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Mathew J, Mehawej J, Wang Z, Orwig T, Ding E, Filippaios A, Naeem S, Otabil EM, Hamel A, Noorishirazi K, Radu I, Saczynski J, McManus DD, Tran KV. Health behavior outcomes in stroke survivors prescribed wearables for atrial fibrillation detection stratified by age. J Geriatr Cardiol 2024; 21:323-330. [PMID: 38665288 PMCID: PMC11040051 DOI: 10.26599/1671-5411.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Smartwatches have become readily accessible tools for detecting atrial fibrillation (AF). There remains limited data on how they affect psychosocial outcomes and engagement in older adults. We examine the health behavior outcomes of stroke survivors prescribed smartwatches for AF detection stratified by age. METHODS We analyzed data from the Pulsewatch study, a randomized controlled trial that enrolled patients (≥ 50 years) with a history of stroke or transient ischemic attack and CHA2DS2-VASc ≥ 2. Intervention participants were equipped with a cardiac patch monitor and a smartwatch-app dyad, while control participants wore the cardiac patch monitor for up to 44 days. We evaluated health behavior parameters using standardized tools, including the Consumer Health Activation Index, the Generalized Anxiety Disorder questionnaire, the 12-Item Short Form Health Survey, and wear time of participants categorized into three age groups: Group 1 (ages 50-60), Group 2 (ages 61-69), and Group 3 (ages 70-87). We performed statistical analysis using a mixed-effects repeated measures linear regression model to examine differences amongst age groups. RESULTS Comparative analysis between Groups 1, 2 and 3 revealed no significant differences in anxiety, patient activation, perception of physical health and wear time. The use of smartwatch technology was associated with a decrease in perception of mental health for Group 2 compared to Group 1 (β = -3.29, P = 0.046). CONCLUSION Stroke survivors demonstrated a willingness to use smartwatches for AF monitoring. Importantly, among these study participants, the majority did not experience negative health behavior outcomes or decreased engagement as age increased.
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Affiliation(s)
- Joanne Mathew
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
- Department of Internal Medicine, Central Michigan University, Mount Pleasant, USA
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
| | - Ziyue Wang
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
| | - Taylor Orwig
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
| | - Eric Ding
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
| | - Andreas Filippaios
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
| | - Syed Naeem
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
| | - Edith Mensah Otabil
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
| | - Alex Hamel
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
| | - Kamran Noorishirazi
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
| | - Irina Radu
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
| | - Jane Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, USA
| | - David D. McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
| | - Khanh-Van Tran
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Lake Avenue North, Worcester, USA
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Mohagheghian F, Han D, Ghetia O, Peitzsch A, Nishita N, Pirayesh Shirazi Nejad M, Ding EY, Noorishirazi K, Hamel A, Otabil EM, DiMezza D, Dickson EL, Tran KV, McManus DD, Chon KH. Noise Reduction in Photoplethysmography Signals Using a Convolutional Denoising Autoencoder With Unconventional Training Scheme. IEEE Trans Biomed Eng 2024; 71:456-466. [PMID: 37682653 DOI: 10.1109/tbme.2023.3307400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
OBJECTIVE We propose an efficient approach based on a convolutional denoising autoencoder (CDA) network to reduce motion and noise artifacts (MNA) from corrupted atrial fibrillation (AF) and non-AF photoplethysmography (PPG) data segments so that an accurate PPG-signal-derived heart rate can be obtained. Our method's main innovation is the optimization of the CDA performance for both rhythms using more AF than non-AF data for training the AF-specific CDA model and vice versa for the non-AF CDA network. METHODS To evaluate this unconventional training scheme, our proposed network was trained and tested on 25-sec PPG data segments from 48 subjects from two different databases-the Pulsewatch dataset and Stanford University's publicly available PPG dataset. In total, our dataset contains 10,773 data segments: 7,001 segments for training and 3,772 independent segments from out-of-sample subjects for testing. RESULTS Using real-life corrupted PPG segments, our approach significantly reduced the average heart rate root mean square error (RMSE) of the reconstructed PPG segments by 45.74% and 23% compared to the corrupted non-AF and AF data, respectively. Further, our approach exhibited lower RMSE, and higher sensitivity and PPV for detected peaks compared to the reconstructed data produced by the alternative methods. CONCLUSION These results show the promise of our approach as a reliable denoising method, which should be used prior to AF detection algorithms for an accurate cardiac health monitoring involving wearable devices. SIGNIFICANCE PPG signals collected from wearables are vulnerable to MNA, which limits their use as a reliable measurement, particularly in uncontrolled real-life environments.
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Mensah Otabil E, Dai Q, Anzenberg P, Filippaios A, Ding E, Mehawej J, Mathew JE, Lessard D, Wang Z, Noorishirazi K, Hamel A, Paul T, DiMezza D, Han D, Mohagheghian F, Soni A, Lin H, Barton B, Saczynski J, Chon KH, Tran KV, McManus DD. Technology engagement is associated with higher perceived physical well-being in stroke patients prescribed smartwatches for atrial fibrillation detection. Front Digit Health 2023; 5:1243959. [PMID: 38125757 PMCID: PMC10731012 DOI: 10.3389/fdgth.2023.1243959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background Increasing ownership of smartphones among Americans provides an opportunity to use these technologies to manage medical conditions. We examine the influence of baseline smartwatch ownership on changes in self-reported anxiety, patient engagement, and health-related quality of life when prescribed smartwatch for AF detection. Method We performed a post-hoc secondary analysis of the Pulsewatch study (NCT03761394), a clinical trial in which 120 participants were randomized to receive a smartwatch-smartphone app dyad and ECG patch monitor compared to an ECG patch monitor alone to establish the accuracy of the smartwatch-smartphone app dyad for detection of AF. At baseline, 14 days, and 44 days, participants completed the Generalized Anxiety Disorder-7 survey, the Health Survey SF-12, and the Consumer Health Activation Index. Mixed-effects linear regression models using repeated measures with anxiety, patient activation, physical and mental health status as outcomes were used to examine their association with smartwatch ownership at baseline. Results Ninety-six participants, primarily White with high income and tertiary education, were randomized to receive a study smartwatch-smartphone dyad. Twenty-four (25%) participants previously owned a smartwatch. Compared to those who did not previously own a smartwatch, smartwatch owners reported significant greater increase in their self-reported physical health (β = 5.07, P < 0.05), no differences in anxiety (β = 0.92, P = 0.33), mental health (β = -2.42, P = 0.16), or patient activation (β = 1.86, P = 0.54). Conclusions Participants who own a smartwatch at baseline reported a greater positive change in self-reported physical health, but not in anxiety, patient activation, or self-reported mental health over the study period.
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Affiliation(s)
- Edith Mensah Otabil
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Qiying Dai
- Division of Cardiovascular Medicine, Department of Medicine, Saint Vincent Hospital, Worcester, MA, United States
| | - Paula Anzenberg
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Andreas Filippaios
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Eric Ding
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Joanne E. Mathew
- Department of Internal Medicine, Central Michigan University, Mount Pleasant, MI, United States
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ziyue Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Kamran Noorishirazi
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Alexander Hamel
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Tenes Paul
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Danielle DiMezza
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Dong Han
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, United States
| | - Fahimeh Mohagheghian
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, United States
| | - Apurv Soni
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Honghuang Lin
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Jane Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, United States
| | - Ki H. Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, United States
| | - Khanh-Van Tran
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - David D. McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
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4
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Ding EY, Tran KV, Lessard D, Wang Z, Han D, Mohagheghian F, Mensah Otabil E, Noorishirazi K, Mehawej J, Filippaios A, Naeem S, Gottbrecht MF, Fitzgibbons TP, Saczynski JS, Barton B, Chon K, McManus DD. Accuracy, Usability, and Adherence of Smartwatches for Atrial Fibrillation Detection in Older Adults After Stroke: Randomized Controlled Trial. JMIR Cardio 2023; 7:e45137. [PMID: 38015598 DOI: 10.2196/45137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/31/2023] [Accepted: 06/19/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a common cause of stroke, and timely diagnosis is critical for secondary prevention. Little is known about smartwatches for AF detection among stroke survivors. We aimed to examine accuracy, usability, and adherence to a smartwatch-based AF monitoring system designed by older stroke survivors and their caregivers. OBJECTIVE This study aims to examine the feasibility of smartwatches for AF detection in older stroke survivors. METHODS Pulsewatch is a randomized controlled trial (RCT) in which stroke survivors received either a smartwatch-smartphone dyad for AF detection (Pulsewatch system) plus an electrocardiogram patch or the patch alone for 14 days to assess the accuracy and usability of the system (phase 1). Participants were subsequently rerandomized to potentially 30 additional days of system use to examine adherence to watch wear (phase 2). Participants were aged 50 years or older, had survived an ischemic stroke, and had no major contraindications to oral anticoagulants. The accuracy for AF detection was determined by comparing it to cardiologist-overread electrocardiogram patch, and the usability was assessed with the System Usability Scale (SUS). Adherence was operationalized as daily watch wear time over the 30-day monitoring period. RESULTS A total of 120 participants were enrolled (mean age 65 years; 50/120, 41% female; 106/120, 88% White). The Pulsewatch system demonstrated 92.9% (95% CI 85.3%-97.4%) accuracy for AF detection. Mean usability score was 65 out of 100, and on average, participants wore the watch for 21.2 (SD 8.3) of the 30 days. CONCLUSIONS Our findings demonstrate that a smartwatch system designed by and for stroke survivors is a viable option for long-term arrhythmia detection among older adults at risk for AF, though it may benefit from strategies to enhance adherence to watch wear. TRIAL REGISTRATION ClinicalTrials.gov NCT03761394; https://clinicaltrials.gov/study/NCT03761394. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.cvdhj.2021.07.002.
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Affiliation(s)
- Eric Y Ding
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Khanh-Van Tran
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ziyue Wang
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Dong Han
- Department of Bioengineering, University of Connecticut, Storrs, CT, United States
| | - Fahimeh Mohagheghian
- Department of Bioengineering, University of Connecticut, Storrs, CT, United States
| | - Edith Mensah Otabil
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Kamran Noorishirazi
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Jordy Mehawej
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Andreas Filippaios
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Syed Naeem
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Matthew F Gottbrecht
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Timothy P Fitzgibbons
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Jane S Saczynski
- Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, MA, United States
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ki Chon
- Department of Bioengineering, University of Connecticut, Storrs, CT, United States
| | - David D McManus
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
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5
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Paul TJ, Tran KV, Mehawej J, Lessard D, Ding E, Filippaios A, Howard-Wilson S, Otabil EM, Noorishirazi K, Naeem S, Hamel A, Han D, Chon KH, Barton B, Saczynski J, McManus D. Anxiety, patient activation, and quality of life among stroke survivors prescribed smartwatches for atrial fibrillation monitoring. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2023; 4:118-125. [PMID: 37600446 PMCID: PMC10435956 DOI: 10.1016/j.cvdhj.2023.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Background The detection of atrial fibrillation (AF) in stroke survivors is critical to decreasing the risk of recurrent stroke. Smartwatches have emerged as a convenient and accurate means of AF diagnosis; however, the impact on critical patient-reported outcomes, including anxiety, engagement, and quality of life, remains ill defined. Objectives To examine the association between smartwatch prescription for AF detection and the patient-reported outcomes of anxiety, patient activation, and self-reported health. Methods We used data from the Pulsewatch trial, a 2-phase randomized controlled trial that included participants aged 50 years or older with a history of ischemic stroke. Participants were randomized to use either a proprietary smartphone-smartwatch app for 30 days of AF monitoring or no cardiac rhythm monitoring. Validated surveys were deployed before and after the 30-day study period to assess anxiety, patient activation, and self-rated physical and mental health. Logistic regression and generalized estimation equations were used to examine the association between smartwatch prescription for AF monitoring and changes in the patient-reported outcomes. Results A total of 110 participants (mean age 64 years, 41% female, 91% non-Hispanic White) were studied. Seventy percent of intervention participants were novice smartwatch users, as opposed to 84% of controls, and there was no significant difference in baseline rates of anxiety, activation, or self-rated health between the 2 groups. The incidence of new AF among smartwatch users was 6%. Participants who were prescribed smartwatches did not have a statistically significant change in anxiety, activation, or self-reported health as compared to those who were not prescribed smartwatches. The results held even after removing participants who received an AF alert on the watch. Conclusion The prescription of smartwatches to stroke survivors for AF monitoring does not adversely affect key patient-reported outcomes. Further research is needed to better inform the successful deployment of smartwatches in clinical practice.
