Apps for cardiovascular disease: The role of avatars in personalisation

How do we help people to improve their health after a heart event? Current guidelines recommend that people with heart disease attend a programme of cardiac rehabilitation (European Society of Cardiology [ESC] 2016). High-quality evidence shows that attendance at cardiac rehabilitation decreases the likelihood of a further cardiac event or death, and improves quality of life (Taylor et al. 2015). The precise content of cardiac rehabilitation programmes varies, but usually includes components of exercise, education, and attention to psychosocial problems (ESC 2016). Behaviour change such as improving diet, increasing regular exercise, taking medications, and reducing stress is a key focus of cardiac rehabilitation (ESC 2016). Cardiac rehabilitation includes formation of a ‘therapeutic alliance’ with the healthcare provider (Woodruffe et al. 2015), and this strong relationship may be central to successful behaviour change. Unfortunately, less than half of the people who could benefit from cardiac rehabilitation attend. Some groups have particularly low attendance, such as women, and those from ethnic minority groups (Clark et al. 2013).
So why don’t people go to cardiac rehabilitation? Cardiac rehabilitation is typically time-limited, conducted in groups and requires people to visit a hospital or community centre (Clark et al. 2013). Distance to the facility, dislike of participating in groups, and the timing of the programmes, which are frequently conducted during working hours, may deter people from attending (Clark et al. 2013).