Novel in-home monitoring device for patients suffering from congestive heart failure

Background: About 5 million Americans suffer from congestive heart failure (CHF), causing great public-health burden and >$40 billion in annual costs, including more than $20 billion in hospital days alone. An estimated 50-60% of CHF hospitalizations are avoidable through proper self-management, and studies show that in-home monitoring of CHF patients leads to better clinical outcomes at lower total cost to the medical system. However, most currently-available in-home CHF monitors are prohibitively expensive and/or are difficult for elderly and underserved patients to use. Objective/Purpose: Our objective is to develop a wireless personalized CHF-monitoring device that is easy-to-use, inexpensive, scalable, and improves clinical outcomes in underserved communities. We present the development process that led to a device that addresses these issues, and the results of usability studies in an underserved Houston community. Methods: We developed a cardiac-monitor by modifying a bathroom scale, a form that is immediately intuitive for CHF patients. The low-cost device comprises a scale, a photoplethysmograph, a 3-lead EKG, and bioimpedance sensors. Algorithms calculate weight, systolic time intervals, and heart rate variability and calibrate them directly to an individual allowing for early warning of decompensation. We have completed in-hospital validity trials, usability studies in an inner-city underserved Houston neighborhood, and completed software and hardware design and development, including database management, data transmission, and Web-based user-interface. Results: This project builds on 4 years of collaboration on public-health-related wireless-computing solutions in this underserved neighborhood, so we were able to build upon relationships with the community. Initial usability results in the community demonstrate over 95% respondent satisfaction. Conclusions: The results of multiple usability studies in collaboration with an underserved community continue to inform the development of a wireless, personalized monitor for CHF that is low-cost, clinically-reliable and relevant, and meets the needs of congestive heart failure patients in the real-world.