2><strong>Digital Tools and Technologies for CR<\/strong><\/h2>\n<p><strong>\u00a0<\/strong>There is a plethora of tools, technologies, devices and sensors in use today or under active research. It\u2019s not possible to cover all of them here, so for the purpose of this article, we will cover only the most popular and widely used ones.<\/p>\n<p><strong>Hypertension \/ High BP<\/strong>: The manual sphygmomanometer used by doctors and clinics is now being replaced by digital, upper-arm sphygmomanometer or BP monitor that can be used at home. The data from it can be integrated with smartphone applications.<\/p>\n<p><strong>Physical activity<\/strong>: The ubiquitous Fitbit and smartphone apps that monitor or measure physical activity are first generation options. Today, CIEDs (cardiac implantable electronic devices) are fitted inside the heart and these use an array of sensors such as accelerometers, pulmonary impedance sensors, ventilation sensors, cardiac contractility sensors and blood temperature sensors.<\/p>\n<p><strong>Weight Management<\/strong>: There are various surgical and non-surgical options available today for weight-loss and weight-management. These are being complemented by smartphone apps that approve or disapprove food purchases by bar-code scanning, remembering recent food inputs (both purchase and consumption), photographs of food consumed or purchased, auto-completion of text and recognizing food items from uploaded photos.<\/p>\n<p><strong>Diabetes Management<\/strong>: The capillary prick method for glucose monitoring will become a thing of the past. Chronic <a href=\"https:\/\/www.kauveryhospital.com\/centers-of-excellence-and-specialties\/diabetology\">diabetics<\/a> can have subcutaneous glucose sensors implanted. Along with smart insulin pens, automatic pumps and decision support-systems, they achieve better diabetes management.<\/p>\n<p><iframe loading=\"lazy\" title=\"How to use Insulin Pen ( Tamil ) | \u0b87\u0ba9\u0bcd\u0b9a\u0bc1\u0bb2\u0bbf\u0ba9\u0bcd \u0baa\u0bc7\u0ba9\u0bbe\u0bb5\u0bc8 \u0b8e\u0bb5\u0bcd\u0bb5\u0bbe\u0bb1\u0bc1 \u0baa\u0baf\u0ba9\u0bcd\u0baa\u0b9f\u0bc1\u0ba4\u0bcd\u0ba4\u0bc1\u0bb5\u0ba4\u0bc1 | Kauvery Hospital\" width=\"900\" height=\"506\" src=\"https:\/\/www.youtube.com\/embed\/Wq_0ZQcAq3E?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe><\/p>\n<p><strong>Smoking Cessation<\/strong>: Exhaled Carbon Monooxide sensors are used in conjunction with smartphone applications that monitor the person\u2019s changes in behavior. Inputs from these two are fed to an AI-based program that predicts Smoking Cessation treatment outcomes. An AI-based chat-bot then follows up with counselling for behavioral change.<\/p>\n<p><strong>Medication Adherence<\/strong>: Smart pillboxes are smartphone apps that remind and monitor the patient\u2019s adherence to prescriptions. Digital pills (still under research) are a drug-device combination that relay a signal when the pill comes in contact with gastric acids.<\/p>\n<p><strong>Sensors in Heart Failure<\/strong>: A Patient Management Intervention System under research captures and transmits daily information on heart rate, body weight, heart rhythm, blood pressure, peripheral capillary oxygen saturation, and self-rated health status. It engages a tele-monitoring system that consists of a three-channel electrocardiogram (ECG), a blood pressure measuring device and weighing scales that provide their inputs to a smartphone application. Studies are underway that use disposable, multi-sensor patches to measure ECG, skin impedance, temperature, and accelerometry in order to derive information about heart rate and variations, arrhythmia burden, body posture, gross activity, respiratory rate, body tilt, walking and sleep.<\/p>\n<p><strong>Tele-monitoring using CIEDs<\/strong>: Cardiac Implantable Electronic Devices such as cardioverter-defibrillators (ICDs) and cardiac resynchronization defibrillators (CRT-Ds) are improving clinical outcomes for patients with heart failure.<\/p>\n<p><strong>Sensors in Arrhythmia Detection and Monitoring<\/strong>: Photo-plethysmo-graphy (PPG) and Electro-cardio-graphy (ECG)-based smartwatches, smart-cameras and smartphone-based apps are being used to monitor and\/or diagnose Atrial Fibrillation (AF) and malignant arrhythmias.<\/p>\n<p><strong>Internet of People<\/strong>: This is in the early stage of research. Biochemical sensors fitted into smart mirrors, smart contact-lenses, smart vehicles and smart sanitation can monitor health parameters of CR (or any heart) patients and trigger alarms or alerts when threshold values are crossed. Voice recordings are being analyzed to detect Coronary Artery Disease (CAD) or heart-failure decompensation.<\/p>\n<p><strong>Digital Twin<\/strong>: The above technology will soon evolve in such a way as to create a digital twin for the patient. One can simulate various structural and physiological characteristics of the patient and create a digital copy of him\/her. This way, the heart function, exercise capacity and medication tolerance can all be simulated and analyzed, without harming or hassling the patient in any way.<\/p>\n<hr \/>\n<p><strong><em>Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals<\/em><\/strong><\/p>\n<hr \/>\n<p>Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.<\/p>\n<p>Chennai \u2013 044 4000 6000 \u2022 Trichy \u2013 Cantonment \u2013 0431 4077777 \u2022 Trichy \u2013 Heartcity \u2013 0431 4077777 \u2022 Trichy \u2013 Tennur \u2013 0431 4022555 \u2022 Maa Kauvery Trichy \u2013 0431 4077777 \u2022 Kauvery Cancer Institute, Trichy \u2013 0431 4077777 \u2022 Hosur \u2013 04344 272727 \u2022 Salem \u2013 0427 2677777 \u2022 Tirunelveli &#8211; 0462 4006000 \u2022 Bengaluru &#8211; 080 6801 6801<\/p>\n","protected":false},"excerpt":{"rendered":"<p>People who have recently suffered a heart-attack or have had a heart surgery, or been admitted for heart failure, need to be inducted into a cardiac rehabilitation program to assist<\/p>\n","protected":false},"author":3,"featured_media":6890,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[73],"tags":[],"class_list":["post-6881","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-heart-health"],"_links":{"self":[{"href":"https:\/\/www.kauveryhospital.com\/blog\/wp-json\/wp\/v2\/posts\/6881","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.kauveryhospital.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.kauveryhospital.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/blog\/wp-json\/wp\/v2\/comments?post=6881"}],"version-history":[{"count":6,"href":"https:\/\/www.kauveryhospital.com\/blog\/wp-json\/wp\/v2\/posts\/6881\/revisions"}],"predecessor-version":[{"id":9025,"href":"https:\/\/www.kauveryhospital.com\/blog\/wp-json\/wp\/v2\/posts\/6881\/revisions\/9025"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/blog\/wp-json\/wp\/v2\/media\/6890"}],"wp:attachment":[{"href":"https:\/\/www.kauveryhospital.com\/blog\/wp-json\/wp\/v2\/media?parent=6881"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/blog\/wp-json\/wp\/v2\/categories?post=6881"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/blog\/wp-json\/wp\/v2\/tags?post=6881"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}