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Marvasti TB, Gao Y, Murray KR, Hershman S, McIntosh C, Moayedi Y. Unlocking Tomorrow's Health Care: Expanding the Clinical Scope of Wearables by Applying Artificial Intelligence. Can J Cardiol 2024:S0828-282X(24)00561-0. [PMID: 39025363 DOI: 10.1016/j.cjca.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/20/2024] Open
Abstract
As an integral aspect of health care, digital technology has enabled modelling of complex relationships to detect, screen, diagnose, and predict patient outcomes. With massive data sets, artificial intelligence (AI) can have marked effects on 3 levels: for patients, clinicians, and health systems. In this review, we discuss contemporary AI-enabled wearable devices undergoing research in the field of cardiovascular medicine. These include devices such as smart watches, electrocardiogram patches, and smart textiles such as smart socks and chest sensors for diagnosis, management, and prognostication of conditions such as atrial fibrillation, heart failure, and hypertension as well as monitoring for cardiac rehabilitation. We review the evolution of machine learning algorithms used in wearable devices from random forest models to the use of convolutional neural networks and transformers. We further discuss frameworks for wearable technologies such as the V3-stage process of verification, analytical validation, and clinical validation as well as challenges of AI integration in medicine such as data veracity, validity, and security and provide a reference framework to maintain fairness and equity. Last, clinician and patient perspectives are discussed to highlight the importance of considering end-user feedback in development and regulatory processes.
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Affiliation(s)
- Tina Binesh Marvasti
- Ted Rogers Centre for Heart Research, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yuan Gao
- Ted Rogers Centre for Heart Research, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kevin R Murray
- Ted Rogers Centre for Heart Research, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Steve Hershman
- Ted Rogers Centre for Heart Research, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Chris McIntosh
- Ted Rogers Centre for Heart Research, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yasbanoo Moayedi
- Ted Rogers Centre for Heart Research, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada; Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
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Pastorino R, Pezzullo AM, Agodi A, de Waure C, Mazzucco W, Russo L, Bianchi M, Maio A, Farina S, Porcelli M, Tona DM, Di Pumpo M, Amore R, Wachocka M, Pasciuto T, Barchitta M, Magnano San Lio R, Favara G, Tuttolomondo A, Tramuto F, Morello G, De Bella DD, Fruscione S, Severino A, Liuzzo G, Boccia S. Efficacy of polygenic risk scores and digital technologies for INNOvative personalized cardiovascular disease PREVention in high-risk adults: protocol of a randomized controlled trial. Front Public Health 2024; 12:1335894. [PMID: 38947346 PMCID: PMC11211566 DOI: 10.3389/fpubh.2024.1335894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
Background Cardiovascular diseases (CVDs) pose a significant global health challenge, necessitating innovative approaches for primary prevention. Personalized prevention, based on genetic risk scores (PRS) and digital technologies, holds promise in revolutionizing CVD preventive strategies. However, the clinical efficacy of these interventions requires further investigation. This study presents the protocol of the INNOPREV randomized controlled trial, aiming to evaluate the clinical efficacy of PRS and digital technologies in personalized cardiovascular disease prevention. Methods The INNOPREV trial is a four-arm RCT conducted in Italy. A total of 1,020 participants, aged 40-69 with high 10-year CVD risk based on SCORE 2 charts, will be randomly assigned to traditional CVD risk assessment, genetic testing (CVD PRS), digital intervention (app and smart band), or a combination of genetic testing and digital intervention. The primary objective is to evaluate the efficacy of providing CVD PRS information, measured at baseline, either alone or in combination with the use of an app and a smart band, on two endpoints: changes in lifestyle patterns, and modification in CVD risk profiles. Participants will undergo a comprehensive assessment and cardiovascular evaluation at baseline, with follow-up visits at one, five, and 12 months. Lifestyle changes and CVD risk profiles will be assessed at different time points beyond the initial assessment, using the Life's Essential 8 and SCORE 2, respectively. Blood samples will be collected at baseline and at study completion to evaluate changes in lipid profiles. The analysis will employ adjusted mixed-effect models for repeated measures to assess significant differences in the data collected over time. Additionally, potential moderators and mediators will be examined to understand the underlying mechanisms of behavior change. Discussion As the largest trial in this context, the INNOPREV trial will contribute to the advancement of personalized cardiovascular disease prevention, with the potential to positively impact public health and reduce the burden of CVDs on healthcare systems. By systematically examining the clinical efficacy of PRS and digital interventions, this trial aims to provide valuable evidence to guide future preventive strategies and enhance population health outcomes.
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Affiliation(s)
- Roberta Pastorino
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angelo Maria Pezzullo
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
- Azienda Ospedaliero Universitaria Policlinico “G. Rodolico-San Marco”, Programme: Hospital Epidemiology and Translational Research: Epidemiological Surveillance, Risk Assessment and Control, Catania, Italy
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Walter Mazzucco
- Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone” di Palermo, Palermo, Italy
- Dipartimento PROMISE, Università degli Studi di Palermo, Palermo, Italy
| | - Luigi Russo
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Bianchi
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Maio
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Farina
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Porcelli
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diego Maria Tona
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Di Pumpo
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosarita Amore
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Malgorzata Wachocka
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tina Pasciuto
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Research Core Facilty Data Collection G-STeP, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Roberta Magnano San Lio
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Giuliana Favara
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Antonino Tuttolomondo
- Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone” di Palermo, Palermo, Italy
- Dipartimento PROMISE, Università degli Studi di Palermo, Palermo, Italy
| | - Fabio Tramuto
- Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone” di Palermo, Palermo, Italy
- Dipartimento PROMISE, Università degli Studi di Palermo, Palermo, Italy
| | - Gaia Morello
- Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone” di Palermo, Palermo, Italy
| | | | - Santo Fruscione
- Dipartimento PROMISE, Università degli Studi di Palermo, Palermo, Italy
| | - Anna Severino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Neri L, Corazza I, Oberdier MT, Lago J, Gallelli I, Cicero AFG, Diemberger I, Orro A, Beker A, Paolocci N, Halperin HR, Borghi C. Comparison Between a Single-Lead ECG Garment Device and a Holter Monitor: A Signal Quality Assessment. J Med Syst 2024; 48:57. [PMID: 38801649 PMCID: PMC11129969 DOI: 10.1007/s10916-024-02077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
Wearable electronics are increasingly common and useful as health monitoring devices, many of which feature the ability to record a single-lead electrocardiogram (ECG). However, recording the ECG commonly requires the user to touch the device to complete the lead circuit, which prevents continuous data acquisition. An alternative approach to enable continuous monitoring without user initiation is to embed the leads in a garment. This study assessed ECG data obtained from the YouCare device (a novel sensorized garment) via comparison with a conventional Holter monitor. A cohort of thirty patients (age range: 20-82 years; 16 females and 14 males) were enrolled and monitored for twenty-four hours with both the YouCare device and a Holter monitor. ECG data from both devices were qualitatively assessed by a panel of three expert cardiologists and quantitatively analyzed using specialized software. Patients also responded to a survey about the comfort of the YouCare device as compared to the Holter monitor. The YouCare device was assessed to have 70% of its ECG signals as "Good", 12% as "Acceptable", and 18% as "Not Readable". The R-wave, independently recorded by the YouCare device and Holter monitor, were synchronized within measurement error during 99.4% of cardiac cycles. In addition, patients found the YouCare device more comfortable than the Holter monitor (comfortable 22 vs. 5 and uncomfortable 1 vs. 18, respectively). Therefore, the quality of ECG data collected from the garment-based device was comparable to a Holter monitor when the signal was sufficiently acquired, and the garment was also comfortable.