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Affiliation(s)
- Tenes J. Paul
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Khanh-Van Tran
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Eric Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Andreas Filippaios
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sakeina Howard-Wilson
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Edith Mensah Otabil
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kamran Noorishirazi
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Syed Naeem
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Alex Hamel
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Dong Han
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| | - Ki H. Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jane Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - David McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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Meza C, Juega J, Francisco J, Santos A, Duran L, Rodriguez M, Alvarez-Sabin J, Sero L, Ustrell X, Bashir S, Serena J, Silva Y, Molina C, Pagola J. Accuracy of a Smartwatch to Assess Heart Rate Monitoring and Atrial Fibrillation in Stroke Patients. SENSORS (BASEL, SWITZERLAND) 2023; 23:4632. [PMID: 37430546 DOI: 10.3390/s23104632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 07/12/2023]
Abstract
(1) Background: Consumer smartwatches may be a helpful tool to screen for atrial fibrillation (AF). However, validation studies on older stroke patients remain scarce. The aim of this pilot study from RCT NCT05565781 was to validate the resting heart rate (HR) measurement and the irregular rhythm notification (IRN) feature in stroke patients in sinus rhythm (SR) and AF. (2) Methods: Resting clinical HR measurements (every 5 min) were assessed using continuous bedside ECG monitoring (CEM) and the Fitbit Charge 5 (FC5). IRNs were gathered after at least 4 h of CEM. Lin's concordance correlation coefficient (CCC), Bland-Altman analysis, and mean absolute percentage error (MAPE) were used for agreement and accuracy assessment. (3) Results: In all, 526 individual pairs of measurements were obtained from 70 stroke patients-age 79.4 years (SD ± 10.2), 63% females, BMI 26.3 (IQ 22.2-30.5), and NIHSS score 8 (IQR 1.5-20). The agreement between the FC5 and CEM was good (CCC 0.791) when evaluating paired HR measurements in SR. Meanwhile, the FC5 provided weak agreement (CCC 0.211) and low accuracy (MAPE 16.48%) when compared to CEM recordings in AF. Regarding the accuracy of the IRN feature, analysis found a low sensitivity (34%) and high specificity (100%) for detecting AF. (4) Conclusion: The FC5 was accurate at assessing the HR during SR, but the accuracy during AF was poor. In contrast, the IRN feature was acceptable for guiding decisions regarding AF screening in stroke patients.
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Affiliation(s)
- Claudia Meza
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| | - Jesus Juega
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| | - Jaume Francisco
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Alba Santos
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Laura Duran
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Maite Rodriguez
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
| | - Jose Alvarez-Sabin
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Laia Sero
- Department of Neurology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
| | - Xavier Ustrell
- Department of Neurology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
| | - Saima Bashir
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), 17790 Girona, Spain
- Department of Neurology, Hospital Universitari de Girona Dr. JosepTrueta, 17007 Girona, Spain
| | - Joaquín Serena
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), 17790 Girona, Spain
- Department of Neurology, Hospital Universitari de Girona Dr. JosepTrueta, 17007 Girona, Spain
| | - Yolanda Silva
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), 17790 Girona, Spain
- Department of Neurology, Hospital Universitari de Girona Dr. JosepTrueta, 17007 Girona, Spain
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
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7
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Tran KV, Filippaios A, Noorishirazi K, Ding E, Han D, Mohagheghian F, Dai Q, Mehawej J, Wang Z, Lessard D, Otabil EM, Hamel A, Paul T, Gottbrecht MF, Fitzgibbons TP, Saczynski J, Chon KH, McManus DD. False Atrial Fibrillation Alerts from Smartwatches are Associated with Decreased Perceived Physical Well-being and Confidence in Chronic Symptoms Management. CARDIOLOGY AND CARDIOVASCULAR MEDICINE 2023; 7:97-107. [PMID: 37476150 PMCID: PMC10358285 DOI: 10.26502/fccm.92920314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Wrist-based wearables have been FDA approved for AF detection. However, the health behavior impact of false AF alerts from wearables on older patients at high risk for AF are not known. In this work, we analyzed data from the Pulsewatch (NCT03761394) study, which randomized patients (≥50 years) with history of stroke or transient ischemic attack to wear a patch monitor and a smartwatch linked to a smartphone running the Pulsewatch application vs to only the cardiac patch monitor over 14 days. At baseline and 14 days, participants completed validated instruments to assess for anxiety, patient activation, perceived mental and physical health, chronic symptom management self-efficacy, and medicine adherence. We employed linear regression to examine associations between false AF alerts with change in patient-reported outcomes. Receipt of false AF alerts was related to a dose-dependent decline in self-perceived physical health and levels of disease self-management. We developed a novel convolutional denoising autoencoder (CDA) to remove motion and noise artifacts in photoplethysmography (PPG) segments to optimize AF detection, which substantially reduced the number of false alerts. A promising approach to avoid negative impact of false alerts is to employ artificial intelligence driven algorithms to improve accuracy.
