Power to the Patient: Design and Test of Closed-Loop Interactive IT for Geriatric Heart Failure Self-Care

Chronic heart failure (CHF) is a serious, costly chronic disease and the leading and fastest-growing cause of death in the United States among all cardiovascular diseases. It is estimated to affect 12 percent of older adults and contributes to many preventable emergency department visits and hospitalizations. To prevent hospitalization and death, many patients with CHF are treated with a cardiovascular implantable electronic device (CIED) to deliver cardiac resynchronization therapy and other interventions. Additionally, people with CHF are instructed to monitor themselves for symptoms. However, studies show many patients fail to detect symptoms or changes in status, misinterpret or misevaluate symptoms, do not take responsive action, or choose the wrong response. Furthermore, self-management is more challenging for older adults due to the complexity of regimens and the role of co-morbidities and use of other medications resulting in multiple symptoms and side effects that may not be easily recognized or interpreted as symptoms of CHF.

To support older adults with CHF in managing their condition, the research team designed and tested an application called Power to the People (P2P). The application uses data collected from CIEDs that correlate with worsening CHF. Historically, CIED data are used for remote monitoring by the implanting clinic. P2P was designed to combine this data with self-reported data, including weight, fatigue, and diet, to present patients with visual displays and recommendations for action, as well as to inform clinicians. The research team applied a user-centered design process to develop P2P to be an acceptable and useful self-management tool for older adults with CHF.

The specific aims of this research were as follows:

• Design novel and interactive prototypes of P2P to inform and support CHF self-management. 
• Assess the usability and acceptability of P2P prototypes for older adults with CHF. 

The research team applied an industry standard user-centered design process to produce interactive P2P prototypes. This involved cognitive task analysis interviews supplemented by standardized surveys performed with 24 patients with CHF aged 65 and older. Next, three rounds of design and laboratory-based prototype testing for acceptability and usability were performed with a new set of 24 older adult patients. Subjective (self-report) and objective (performance-based) data were collected and analyzed during prototype testing.

Three sets of findings from the study served as input into the P2P design. First, patients’ decision making occurred in phases of monitoring, interpreting, and acting. Second, three decision-making personas or styles were defined: rule-following, researching, and disengaging. Third, three clinically valid use-case scenarios were developed. The study demonstrated P2P to be above average in acceptability and acceptable usability among older adults. Having demonstrated usability and acceptability, future trials will focus on safety and effectiveness of the prototype.