1. Behavior Change in heart failure patients Adetania Pramanik Durga Kudtarkar Shubhshankar M. Sankachelvi

2. SRD Significance sodium restricted diet 25% of heart failure (HF) related patients were readmitted Limiting sodium intake is one of the ways of readmission prevention for HF patients. However, it is difficult for patients to understand how to manage and change their daily sodium intake

3. Background Heart Failure Most common cause HF: coronary artery disease (narrowing the blood vessels that supply the heart) Conditions that contribute to HF: obesity, diabetes, smoking, hypercholesterolemia, hypertension,… Is a progressive, chronic disease

4. Background Functional classification (NYHA):Four stages of HF(ACC / AHA): Class I: no limitation is experienced in any activities; there are no symptoms from ordinary activities. Class II: slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion. Class III: marked limitation of any activity; the patient is comfortable only at rest. Class IV: any physical activity brings on discomfort and symptoms occur at rest. Stage A: high risk for HF but no functional or structural heart disorder Stage B: a structural heart disorder but no symptoms at any stage Stage C: an underlying structural heart problem, but managed with medical treatment Stage C: an underlying structural heart problem, but managed with medical Stage D: hospital-based support, a heart transplant or palliative care.

5. Risk Factors Cannot be changed Can be treated

6. Treatment Plan

7. Nutritional Diet Sodium intake < 3,000 mg/day Lesser HF symptoms What does 1500, 2300 or 3000 mg/day mean? Low salt doesn’t mean low sodium

8. SRD sodium restricted diet Understanding sodium content of food Lack of food selection Food preparation habits Fast foods and convenience products Understanding the symptoms of HF Literacy Co-morbidities Depression: worse self-care & poorer prognosis

9. Helpless Acceptance Proactive SRD sodium restricted diet Education and Motivation Fun Meaningful Can do vs Cannot do

10. The Problem How can we assist HF patients in understanding their appropriate daily sodium intake and motivate them to bring about a behavior change?

11. informative hospital food + interactive packaging Solution 1

12. informative hospital food

13. Solution 1 interactive packaging

14. Related Work How to Nudge In Situ: Designing Lambent Devices to deliver Information Salience in Supermarkets http://mapawatt.com/2009/10/07/list-of-energy-monitoring-tools/ http://daeyoon-scale-industrial-co.tradenote.net/images/users/000/195/393/products_images/567029.jpg

15. Solution 2 Trust Labels, not taste buds = Difficult to follow everyday

16. Solution 2 Apps to monitor sodium intake www.nal.usda.gov/fnic/foodcomp/search/ Milk, fluid, 1% fat, without added vitamin A and vitamin D Magnesium, Mg mg11220.093 Phosphorus, P mg95210.368 Potassium, K mg150111.088 Sodium, Namg44230.760 Zinc, Znmg0.42110.003 NutrientUnits Value per 100 grams Number of Data Points Std. Error on-line global nutrition information

17. Solution 2 App architecture design Input: QR code or text Mobile device Web server USDA Database Scan QR code Client server communication Data retrieval Intuitive output

18. Solution 3 Dietary Recall systems Track daily sodium consumption and provide feedback. QuestionnaireTiming Frequently consumed items Quantity

19. Solution 4 Food recommendations

20. Thanks