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The challenge

Uptake of cardiac rehabilitation is poor

Health services in the home and community are seen globally as a key to tackling the increasing prevalence of chronic diseases – and their associated costs to the economy.

In the case of heart-related conditions such as heart disease, cardiac rehab programs can help to prevent the recurrence of cardiac events and reduce hospital re-admissions. Research has shown, for example, that heart attack survivors who complete rehabilitation are 40 per cent less likely to experience another attack.

Cardiac rehab programs traditionally take the form of group-based exercise and educational activities and are undertaken at hospitals or clinics.

Unfortunately, uptake of these programs is poor, particularly in women and older patients.

Our response

We've created an online cardiac rehabilitation platform

[Music plays and CSIRO logo and text appears: Life saving app for recovering heart attack patients]

[Image changes to show Dr. Mohan Karunanithi, Research group leader, CSIRO]

Dr. Mohan Karunanithi: Every year there’s about 55,000 Australians who suffer a heart attack.  That’s, when you look at it, in terms of scale it’s one in every ten minutes somebody’s having a heart attack.  So it’s really quite significant.

[Image changes to show Professor Darren Walters, Executive Director of Cardiology]

Professor Darren Walters: And once you’ve had a heart attack you’re at high risk for further problems over the course of your life.  One thing that you can do that will help prevent people needing to come back into hospital is to undertake cardiac rehabilitation.

[Images flash through of people undertaking walking and exercise bike cardiac rehabilitation exercises]

Cardiac Rehabilitation’s really an overall comprehensive programme life style modification, risk factor modification.

[Image changes back to Professor Darren Walters]

The development of the sustainable exercise strategies to lower your risk into the future. 

[Image changes to show a person on an exercise chair rehabilitation exercise]

The trouble is, for various reasons we can’t get people to cardiac rehab.

[Image changes back to Professor Darren Walters]

They either are not referred or if they’re referred they don’t come or if they do come they don’t see it through.

[Image changes to show a smart phone]

Imagine if you could conduct this research using a smart phone. 

[Image changes back to Professor Darren Walters]

Put physiological parameters into the phone like a weight and blood pressure, track it over time, do all the things you’d do in a rehab setting.

[Image changes to show a smart phone]

Dr. Mohan Karunanithi: The Smartphone app captures health measurements and the life style risk factor modification.  It also provides education and motivational components that will give you an SMS text messages. 

[Image changes to show Dr. Mohan Karunanithi]

The information from there is uploaded into a clinical programme which a care mentor uses to provide weekly consultation through the six week programme.

[Image changes back to Professor Darren Walters]

Professor Darren Walters: We get twice as many people through using this technology than we could if we just referred them to a community based rehabilitation programme and that has the potential over the long course.  If you double the number of people going to rehab to save lives and save money.

[Image changes to show a smart phone displaying the health measures screen revolving]

Dr. Mohan Karunanithi: The smart phone helps them to complete the cardiac rehab programme simply because it aligns with the patient’s daily routine.

[Image changes to show Chris Porter, Cardiac rehabilitation client walking on an oval and then sitting in a chair]

Chris Porter: My name is Chris and I got the app from Queensland health after I had a heart event.  The app prompt me with my rehabilitation every day.  They sent information through and motivational and educational tutorials and so every day I would see more and more changes in my lifestyle and moving away from the lifestyle that I had that created the heart event.

[Image changes to show Dr. Mohan Karunanithi]

Dr. Mohan Karunanithi: It takes them through providing education so that it can inform them of their health condition and what more... and how to motivate themselves into self managing the condition.

[Image changes to show Chris Porter and then the camera zooms in on his hand holding the smart phone]

Chris Porter: Managing my own rehabilitation certainly gives you a certain amount of empowerment that you’re not having to rely on going to the doctors or going to some sort of health professional all the time.

[Image changes back to Professor Darren Walters]

Professor Darren Walters: CSIRO have been a pleasure to work with. I mean finding someone who will partner and make your concepts or your ideas and turn them into a reality, that’s... that’s been, you know, very satisfying.  It’s been an incredible journey.

[Image changes to show Dr. Mohan Karunanithi]

Dr. Mohan Karunanithi: Without working with Queensland Health we wouldn’t have actually been able to deliver the care delivery that closely aligns with what is... currently providing the traditional skill.

[Image changes back to Professor Darren Walters]

Professor Darren Walters: We have demonstrated “Wow, this works”.

[Image changes to show a revolving smart phone displaying the health measures screen]

People have embraced the technology and that’s the exciting phase. 

[Image changes back to Professor Darren Walters]

We have embedded this now in usual practice for people and we’re currently transitioned it into a real option for people in Metro North and in West Morton.

[Image changes to show Chris Porter using a smart phone displaying the health measures screen]

[Image changes back to Professor Darren Walters]

And I think this trial for the first time gives you that level of evidence and confidence that these new interventions do work.

[Image changes and camera zooms in to show a smart phone in Chris Porter’s hands]

[Image changes to show Dr. Mohan Karunanithi]

Dr. Mohan Karunanithi: Well if you look at cardiac rehab and the app that we’ve got now it addresses risk factors very similar to other chronic diseases.

[Image changes to show Chris Porter using a smart phone displaying the health measures screen]

[Image changes to show Dr. Mohan Karunanithi]

And what we are looking at extending is to this pulmonary diseases, diabetes and heart failure.

[Image changes back to Professor Darren Walters]

Professor Darren Walters:  All of these conditions could be managed through a similar type platform.

[Music plays and CSIRO logo and text appears: Big ideas start here,]

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Our researchers at the Australian eHealth Research Centre, in partnership with Queensland Health, have developed a digital platform to support cardiac patients and their carers, providing convenient access to rehabilitation tools remotely.

The platform comprises a web portal for clinicians and a smartphone application for patients. Patients can access rehab at home with the app, rather than travel regularly to outpatient clinics.

The app delivers the core components of a cardiac rehabilitation program such as education, behaviour modification and psychological counselling, which are informed by patients’ clinical needs and information they have collected about themselves. Clinicians can access this data remotely through the web portal, improving communication around patient experiences and outcomes.

While not designed to replace a standard rehabilitation program, the platform offers a more flexible option for eligible patients and greatly minimises reliance on health centre visits.

The results

Increasing uptake and completion for better outcomes

A simple app can improve the rehabilitation of heart attack survivors. ©  Cardihab

Our clinical trial found that cardiac patients who were offered a rehabilitation program online were far more likely to participate than those who had to travel to an outpatient clinic (80 per cent to 62 per cent).

Those who used the platform were more likely to adhere to the guidelines of the program (94 per cent to 68 per cent) and see it through to completion (80 per cent to 48 per cent).

This study demonstrates that the online rehab program delivers the same, if not better, health outcomes as traditional rehabilitation programs, with the increased likelihood of adoption and completion.

In 2017, our cardiac rehabilitation platform was commercialised as Cardihab. This led to the establishment of the standalone company Cardihab™ Pty Ltd, which spun out from the CSIRO in 2017 after raising $1.35 million in venture capital.

Cardihab™ has been used by Australian private health insurers, clinicians and patients in Queensland, Victoria and South Australia.

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