1. Authors: Arif Ahsan, Ashish Brahmbhatt, Dermot Cantwell, Ashot Meli-Martirosian, Jerri-Ann Meyer
Wearable Sensors for Cardiac Rehabilitation
This work was created in an open classroom environment as part of the Engineering Leadership Professional Program
(ELPP) developed and led by Prof. Ikhlaq Sidhu at UC Berkeley. There should be no proprietary information contained in
this work. No information contained in this work is intended to affect or influence public relations with any firm affiliated
with any of the authors. The views represented are those of the authors alone and do not reflect those of the University
of California Berkeley.

2. BACKGROUND&HYPOTHESIS
• Fact 1: The tsunami of wearable devices is coming!
• Sales of wearable wireless medical devices are expected to reach 100mln units
or $2.9bln in 2016.
• Fact 2: Health care costs are projected to rise (see next slide).
Jawbone UP
Basis
Fitbit Ultra
Samsung Gear Fit Google
contact lensBodyMedia FIT
iHealth
CSR bluetooth
necklace
Sony
SmartBand
AveryDennison
Metria
• Hypothesis: There is a great opportunity to improve effectiveness and
reduce cost of cardiac rehabilitation by using wearable sensors.
• Could wearable medical sensors help address this problem?

3. BACKGROUND&MARKETSUMMARY
• CVD is the number one cause of
death in US: 780,000 deaths (2010)
• Direct and indirect cost of
CVD $315bln (2010)
• Projected total cost
of CVD is expected
to rise to $1,200bln
in 2030 (2012$)
• Even a 1% cost
reduction results in
$multi-bln savings!

4. BACKGROUND
• What is Cardiac Rehabilitation (CR)?
• CR programs are generally divided into 3 main phases:
• Phase 1: Inpatient CR – in-hospital program following a CVD event
• Phase 2: Early outpatient CR – generally within first 3-6 months after a
CVD event, but may continue for up to 1 year. Requires one or more
weekly visits to hospital or CR center for several weeks and/or nurse/PT
visits to patients homes.
• Phase 3/4: Long-term outpatient CR – beyond 1 year
• The National Institute of Health stresses that cardiac rehab requires “a long-
term commitment from the patient and a team of health care providers.”
• The Mayo Clinic defines CR as “a customized program of
exercise and education. Cardiac rehabilitation is designed to
help you recover from a heart attack, other forms of heart
disease or surgery to treat heart disease.”
• The health benefits of CR, especially Phase 2 CR,
are well documented
• 26% reduction in cardiovascular death
• 20% reduction in all-cause death
• The economic benefits of CR are also known:
estimated cost savings typically range in thousands
of $ per QALY (Quality Adjusted Life Year)

5. BACKGROUND
• What do the doctors monitor during Cardiac Rehabilitation?
• Weight – maintain healthy weight
• Physical activity – regular exercise
• Diet – increase intake of Omega-3 (oily fish diet supplement)
• Blood pressure – maintain BP within proper range
• Medicine intake – confirm that patient takes medicine
• EKG
• Heart rate – normal and in response to exercise
• Alcohol – do not exceed the recommended daily limits
• Smoking – if you smoke, it is strongly recommended you quit ASAP
• What are the problems and challenges of today’s Cardiac Rehabilitation?
• Science Advisory from American Heart Association notes that
“current statistics continue to demonstrate that referral and participation
rates of eligible patients remain alarmingly low” (only about 30%)
• Aug 2013 article in the International Journal for Equity in Health concludes:
“rural inhabitants and patients of low SES experience greater barriers to CR
utilization when compared to their urban, high SES counterparts”
• Dec 2013 article in the Journal of the American Heart Association concludes:
“New strategies for promoting participation in cardiac rehabilitation are
desperately needed. Initial evidence supports the feasibility and acceptability
of using mobile technology for cardiac rehabilitation.”
• Obamacare mandates that all insurance plans cover CR!
• This is a disruptive opportunity!

6. ANALYSIS
Preventice
BodyGuardian ECG
and cloud-based
CarePlatform
Giner transdermal
alcohol sensor
SHL smartheartTM ECG and
Cardiac Monitoring service
Corventis NUVANT
cardiac monitor
Samsung Gear Fit
w/heart rate sensor
iHealth BP
monitor
Proteus
smart pill
iHealth
ECG
• What is the technology needed for future Cardiac Rehabilitation?
• Wearable sensors to monitor relevant data
• Secure wireless data transmission and storage platform
• All of the needed technology pieces exists today, but no company
has yet integrated and applied them to Cardiac Rehabilitation!
Qualcomm Life 2net
Hub, Mobile, and
cloud-based Platform

7. EXISTINGPLAYERS
• Blue Box Health is almost there!
• Founded in 2009 by Clifford Dacso, M.D.
• Privately held, HQ in Houston, TX
• From LinkedIn description:
“The Company has developed a prototype sensor, Blue Scale,
for chronically ill heart failure patients' use in the home.”
• Dr. Dacso says: “Turn a 2am emergency into a 10am urgency!”
• Dr. Dacso and Dr. Luca Pollonini demonstrated at the
2011 AMA-IEEE conference a wearable device,
measuring non-invasively in real-time EKG,
photoplethysmography (PPT), and muscle oxygenation
parameters (using optical NIRS sensor)
• Future plans:
• “wireless EKG and PPT to maximize wearing
comfort and quality of the readings”
• “a more extended clinical trial with CAD patients
enrolled in standard and non-standard
rehabilitation programs”
• “long-term goal is promoting home-based, self-
assessed rehabilitation programs to reduce
mortality and increase well-being of the CAD
population.”

8. STRATEGY&FUTUREPREDICTIONS
• What are the considerations for the future of this CR technology?
• Insurance companies
• Lower costs, improve outcomes
• No payment system in place to pay for this service
• Hospitals
• Improve outcomes, lower the 30-day readmission rate
• Lower costs through savings vs. existing/legacy CR programs
• Marketing/PR image through use of cutting edge technology
• Doctors
• Payment: Not covered in existing fee for service system
• Data overload: Need more actionable data, not raw data
• Liability: Who is responsible for decisions made, based on collected data
• Patients
• Gives patients the ability to become more involved and informed
• Cost: cardiac healthcare is covered by insurance, but outpatient CR was not
• Sensitive to cost of the device
• Suggested adoption strategy
• First adopters: organizations with “global risk”, i.e. HMOs (Kaiser), national
healthcare services (NHS in UK, Canadian health care) in partnership with
device makers (Blue Box) and data platform providers (Qualcomm Life)
• Doctors financially incentivized to use this technology
• Data securely handled within internal medical IT departments
• Subsidize the cost of device and data infrastructure

9. ”We need to replace your pinky ring with a wearable heart rate
monitor.”
AGLIMPSEINTOTHEFUTURE