A personalised cardiac rehabilitation programme to remotely monitor patients

Portsmouth Hospitals University NHS Trust cardiac rehab service is a busy specialist nurse-led service from phase 1 to 4.

The team supports patients:

• following a cardiac event or surgery
• with longer term conditions such as cardiac rehab
• during discharge
• with outpatient-led cardiac rehabilitation and support

Before the COVID-19 pandemic, patients attended traditional face-to-face cardiac rehab classes under the supervision of the cardiac rehab team.

During the pandemic, the cardiac team at Portsmouth Hospital wanted to continue delivering their service whilst remotely monitoring their patients.

They wanted to provide a virtual rehabilitation programme for patients that is:

• intelligent
• automated
• evidence-based
• personalised

Situation

During the pandemic, face-to-face rehab was unavailable.

The team wanted to offer a digital service to continue to help people increase their activity after their cardiac event or intervention.

Aspiration

The team wanted to:

• innovate their service
• increase cardiac rehab uptake
• increase the level of data that was available to them

Solution and impact

The team used EXi, a patient-facing app with a web-based clinician data portal to help deliver a remotely monitored service.

EXi is a Class 1 CE marked medical app which analyses patient health and prescribes a personalised exercise programme. This is set at the right level of intensity for the patient.

Based on the latest medical guidelines, the app can tailor the exercise programme to any number of 23 in-built long-term conditions. This includes:

• heart disease
• hypertension
• hyperlipidaemia
• peripheral arterial disease
• chronic obstructive pulmonary disease
• osteoarthritis

Data is sent back to the clinical teams through EXi's GDPR-compliant web-based data portal.

Adherence rates with the personalised prescription were high. Over 60% of the patients’ personalised weekly exercise goals were met over 12 weeks.

Completion rate for the 12 week programme was 75%.

Functionality

• The app does an initial medical screening to assess if it’s suitable for the patient.
• The app has a colour-coded risk profile for cardiometabolic risk factors such as resting heart rate, blood pressure, waist circumference, weight and body mass index available.
• There is a library of information for each medical condition, including disease-specific precautions and contraindications.
• Exercise prescription is personalised and based on an analysis of the patient’s data.
• The patient is presented with the exercise content that’s the right intensity for them, for example, home workouts and GPS-tracked walking.
• The app tracks personalised health metrics.
• The Apple Watch programme monitors the patient’s personalised heart rate zone in real-time. It uses haptic feedback to notify the user if they are working outside their prescribed training zone.
• Reports can be sent directly from the app.
• A large volume of real-time activity and health data is available for the clinician to view using EXi's web-based data portal.

Capabilities

EXi:

• is an app for patients
• is available on iOS and Android
• is a data portal for clinicians
• can pull data from many wearable devices
• has a bespoke programme for patients who have an Apple Watch

Scope

The app can be used at home and in a clinical setting.

Patients can download the app themselves and get started. However, having a clinical team who looks at their data is more effective. This makes patients more accountable and they are more likely to complete the programme.

Key learning points

The team learned a lot about patient contact points during the pandemic. They realised that it's not always necessary to contact people.

It makes a big difference when people have the resources and the correct information.

Key contact

Carol Brady, Lead Cardiac Rehab Nurse Specialist, Portsmouth Hospital

info@portsmouthcardiac.co.uk

Carron Manning, Clinical Director, EXi

carron@exi.life