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Affiliation(s)
- Khanh-Van Tran
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Andreas Filippaios
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Kamran Noorishirazi
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Eric Ding
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Dong Han
- Department of Biomedical Engineering, University of Connecticut, 260 Glenbrook Road, Storrs, CT 06269, USA
| | - Fahimeh Mohagheghian
- Department of Biomedical Engineering, University of Connecticut, 260 Glenbrook Road, Storrs, CT 06269, USA
| | - Qiying Dai
- Division of Cardiovascular Medicine, Department of Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608, USA
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Ziyue Wang
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Darleen Lessard
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Edith Mensah Otabil
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Alex Hamel
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Tenes Paul
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Matthew F Gottbrecht
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Timothy P Fitzgibbons
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Jane Saczynski
- Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Ki H Chon
- Department of Biomedical Engineering, University of Connecticut, 260 Glenbrook Road, Storrs, CT 06269, USA
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
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8
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Leung T, Ding EY, Cho C, Jung H, Dickson EL, Mohagheghian F, Peitzsch AG, DiMezza D, Tran KV, McManus DD, Chon KH. A Smartwatch System for Continuous Monitoring of Atrial Fibrillation in Older Adults After Stroke or Transient Ischemic Attack: Application Design Study. JMIR Cardio 2023; 7:e41691. [PMID: 36780211 PMCID: PMC9972205 DOI: 10.2196/41691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/21/2022] [Accepted: 12/31/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The prevalence of atrial fibrillation (AF) increases with age and can lead to stroke. Therefore, older adults may benefit the most from AF screening. However, older adult populations tend to lag more than younger groups in the adoption of, and comfort with, the use of mobile health (mHealth) apps. Furthermore, although mobile apps that can detect AF are available to the public, most are designed for intermittent AF detection and for younger users. No app designed for long-term AF monitoring has released detailed system design specifications that can handle large data collections, especially in this age group. OBJECTIVE This study aimed to design an innovative smartwatch-based AF monitoring mHealth solution in collaboration with older adult participants and clinicians. METHODS The Pulsewatch system is designed to link smartwatches and smartphone apps, a website for data verification, and user data organization on a cloud server. The smartwatch in the Pulsewatch system is designed to continuously monitor the pulse rate with embedded AF detection algorithms, and the smartphone in the Pulsewatch system is designed to serve as the data-transferring hub to the cloud storage server. RESULTS We implemented the Pulsewatch system based on the functionality that patients and caregivers recommended. The user interfaces of the smartwatch and smartphone apps were specifically designed for older adults at risk for AF. We improved our Pulsewatch system based on feedback from focus groups consisting of patients with stroke and clinicians. The Pulsewatch system was used by the intervention group for up to 6 weeks in the 2 phases of our randomized clinical trial. At the conclusion of phase 1, 90 trial participants who had used the Pulsewatch app and smartwatch for 14 days completed a System Usability Scale to assess the usability of the Pulsewatch system; of 88 participants, 56 (64%) endorsed that the smartwatch app is "easy to use." For phases 1 and 2 of the study, we collected 9224.4 hours of smartwatch recordings from the participants. The longest recording streak in phase 2 was 21 days of consecutive recordings out of the 30 days of data collection. CONCLUSIONS This is one of the first studies to provide a detailed design for a smartphone-smartwatch dyad for ambulatory AF monitoring. In this paper, we report on the system's usability and opportunities to increase the acceptability of mHealth solutions among older patients with cognitive impairment. TRIAL REGISTRATION ClinicalTrials.gov NCT03761394; https://www.clinicaltrials.gov/ct2/show/NCT03761394. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.cvdhj.2021.07.002.
