According to the World Health Organisation, cardiovascular disease (CVD) is the leading cause of death globally.
An estimated 17.9 million people died from CVD in 2019, which accounted for 32 per cent of all global deaths. Of these, 85 per cent were from either heart attack and stroke.
But what if there were an easy way to monitor your heart health, without the need for expensive wearables or a visit to the doctor, which could detect stress quickly and discreetly via a smartphone?
That is the thinking behind Berlin-based startup Kenkou’s stress monitoring technology, which can measure a user’s heart health and enable preventative action to be taken.
And through its growing array of major employers as clients, Kenkou is enabling these businesses to offer additional and cutting-edge support to their workforce during times when mental health and wellbeing are of greater concern than ever before.
Matthias Puls, CEO of Kenkou, told Health Tech World: “We originally rolled out a typical B2B2C solution in the area of stress and burnout prevention, with an app called Kenkou Stress Guide.
“Its USP was that that you could measure stress simply with your finger on the smartphone camera, for one minute, and it would then measure the pulse in close to ECG quality.
“From that, we could detect biomarkers such as heart rate variability, which is a marker for stress and tension on the body.
“Once the user has their results, they would be directed towards typical content like meditation, mindfulness or breathing exercises, so it was a very authentic way to help users.”
Reducing stress is key to reducing CVD; as Matthias says: “The body doesn’t care where the stress comes from, it’s just stress. And when bodies are under constant stress, they start developing chronic inflammation, which can then lead to chronic diseases, including cardiovascular disease.”
Using the app has the benefit of allowing the user to take control of their own health, without having to disclose anything to either their doctor or their employer if they don’t want to.
Matthias added: “Increasingly, we’re seeing more and more initiatives coming from employers because they want to take care of their employees.
“What’s actually happening in their bodies, of course, is subject to data protection, but if you enable the individual to do it for themselves, they can be more proactive when it comes to their health.”
Like so many companies, Kenkou pivoted over the course of the pandemic, launching a Software Development Kit (SDK) that could be integrated into any platform, dramatically widening the scope of its stress monitoring technology.
While the idea had first been mooted prior to COVID, the pandemic brought it to the forefront.
“We understood that COVID would cause a big wave for mental health demand, but should we be the ones who were offering the intervention? Or should we be the ones who are supporting the intervention?,” said Matthias.
The wellbeing app market is saturated, dominated by the big names such as Headspace and Mintopia – but what if, thought Matthias and business partner Alexander Gorny, the company could make existing apps better by allowing the Kenkou technology to be merged?
Matthias said: “There’s not enough space for 50,000 mental health apps on this planet, there’s so many content apps out there, and they’re easy to copy, but they’re very much one size fits all.
“What you need to better understand is the user, so that patient A gets a different treatment from patient B, and therefore they need relevant medical information.
“So our main driver for diversifying was the fact that we understand the market, we have an idea what the future of the digital health market will look like, and we knew that to enable more individual ways of creating therapies, you need vital signs and biomarkers – which Kenkou can provide.
“We changed the strategy to focus on implementing technology, with our SDK that can be seamlessly integrated into any other app out there. This means we can turn any app out there into a medical one, with a focus on digital health apps, of course.”
Which leads into Kenkou’s other USP – accessibility. With wearable smart devices costing in the hundreds of pounds, making them unattainable for many, the Kenkou SDK just needs a smartphone.
With CVD closely related to socio-economic status, the more people who can access basic health information the better.
“This was another one of our key drivers,” explained Matthias.
“In the US market, something like 15 per cent of people use wearables; what are you doing with the other 85 per cent?
“That proportion are especially likely to come from low-income classes, who are more affected by chronic diseases. So we want this app to be available anywhere and everywhere to help with early prevention of cardiovascular disease, because all chronic disease will end up in cardiovascular disease or have the cardiovascular component.”
Ultimately, Matthias hopes that the technology will be able to use the data it collects to create a stress map of a country, taking into account all sorts of variables including sex, age and COVID status.
The software has already been rolled out in Germany, with the firm targeting the US, UK, Nordic countries and APAC next.
Moreover, Kenkou recently rolled out its HRV-Biofeedback module, based on paced breathing.
Matthias said: “We are putting heart rate at the heart of users’ breathing cycle, because when you inhale, your heart beats a bit faster and when you exhale it slows down.
“Biofeedback exercises are known for being super effective across all chronic diseases (mental health, cancer, cardiovascular disease, diabetes, etc) because it’s a very easy way to stimulate your autonomic nervous system (ANS). In these cases, something which is now known for all chronic diseases is that the patients’ ANS balance is impaired, leading to a sympathetic overstimulation of the vagal activity.
This dysautonomia could be considered as a consequence of illness but also as a major risk factor involved in the starting point of chronic diseases and in their evolution. Disease states imply several physiological alterations, such as sleep alterations, hypertension, immune dysfunction, and chronic respiratory disease. These alterations contribute to health deterioration and the development of comorbidities.
So regular breathing exercises accompanied by HRV measurements can therefore have a very positive effect on chronic diseases programs being offered by digital health apps – it’s all about helping users help themselves.”
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