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Affiliation(s)
- Luca Neri
- Department of Medicine, Division of Cardiology, Johns Hopkins University, 1721 East Madison Street Traylor Hall 901, Baltimore, MD, 21205, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ivan Corazza
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Matt T Oberdier
- Department of Medicine, Division of Cardiology, Johns Hopkins University, 1721 East Madison Street Traylor Hall 901, Baltimore, MD, 21205, USA
| | - Jessica Lago
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ilaria Gallelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Arrigo F G Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Igor Diemberger
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Orro
- Institute for Biomedical Technologies, National Research Council (ITB-CNR), Segrate, Italy
| | | | - Nazareno Paolocci
- Department of Medicine, Division of Cardiology, Johns Hopkins University, 1721 East Madison Street Traylor Hall 901, Baltimore, MD, 21205, USA
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Henry R Halperin
- Department of Medicine, Division of Cardiology, Johns Hopkins University, 1721 East Madison Street Traylor Hall 901, Baltimore, MD, 21205, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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May C, Or G, Gad S, Daniel Z, Hila H, Boris F, Pninit L, Hadar A, Galia B. Can Patients with Electrolyte Disturbances Be Safely and Effectively Treated in a Hospital-at-Home, Telemedicine-Controlled Environment? A Retrospective Analysis of 267 Patients. J Clin Med 2024; 13:1409. [PMID: 38592241 PMCID: PMC10932046 DOI: 10.3390/jcm13051409] [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: 01/20/2024] [Revised: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Morbidities indicated for hospital-at-home (HAH) treatment include infectious diseases and exacerbations of chronic conditions. Electrolyte disturbances are not included per se. However, their rate is high. We aimed to describe our experience via the monitoring and treatment of such patients. METHODS This was a retrospective analysis of patients in the setting of telemedicine-controlled HAH treatment. We collected data from the electronic medical records of patients who presented electrolyte disturbances. RESULTS For 14 months, we treated 267 patients in total in HAH settings, with a mean age of 72.2 + 16.4, 44.2% for males. In total, 261 (97.75%) patients were flagged with electrolyte disturbances, of whom 149 had true electrolyte disturbances. Furthermore, 67 cases (44.96%) had hyponatremia, 9 (6.04%) had hypernatremia after correction for hyperglycemia, 20 (13.42%) had hypokalemia and 27 (18.12%) had hyperkalemia after the exclusion of hemolytic samples. Ten (6.09%) patients had hypocalcemia and two (1.34%) had hypercalcemia corrected to albumin levels. Thirteen (8.72%) patients had hypomagnesemia and one (0.67%) had hypermagnesemia. Patients with electrolyte disturbances suffered from more chronic kidney disease (24.2% vs. 12.2%; p = 0.03) and malignancy (6.3% vs. 0.6%; p = 0.006), and were more often treated with diuretics (12.6% vs. 4.1%; p = 0.016). No patient died or suffered from clinically significant cardiac arrhythmias. CONCLUSIONS The extent of electrolyte disturbances amongst HAH treatment patients is high. The monitoring and treatment of such patients can be conducted safely in this setting.
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Affiliation(s)
- Cohn May
- 3rd Faculty of Medicine, Charles University, 11636 Prague, Czech Republic
| | - Gueron Or
- School of Medicine, University of Nicosia, Nicosia 2417, Cyprus;
| | - Segal Gad
- Chaim Sheba Medical Center, Education Authority, 2nd Sheba Road, Ramat-Gan 5262000, Israel
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Zubli Daniel
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
- Chaim Sheba Medical Center, The Infection Prevention & Control Unit, 2nd Sheba Road, Ramat-Gan 5262000, Israel
| | - Hakim Hila
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
| | - Fizdel Boris
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
| | - Liber Pninit
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
| | - Amir Hadar
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
| | - Barkai Galia
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
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Neri L, Gallelli I, Dall'Olio M, Lago J, Borghi C, Diemberger I, Corazza I. Validation of a New and Straightforward Algorithm to Evaluate Signal Quality during ECG Monitoring with Wearable Devices Used in a Clinical Setting. Bioengineering (Basel) 2024; 11:222. [PMID: 38534496 DOI: 10.3390/bioengineering11030222] [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: 01/12/2024] [Revised: 02/03/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Wearable devices represent a new approach for monitoring key clinical parameters, such as ECG signals, for research and health purposes. These devices could outcompete medical devices in terms of affordability and use in out-clinic settings, allowing remote monitoring. The major limitation, especially when compared to implantable devices, is the presence of artifacts. Several authors reported a relevant percentage of recording time with poor/unusable traces for ECG, potentially hampering the use of these devices for this purpose. For this reason, it is of the utmost importance to develop a simple and inexpensive system enabling the user of the wearable devices to have immediate feedback on the quality of the acquired signal, allowing for real-time correction. METHODS A simple algorithm that can work in real time to verify the quality of the ECG signal (acceptable and unacceptable) was validated. Based on simple statistical parameters, the algorithm was blindly tested by comparison with ECG tracings previously classified by two expert cardiologists. RESULTS The classifications of 7200 10s-signal samples acquired on 20 patients with a commercial wearable ECG monitor were compared. The algorithm has an overall efficiency of approximately 95%, with a sensitivity of 94.7% and a specificity of 95.3%. CONCLUSIONS The results demonstrate that even a simple algorithm can be used to classify signal coarseness, and this could allow real-time intervention by the subject or the technician.