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Affiliation(s)
| | - Eric Y Ding
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Chaeho Cho
- Zebra Technologies Inc, Holtsville, NY, United States
| | - Haewook Jung
- SSP, Seoul, Republic of Korea.,Mediporte Co, Ltd, Gyeonggi-do, Republic of Korea
| | - Emily L Dickson
- College of Osteopathic Medicine, Des Moines University, Des Moines, IA, United States
| | - Fahimeh Mohagheghian
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, United States
| | - Andrew G Peitzsch
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, United States
| | | | - Khanh-Van Tran
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - David D McManus
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ki H Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, United States
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9
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Filippaios A, Tran KVT, Mehawej J, Ding E, Paul T, Lessard D, Barton B, Lin H, Naeem S, Otabil EM, Noorishirazi K, Dai Q, Sadiq H, Chon KH, Soni A, Saczynski J, McManus DD. Psychosocial measures in relation to smartwatch alerts for atrial fibrillation detection. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:198-200. [PMID: 36310684 PMCID: PMC9596300 DOI: 10.1016/j.cvdhj.2022.07.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andreas Filippaios
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Khanh-Van T Tran
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Eric Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Tenes Paul
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Honghuang Lin
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Syed Naeem
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Edith Mensah Otabil
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Kamran Noorishirazi
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Qiying Dai
- Division of Cardiovascular Medicine, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Hammad Sadiq
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Ki H Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| | - Apurv Soni
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jane Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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10
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Mohagheghian F, Han D, Peitzsch A, Nishita N, Ding E, Dickson EL, DiMezza D, Otabil EM, Noorishirazi K, Scott J, Lessard D, Wang Z, Whitcomb C, Tran KV, Fitzgibbons TP, McManus DD, Chon KH. Optimized Signal Quality Assessment for Photoplethysmogram Signals Using Feature Selection. IEEE Trans Biomed Eng 2022; 69:2982-2993. [PMID: 35275809 PMCID: PMC9478959 DOI: 10.1109/tbme.2022.3158582] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE With the increasing use of wearable healthcare devices for remote patient monitoring, reliable signal quality assessment (SQA) is required to ensure the high accuracy of interpretation and diagnosis on the recorded data from patients. Photoplethysmographic (PPG) signals non-invasively measured by wearable devices are extensively used to provide information about the cardiovascular system and its associated diseases. In this study, we propose an approach to optimize the quality assessment of the PPG signals. METHODS We used an ensemble-based feature selection scheme to enhance the prediction performance of the classification model to assess the quality of the PPG signals. Our approach for feature and subset size selection yielded the best-suited feature subset, which was optimized to differentiate between the clean and artifact corrupted PPG segments. CONCLUSION A high discriminatory power was achieved between two classes on the test data by the proposed feature selection approach, which led to strong performance on all dependent and independent test datasets. We achieved accuracy, sensitivity, and specificity rates of higher than 0.93, 0.89, and 0.97, respectively, for dependent test datasets, independent of heartbeat type, i.e., atrial fibrillation (AF) or non-AF data including normal sinus rhythm (NSR), premature atrial contraction (PAC), and premature ventricular contraction (PVC). For independent test datasets, accuracy, sensitivity, and specificity rates were greater than 0.93, 0.89, and 0.97, respectively, on PPG data recorded from AF and non-AF subjects. These results were found to be more accurate than those of all of the contemporary methods cited in this work. SIGNIFICANCE As the results illustrate, the advantage of our proposed scheme is its robustness against dynamic variations in the PPG signal during long-term 14-day recordings accompanied with different types of physical activities and a diverse range of fluctuations and waveforms caused by different individual hemodynamic characteristics, and various types of recording devices. This robustness instills confidence in the application of the algorithm to various kinds of wearable devices as a reliable PPG signal quality assessment approach.
