Maximising the benefits of the next generation of blood pressure measurement devices

Maximising the benefits of the next generation of blood pressure measurement devices

Project description

The George Institute is 700+ people around the world, all focused on improving the health of millions of people worldwide. As a medical research institute affiliated with leading universities and with projects in approximately 50 countries, we are challenging the status quo in healthcare to:

  • Find better treatments for the world's biggest health problems
  • Transform primary health care to support better health for more people
  • Harness the power of communities, governments and markets to improve health

Our innovative commercial enterprises help maximise our impact. Please visit our website to read more about how we are addressing the world's biggest health problems.

We currently have a scholarship available for a suitably qualified candidate to undertake a 3 year, full-time PhD. The successful student will be enrolled in the School of Population Health at UNSW, Sydney however will be based at The George Institute for Global Health. 'The George' hosts a thriving program for PhD students, including development opportunities as well as exposure to some of the world’s leading research minds in the field of noncommunicable disease research.

Uncontrolled blood pressure (BP) is the leading cause of death due to heart disease and stroke. Although we have had BP machines and medication for decades, progress has been slow in ensuring that people with hypertension are aware of it and treated effectively.

One effective tool to activate the community is by home BP monitoring. It encourages patient engagement, goal attainment using medication, and improves BP control. However, it remains a tedious task with potential for measurement error, provides only static BP and no nighttime readings. 24-Hour ambulatory monitoring measures BP in real-life including rich nighttime information, but is expensive and uncomfortable.

Attempts to overcome these challenges have resulted in a plethora of >530 cuffless wristband BP devices in Australia. But their reputation is poor without published validation studies to ensure accuracy. The European Society of Hypertension Working Group on BP Monitoring advised in the 2021 Practice Guidelines against using “wristband wearables” due to a lack of evidence on accuracy and usability.  However, we now have the opportunity in NSW to initiate world-first studies on the next generation of validated cuffless BP devices, with the potential to overhaul existing cuff-based methods and impact global standards of BP measurement.

In 2021, a new device from Switzerland became the first wrist-worn wearable that meets standard accuracy and validation criteria for static BP measurements. The device uses photoplethysmographic signals to calculate BP using pulse wave analysis combined with appropriate algorithms. Pioneers in hypertension research predict this technology could cause a paradigm shift in BP monitoring.

This PhD project will include a series of novel studies aiming at maximising the utility of this device in research, practice and at home.

Methods:

Aktiia landscape assessment

Using qualitative approaches to determine consumer/user acceptability and demand:

  • we will engage with GPs, patients and family members on the feasibility of different approaches to continuous home BP monitoring
  • A consumer discrete choice experiment will be done to determine consumer demand and the value of different device attributes and potential trade-offs
  • Focusing on a ‘user centred approach’ end-user input will be sought to co-evaluate the acceptability of long-term use of the cuffless BP device
  • We will also explore a framework that predicts and evaluates the likely success of implementing technology-supported health devices such as Aktiia into the Australian context (NASSS).

Implementing the Aktiia in Research and Clinical Trials

Project 1: Comparison with traditional cuff-based BP tracking: We will compare 24-hour, awake and asleep BP estimated by the Aktiia versus validated ambulatory BP monitoring  in two centres (Perth and Athens). We will use a crossover design with each person serving as his/her own control, including 100 patients (90% power, alpha at 0.05 to detect a difference of 5mmHg SBP, allowing for 10% dropout).

Project 2: A nested randomised study in cardiac patients using the TeleClinical Care (TCC)-Cardiac app to evaluate patient satisfaction using the Aktiia vs standard home BP. The TCC-Cardiac is a novel mHealth mobile app with demonstrated improved cardiac rehabilitation completion rates (88% vs 67% usual care). The app monitors physiological data, pairs with wearable monitors and delivers patient education. We will randomise 100 patients enrolled in the NSW funded TCC-Cardiac care study to receive either the Aktiia or a cuff-based home BP monitor, with the primary outcome being patient satisfaction. Secondary outcome is the proportion with BP control after 2 months. Randomising 96 patients will provide 90% power to detect a 1.2 unit difference in patient satisfaction.

Project 3: A three-arm randomised trial evaluating whether a major improvement in BP measurement will lead to increased patient engagement in managing BP. We will use the May Measurement Month BP awareness campaign as entry point for adults newly detected with high BP in remote and urban NSW. The campaign has 2000~3000 screenees annually in Australia. Adults with high BP will be randomised to receive either an Aktiia, a traditional home BP device or no device. Primary outcome is patient engagement in appropriately managing BP assessed after 3 months. Randomising 240 participants will provide 90% power to detect a 20% improvement in active patient engagement (GP visits/lifestyle/medication uptake) with Aktiia vs no BP device.

Supervisor:

Professor Schutte is the Principal Theme Lead of Cardiac, Vascular and Metabolic Medicine at UNSW, Sydney and Professorial Fellow at The George Institute for Global Health. She has extensive experience in working in the field of hypertension and cardiovascular disease.

    Award Amount:

    The stipend for the scholarship is $30k per annum for up to 3 years.

    Students will be supported to apply for competitive scholarship funding.

    Application Guide:

    Applications must include a cover letter (requirements below), current CV, copy of academic transcripts, proof of citizenship or permanent residency, and the names and contact details of at least two referees.

    Please include in your cover letter:

    • Why you are interested in this opportunity
    • Prior relevant research or relevant health sector experience
    • Ability to work as part of a team
    • Evidence of excellent written and verbal communication skills

    Closing Date - Sunday 3rd October 2021

    If you are interested in undertaking this research project and require further information, please contact Professor Alta Schutte - a.schutte [at] unsw.edu.au

    Eligibility

    Applicants should hold an appropriate undergraduate or Masters degree in a related discipline. Professional experience in the Australian health sector, health research, or other related health disciplines would be an advantage.

    Please note, only Australian citizens, New Zealand citizens or Australian permanent residents are eligible to apply.

    Skills required:

    Essential

    • Experience with statistical analysis software such as Stata, R or SAS
    • Outstanding communication skills
    • Highly developed writing ability, ideally with publications in the peer reviewed literature
    • Capacity to work both independently as well as within a team environment
    • Capacity to problem solve and persevere through unexpected challenges

    Desirable

    • Experience using a variety of blood pressure measurement devices
    • Basic knowledge on available wearable technology
    • Understanding of hypertension and its management