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Affiliation(s)
- Luca Neri
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | | | | | - Jessica Lago
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
- IRCCS AOU, Policlinico di S. Orsola, 40138 Bologna, Italy
| | - Igor Diemberger
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
- IRCCS AOU, Policlinico di S. Orsola, 40138 Bologna, Italy
| | - Ivan Corazza
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
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Dervieux E, Guerrero F, Uhring W, Giroux-Metgès MA, Théron M. Skin temperature influence on transcutaneous carbon dioxide (CO 2) conductivity and skin blood flow in healthy human subjects at the arm and wrist. Front Physiol 2024; 14:1293752. [PMID: 38321986 PMCID: PMC10846589 DOI: 10.3389/fphys.2023.1293752] [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: 09/13/2023] [Accepted: 12/05/2023] [Indexed: 02/08/2024] Open
Abstract
Objective: present transcutaneous carbon dioxide (CO2)-tcpCO2-monitors suffer from limitations which hamper their widespread use, and call for a new tcpCO2 measurement technique. However, the progress in this area is hindered by the lack of knowledge in transcutaneous CO2 diffusion. To address this knowledge gap, this study focuses on investigating the influence of skin temperature on two key skin properties: CO2 permeability and skin blood flow. Methods: a monocentric prospective exploratory study including 40 healthy adults was undertaken. Each subject experienced a 90 min visit split into five 18 min sessions at different skin temperatures-Non-Heated (NH), 35, 38, 41, and 44°C. At each temperature, custom sensors measured transcutaneous CO2 conductivity and exhalation rate at the arm and wrist, while Laser Doppler Flowmetry (LDF) assessed skin blood flow at the arm. Results: the three studied metrics sharply increased with rising skin temperature. Mean values increased from the NH situation up to 44°C from 4.03 up to 8.88 and from 2.94 up to 8.11 m·s-1 for skin conductivity, and from 80.4 up to 177.5 and from 58.7 up to 162.3 cm3·m-2·h-1 for exhalation rate at the arm and wrist, respectively. Likewise, skin blood flow increased elevenfold for the same temperature increase. Of note, all metrics already augmented significantly in the 35-38°C skin temperature range, which may be reached without active heating-i.e. only using a warm clothing. Conclusion: these results are extremely encouraging for the development of next-generation tcpCO2 sensors. Indeed, the moderate increase (× 2) in skin conductivity from NH to 44°C tends to indicate that heating the skin is not critical from a response time point of view, i.e. little to no skin heating would only result in a doubled sensor response time in the worst case, compared to a maximal heating at 44°C. Crucially, a skin temperature within the 35-38°C range already sharply increases the skin blood flow, suggesting that tcpCO2 correlates well with the arterial paCO2 even at such low skin temperatures. These two conclusions further strengthen the viability of non-heated tcpCO2 sensors, thereby paving the way for the development of wearable transcutaneous capnometers.
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Affiliation(s)
- Emmanuel Dervieux
- Biosency, Cesson-Sévigné, France
- EA4324-ORPHY, Univ Brest, Brest, France
- ICube, University of Strasbourg and CNRS, Strasbourg, France
| | | | - Wilfried Uhring
- ICube, University of Strasbourg and CNRS, Strasbourg, France
| | - Marie-Agnès Giroux-Metgès
- EA4324-ORPHY, Univ Brest, Brest, France
- Explorations Fonctionnelles Respiratoires, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
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Shahid I, Khan MS, Fonarow GC, Butler J, Greene SJ. Bridging gaps and optimizing implementation of guideline-directed medical therapy for heart failure. Prog Cardiovasc Dis 2024; 82:61-69. [PMID: 38244825 DOI: 10.1016/j.pcad.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
Despite robust scientific evidence and strong guideline recommendations, there remain significant gaps in initiation and dose titration of guideline-directed medical therapy (GDMT) for heart failure (HF) among eligible patients. Reasons surrounding these gaps are multifactorial, and largely attributed to patient, healthcare professionals, and institutional challenges. Concurrently, HF remains a predominant cause of mortality and hospitalization, emphasizing the critical need for improved delivery of therapy to patients in routine clinical practice. To optimize GDMT, various implementation strategies have emerged in the recent decade such as in-hospital rapid initiation of GDMT, improving patient adherence, addressing clinical inertia, improving affordability, engagement in quality improvement registries, multidisciplinary clinics, and EHR-integrated interventions. This review highlights the current use and barriers to optimal utilization of GDMT, and proposes novel strategies aimed at improving GDMT in HF.
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Affiliation(s)
- Izza Shahid
- Division of Preventive Cardiology, Houston Methodist Academic Institute, Houston, TX, USA
| | | | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA; Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
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Li K, Cardoso C, Moctezuma-Ramirez A, Elgalad A, Perin E. Heart Rate Variability Measurement through a Smart Wearable Device: Another Breakthrough for Personal Health Monitoring? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7146. [PMID: 38131698 PMCID: PMC10742885 DOI: 10.3390/ijerph20247146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/06/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
Heart rate variability (HRV) is a measurement of the fluctuation of time between each heartbeat and reflects the function of the autonomic nervous system. HRV is an important indicator for both physical and mental status and for broad-scope diseases. In this review, we discuss how wearable devices can be used to monitor HRV, and we compare the HRV monitoring function among different devices. In addition, we have reviewed the recent progress in HRV tracking with wearable devices and its value in health monitoring and disease diagnosis. Although many challenges remain, we believe HRV tracking with wearable devices is a promising tool that can be used to improve personal health.
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Affiliation(s)
- Ke Li
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX 77030, USA
| | - Cristiano Cardoso
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX 77030, USA
| | - Angel Moctezuma-Ramirez
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX 77030, USA
| | - Abdelmotagaly Elgalad
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX 77030, USA
| | - Emerson Perin
- Center for Clinical Research, The Texas Heart Institute, Houston, TX 77030, USA
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Tran HHV, Urgessa NA, Geethakumari P, Kampa P, Parchuri R, Bhandari R, Alnasser AR, Akram A, Kar S, Osman F, Mashat GD, Mohammed L. Detection and Diagnostic Accuracy of Cardiac Arrhythmias Using Wearable Health Devices: A Systematic Review. Cureus 2023; 15:e50952. [PMID: 38249280 PMCID: PMC10800119 DOI: 10.7759/cureus.50952] [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: 08/28/2022] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Photoplethysmography (PPG) is the wearable devices' most widely used technology for monitoring heart rate. The systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and guidelines. This systematic review seeks to establish the effects of wearable health devices on cardiac arrhythmias concerning their impact on the personalization of cardiac management, their refining effect on stroke prevention strategies, and their influence on research and preventive care of cardiac arrhythmias and their re-evaluation of the patient-physician relationship. The population, exposure, control, outcomes, and studies (PECOS) criteria were used in the systematic review. This review considered studies that covered the tests conducted on individuals who presented with cardiovascular diseases (CVD) and also healthy people. The intervention for studies included wearable health devices that could detect and diagnose cardiac arrhythmias. The study considered articles that reported on the personalization of cardiac management, stroke prevention strategies, influence in research and preventive care of cardiac arrhythmias, and the re-evaluation of the patient-physician relationship. Two independent researchers were used in the extraction of the data. In case of dispute, the issue was resolved using a third party. The study's quality analysis was conducted using AXIS. The management of atrial fibrillation (AF) lies heavily in the prevention of stroke. The accuracy being reported in the prediction of arrhythmias and the monitoring of heart rates makes wearable devices an efficient means to personalize health care. Personalization of health and treatment in preventing and managing arrhythmias becomes possible due to the portability of smart wearable devices. However, limitations may be observed due to the high costs incurred in their purchase and use. Using smart wearable devices for the detection of cardiac arrhythmias was very significant.
