# Piloting a Novel eHealth Technology for the Control and Management of Elevated Blood Pressure in Rwanda (HeartCare@Home Project): Protocol for a 2-Phase Crossover Study

## TL;DR

This study tests a new eHealth system in Rwanda to improve hypertension management through home and clinic-based blood pressure monitoring.

## Contribution

The study introduces the HeartCare@Home system, a locally designed eHealth technology for hypertension management in Rwanda.

## Key findings

- The HeartCare@Home system will provide a technical infrastructure for hypertension control in outpatient clinics.
- The study will assess clinical efficacy, feasibility, and acceptability of the system in a real-world setting.
- Findings may inform scalability of the system to other noncommunicable disease clinics.

## Abstract

Effective blood pressure (BP) monitoring is vital for the management of hypertension, allowing timely adjustments in treatment. This study focuses on the development and implementation of an innovative, locally designed eHealth technology, the HeartCare@Home system, to enhance the control and management of hypertension in outpatient noncommunicable disease (NCD) clinics in Rwanda. The HeartCare@Home system comprises a mobile health app that incorporates rapid SMS technology, an integrated dashboard for signal reception at the clinic office level, and a clinical decision support algorithm.

This study aims to assess the clinical efficacy, feasibility, and acceptability of a novel eHealth technology, the HeartCare@Home system, that uses home and clinic-based automated BP monitoring with real-time management of elevated BP in an outpatient NCD clinic in Rwanda.

This pilot study will use an interventional design with a crossover approach to test the clinical efficacy of the HeartCare@Home system at the NCD clinic of Kibagabaga District Hospital. A total of 140 patients with hypertension will take part in the study. All enrolled patients will be allocated to either the interventional group or the standard of care group. The follow-up for each group will be 6 months (3 months in each group follow-up). The data for the intervention group will be generated by our mobile health app, while data for the control group (standard care) will be retrieved from usual patient files at the NCD clinic. Data extraction sheets will be used for standard care data retrieval. The Feasibility of Intervention Measure and Acceptability of Intervention Measure tools will be used to cross-sectionally evaluate the feasibility and acceptability of the HeartCare@Home system. Data will be summarized with descriptive statistics. A paired sample 2-tailed t test will be used to test for differences between the pre- and postintervention records for hypertension control.

This study will yield a technical infrastructure, the HeartCare@Home system, to support the control and management of hypertension in outpatient NCD clinics. It will introduce a new model of health care delivery through innovative technology that enables home-based BP monitoring. This will offer a unique technology to enable elevated BP control and timely hypertension management and will also ensure a real-time communication linkage between patients and the appropriate level of care. Furthermore, the findings from the assessment of the clinical efficacy, feasibility, and acceptability of the HeartCare@Home system will inform possible scalability of the system to more NCD clinics. The study is currently in the implementation stage.

The HeartCare@Home project will address the important gap of low BP control rates in patients with hypertension, which has contributed to delayed consultations and increased cardiovascular mortality. Such eHealth technology infrastructure may also be scalable to other settings.

DERR1-10.2196/66211