Congestive Heart Failure Monitoring after Discharge with Apple CareKit and Apple Watch

Originally published on Doctella blog: Sep 13, 2017

Wearable health technology is another step in the direction of bringing the doctor’s office home with you and making health service ubiquitous. A big focus and theme in recent digital health interventions, as well as other health technology innovations in general, has been continuing care and contact outside the confines of the office. This started with small steps, mainly education that was accessible anywhere and has leaped to being able to take vitals and diagnostics from the comfort of your own home, load the data into your smartphone or computer and then share it with your doctor. If that’s not enough, we can now use this data and set parameters to alert the doctor if anything is wrong, completely automating the monitoring process.

One of the issues with our rapidly advancing technologies is that we have not quite caught up yet. We have a number of technologies at our disposal, yet we still use them similarly to how we use antiquated technologies. Many people have scales that sync to their smartphone, yet still simply look at the number and either smile or frown then go about their day. Patients have heart rate monitors that they only really pay attention to while they’re exercising or use as a novelty. Even many diabetics still take their blood glucose level multiple times per day via finger tip pen prick, write down their reading in a notebook, and use an inexact science consisting of “ballparking it” on how much insulin to inject. None of these patients are leveraging

  1. The new technologies that make these actions easier, automated, and “smarter”
  2. The ability to use data on a continuum to create actionable insights or track and enhance progress

When we can automate certain processes, this allows us to focus more on other aspects of our care, catch troubling signs earlier, and know what to do and when to do it. This is only beginning to happen. One notable example is Apple’s announcement that the Apple Watch 3 will transcend simply reading heart rate and be able to detect and alert you if you are experiencing Atrial Fibrillation.

These developments are great, but hospitals, doctors, and nurses are still stuck using only the tools that have been released by others. This is because building apps require software developers and a lot of resources. There is a bottleneck created by the need for hiring software developers, high costs, collaboration and development time, etc. whereas, it would be nice if experts were able to use their knowledge, experience and research to simply create their own apps for patients that are clinically intelligent as well as read data from patients phone, sensors, activity and receive reported outcomes to help.

Doctella solves this problem by allowing doctors and other medical professionals to quickly create personalized Apple CareKit apps online using Doctella’s Digital Health Studio. Doctella has invented CarePrograms that allow Doctors to personalize education, alerts, reminders and data gathering using pre-made, physician curated, and research-backed templates that we call CarePrograms. These CarePrograms are used by patients in CareKit apps iOS, Android or web apps. One example of this is with Heart Failure.

Heart failure affects about 5.7 million patients in the US. It accounts for a lot of complications and deaths as well as a large portion of spending on health care. Figures show that more than 23% of patients hospitalized for heart failure will be readmitted to the hospital within 30 days of discharge and that 11.7% die within 30 days.


Source– 30-day mortality is on average 11.7%

Furthermore, about half of people who develop heart failure die within 5 years of diagnosis.

These statistics add up to $38 billion of healthcare spending annually. Because of these implications and the dire need for improvement, it is a condition that hospitals typically get graded for condition-specific outcomes measures and for financial penalties. This information is readily available, and you can even see how specific hospitals rank. This is how open this issue is and how transparent the efforts to improve outcomes have been. The intent is to create an impetus for change and improvement by following evidence-based protocols.

Based off of the studies, some effective techniques are:

  • Patient education at discharge
  • Medication reconciliation
  • Timely access to care after discharge
  • Hand-off communications between primary care providers and acute care facilities
  • Rapid distribution of hospital documentation to primary care providers
  • Home health interventions
  • Follow-up phone calls


This is where we are failing to catch up with technology and integrate the information we know. In the past decades, we have churned out more research than ever before and come up with protocols for care and ways to improve. We now need to take this information and integrate digital health interventions and devices.

Doctella leverages education, active alerts, and reminders, research-based self-care protocols, medication adherence, and smart notifications to providers if patients exhibit any symptoms that point towards mortality or readmission. These smart notifications are based on daily questioning as well as pulling data from wearable technology.



  • Education about the condition, symptoms, what to look out for, information about medications and how to take them, etc.
  • Multimedia to support education via pictures, videos, health sheets, etc.
  • Device integration to give more data points on
    • Weight
    • Blood pressure
    • Pulse
    • Steps and activity
  • Daily questioning and self-reporting to automate the follow-up and check-in process
    • Medications
    • Limiting salt intake
    • Limiting alcohol intake
    • Swelling
    • Activity level
  • Appointment follow up reminders
  • Caregiver mode and ability to share data with whomever you want, whether that be friends/families or another physician
  • Intelligent, condition and event-based content and instructions for patients
    • For example, if a patient answers a series of questions in a way that indicates they may be in danger, it gives them instructions on how to seek help
  • Real-time alerts for providers triggered by clinically proven protocols so that they can intervene as quickly as possible and automate dashboard monitoring

Patient Experience

Provider Notification


Using these CarePrograms will greatly enhance our visibility and our ability to react to adverse situations and prevent issues. Furthermore, we have never had more access to behavioral data that we can match up with outcomes. CarePrograms for CHF will give us more data on the types of issues that lead to acute heart failure events most often so that we can add to our base of knowledge. Not only are we finally catching up our technological advances with our knowledge, but are able to further add to them in ways we could not before.

If you’d like to use the CHF CareProgram in your practice or make your own CareProgram that utilizes device integration, please go to to get started for free. Please see an example of this CareProgram and test drive it as a patient by clicking on this link: Click here

If you would like to see a demo of the CHF list and learn more specific information, please contact us or view our past webinar below:

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