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Affiliation(s)
- Hadrian Hoang-Vu Tran
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Neway A Urgessa
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Prabhitha Geethakumari
- Internal Medicine, California Institute of Behavioural Neurosciences & Psycholgy, Fairfield, USA
| | - Prathima Kampa
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rakesh Parchuri
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Renu Bhandari
- Internal Medicine, Manipal College of Medical Sciences, Pokhara, NPL
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ali R Alnasser
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aqsa Akram
- Internal Medicine, Dallah Hospital, Riyadh, SAU
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Saikat Kar
- Neurosciences and Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Fatema Osman
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ghadi D Mashat
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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10
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Fruytier LA, Janssen DM, Campero Jurado I, van de Sande DA, Lorato I, Stuart S, Panditha P, de Kok M, Kemps HM. The Utility of a Novel Electrocardiogram Patch Using Dry Electrodes Technology for Arrhythmia Detection During Exercise and Prolonged Monitoring: Proof-of-Concept Study. JMIR Form Res 2023; 7:e49346. [PMID: 38032699 PMCID: PMC10722364 DOI: 10.2196/49346] [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: 05/25/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Accurate detection of myocardial ischemia and arrhythmias during free-living exercise could play a pivotal role in screening and monitoring for the prevention of exercise-related cardiovascular events in high-risk populations. Although remote electrocardiogram (ECG) solutions are emerging rapidly, existing technology is neither designed nor validated for continuous use during vigorous exercise. OBJECTIVE In this proof-of-concept study, we evaluated the usability, signal quality, and accuracy for arrhythmia detection of a single-lead ECG patch platform featuring self-adhesive dry electrode technology in individuals with chronic coronary syndrome. This sensor was evaluated during exercise and for prolonged, continuous monitoring. METHODS We recruited a total of 6 consecutive patients with chronic coronary syndrome scheduled for an exercise stress test (EST) as part of routine cardiac follow-up. Traditional 12-lead ECG recording was combined with monitoring with the ECG patch. Following the EST, the participants continuously wore the sensor for 5 days. Intraclass correlation coefficients (ICC) and Wilcoxon signed rank tests were used to assess the utility of detecting arrhythmias with the patch by comparing the evaluations of 2 blinded assessors. Signal quality during EST and prolonged monitoring was evaluated by using a signal quality indicator. Additionally, connection time was calculated for prolonged ECG monitoring. The comfort and usability of the patch were evaluated by a web-based self-assessment questionnaire. RESULTS A total of 6 male patients with chronic coronary syndrome (mean age 69.8, SD 6.2 years) completed the study protocol. The patch was worn for a mean of 118.3 (SD 5.6) hours. The level of agreement between the patch and 12-lead ECG was excellent for the detection of premature atrial contractions and premature ventricular contractions during the whole test (ICC=0.998, ICC=1.000). No significant differences in the total number of premature atrial contractions and premature ventricular contractions were detected neither during the entire exercise test (P=.79 and P=.18, respectively) nor during the exercise and recovery stages separately (P=.41, P=.66, P=.18, and P=.66). A total of 1 episode of atrial fibrillation was detected by both methods. Total connection time during recording was between 88% and 100% for all participants. There were no reports of skin irritation, erythema, or pain while wearing the patch. CONCLUSIONS This proof-of-concept study showed that this innovative ECG patch based on self-adhesive dry electrode technology can potentially be used for arrhythmia detection during vigorous exercise. The results suggest that the wearable patch is also usable for prolonged continuous ECG monitoring in free-living conditions and can therefore be of potential use in cardiac rehabilitation and tele-monitoring for the prevention of exercise-related cardiovascular events. Future efforts will focus on optimizing signal quality over time and conducting a larger-scale validation study focusing on both arrhythmia and ischemia detection.
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Affiliation(s)
- Lonneke A Fruytier
- Department of Cardiology, Máxima MC Eindhoven/Veldhoven, Veldhoven, Netherlands
| | - Daan M Janssen
- Department of Cardiology, Máxima MC Eindhoven/Veldhoven, Veldhoven, Netherlands
| | - Israel Campero Jurado
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Danny Ajp van de Sande
- Department of Cardiology, Máxima MC Eindhoven/Veldhoven, Veldhoven, Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ilde Lorato
- Stichting imec Nederland, Eindhoven, Netherlands
| | | | | | | | - Hareld Mc Kemps
- Department of Cardiology, Máxima MC Eindhoven/Veldhoven, Veldhoven, Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
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11
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Diodato S, Bardacci Y, El Aoufy K, Belli S, Bambi S. Early myopericarditis diagnosed in a 31-year-old patient using smartwatch technology: A case report. Int Emerg Nurs 2023; 71:101365. [PMID: 37797416 DOI: 10.1016/j.ienj.2023.101365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/06/2023] [Accepted: 09/23/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Smartwatches, wrist-mounted devices with computing capacity able to connect with other devices via short-range wireless networking, are today commonly used by the general population to monitor their health status using specific applications. Currently, these devices offer new possibilities in remote health care monitoring and integration with other applications, through alert notifications, collection of personal data by a variety of sensors and the storage of these data. Several companies are introducing smartwatches with "health status" monitoring software with multiple functions, i.e. electrocardiogram (ECG) sensors. Recently, detection of atrial fibrillation based on heart rate monitoring by optical sensors resulted to be feasible and reliable when using the Apple Watch® and its corresponding application. Indeed, previous case reports highlighted its sensitivity in detecting morphological changes typical of the Acute Coronary Syndrome. CASE REPORT We report the case of a healthcare worker, who experienced chest pain and diffuse myalgia, detected ECG alterations in the ST segment, and reached the Emergency Department Myopericarditis was diagnosed and treated promptly to prevent complications. DISCUSSION Acute viral myocarditis and pericarditis are clinical conditions, usually characterized by 21 a benign course that does not require medical evaluation. However, ventricular arrhythmias are also common in viral myocarditis, and the latter is associated with a large proportion of sudden cardiac deaths in the young population without previous structural heart disease. In this case report, smartwatch technology allowed the preventive implementation of interventions against potentially life-threatening complications. Further developments in smartwatch technology could lead to more sensitive and specific diagnostic algorithms for conditions that require immediate medical intervention.
