Development and usability test of an intelligent cardiovascular risk elimination application for patients with coronary heart disease
Authors: Chen Y.L , Wu Y , Wang Q.Y , Deng Y , Guo Y.Q , Dong X.J , Liu M.X , Wu F.Q , Li J , Yue P , Fu Z.Y 
Published: November 2020

Abstract

Background
The mortality of coronary heart disease (CHD) can be largely reduced by improving CHD risk factors through facilitating adherence to unhealthy lifestyle modification (UhLM) and secondary preventive medications (SPMs). Current interventions, however, have been unsatisfactory worldwide.

Purpose
To develop an Individualized, Intelligent and Integrated Cardiovascular Application for Risk Elimination system (iCARE) for facilitating adherence to UhLM and SPMs, and test its usability and feasibility for implementation.

Methods
Based on a set of individualized interventions formulated in our preliminary work, we developed iCARE using mHealth techniques and a user-centred approach, which included 3 phases: (1) identifying patient preferences regarding formats for providing interventions; (2) designing the functions, architecture, and user interface (UI); (3) developing the iCARE using prototyping techniques. Usability test was conducted in patients with acute coronary syndromes and/or underwent percutaneous coronary intervention from January to March 2019 in two University affiliated hospitals in our city. The iCARE was implemented in 4 cardiac units of the same hospitals thereafter.

Results
The iCARE architecture and UI are displayed in Fig 1. Different from most current available mHealth CHD management system, the iCARE has a set of interventions and IF-THEN algorithms triggering interventions to ensure that patients receive individualized recommendations for UhLM and SPMs adherence. To improve effectiveness of iCARE interventions, visualization was used to augment patients' perceptions of risks of non-adherence to UhLM and SPMs, and effectiveness of adopting healthy lifestyles etc. Interventions are triggered by results of initial assessment and health data from daily monitoring. The initial assessment is conducted before patients are discharged, and a health report as well as individualized goals for risk reduction are formulated automatically. Daily diet, physical activities, smoking, medication adherence, blood pressure, blood sugar, and symptoms are monitored either through wearable devices or manual entry. Instant and individualized feedbacks as well as recommended actions are sent to patients automatically. A build-in artificial intelligent Q-A function was also included in iCARE. For the usability test, 88 patients with 71.3% male and mean age of 60 (SD 9.9) were recruited, 87.5% were satisfied with iCARE; 89.5% and 81.4% reported that iCARE was useful and easy to use, respectively. Currently, a total of 201 patients with 83.1% male and mean age of 54 (SD 10.2) were recruited from June 2019 to January 2020, and 46 of them have been followed up for 3 months.

Conclusions
The iCARE has achieved its functions of serving as an individualized and intelligent CHD management tool to improve adherence to UhLM and SPMs. The usability is satisfactory and it is feasible to implement in clinical settings.
Figure 1. The iCARE system. iCARE, Individualized, Intelligent and Integrated Cardiovascular Applicaton for Risk Elimination (iCARE) system, CHD, coronary heart disease.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Natural Science Funding of China