Newly launched selfcare tool pumps hope into heart patients

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Sarah Wayogereire Mwegombe, a heart patient, was diagnosed with heart failure in March 2020.

Sarah Wayogereire Mwegombe, heart patient.

She recalls her health woes starting with sudden severe pain and general body weakness, prompting her to check in at Nakasero Hospital in Kampala, where she was admitted and started on treatment. 

A week later, Wayogereire was discharged and referred to Uganda Heart Institute — also in Kampala — for further management. While receiving treatment at the institute, she was enrolled on the Medly Uganda digital health tool.

On a regular basis, Wayogereire was sent information on her phone which she in turn responded to and received feedback. Sometimes, the doctors rang back instructing her how to manage the signs and symptoms. 

Today, Wayogereire’s heart health has greatly improved.

She is the reason Uganda's health ministry launched a digital health self-care tool to support heart patients. 

The launch happened on Tuesday this week at Protea Hotel during a meeting organized by the health ministry in collaboration with Uganda Initiative for Integrated Non-Communicable Diseases, University Health Network Toronto and Makerere University Kampala.

Participants during the Medly Uganda stakeholders meeting at Protea Hotel.

This digital health tool is being rolled out in six regional referral hospitals: Arua, Lira, Mbale, Masaka, Mbarara and Fort Portal.

'Happy to embrace'

Dr Daniel Kyabayinze, the director of public health at the health ministry, said during its launch that there is need to start preventing health conditions given that the health care system cannot exhaustively manage everybody in a health facility setting.

He said that the rolling out of this tool will help to decongest health facilities. As such, health workers will see only patients who require urgent care or treatment.

“It is one of the tools that the health care provision is happy to embrace. As the number of people who require care increases, they put a lot of pressure on health facilities, on the doctors and nurses offering health care,” said Kyabayinze.

The principal investigator at Medly Project, Jeremy Schwartz, said for the tool to succeed, the clinical services should meet the required standard.

This digital health self-care tool was first used in Toronto, before it was piloted among 76 heart patients for six months at the Uganda Heart Institute.  

Highlighting lessons learnt during the pilot, principal investigator Dr Isaac Ssinabulya said hospitalization for heart patients was cut down greatly from 20% to less than 8%.

Additionally, there was a transition from severe to less symptoms given that in the event of a heart failure, complications such as shortness of breath, tiredness and swelling of legs set in, making it difficult for the patient to move.

Importantly, patients were able to adhere to medication and ask questions in time and were given treatment, he said.

Ssinabulya noted that when an individual gets admitted, their health is greatly affected, consequently reducing their lifespan. As such, reducing risk of death in heart failure is a key component.

Counting the cost

The executive director of Uganda Heart institute, Dr John Omagino, said that often heart failure patients require open heart surgery which costs about $5,000 (sh19.4 million) in Uganda while abroad the fees go as high as $20,000 (sh77.8 million).

When heart failure is as a result of hypertension, the costs are slightly below US $2,000 (sh7.7 million) and treatment is long term.

Omagino said that even after the patient stabilizes, they will require up to a tune of sh1 million every month. 

Not forgetting the time lost frequenting health facilities for treatment.

A global killer

World over, heart failure affects more than 64 million people. Worth noting is that it contributes a high burden of mortality and in Sub-Saharan Africa, the death rate shoots as high as more than 30%.

Data from Uganda Heart Institute reveals that heart failure is the biggest cause of admissions, due to underlying health conditions, for example hypertension, rheumatic heart disease, heart attacks, pulmonary embolism and rhythm disturbances that make the heart to fail.

When not responded to in time, patients may suffer severe complications that may result to death, said Ssinabulya.

Dr Godfrey Zziwa Buuka, a cardiologist at Masaka Regional Referral Hospital, said the digital health tool will help health workers to monitor and capture symptoms early, consequently reducing frequent admissions coupled with the huge medical costs.

Zziwa said heart failure patients would unnecessarily frequent the health facility and following up has been difficult. As such, health workers would have to wait to connect with them during the review (medical appointment).

How the tool works

Dr Ann Akiteng, the national coordinator at Medly Uganda, said that a heart failure patient can tap into the benefits of the digital health tool by either using an ordinary or smartphone.

All they have to do is to dial a certain code that is already set and it takes them through a number of symptoms that they may be experiencing.

The tool also gives them guidance on how to respond.

At the end of the interaction, the tool grades the symptoms based on severity. 

If the patient is stable, it gives a reminder to continue ensuring a healthy lifestyle.  In case, the symptoms are mild to moderate, the tool informs the patient that they will be contacted by a health worker.

Using the same system, the patient can signal the health care team to give alerts as well as the specialist to respond to critical alerts.

By the time the patient comes in, the specialist already has an idea of the issue to address.

Understanding heart failure

Heart failure is a chronic condition where the heart is unable to pump adequate blood to the entire body.

The symptoms may include shortness of breath, fatigue, swollen legs and rapid heartbeat.

Management includes heart-healthy lifestyle habits such as eating less salt, limiting fluid intake and taking prescription medication. 

Others include ensuring a healthy weight (since extra weight is associated with cardiovascular diseases), regular physical activity, quitting smoking and avoiding or limiting alcohol consumption.