Motivation and training routine after heart attack thanks to ‘Carity’

After a heart attack, there are good rehabilitation programs in Switzerland, but they are too short. Three to four weeks of inpatient rehabilitation are followed by 6-12 weeks of outpatient care. However, most patients stop doing their exercises because they don’t want to overburden their heart. To change this, the ‘Carity’ app has been helping people during and after cardiac rehabilitation since the end of September 2024, to keep their motivation and training routine up and running, and to enable them to live active and self-determined lives.

thebroker speaks with Aliaksei Tsitovich, PhD, Computer Scientist, and co-founder of Carity, about the company founded in 2021.

How did you come up with the idea for this app?

The app is not the central idea; it’s simply a means to deliver a comprehensive cardiac rehabilitation service. At Evoleen (the incubator in which Carity was started), exploration of a cardiac rehab service began back in 2019. Collaborating closely with cardiologists, we aimed to support and extend cardiac rehabilitation offerings, experimenting with several approaches—24/7 patient monitoring, dedicated wearables, and tele-consultations, among others. What we have today is the outcome of refining multiple iterations.

Exercise-based cardiac rehab is recognized as a „must-have“ intervention by the European Society of Cardiology, a Class I guideline. Physical activity is essential for reducing risks among patients, with strong research backing this. The challenge is to encourage steady, sustainable activity to avoid over-exertion and maintain it over time. Currently, in Switzerland, survivors of acute myocardial infarction are „fortunate“—over 50% participate in rehabilitation. However, insurance typically covers around three weeks of in-patient care or 36 outpatient visits over 6–12 weeks. After that, patients often feel left alone in what they call a „black hole“ phase. We listened to these concerns and believe we can enhance the experience to benefit all stakeholders—patients, healthcare professionals, clinics, and, ultimately, the insurers and society that bear the healthcare costs.

What does the Carity app offer?

Carity is a digital health service designed to enhance and extend cardiac rehabilitation. It’s an approved medical device in Switzerland, integrated with smartwatch data (initially the Apple Watch) to support patients in their rehabilitation journey, helping them lead more active and self-determined lives.

The app motivates patients and personalizes rehabilitation goals by focusing on three key areas:

• Heart – Carity visualizes long-term cardiac fitness through indicators like estimated HRV, VO₂ max, and a 6-minute walking test, providing insights into heart health improvements over time.

• Mind – By compiling validated psychological questionnaire results, Carity enables sustained mental health monitoring, alerting patients if their responses suggest a need for psychological support.

• Performance – Carity tracks weekly physical achievements toward exercise goals. „Performance“ resets every Monday, encouraging patients to adhere to recommended exercise intensities and rewarding them for training within optimal zones.

The app guides patients through specific tasks and exercises recommended by their Care Team. It also encourages them to share a weekly report with their Care Team or Personal Health Coach to reflect on progress. These reports serve a dual purpose: they provide distilled, easy-to-understand insights for Care Teams, enabling tailored rehabilitation programs in outpatient, inpatient, or blended care settings. They also harness a motivational effect, promoting accountability and encouragement—from the Care Team to the patient and, later in the program, from health coaches or close supporters.

For healthcare providers and clinics, Carity is a medically certified product, backed by clinical research. Privacy-focused and integration-ready, Carity can be deployed in both standard and value-based clinical environments, offering both simplified PDF reporting and full-scale HL7 FHIR API integrations.

The „Blended Care“ solution has been available to rehab clinics and cardiology practices for their patients since September 29, 2024. Could you please explain this solution?

The Blended Care solution is structured alongside the standard of care for outpatient cardiac rehabilitation, seamlessly integrating into the rehabilitation journey. This approach follows a patient pathway that provides continuous support for both patients and clinicians at each stage. Here’s a breakdown of the patient journey:

Enrollment – Patients are introduced to Carity through their rehabilitation clinic, typically at the beginning of phase 2. We train clinic personnel on Carity onboarding, equip them with onboarding QR codes, and, if necessary, provide technical support directly or through retail partners like DQ Solutions (for smartwatch setup, such as the Apple Watch).

Onboarding – The app guides patients in setting up Apple Watch integration and familiarizes them with the app’s features, including progress tracking.

Tasks and Report Sharing – Throughout the week, Carity helps patients complete essential tasks, including sharing a weekly report. This report enables their Care Team to monitor progress and adjust therapy targets to optimize rehabilitation.

Completion, Follow-up, and Long-term Support – At the end of the outpatient program, Carity continues to support patients in maintaining lifestyle changes, encouraging sustained activity levels and ongoing engagement with health monitoring tools. Carity serves as a bridge beyond traditional rehabilitation, offering multiple options for continued support, including a Personal Health Coach for phase 3, ultimately guiding patients toward integrating long-term physical and mental wellness into their daily lives.

Through this pathway, Carity’s Blended Care model supports a smoother transition from guided rehabilitation to independent management, fostering lasting lifestyle changes.

Our studies have shown that cardiac rehabilitation is implemented differently across clinics. Rather than imposing Carity’s program, we equip clinics with digital tools that allow them to maintain their unique approaches and enhance their rehabilitation programs with Carity’s resources.

We tried downloading the app but couldn’t find it anywhere. Why is that?

Carity currently operates exclusively in Switzerland, so the app is available only on the Swiss App Store. For those located in Switzerland, here is the direct link to the app’s page on the App Store: www.carity.care/app.

What kind of training do the coaches have?