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Affiliation(s)
- Samuele Diodato
- Emergency and Trauma Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Yari Bardacci
- Emergency and Trauma Intensive Care Unit, Careggi University Hospital, Florence, Italy.
| | - Khadija El Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Simone Belli
- Emergency and Trauma Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Stefano Bambi
- Department of Health Science, University of Florence, Italy
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12
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Tackney MS, Williamson E, Cook DG, Limb E, Harris T, Carpenter J. Multiple imputation approaches for epoch-level accelerometer data in trials. Stat Methods Med Res 2023; 32:1936-1960. [PMID: 37519214 PMCID: PMC10563375 DOI: 10.1177/09622802231188518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Clinical trials that investigate physical activity interventions often use accelerometers to measure step count at a very granular level, for example in 5-second epochs. Participants typically wear the accelerometer for a week-long period at baseline, and for one or more week-long follow-up periods after the intervention. The data is aggregated to provide daily or weekly step counts for the primary analysis. Missing data are common as participants may not wear the device as per protocol. Approaches to handling missing data in the literature have defined missingness on the day level using a threshold on daily weartime, which leads to loss of information on the time of day when data are missing. We propose an approach to identifying and classifying missingness at the finer epoch-level and present two approaches to handling missingness using multiple imputation. Firstly, we present a parametric approach which accounts for the number of missing epochs per day. Secondly, we describe a non-parametric approach where missing periods during the day are replaced by donor data from the same person where possible, or data from a different person who is matched on demographic and physical activity-related variables. Our simulation studies show that the non-parametric approach leads to estimates of the effect of treatment that are least biased while maintaining small standard errors. We illustrate the application of these different multiple imputation strategies to the analysis of the 2017 PACE-UP trial. The proposed framework is likely to be applicable to other digital health outcomes and to other wearable devices.
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Affiliation(s)
- Mia S Tackney
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK
| | - Elizabeth Williamson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK
| | - Derek G Cook
- Population Health Research Institute, St George’s, University of London, UK
| | - Elizabeth Limb
- Population Health Research Institute, St George’s, University of London, UK
| | - Tess Harris
- Population Health Research Institute, St George’s, University of London, UK
| | - James Carpenter
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK
- MRC Clinical Trials Unit at University College London, UK
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13
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Jahre LM, Lortz J, Rassaf T, Rammos C, Mallien C, Skoda EM, Teufel M, Bäuerle A. Needs and demands for mHealth cardiac health promotion among individuals with cardiac diseases: a patient-centred design approach. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:393-401. [PMID: 37794866 PMCID: PMC10545514 DOI: 10.1093/ehjdh/ztad038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/05/2023] [Indexed: 10/06/2023]
Abstract
Aims Cardiovascular diseases are one of the main contributors to disability and mortality worldwide. Meanwhile, risk factors can be modified by lifestyle changes. mHealth is an innovative and effective way to deliver cardiac health promotion. This study aims to examine the needs and demands regarding the design and contents of an mHealth intervention for cardiac health promotion among individuals with cardiac diseases. Different clusters were determined and analysed in terms of the intention to use an mHealth intervention. Methods and results A cross-sectional study was conducted via a web-based survey. Three hundred and four individuals with coronary artery diseases (CADs) and/or congestive heart failure (CHF) were included in the data analysis. Descriptive statistics were applied to evaluate needs and demands regarding an mHealth intervention. A k-medoids cluster analysis was performed. Individuals with CAD and CHF favoured an mHealth intervention that supports its users permanently and is easily integrated into everyday life. Handheld devices and content formats that involve active user participation and regular updates were preferred. Three clusters were observed and labelled high, moderate, and low burden, according to their psychometric properties. The high burden cluster indicated higher behavioural intention towards use of an mHealth intervention than the other clusters. Conclusion The results of the study are a valuable foundation for the development of an mHealth intervention for cardiac health promotion following a user-centred design approach. Individuals with cardiac diseases report positive attitudes in the form of high usage intention regarding mHealth. Highly burdened individuals report a high intention to use such interventions.
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Affiliation(s)
- Lisa Maria Jahre
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Virchowstr. 174, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Julia Lortz
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Christos Rammos
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Charlotta Mallien
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Virchowstr. 174, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Virchowstr. 174, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Virchowstr. 174, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Virchowstr. 174, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
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14
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Dhingra LS, Shen M, Mangla A, Khera R. Cardiovascular Care Innovation through Data-Driven Discoveries in the Electronic Health Record. Am J Cardiol 2023; 203:136-148. [PMID: 37499593 PMCID: PMC10865722 DOI: 10.1016/j.amjcard.2023.06.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
The electronic health record (EHR) represents a rich source of patient information, increasingly being leveraged for cardiovascular research. Although its primary use remains the seamless delivery of health care, the various longitudinally aggregated structured and unstructured data elements for each patient within the EHR can define the computational phenotypes of disease and care signatures and their association with outcomes. Although structured data elements, such as demographic characteristics, laboratory measurements, problem lists, and medications, are easily extracted, unstructured data are underused. The latter include free text in clinical narratives, documentation of procedures, and reports of imaging and pathology. Rapid scaling up of data storage and rapid innovation in natural language processing and computer vision can power insights from unstructured data streams. However, despite an array of opportunities for research using the EHR, specific expertise is necessary to adequately address confidentiality, accuracy, completeness, and heterogeneity challenges in EHR-based research. These often require methodological innovation and best practices to design and conduct successful research studies. Our review discusses these challenges and their proposed solutions. In addition, we highlight the ongoing innovations in federated learning in the EHR through a greater focus on common data models and discuss ongoing work that defines such an approach to large-scale, multicenter, federated studies. Such parallel improvements in technology and research methods enable innovative care and optimization of patient outcomes.
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Affiliation(s)
| | - Miles Shen
- Section of Cardiovascular Medicine, Department of Internal Medicine; Department of Internal Medicine
| | - Anjali Mangla
- Section of Cardiovascular Medicine, Department of Internal Medicine; Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine; Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut; Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.; Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut.
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15
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Ackerman KE, Rogers MA, Heikura IA, Burke LM, Stellingwerff T, Hackney AC, Verhagen E, Schley S, Saville GH, Mountjoy M, Holtzman B. Methodology for studying Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the International Olympic Committee (IOC) consensus on REDs. Br J Sports Med 2023; 57:1136-1147. [PMID: 37752010 DOI: 10.1136/bjsports-2023-107359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/28/2023]
Abstract
In the past decade, the study of relationships among nutrition, exercise and the effects on health and athletic performance, has substantially increased. The 2014 introduction of Relative Energy Deficiency in Sport (REDs) prompted sports scientists and clinicians to investigate these relationships in more populations and with more outcomes than had been previously pursued in mostly white, adolescent or young adult, female athletes. Much of the existing physiology and concepts, however, are either based on or extrapolated from limited studies, and the comparison of studies is hindered by the lack of standardised protocols. In this review, we have evaluated and outlined current best practice methodologies to study REDs in an attempt to guide future research.This includes an agreement on the definition of key terms, a summary of study designs with appropriate applications, descriptions of best practices for blood collection and assessment and a description of methods used to assess specific REDs sequelae, stratified as either Preferred, Used and Recommended or Potential Researchers can use the compiled information herein when planning studies to more consistently select the proper tools to investigate their domain of interest. Thus, the goal of this review is to standardise REDs research methods to strengthen future studies and improve REDs prevention, diagnosis and care.
