Mild intensity aerobic exercise, combined with positive lifestyle changes (eg. quitting smoking) has been demonstrated to be beneficial in case of rehabilitation after cardiovascular surgery, reducing mortality rate up to 39%. However, multiple clinical trials observed that 6 months and 1 year adherence to clinical prescriptions is under 30%, with patients falling back to bad behaviours and increasing again their cardiovascular risk. The main cause of the problem is the impossibility of the hospitals to handle many cardiac patients in the long-time (ideally, the rest of their life) due to low staffing or reduced resources, which leaves the patients alone and in an environment that does not promote positive lifestyle. The objective of this project is to create an application that helps both the patients staying adherent to the prescription, and the clinicians tracking their activity with minimal overhead and automated reporting. The application, combined with a wearable heart-rate device, tracks how many times during the week a patient performs aerobic exercise and its intensity. On the other side, the doctor can observe if the patient performed it with the optimal frequency and intensity, in order to give feedbacks to the patient and/or modify the prescription accordingly.

1. MoRa Heart:
simplify and improve cardiac rehabilitation
through hassle-free online medical supervision
Da Vinci Conference Room @ Stanford OTL
05/29/2018
Luca Cerina <luca.cerina@polimi.it>
Fosco Cancelliere <fosco.cancelliere@mail.polimi.it>
Riccardo Cavadini <riccardo1.cavadini@mail.polimi.it>
Michele A. Corazza <michelealdo.corazza@mail.polimi.it>
Politecnico di Milano

2. 2
Context 2
Benjamin, Emelia J., et al. "Heart disease and stroke statistics—2018 update: a report from the American Heart
Association." Circulation 137.12 (2018): e67-e492.

3. 3
Is prevention the answer?
3

4. 4
Only a piece of the puzzle 4

5. 5
Manage unpredictability 5
Gheorghiade, Mihai, et al. "Rehospitalization for heart failure: problems and perspectives." Journal of the
American College of Cardiology 61.4 (2013): 391-403.
Increased re-hospitalization
after cardiac surgery, with
percentages increasing on 6
months and 1 year.
CARDIAC
REHABILITATION

6. 6
Cardiac Rehabilitation 6
Dunlay, Shannon M., et al. "Participation in cardiac rehabilitation, readmissions, and death after acute
myocardial infarction." The American journal of medicine 127.6 (2014): 538-546.
Exercise training
+
Habit changes
+
Nutritional counseling
+
Medical supervision

7. 7
Heavy under-utilization 7
Pack, Quinn R., et al. "The Current and Potential Capacity for Cardiac Rehabilitation Utilization in the United
States." Journal of Cardiopulmonary Rehabilitation and Prevention 34 (2014): 318-326.
“most program directors felt primarily limited by facilities, personnel, and
copays/ insurance problems rather than patient behavior, suggesting that
program capacity restraint is a significant contributor to the
underutilization of CR services across the United States”

8. 8
Our proposal 8
CR Progress tracking
Remote prescription
delivery
Clinician evaluates
weekly reports
Real-time HR tracking
with feedback
Help patients during Cardiac Rehabilitation in order to increase
adherence on prescribed Exercise Training.
AND
Help clinician / structures with a scalable tool to follow an increasing
number of CR without excessive overhead.

9. 9
Patient’s application 9
Receive weekly prescribed training
from MD.
Parameters tracked:
● Heart Rate or Heart Rate
Variability with off-the-shelf
commercial sensors.
● Distance and speed (walking) or
cycling load (if available)
● Borg’s scale for muscular and
respiratory distress.
Weekly report adherence and
results to the MD
Educate and push the patient
towards exercise, following its
personal capabilities and limits.

10. 10
Other features 10
● Optimal planning of training difficulty → Prediction of subjects’
improvements.
● Tailored feedback → Push subjects’ given their lacking on targets
(speed, heart rate, number of sessions)
● Track undesired events

11. 11
Planned clinical trial 11
A randomized clinical trial is in preparation with
an italian research hospital, where patients will
follow remote CR from home.
Aim of the project:
● Verify if remote CR is beneficial for patients’
health
● Quantify the staffing overhead necessary to
use remote CR

12. QUESTIONS?
MoRa Heart:
simplify and improve cardiac rehabilitation
through hassle-free online medical supervision
Luca Cerina <luca.cerina@polimi.it>
Fosco Cancelliere <fosco.cancelliere@mail.polimi.it>
Riccardo Cavadini <riccardo1.cavadini@mail.polimi.it>
Michele A. Corazza <michelealdo.corazza@mail.polimi.it>
Politecnico di Milano
Slides available at: https://www.slideshare.net/necstlab