A hospital at home, AI algorithms, WhatsApp notifications, a caretaker at service – pharmaceutical major Lupin has rolled out its first digital health programme to capture the market of heart patients in India, and, possibly, predict a heart attack in the future.
In January, the Mumbai-based company announced the launch of a digital therapeutics solution by its wholly-owned subsidiary, Lupin Digital Health.
LYFE is a programme designed to reduce the risk of heart attacks significantly and improve vitals and quality of life for cardiac patients.
The news of heart and cardiac arrests had made the headlines last year. And this solution manages patients who have just witnessed a heart attack or a severe cardiac event and prevent the second such event.
According to the study by The Lancet medical journal, one in four deaths in India are because of cardiovascular diseases with ischemic heart disease, and stroke responsible for more than 80% of this burden.
The patient, under the heart care programme, will be connected via devices saving the vital parameters, collating millions of data points. These parameters include blood pressure reading, blood sugar levels, ECG and lipid profile.
With the billions of data at the back-end, the company hopes to predict a “heart attack” in the future.
“If we had enough information on every single day’s blood pressure, heart rate, cholesterol data… and then data just prior to when patient had an attack,” Sidharth Srinivasan, chief executive officer, Lupin Digital Health, told News18.com.
All the important parameters such as the BP readings three days before a heart attack or heart rate readings will be stored.
“If we have enough data of the patient, we should be able to actually create these combinations and potentially predict (the heart attack),” Srinivasan explained.
Moreover, the company also aims to create “Heart Health Score” which is an algorithm that “can create a score of the risk profile of the possibility of having an attack in the next year or 10 years.”
The company has set up a dedicated digital therapeutics hub in Bangalore, which is working with nearly 25 data scientists and overall headcount of 70 so far.
How Lupin LYFE works?
The company’s new programme, which started in January, gives patients personalised diagnostics, which could be monitored by doctors who can motivate them to improve clinical outcomes.
“When a patient is in the hospital, they receive the finest care but doctors notice the largest drop-off once the patient goes back,” Srinivasan said.
“Is the patient really adhering to the treatment protocol that the doctor has set up or once the patient starts feeling good after three months, they drop off some medications.”
“Do they listen to the advice of their chemist instead of the doctor? Do they stop eating a few medicines? Or introduce changes in their nutrition lifestyle or begin doing exercises?”
These are the gaps that even cardiologists and hospitals are facing, the company found out.
“Despite giving the best treatment, if you have 10 to 15% of patients coming back to the hospital very soon, with some more conditions, it is concerning.”
LYFE tries to fix this gap.
“It acts as force multiplier for patients.”
“We are supplementing doctors’ efforts to make sure that while the patient is back home, they are adhering to whatever treatment protocol their cardiologist has set up.”
“In a market like Delhi especially, I think we have seen a tremendous demand. We’ve seen hospitals and cardiologists want to have such a service for their patients.”
Target of 4,500 cardiologists in next 12 months
At present, the company is into acute coronary syndrome (ACS) area. ACS is used to describe a range of conditions associated with sudden, reduced blood flow to the heart. One such condition is heart attack.
The company has roped in more than 300 cardiologists since January.
“We need to keep in mind that the interventional cardiologists, doctors who do angioplasties and actually do cardiac interventions, are only 5,500 in India. We hope that we will be covering as many as 4,500 interventional cardiologists this year, across the top 30 cities and through these 30 cities, we will also cover almost 100 towns,” he added.
From this, Srinivasan said, the next logical step is to get into other aspects of heart disease.
“We are moving into heart failure, hypertension. For all the patients that a cardiologist sees, should be able to refer to our programme,” he said.
Srinivasan believes while this will be “mammoth task”, but, if done, the company can move into other chronic illnesses.
“There is diabetes, respiratory illnesses and many more… Globally, mental health and women’s health are also picking up when it comes to digital therapeutics.”
He further said healthcare industry is evolving globally, and spending on healthcare is increasing dramatically.
“The Indian government has actually taken digital health as one of the pillars of the G20. So, I think it all points to the fact that potentially we are in the right place at the right time and there’s a lot of opportunity there.”
Improvement in Patient’s Vital Parameters
Before going live in January, the company claims to have done extensive testing of the model.
The company claims improvements were seen in patient’s vital parameters during its pilot phase. “In the real-world evidence study, we found that an average patient’s blood pressure was improved by eight counts, just in the first three months of the study.”
The company said the lipid levels were found to have reduced, sugar (blood glucose) was stabilised, and quality of life became significantly better. It claims that on average, patients have 89% satisfaction rate with the programme.
How Does the Programme Work?
LYFE is a subscription-based programme, where the first step starts with the doctor’s recommendation. In some cases, the doctor advises this programme not for patient but for a caregiver, such as a son or a daughter who lives in a different city than the patient.
Once suggested by the doctor, Lupin’s team will approach the patient’s family and pitch the programme.
While the charge of service is Rs 500, the cost of diagnostic devices is extra. The company will create a mini-hospital setting by deploying a set of FDA-approved devices such as trackers, BP monitors, glucometers and home ECGs.
These are connected devices where every reading gets logged on to the app available with the doctor, loved-ones and at Lupin’s back-end centre. Also, LYFE’s back-end centre will monitor patients every time.
If the patient’s normal blood pressure increases from 140 to 170, he will immediately receive a phone call enquiring about the health condition.
The caller follows a treatment protocol. “They will check on the list of symptoms and then may try to relax the patient or call up an ambulance or doctor or react as per the assessment.”
Apart from keeping a daily check and collecting data, the programme’s other objective is to help patients “adhere” to an ideal lifestyle.
The subscriber will be given a dedicated “care manager” who will speak patient’s mother tongue or other language.
The patients will receive WhatsApp messages to take the blood pressure or glucose or other readings. “If you have still not taken it, then someone will actually call—your care manager, who acts like a relationship manager,” Srinivasan said.
The patient will also be assigned a nutritionist to make structural changes in lifestyle and yoga instructor. “Our coaches will talk to people cooking in the house to understand the diet,” he added.
The coaches, the care manager, the patient and the caregiver will all be available on a WhatsApp group. “This becomes a team that has to succeed over the next 12 months.”
Mix of Tech and Human Intervention
Srinivasan explained AI learning algorithm actually notices the behavioural pattern of the patient. “It will understand your preferences on how you like to be reminded to do certain tasks.”
“For instance: AI will read if the patient even likes nudging? If yes, how do I nudge – through push notification, through WhatsApp or through a call? Should it be one time in the day, many times during the day or one time at night.”
Care-giver or coaches will call patients to talk to them and motivate. “A lot of our senior patients talk to their coaches for hours… sometimes they share their personal stories too,” Srinivasan said in a lighter vein.
Younger Patients On Board
According to the data from the National Intervention Council, 2018, around 25% or one fourth of cardio patients were below the age of 40.
“People in their 30s and 40s were having heart attacks. Similarly, we are also seeing almost 15-20% of our patients are below the age of 50 and the bulk of our patients are between the ages of say 45 and 60,” Srinivasan.
The good thing with this group is that they are relatively technology savvy and know how to use an app or WhatsApp and are therefore comfortable with digital, he claimed. “Also, they actually have the resources to invest.”
“If our programme costs Rs 15,000- 20,000 a year, it’s not a scary amount for a patient who’s a heart patient and wants to make sure that they have that comfort and security that someone is always monitoring,” said Srinivasan.
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