CHF is a disease with inconvenient symptoms, which can lead to reduced QoL. Studies have shown that patients with CHF have a higher QoL if they have knowledge of the disease and treatment, and can respond to symptoms of deterioration. It is found that technology can be a useful tool to increase QoL, but there is lack of knowledge about the extent to which patients' empowerment increases through use of technology, especially among elders, and in what way the knowledge should be disseminated.
Chronic heart failure (CHF) is a common, progressive and symptomatic illness with an average survival rate of
approximately five years. Prognosis can be difficult to predict, as it depends on gender, age, comorbidity and stage
of illness at the time of diagnosis. The most frequent clinical symptoms are dyspnea, fatigue and edema, which is
often perceived as being disabling and causing reduced Quality of Life (QoL). In order to provide patients and their
relatives with an increased understanding of CHF, different types of home monitoring systems have been developed
including virtual technology. Despite positive results with home monitoring, it is not currently an option available in all
outpatient clinics in Denmark. Moreover, it is known that technology has the greatest impact if it is developed in
collaboration with those who need it, which is neither a frequently used method, nor is it well described in relation to
CHF. This indicates a potential opportunity for improving existing treatment options for patients suffering from CHF
by developing a solution in collaboration with the end-users.
Over the past 20 years, the incidence of CHF has decreased, while the prevalence has increased meaning that patients
are living longer with heart failure today than they did previously. In 2014, approximately 9,000 people were
diagnosed with CHF in Denmark, while 66,000 people were living with heart failure. One of the reasons is that the
existing medical treatment of CHF is successful in prolonging lives and reduce the symptom burden. In addition to
the medical treatment, it is proven that knowledge of worsening symptoms and how to respond to symptoms improves
patient self-care behavior and QoL. Furthermore, awareness of worsening symptoms has shown tendency in
Several studies have tested various types of technological solutions for patients with different heart diseases.
Common to the studies is that a technological solution is beneficial, because it makes the patients aware and reminds them to be involved in their own disease. Some studies with CHF patients have focused on home monitoring of different measurements such as: weight, lung impedance, blood pressure, heart rate, and pulse. In addition, the studies
used different questionnaires to measure symptoms, QoL and self-care, and one study also used automatic algorithms
with suggested actions.
Vestergaard et al has proven a technological solution as being cost-effective, with a significant cost saving on
admissions, primary care contacts and total costs. The patients with CHF where asked to measure blood pressure
and weight twice a week within one year of follow-up resulting in a reduction of 35% in total healthcare costs. At
the same time, Pedersen et al found that it can be difficult for older people to deal with new technology, and it might be
confusing to understand and learn from technology. Despite of this knowledge, investigating the effect of increasing
empowerment by using alternative forms of learning from technology is not found in the literature. As incidences of CHF
increase with age, technological solutions, which aims to increase empowerment and QoL, must be widely inclusive,
particularly for the elderly. One proposal could be producing podcasts and videos with information about disease,
symptoms, medicine, side effects etc. Furthermore, it is a fact that relatives often suffer as much or even more than the
patient, and there is a lack of information on how a technological solution affects the relatives, and what is needed
to empower them in a vulnerable situation.
Aim and objectives
The overall aim of this PhD project is to improve patient empowerment and QoL of patients with CHF by exploring current practice of CHF management in the
outpatient clinic. Furthermore, the project will develop a customized solution and determine if the solution is feasible in close collaboration with the users (patients, relatives and healthcare
professionals) and explore the relevant enabling technology.
The objectives of the study are to:
o Explore current clinical practice in the outpatient clinic focusing on patients with CHF and
investigate the needs of patients and relatives as well as the perspectives of healthcare
o Design and develop a solution/ technology based on identified needs.
o Test the solution/ technology in clinical practice and evaluate if it is feasible, suitable and