Our coaches are trained with specialized certifications from reputable institutions. Many have completed the CAS Personal Health Coach program offered by the University of Basel, which provides in-depth training in health coaching and lifestyle modification. Additionally, some of our coaches are certified heart therapists, trained through programs endorsed by medical schools in Switzerland. These programs, aligned with guidelines from the Swiss Cardiac Prevention and Rehabilitation Society (SCPRS), equip our coaches with the expertise to guide cardiac rehabilitation patients effectively and support their long-term health and fitness goals.

The award-winning comedian and entrepreneur Dr. Fabian Unteregger is also involved as a medical advisor. How did this collaboration come about?

We met Dr. Fabian Unteregger at Evoleen during the early ideation phase. At that time, we were still weighing whether or not to start the company. His words, among others, were a key motivator for us. He said something to the effect of, „Regardless of how successful the Carity solution becomes, Swiss healthcare will inevitably advance in digitalization and in promoting patient self-responsibility within healthcare processes. So, you’re doing good for all of us.“ His encouragement helped solidify our commitment to moving forward with Carity.

According to Swissmedic, Carity is a Class I medical device. What does that mean?

Being classified as a Class I medical device by Swissmedic primarily signifies Carity’s commitment to medical safety. Developed in compliance with ISO 13485, a standard for medical devices with software, each feature in Carity undergoes rigorous evaluation with a defensive approach, always asking, „What could go wrong?“ This process includes conducting multiple usability studies before each software release, ensuring that the product’s usability and safety measures meet the high standards expected. This classification provides peace of mind to healthcare professionals and patients, reinforcing that Carity is a safe and reliable tool in cardiac rehabilitation.

How does it differ from a fitness app?

This question ties well into the previous discussion. Unlike a fitness app, Carity, as a medical device, has a clearly defined intended use and a specific target population—similar to the detailed purpose outlined for any medical product, like the small-print information provided with medications. This intended use shapes Carity’s design and functionality; our UX design, risk management, and clinical studies—including our ongoing Carity-P trial—are all tailored to deliver specific clinical outcomes for cardiac rehabilitation.

For example, since a significant portion of our patients are 65 and older, we optimize the app’s usability with this demographic in mind. Similarly, we tailor PDF reports to meet the specific roles and needs of Care Team members in line with standard care practices. These are all considerations a fitness app would not typically address, as its focus is generally on general wellness rather than medically guided rehabilitation.

Since spring 2024, Carity has been part of the Future of Health Grant (FoHG) program by CSS and EPFL Innovation Park. Following this, a pilot project with CSS will begin in early 2025. What is this project about?

Having CSS as a partner is invaluable, as we share a common goal: extended patient care to reduce the risk of rehospitalization. By encouraging patients to stay active for longer, we help avoid costly interventions, benefiting both the patient and the insurer. While health economics justify any startup-insurance partnership, the Future of Health Grant (FoHG) program takes this collaboration further. Through it, we work closely with CSS and their network, gaining insights and even influencing the care processes for our patients. Specifically, we’ll be working with CSS’s health coaches to onboard them with Carity, enabling them to support Carity patients through the third phase of cardiac rehabilitation. The feedback from CSS’s coaches will hopefully allow us to refine and improve Carity.

How far along are you in the clinical trial?

We are currently ten months into the study, with plans to reach the first data analysis milestone by spring 2025 and to complete the study later in the year. While this pace might feel slow in the software world, it’s quite standard in the medical field. Fortunately, we’re already collaborating with three major hospitals—University Hospital Zurich (USZ) and the cantonal hospitals of St. Gallen and Lucerne—which helps accelerate our patient recruitment rate.

When do you expect the app to start generating revenue?

We expect to start generating revenue in Q1 2025, with a gradual ramp-up from there. However, it’s important to emphasize again that the app itself is simply a tool—our primary goal is to provide a comprehensive service to patients.

What is the goal of the Carity app?

Ultimately, the goal of Carity is to reduce secondary cardiac events. This overarching objective is divided into specific goals for both patients and healthcare professionals (HCPs).

For Patients:

• To gain confidence in their heart health,
• To maintain a positive state of mind, and
• To sustain healthy activity levels over the long term.

For Healthcare Professionals:

• To receive timely notifications on when and how to adjust care,
• To gain clear insights into patient progress outside the clinical setting without being overwhelmed by excessive data, and
• To guide patients toward a stable, self-sustaining healthy state.

And finally, after 12 weeks of free use, the app requires a subscription. How much does it cost?

We offer a 12-week Carity program for each patient who receives an onboarding code from a participating clinic. This period aligns with a typical phase 2 outpatient cardiac rehabilitation. Patients can then choose to extend the program to a full 52 weeks for 510 CHF. During our initial launch phase, we’re providing substantial discounts to patients willing to share their anonymized data for research purposes. I’m also pleased to announce that Carity is now included in the CSS myFlex Outpatient Insurance plan.

In the long term, we are gathering health economic data to support our case with the Swiss Federal Office of Public Health (BAG) for reimbursement under standard insurance. Preliminary data show that Carity could save around 1,500 to 2,500 CHF per patient by reducing the risk of rehospitalization.

In the long term, we are collecting health economic data to support our application to the Federal Office of Public Health (FOPH) for reimbursement through standard insurance. Preliminary data show that Carity could save about CHF 1,500 to 2,500 per patient by reducing the risk of rehospitalisation.

Aliaksei Tsitovich: Software engineer by training and passion. In his PhD thesis, he focused on topics in theoretical computer science, while his extensive industry experience has been strongly practice-oriented – particularly in the areas of medtech, digital health and patient journeys. For the last 15 years, he has been working for Sonova, BrightInsight and Carity on cloud platforms and SaMD products across all security classes. His expertise covers various health areas such as hearing health, diabetes, eye health and, most recently, cardiology.

Also read: Future of Health Grant: 8 start-ups selected to revolutionise digital health