Introduction
Heart Failure (HF) is the inability of the heart to provide enough blood according to the body’s requirements [1]. It is a chronic and lifestyle-related disease that affects patients quality of life and is the leading cause of hospitalization in adults over 65 years old [2].
Delays in symptom recognition, medication and dietary noncompliance, as well as lack of knowledge and skills for competent self-management, are common reasons for re-hospitalizations of HF patients [3,4].
Several studies indicate that multidisciplinary post-discharge treatment programs, as telemonitoring systems, can avoid a large portion of HF-related readmissions and improve patients quality of life [5].
Telemonitoring is defined as the use of information and communication technology to monitor healthy individuals or chronically-ill patients remotely. The literature suggests that the most promising applications for home telemonitoring are for chronic illnesses such as HF [6].
Some telemonitoring systems use TV sets as the main device for patients [7] others use video game consoles [3,8,9] and others use Smartphones. In the latter case, telemonitoring is better referred to as Mobile Health Technology (mHealth) [10].
As Schnall et al [11] have remarked, mHealth is a promising tool for actively involving patients in their own health care because most people own and regularly use a mobile phone. For these reasons, to develop a telemonitoring system to follow-up HF patients, an mHealth application using Smartphones as the main device for patients seems to be the alternative of choice for effective management of this disease and to reach as many patients as possible. On the other hand, in different reviews of telemonitoring systems for cardiovascular patients, the authors had concluded that it is still not clear as to whether or not the existing telemonitoring systems actually improve patient condition and well-being [12]. Also, in previous works, it was recognized that further research efforts are needed to understand the causes underlying the success of telemonitoring as a key driver to improve health conditions of chronically-ill patients [13]. More specifically, telemonitoring systems have been developed based on different functionalities and monitor different parameters, since the minimal set of functional requirements that an HF monitoring system should deploy have not been identified yet. However, there are many evidence-based Clinical Practice Guidelines (CPGs) of the most relevant cardiology associations about HF management. CPGs are statements that include recommendations intended to optimize patient care that are based on a systematic review of evidence and an assessment of the benefits and harms of alternative care options [14]. Besides, as Kang and Park [15] have highlighted, these CPGs need to be converted into a computer-interpretable guideline for the development of an mHealth app that provides tailored information and recommendations on lifestyle management based on facts and evidence. Therefore, the main objective of this work is to present a prototype of a telemonitoring system for HF patients, named SiTe iC, that has been developed using widely accepted CPGs, highlighting its design, prototyping and validation. The proposed prototype has an mHealth app as a core component.