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Affiliation(s)
- Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margot Anne Rogers
- Australian Institute of Sport, Bruce, South Australia, Australia
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australian Capital Territory, Australia
| | - Ida A Heikura
- Canadian Sport Institute-Pacific, Victoria, British Columbia, Canada
- Department of Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Louise M Burke
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Trent Stellingwerff
- Canadian Sport Institute-Pacific, Victoria, British Columbia, Canada
- Department of Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Anthony C Hackney
- Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports and Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Stacey Schley
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Grace H Saville
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Games Group, International Olympic Committee, Lausanne, Switzerland
| | - Bryan Holtzman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Mass General for Children, Boston, Massachusetts, USA
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16
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Lalanza JF, Lorente S, Bullich R, García C, Losilla JM, Capdevila L. Methods for Heart Rate Variability Biofeedback (HRVB): A Systematic Review and Guidelines. Appl Psychophysiol Biofeedback 2023; 48:275-297. [PMID: 36917418 PMCID: PMC10412682 DOI: 10.1007/s10484-023-09582-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/16/2023]
Abstract
Heart Rate Variability Biofeedback (HRVB) has been widely used to improve cardiovascular health and well-being. HRVB is based on breathing at an individual's resonance frequency, which stimulates respiratory sinus arrhythmia (RSA) and the baroreflex. There is, however, no methodological consensus on how to apply HRVB, while details about the protocol used are often not well reported. Thus, the objectives of this systematic review are to describe the different HRVB protocols and detect methodological concerns. PsycINFO, CINALH, Medline and Web of Science were searched between 2000 and April 2021. Data extraction and quality assessment were based on PRISMA guidelines. A total of 143 studies were finally included from any scientific field and any type of sample. Three protocols for HRVB were found: (i) "Optimal RF" (n = 37), each participant breathes at their previously detected RF; (ii) "Individual RF" (n = 48), each participant follows a biofeedback device that shows the optimal breathing rate based on cardiovascular data in real time, and (iii) "Preset-pace RF" (n = 51), all participants breathe at the same rate rate, usually 6 breaths/minute. In addition, we found several methodological differences for applying HRVB in terms of number of weeks, duration of breathing or combination of laboratory and home sessions. Remarkably, almost 2/3 of the studies did not report enough information to replicate the HRVB protocol in terms of breathing duration, inhalation/exhalation ratio, breathing control or body position. Methodological guidelines and a checklist are proposed to enhance the methodological quality of future HRVB studies and increase the information reported.
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Affiliation(s)
- Jaume F Lalanza
- Department of Basic Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sonia Lorente
- Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Pediatric Area, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Raimon Bullich
- Department of Basic Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Carlos García
- Department of Basic Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Josep-Maria Losilla
- Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Sport Research Institute UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Lluis Capdevila
- Department of Basic Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- Sport Research Institute UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- Departament of Basic Psychology, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain.
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17
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Petek BJ, Al-Alusi MA, Moulson N, Grant AJ, Besson C, Guseh JS, Wasfy MM, Gremeaux V, Churchill TW, Baggish AL. Consumer Wearable Health and Fitness Technology in Cardiovascular Medicine: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:245-264. [PMID: 37438010 PMCID: PMC10662962 DOI: 10.1016/j.jacc.2023.04.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 07/14/2023]
Abstract
The use of consumer wearable devices (CWDs) to track health and fitness has rapidly expanded over recent years because of advances in technology. The general population now has the capability to continuously track vital signs, exercise output, and advanced health metrics. Although understanding of basic health metrics may be intuitive (eg, peak heart rate), more complex metrics are derived from proprietary algorithms, differ among device manufacturers, and may not historically be common in clinical practice (eg, peak V˙O2, exercise recovery scores). With the massive expansion of data collected at an individual patient level, careful interpretation is imperative. In this review, we critically analyze common health metrics provided by CWDs, describe common pitfalls in CWD interpretation, provide recommendations for the interpretation of abnormal results, present the utility of CWDs in exercise prescription, examine health disparities and inequities in CWD use and development, and present future directions for research and development.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA; Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Mostafa A Al-Alusi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathaniel Moulson
- Division of Cardiology and Sports Cardiology BC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aubrey J Grant
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cyril Besson
- Swiss Olympic Medical Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - J Sawalla Guseh
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vincent Gremeaux
- Swiss Olympic Medical Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA; Swiss Olympic Medical Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland.
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Turcu AM, Ilie AC, Ștefăniu R, Țăranu SM, Sandu IA, Alexa-Stratulat T, Pîslaru AI, Alexa ID. The Impact of Heart Rate Variability Monitoring on Preventing Severe Cardiovascular Events. Diagnostics (Basel) 2023; 13:2382. [PMID: 37510126 PMCID: PMC10378206 DOI: 10.3390/diagnostics13142382] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
The increase in the incidence of cardiovascular diseases worldwide raises concerns about the urgent need to increase definite measures for the self-determination of different parameters, especially those defining cardiac function. Heart rate variability (HRV) is a non-invasive method used to evaluate autonomic nervous system modulation on the cardiac sinus node, thus describing the oscillations between consecutive electrocardiogram R-R intervals. These fluctuations are undetectable except when using specialized devices, with ECG Holter monitoring considered the gold standard. HRV is considered an independent biomarker for measuring cardiovascular risk and for screening the occurrence of both acute and chronic heart diseases. Also, it can be an important predictive factor of frailty or neurocognitive disorders, like anxiety and depression. An increased HRV is correlated with rest, exercise, and good recovery, while a decreased HRV is an effect of stress or illness. Until now, ECG Holter monitoring has been considered the gold standard for determining HRV, but the recent decade has led to an accelerated development of technology using numerous devices that were created specifically for the pre-hospital self-monitoring of health statuses. The new generation of devices is based on the use of photoplethysmography, which involves the determination of blood changes at the level of blood vessels. These devices provide additional information about heart rate (HR), blood pressure (BP), peripheral oxygen saturation (SpO2), step counting, physical activity, and sleep monitoring. The most common devices that have this technique are smartwatches (used on a large scale) and chest strap monitors. Therefore, the use of technology and the self-monitoring of heart rate and heart rate variability can be an important first step in screening cardiovascular pathology and reducing the pressure on medical services in a hospital. The use of telemedicine can be an alternative, especially among elderly patients who are associated with walking disorders, frailty, or neurocognitive disorders.
