Country: IndiaFocus: Medical ServicePartner: Narayana Hrudayalaya HospitalPost-Extreme Lab: Social E LabStatus: Handed to PartnerYear: 2012


2012 Extreme HeartMap Logo

Partner: Narayana Hrudayalaya Hospital

heartMAP is a simple medication adherence program designed to help low-literacy patients manage heart disease. We use basic phone technology to achieve high levels of medication accuracy, and have created a program that is simple enough to be operated by non-medical staff. heartMAP is initially designed for patients with prosthetic heart valves requiring blood-thinners. In our pilot at the Bangalore-based Narayana Hrudayalaya Hospital, heartMAP will prevent 264 strokes, 1100 bleeds and 148 deaths in the first five years of operation at a cost of $20 per life-year saved. heartMAP is a versatile program that can scale to millions of patients living with chronic disease in developing countries.

Product Area: Low-cost medical services

Big Idea: A system to improve adherence to cardiac medications, especially for low-literacy patients

Project Launched: February 2012

Team:  Dhruv Kazi, Kentaro Watari, Nimi Mastey, Allison Fink

The Challenge

Taking medications accurately and consistently is absolutely critical to a patient’s survival. Compared to a complex surgery, it seems like low-hanging fruit: however, across the globe, non-compliance with medication regimens is rampant and costly. In the United States, it is estimated that medication non-adherence costs the  healthcare system some $300 billion annually. Globally, it costs billions of dollars more. Of course, more important are the human costs, deaths from a truly preventable cause.

The Insight
Researchers have identified “belief” and “recall” as two critical barriers to medication adherence – “belief” that the medication is valuable and necessary, and “recall” of how and when to take the medication. For low literacy patients, these effects are exacerbated. In Narayana Hrudayalaya’s case, many patients leave the hospital without a clear understanding of why or how to take their critical medications. These patients need support and guidance to help them manage a daunting medication regimen and thrive.

The Product
heartMAP is a comprehensive system with both in-patient and out-patient modules to improve medication adherence for all patients, regardless of literacy level. We are using Warfarin, a blood-thinning medication that is particularly tricky to manage, as our test case. The heartMAP system includes in-hospital video modules and skills training curriculum for patients being discharged on Warfarin, as well as a long-term tracking system and database to track patients after discharge. Employees of heartMAP’s “Virtual Warfarin Clinic” track patient outcomes, adjust medication doses, and help patients monitor symptoms, all at minimal cost to the hospital.

What’s Happening Now?

The HeartMAP team is applying for Social E Lab funding to return to India. On the ground, we will work closely with NH to build out a full pilot program for Warfarin management. This will include finalizing in-patient education videos, training educators and Virtual Warfarin Clinic managers, and iterating on the database. This project has been supported, in part, by a global health innovation grant from the NIH, known as C-IDEA.

For more information, contact: