The objective of the HAZLO (“Do it”) project is to implement and evaluate a CRP (Cardiac rehabilitation programme) on low risk patients, called e-supervision, that is optimised for the daily life environment of the individual patient.
CRP are multidisciplinary actions, limited in time (two or three months), that combine therapeutic and functional assessment activities for the recovery and secondary prevention of cardiac events. This rehabilitation needs to be applied in multiple areas: Physical (resistance and strength); psychological (anxiety control, relaxation); education in cardiovascular risk factor control (medication, life habits); return to work; sexual dysfunction; and others. The activities are selected in relation to their scope and intensity, according to the patient's conditions and a stratification of cardiovascular risk (usually low, medium and high risk) and the units' own capacities and resources. The most innovative recommendations propose a rethinking of the provision models for rehabilitation to optimize the use of available resources and improve patient acceptance and adherence.
The programme is personalised for each patient by the multidisciplinary team through a patient profile with 4 dimensions (diagnosis, risk factors, psychological factors, others) and 26 characteristics that automatically determine all the components of the PRC. It incorporates a multimedia educational program (12 areas, 70 resources) and personalized walking and relaxation sessions supported by apps, pulse monitoring and audio messages that automatically guide the patient to perform them correctly and safely. In addition, web messaging with guaranteed response in less than 24h and video call functionality are included.
In this project, the concept of personalised medicine (PM) is extended to a broader perspective referring to the dynamic adaptation of treatments and care plans to the patient's life style and social conditions. The dynamic personalisation of the cardiac rehabilitation plan is reached in two phases:
- Initial set-up of the rehabilitation plan:
In this phase, the patient's profile is established according to a series of characteristics related to the diagnosis, cardiovascular and psychological risk factors, work, etc. The core components of the plan and its initial configuration are automatically established: Exercises, training ranges, adapted educational plan, activity planning according to the social and family situation. The dimensions/main characteristics considered are: 1) heart rate ranges (maximum, minimum); 2) diagnosis related: cardiopathies, such as ischemic, congenital, and/or vascular cardiopathies; interfering pathologies in training such as diabetes, obesity, COPD, peripheral vasculopathy, chronic arthropathy, pacemaker; and other cardiopathies, such as atherosclerosis, maximum ischemic rate, anticoagulation and atrial fibrillation 3) cardiovascular risk factors, such as dyslipidemia, diabetes, arterial hypertension, obesity, smoking and physical inactivity 4) psychological risk factors, such as anxiety, depression and hostility. In addition, requirements based on the occupational situation are also taken into account. In summary, the initial rehabilitation plan is developed based on medical and social factors as well as patient preferences.
- Dynamic adaptation of the rehabilitation plan:
The precision with which the rehabilitation plan is defined, according to the patient's multidimensional profile, allows precise and timely modifications of the plan as it is carried out. Technological resources (as proposed in HAZLO) not only support patients in carrying out their rehabilitation plan in a safe and assisted manner, but also enable daily remote monitoring as well as recording of the development of programmed activities. This allows health professionals to carry out precise modifications to the plans according to the evolution and achievement of therapeutic objectives, or changes in the patients’ personal situations, symptoms, and preferences.
HAZLO contributes to the improvement of out-of-hospital cardiac rehabilitation plans, aiming for a change from traditional quasi-static proposals to personalised programmes of dynamic therapeutic activities adapted to the evolution of patients based on objective facts. With the help of technological resources, it becomes feasible to provide the right treatment to the right patient at the right time, based on both objective data and patient preferences, in order to achieve improved healthcare outcomes.
Finally, it should be noted that in a pandemic situation such as the one we are living in today, which combines potential measures of confinement and saturation of health services, this model can contribute to maintaining high-quality health care.