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Affiliation(s)
- Ana-Maria Turcu
- Department of Medical Specialties II, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Adina Carmen Ilie
- Department of Medical Specialties II, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ramona Ștefăniu
- Department of Medical Specialties II, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Sabinne Marie Țăranu
- Department of Medical Specialties II, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioana Alexandra Sandu
- Department of Medical Specialties II, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Teodora Alexa-Stratulat
- Department of Medical Oncology-Radiotherapy, Faculty of Medicine, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Iuliana Pîslaru
- Department of Medical Specialties II, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioana Dana Alexa
- Department of Medical Specialties II, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
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Dhingra LS, Aminorroaya A, Oikonomou EK, Nargesi AA, Wilson FP, Krumholz HM, Khera R. Use of Wearable Devices in Individuals With or at Risk for Cardiovascular Disease in the US, 2019 to 2020. JAMA Netw Open 2023; 6:e2316634. [PMID: 37285157 PMCID: PMC10248745 DOI: 10.1001/jamanetworkopen.2023.16634] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/16/2023] [Indexed: 06/08/2023] Open
Abstract
Importance Wearable devices may be able to improve cardiovascular health, but the current adoption of these devices could be skewed in ways that could exacerbate disparities. Objective To assess sociodemographic patterns of use of wearable devices among adults with or at risk for cardiovascular disease (CVD) in the US population in 2019 to 2020. Design, Setting, and Participants This population-based cross-sectional study included a nationally representative sample of the US adults from the Health Information National Trends Survey (HINTS). Data were analyzed from June 1 to November 15, 2022. Exposures Self-reported CVD (history of heart attack, angina, or congestive heart failure) and CVD risk factors (≥1 risk factor among hypertension, diabetes, obesity, or cigarette smoking). Main Outcomes and Measures Self-reported access to wearable devices, frequency of use, and willingness to share health data with clinicians (referred to as health care providers in the survey). Results Of the overall 9303 HINTS participants representing 247.3 million US adults (mean [SD] age, 48.8 [17.9] years; 51% [95% CI, 49%-53%] women), 933 (10.0%) representing 20.3 million US adults had CVD (mean [SD] age, 62.2 [17.0] years; 43% [95% CI, 37%-49%] women), and 5185 (55.7%) representing 134.9 million US adults were at risk for CVD (mean [SD] age, 51.4 [16.9] years; 43% [95% CI, 37%-49%] women). In nationally weighted assessments, an estimated 3.6 million US adults with CVD (18% [95% CI, 14%-23%]) and 34.5 million at risk for CVD (26% [95% CI, 24%-28%]) used wearable devices compared with an estimated 29% (95% CI, 27%-30%) of the overall US adult population. After accounting for differences in demographic characteristics, cardiovascular risk factor profile, and socioeconomic features, older age (odds ratio [OR], 0.35 [95% CI, 0.26-0.48]), lower educational attainment (OR, 0.35 [95% CI, 0.24-0.52]), and lower household income (OR, 0.42 [95% CI, 0.29-0.60]) were independently associated with lower use of wearable devices in US adults at risk for CVD. Among wearable device users, a smaller proportion of adults with CVD reported using wearable devices every day (38% [95% CI, 26%-50%]) compared with overall (49% [95% CI, 45%-53%]) and at-risk (48% [95% CI, 43%-53%]) populations. Among wearable device users, an estimated 83% (95% CI, 70%-92%) of US adults with CVD and 81% (95% CI, 76%-85%) at risk for CVD favored sharing wearable device data with their clinicians to improve care. Conclusions and Relevance Among individuals with or at risk for CVD, fewer than 1 in 4 use wearable devices, with only half of those reporting consistent daily use. As wearable devices emerge as tools that can improve cardiovascular health, the current use patterns could exacerbate disparities unless there are strategies to ensure equitable adoption.
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Affiliation(s)
- Lovedeep S. Dhingra
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Arya Aminorroaya
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Evangelos K. Oikonomou
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Arash Aghajani Nargesi
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francis Perry Wilson
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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20
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Neri L, Oberdier MT, van Abeelen KCJ, Menghini L, Tumarkin E, Tripathi H, Jaipalli S, Orro A, Paolocci N, Gallelli I, Dall’Olio M, Beker A, Carrick RT, Borghi C, Halperin HR. Electrocardiogram Monitoring Wearable Devices and Artificial-Intelligence-Enabled Diagnostic Capabilities: A Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:4805. [PMID: 37430719 PMCID: PMC10223364 DOI: 10.3390/s23104805] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 07/12/2023]
Abstract
Worldwide, population aging and unhealthy lifestyles have increased the incidence of high-risk health conditions such as cardiovascular diseases, sleep apnea, and other conditions. Recently, to facilitate early identification and diagnosis, efforts have been made in the research and development of new wearable devices to make them smaller, more comfortable, more accurate, and increasingly compatible with artificial intelligence technologies. These efforts can pave the way to the longer and continuous health monitoring of different biosignals, including the real-time detection of diseases, thus providing more timely and accurate predictions of health events that can drastically improve the healthcare management of patients. Most recent reviews focus on a specific category of disease, the use of artificial intelligence in 12-lead electrocardiograms, or on wearable technology. However, we present recent advances in the use of electrocardiogram signals acquired with wearable devices or from publicly available databases and the analysis of such signals with artificial intelligence methods to detect and predict diseases. As expected, most of the available research focuses on heart diseases, sleep apnea, and other emerging areas, such as mental stress. From a methodological point of view, although traditional statistical methods and machine learning are still widely used, we observe an increasing use of more advanced deep learning methods, specifically architectures that can handle the complexity of biosignal data. These deep learning methods typically include convolutional and recurrent neural networks. Moreover, when proposing new artificial intelligence methods, we observe that the prevalent choice is to use publicly available databases rather than collecting new data.
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Affiliation(s)
- Luca Neri
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Matt T. Oberdier
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Kirsten C. J. van Abeelen
- Department of Informatics, Systems, and Communication, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Internal Medicine, Radboud University Medical Center, 6525 AJ Nijmegen, The Netherlands
| | - Luca Menghini
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Ethan Tumarkin
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Hemantkumar Tripathi
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Sujai Jaipalli
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Alessandro Orro
- Institute of Biomedical Technologies, National Research Council, 20054 Segrate, Italy
| | - Nazareno Paolocci
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Ilaria Gallelli
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Massimo Dall’Olio
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Amir Beker
- AccYouRate Group S.p.A., 67100 L’Aquila, Italy
| | - Richard T. Carrick
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Henry R. Halperin
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Radiology, Johns Hopkins University, Baltimore, MD 21205, USA
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21
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Hearn J, Van den Eynde J, Chinni B, Cedars A, Gottlieb Sen D, Kutty S, Manlhiot C. Data Quality Degradation on Prediction Models Generated From Continuous Activity and Heart Rate Monitoring: Exploratory Analysis Using Simulation. JMIR Cardio 2023; 7:e40524. [PMID: 37133921 DOI: 10.2196/40524] [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: 06/24/2022] [Revised: 11/10/2022] [Accepted: 11/30/2022] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Limited data accuracy is often cited as a reason for caution in the integration of physiological data obtained from consumer-oriented wearable devices in care management pathways. The effect of decreasing accuracy on predictive models generated from these data has not been previously investigated. OBJECTIVE The aim of this study is to simulate the effect of data degradation on the reliability of prediction models generated from those data and thus determine the extent to which lower device accuracy might or might not limit their use in clinical settings. METHODS Using the Multilevel Monitoring of Activity and Sleep in Healthy People data set, which includes continuous free-living step count and heart rate data from 21 healthy volunteers, we trained a random forest model to predict cardiac competence. Model performance in 75 perturbed data sets with increasing missingness, noisiness, bias, and a combination of all 3 perturbations was compared to model performance for the unperturbed data set. RESULTS The unperturbed data set achieved a mean root mean square error (RMSE) of 0.079 (SD 0.001) in predicting cardiac competence index. For all types of perturbations, RMSE remained stable up to 20%-30% perturbation. Above this level, RMSE started increasing and reached the point at which the model was no longer predictive at 80% for noise, 50% for missingness, and 35% for the combination of all perturbations. Introducing systematic bias in the underlying data had no effect on RMSE. CONCLUSIONS In this proof-of-concept study, the performance of predictive models for cardiac competence generated from continuously acquired physiological data was relatively stable with declining quality of the source data. As such, lower accuracy of consumer-oriented wearable devices might not be an absolute contraindication for their use in clinical prediction models.
