A lifestyle monitoring system for cardiovascular care: protocol of a prospective observational trial
Authors: Goevaerts W F , Kemps H M C , Kop W J , Lu Y , Birk M V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation.

Background
In cardiac rehabilitation, technological innovations can improve patient-relevant outcomes and are associated with reductions in health care costs by enabling personalized care. Lifestyle factors such as physical fitness, dietary habits, mental stress, and sleep quality, are strong predictors of the occurrence, clinical course, and overall treatment outcomes of common cardiovascular diseases such as coronary artery disease and atrial fibrillation. However, these lifestyle factors are rarely monitored, nor used in daily clinical practice and personalized cardiac care. Moreover, non-adherence to long-term self-reporting is common.

Purpose
The main purpose of this study is to evaluate adherence to a continuous unobtrusive and patient-friendly lifestyle monitoring system.

Methods
In a prospective observational trial we investigate usability and adherence of a monitoring system for lifestyle factors, i.e., daily physical activity levels, dietary habits, mental stress, smoking habit, and sleep quality. Patients (n = 100) scheduled for or who recently underwent coronary artery bypass surgery, an electrophysiology study and/or radiofrequency catheter ablation, a transcatheter aortic valve implantation, a fractional flow reserve test and/or a percutaneous coronary intervention, and/or valve surgery are asked to participate.
The monitoring system consists of a care platform with a custom-built conversational interface—a chatbot—and a wrist-worn wearable medical device. The wrist-worn device collects continuous objective data on physical activity and the chatbot collects subjective data (e.g., sleep quality, nutrition intake and mental stress levels), both for 7 separate days per month repeatedly during the study period. Data collection starts one week before treatment and continues until 1-year after discharge. Via a dashboard, patients can observe their lifestyle measures and adherence to self-reporting, track personal goals, and share their lifestyle data with practitioners and relatives.
The primary outcome of the trail is adherence to using the integrated platform for self-tracking data. The secondary outcomes include system usability, determinants of adherence and the relation between baseline lifestyle behaviour and long-term patient-relevant outcomes.

Discussion
Systematic monitoring during daily life is key to gain insights into patients’ lifestyle behaviours. In this context, adherence to monitoring systems is critical for cardiologists and other care providers to obtain crucial information to personalize care. In this project, we present insights into the evaluation of adherence to monitoring technology including a conversational agent and continuous monitoring, focusing on multiple lifestyle domains for one year. This work contributes to our understanding of adherence, patient-centred data collection and interpretation, to enable personalized cardiac interventions, improve patient-relevant outcomes, and reduce health care costs.