Cardiovascular disease, including myocardial infarction (heart attack), accounts for approximately 36% of all deaths annually in Europe. Around 6,000 people experience a heart attack each year in Ireland, and cardiac rehabilitation (CR) is critical to long-term recovery. Successful completion of CR programmes has been shown to reduce hospital readmission rates from 30.7% to 26.1% and to lower cardiovascular mortality by approximately 26%.

Post-discharge care has yet often been shown to prove challenging for health services to coordinate — and the related lifestyle changes challenging for patients to sustain as a result. Many have turned to digital tools as potential cardiac rehabilitation supports: including mobile apps, wearable technologies, and AI chatbots designed to promote healthy habits, support motivation and self-monitoring, and provide patient education. Significant barriers to the use and adoption of these technologies however remain, including limited scientific validation, misleading reports leading to false alarms, poor integration with hospital records, and generic educational practices which fail to target patients’ needs. As a result, approximately 20% of patients who experience a cardiac event are readmitted within a year.

At Beaumont Cardiology Department, digital innovation is increasingly central to the success of the multidisciplinary Heart Team, and this challenge we sought to confront through the design of an innovative digital solution to support patients’ transition back to everyday life following a cardiac event — through enhanced digital monitoring and follow-up to augment cardiac rehabilitation. Central to this effort is strengthening the continuity of care between hospital and community settings, especially for patients who must travel long distances for treatment, given only seven percutaneous coronary intervention centres in Ireland operate on a 24/7 basis.

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It is this challenge that Mekhala Kota L, Jessica Lazar, Mohammed Sameer and Sreerag VK embraced through their HCI Design Project undertaken as part of their MSc in Human-Computer Interaction at University College Dublin. Adopting a user-centred approach, the team conducted surveys with patients, and interviews with clinicians at Beaumont Hospital. These efforts, combined with detailed patient and clinician journey mapping - from cardiac event through hospitalisation to recovery – surfaced novel opportunities for technological intervention. Analysis of the team’s data highlighted key findings, including concerning the impact of face-to-face versus booklet-based delivery of cardiac rehabilitation information on patients’ confidence to initiate rehabilitation post-discharge, challenges patients face tracking multiple streams of health data, and clinicians’ limited visibility over patients’ progress between hospital visits.

These insights informed the ideation of a range of technological approaches, including the automated collection of health vitals recorded in a centralised system for clinicians’ access, virtual care solutions to support patients unable to attend in-person sessions, and tools to support healthy lifestyle habit building and medication adherence. Following collaborative evaluation of the feasibility and value of diverse concepts, the team designed, Caroa; a smartphone application incorporating digital monitoring and structured follow-up in line with HSE metrics and the Beaumont Hospital Cardiology team’s best practices.

Positioned to address the specific needs of patients and clinicians within the Beaumont Hospital Cardiology Department, Caroa was designed to enhance connectivity between patients and their multidisciplinary care team, deliver up-to-date educational and clinical information, provide medication reminders, support emotional wellbeing, and facilitate peer support. Additional features include personalised health summaries, appointment reminders, lifestyle and dietary guidance, and integration with complementary health technologies.