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11
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Han D, Bashar SK, Lázaro J, Mohagheghian F, Peitzsch A, Nishita N, Ding E, Dickson EL, DiMezza D, Scott J, Whitcomb C, Fitzgibbons TP, McManus DD, Chon KH. A Real-Time PPG Peak Detection Method for Accurate Determination of Heart Rate during Sinus Rhythm and Cardiac Arrhythmia. BIOSENSORS 2022; 12:82. [PMID: 35200342 PMCID: PMC8869811 DOI: 10.3390/bios12020082] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We have developed a peak detection algorithm for accurate determination of heart rate, using photoplethysmographic (PPG) signals from a smartwatch, even in the presence of various cardiac rhythms, including normal sinus rhythm (NSR), premature atrial contraction (PAC), premature ventricle contraction (PVC), and atrial fibrillation (AF). Given the clinical need for accurate heart rate estimation in patients with AF, we developed a novel approach that reduces heart rate estimation errors when compared to peak detection algorithms designed for NSR. METHODS Our peak detection method is composed of a sequential series of algorithms that are combined to discriminate the various arrhythmias described above. Moreover, a novel Poincaré plot scheme is used to discriminate between basal heart rate AF and rapid ventricular response (RVR) AF, and to differentiate PAC/PVC from NSR and AF. Training of the algorithm was performed only with Samsung Simband smartwatch data, whereas independent testing data which had more samples than did the training data were obtained from Samsung's Gear S3 and Galaxy Watch 3. RESULTS The new PPG peak detection algorithm provides significantly lower average heart rate and interbeat interval beat-to-beat estimation errors-30% and 66% lower-and mean heart rate and mean interbeat interval estimation errors-60% and 77% lower-when compared to the best of the seven other traditional peak detection algorithms that are known to be accurate for NSR. Our new PPG peak detection algorithm was the overall best performers for other arrhythmias. CONCLUSION The proposed method for PPG peak detection automatically detects and discriminates between various arrhythmias among different waveforms of PPG data, delivers significantly lower heart rate estimation errors for participants with AF, and reduces the number of false negative peaks. SIGNIFICANCE By enabling accurate determination of heart rate despite the presence of AF with rapid ventricular response or PAC/PVCs, we enable clinicians to make more accurate recommendations for heart rate control from PPG data.
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Affiliation(s)
- Dong Han
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA; (D.H.); (F.M.); (A.P.)
| | - Syed Khairul Bashar
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA;
| | - Jesús Lázaro
- BSICoS Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, 50018 Zaragoza, Spain;
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain
| | - Fahimeh Mohagheghian
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA; (D.H.); (F.M.); (A.P.)
| | - Andrew Peitzsch
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA; (D.H.); (F.M.); (A.P.)
| | - Nishat Nishita
- Department of Public Health Sciences, University of Connecticut Health, Farmington, CT 06030, USA;
| | - Eric Ding
- Division of Cardiology, University of Massachusetts Medical School, Worcester, MA 01655, USA; (E.D.); (D.D.); (J.S.); (T.P.F.); (D.D.M.)
| | - Emily L. Dickson
- College of Osteopathic Medicine, Des Moines University, Des Moines, IA 50312, USA;
| | - Danielle DiMezza
- Division of Cardiology, University of Massachusetts Medical School, Worcester, MA 01655, USA; (E.D.); (D.D.); (J.S.); (T.P.F.); (D.D.M.)
| | - Jessica Scott
- Division of Cardiology, University of Massachusetts Medical School, Worcester, MA 01655, USA; (E.D.); (D.D.); (J.S.); (T.P.F.); (D.D.M.)
| | - Cody Whitcomb
- School of Medicine, Tufts University, Medford, MA 02155, USA;
| | - Timothy P. Fitzgibbons
- Division of Cardiology, University of Massachusetts Medical School, Worcester, MA 01655, USA; (E.D.); (D.D.); (J.S.); (T.P.F.); (D.D.M.)
| | - David D. McManus
- Division of Cardiology, University of Massachusetts Medical School, Worcester, MA 01655, USA; (E.D.); (D.D.); (J.S.); (T.P.F.); (D.D.M.)
| | - Ki H. Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA; (D.H.); (F.M.); (A.P.)
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