Having a heart attack is no picnic. That’s obvious. And some might say the experience itself is traumatic enough that it should snap people out of unhealthful lifestyles.
Not so. Part of the problem is that when patients leave the hospital, they’re bombarded with information about what they should and shouldn’t do – how and when to take medications, when to exercise, what foods to avoid, when to visit a cardiac rehab clinic. The list goes on.
Jacob Sattelmair, who’s an epidemiologist by training, is trying to change that approach with Wellframe, an app that breaks down the cardiac rehabilitation process into daily digestible chunks of information delivered through a mobile device.
“The idea is to not overwhelm [patients],” he says. “But to make them feel it’s something for them and that they’re getting cared for even on those days that they’re not going to clinic.” Keeping patients engaged in their care is important because data show that successfully going through cardiac rehab does result in better outcomes.
After installing the Wellframe app, a patient gets an activation code from their clinician which serves as her Wellframe ID and matches her to her clinical program. (Each clinic licenses a set number of codes.) Every day, Wellframe sends her a daily to-do list and reminders based on national standards for cardiac rehabilitation, along with feedback about her engagement. Plus, the clinicians who interact with her in the clinic can keep virtual tabs on her through a web dashboard while she's going through the program at home.
"We're not trying to replace human care. We're really trying to amplify and extend human care," Sattelmair says. Because the app doesn't work without the activation code, patients can't use the Wellframe mobile platform without also enrolling in a physical-world medical program, a point that differentiates Wellframe from other consumer health and fitness apps.
"I think it's a really good idea," says cardiologist Dr. Eric Topol. "As long as it's validated, I think it would be a welcomed new path." There hasn't been any innovation in cardiac rehab strategies for the last 40 to 50 years because cardiologists are disengaged in the process. The program is usually farmed out to nurses and rehab techs, he says. So one of the challenges Wellframe will face is getting doctors to prescribe cardiac rehab to their patients. Most docs don't, although the program improves outcomes and is covered by Medicare, Topol says. It's also important to realize Wellframe is not a one-size-fits-all solution. An at-home, remote strategy might only work for low- to moderate-risk patients.
The app currently doesn't provide any diagnostic services. It's an attempt to foster healthy habits, a distinction that saves the company from having to get the federal Food and Drug Administration's seal of approval as a medical device, which can take months.
Part of the promise of services like Wellframe - including Wildflower Health and Ginger.io -- is the vast amounts of crowd-sourced data they can generate. Right now, cardiac rehab standards, including the ones the Wellframe crew is deploying through their app, are not really personalized. The team has scoured the scientific and clinical literature to make the best approximations possible as to when to deliver certain tasks to patients - to take their medications or to go out for a walk. There's "an inherent level of inference" currently built in to the Wellframe app, but the team is banking on making their algorithm smarter based on the data they gather from their initial users. Right now cardiac rehab works pretty much the same whether you're 40 or 80, but real people have different goals and needs. Some want to quit smoking, lose weight or manage their blood sugar levels better to improve the health of their tickers.
"That may mean they need different parts of the program delivered at different times," says Sattelmair. "What we're driving toward is...making the program increasingly intelligent so it will be adaptive to how a patient is progressing."
In the future, users should also be able to download their own data if they choose. That't not an option currently, but the company will send patients their data if they request it, Sattelmair says.
Wellframe recently finished up a small pilot program at Harvard-associated Brigham and Women's Hospital and South Shore Hospital. The team has gotten positive feedback and good engagement from patients and clinicians, Sattelmair says. They're hoping to present the results at a cardiac rehab conference in the fall. In the meantime, they'll be trying to release an Android version of their app and to expand to other hospitals.
