The design of a self-monitoring solution to detect comorbidity in cardiovascular disease

Abstract

Chronic diseases often come together. Having one disease increases the risk of having another different disease. A coexisting disease, also known as a comorbidity, drastically decreases the quality of life and can result in further health decline, as they come unnoticed and untreated. Detection of the first disease signs gives rise to timely seeking help and intervention. Therefore, screening for other diseases than the one diagnosed is essential for the health and well-being of patients.

This graduation project aims to improve secondary prevention of cardiovascular disease by design. It focused on opportunities to encourage people with established cardiovascular disease to act on cardiovascular risk and decline, using data derived from self-monitoring. The project aim was to develop a solution which helps patients at home with the interpretation of clinical signs indicative of cardiovascular decline and undetected co-occurring diseases.
The project is carried out for the CardioLab, a research consortium between Philips Healthcare, the Dutch Heart Foundation and the faculty Industrial Design Engineering. The common goal of the three partners is to “join forces in research and design to decrease the large number of heart patients and casualties due to heart failure with the use of data-driven technologies”.

Problem
The prevalence and detection of comorbidities bring along various problems. The actual prevalence of comorbidities is underestimated due to underdiagnosis of the primary disease and the comorbidity. It may that the comorbidity is confounded by shared risk factors or that the features of the comorbidity overlap with features used to define the primary disease. The first signs of the comorbidity are often undetected or unacknowledged as checkups at the specialist are just isolated samples. Complaints and clinical signs do not always present or are not actively sought during these samples. Also, the timing can be just unfortunate. The presence of the comorbidity causes many complaints and can result in contradictory treatments. Needless to say, new strategies for comorbidity detection and care are necessary.

Research
Longitudinal screening through self-monitoring could pick up on the first signs of disease. Literature and field research showed that certain health variables, such as heart rhythm and blood pressure, are indicative of multiple diseases. Combinations of these variables can be suggestive towards specific diseases. Therefore, integrating these variables in a home-use screening device enables patients to monitor the risk of various diseases continuously.

Design proposal
The project proposes a self-monitoring solution which enables patients to monitor their risk of complications and comorbidity by using a home use stethoscope and a smartphone application. The smartphone application visually demonstrates the near future risk of complications and gives patient-tailored action points to reduce this risk.

The proactive feedback intent to evoke a well-considered patient response, ranging from encouraging healthy lifestyle habits, to the reassurance of seeking help. It aims to engage and empower patients in the ambiguity of risk management by providing insights on the whys and hows of preventative self-management strategies which apply to their situation.

Evaluation
The user evaluation demonstrated that most participants, with and without a cardiovascular disease, perceive the design proposal as helpful and motivating. However, the experience of stress due to an increased risk level for disease was perceived as a concern by many. Some saw the risk insights as a necessary evil to come in action to reduce their risk; others wouldn’t want to know about it. This assumes that the platform would not be suitable for all personality types. Further research needs to assess the role of stress in these risk scenarios.

The project explored a new strategy to improve secondary prevention of cardiovascular disease. Further research and development are needed to substantiate the true effectiveness of the proposal.