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Affiliation(s)
- Jason Hearn
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
| | - Jef Van den Eynde
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
| | - Bhargava Chinni
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
| | - Ari Cedars
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
| | - Danielle Gottlieb Sen
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
| | - Shelby Kutty
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
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22
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Brunetti ND, Curcio A, Nodari S, Parati G, Carugo S, Molinari M, Acquistapace F, Gensini G, Molinari G. The Italian Society of Cardiology and Working Group on Telecardiology and Informatics 2023 updated position paper on telemedicine and artificial intelligence in cardiovascular disease. J Cardiovasc Med (Hagerstown) 2023; 24:e168-e177. [PMID: 37186567 DOI: 10.2459/jcm.0000000000001447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In 2015, the Italian Society of Cardiology and its Working Group on Telemedicine and Informatics issued a position paper on Telecardiology, resuming the most eminent evidence supporting the use of information and communication technology in principal areas of cardiovascular care, ranked by level of evidence. More than 5 years later and after the global shock inflicted by the SARS-CoV-2 pandemic, an update on the topic is warranted. Recent evidence and studies on principal areas of cardiovascular disease will be therefore reported and discussed, with particular focus on telemedicine for cardiovascular care in the COVID-19 context. Novel perspectives and opportunities disclosed by artificial intelligence and its applications in cardiovascular disease will also be discussed. Finally, modalities by which machine learning have realized remote patient monitoring and long-term care in recent years, mainly filtering critical clinical data requiring selective hospital admission, will be provided.
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Affiliation(s)
- Natale D Brunetti
- Division of Cardiology, Department of Medical & Surgical Sciences, University of Foggia, Foggia
| | - Antonio Curcio
- Division of Cardiology, Department of Medical and Surgical Sciences, University 'Magna Graecia' of Catanzaro, Catanzaro
| | - Savina Nodari
- Dept. of Medical and Surgical Specialities, Radiological Sciences and Public Health-University of Brescia Medical School
- University of Brescia Medical School, Brescia
| | | | - Stefano Carugo
- Department of Clinical Sciences and Community Health
- Cardiology Unit, Dept. of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore, University of Milan, Milan
| | - Martina Molinari
- Department of Cardiology, Ospedale 'P.A. Micone', ASL 3 Genovese, Genoa, Italy
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23
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Mannhart D, Lefebvre B, Gardella C, Henry C, Serban T, Knecht S, Kühne M, Sticherling C, Badertscher P. Clinical validation of an artificial intelligence algorithm offering cross-platform detection of atrial fibrillation using smart device electrocardiograms. Arch Cardiovasc Dis 2023; 116:249-257. [PMID: 37183163 DOI: 10.1016/j.acvd.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Several smart devices are able to detect atrial fibrillation automatically by recording a single-lead electrocardiogram, and have created a work overload at the hospital level as a result of the need for over-reads by physicians. AIM To compare the atrial fibrillation detection performances of the manufacturers' algorithms of five smart devices and a novel deep neural network-based algorithm. METHODS We compared the rate of inconclusive tracings and the diagnostic accuracy for the detection of atrial fibrillation between the manufacturers' algorithms and the deep neural network-based algorithm on five smart devices, using a physician-interpreted 12-lead electrocardiogram as the reference standard. RESULTS Of the 117 patients (27% female, median age 65 years, atrial fibrillation present at time of recording in 30%) included in the final analysis (resulting in 585 analyzed single-lead electrocardiogram tracings), the deep neural network-based algorithm exhibited a higher conclusive rate relative to the manufacturer algorithm for all five models: 98% vs. 84% for Apple; 99% vs. 81% for Fitbit; 96% vs. 77% for AliveCor; 99% vs. 85% for Samsung; and 97% vs. 74% for Withings (P<0.01, for each model). When applying our deep neural network-based algorithm, sensitivity and specificity to correctly identify atrial fibrillation were not significantly different for all assessed smart devices. CONCLUSION In this clinical validation, the deep neural network-based algorithm significantly reduced the number of tracings labeled inconclusive, while demonstrating similarly high diagnostic accuracy for the detection of atrial fibrillation, thereby providing a possible solution to the data surge created by these smart devices.
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Affiliation(s)
| | | | | | | | - Teodor Serban
- University Hospital of Basel, 4031 Basel, Switzerland
| | - Sven Knecht
- University Hospital of Basel, 4031 Basel, Switzerland
| | - Michael Kühne
- University Hospital of Basel, 4031 Basel, Switzerland
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24
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Sauerbrei A, Kerasidou A, Lucivero F, Hallowell N. The impact of artificial intelligence on the person-centred, doctor-patient relationship: some problems and solutions. BMC Med Inform Decis Mak 2023; 23:73. [PMID: 37081503 PMCID: PMC10116477 DOI: 10.1186/s12911-023-02162-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/29/2023] [Indexed: 04/22/2023] Open
Abstract
Artificial intelligence (AI) is often cited as a possible solution to current issues faced by healthcare systems. This includes the freeing up of time for doctors and facilitating person-centred doctor-patient relationships. However, given the novelty of artificial intelligence tools, there is very little concrete evidence on their impact on the doctor-patient relationship or on how to ensure that they are implemented in a way which is beneficial for person-centred care.Given the importance of empathy and compassion in the practice of person-centred care, we conducted a literature review to explore how AI impacts these two values. Besides empathy and compassion, shared decision-making, and trust relationships emerged as key values in the reviewed papers. We identified two concrete ways which can help ensure that the use of AI tools have a positive impact on person-centred doctor-patient relationships. These are (1) using AI tools in an assistive role and (2) adapting medical education. The study suggests that we need to take intentional steps in order to ensure that the deployment of AI tools in healthcare has a positive impact on person-centred doctor-patient relationships. We argue that the proposed solutions are contingent upon clarifying the values underlying future healthcare systems.
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Affiliation(s)
- Aurelia Sauerbrei
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Angeliki Kerasidou
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK
| | - Federica Lucivero
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK
| | - Nina Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK
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25
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Keshet A, Reicher L, Bar N, Segal E. Wearable and digital devices to monitor and treat metabolic diseases. Nat Metab 2023; 5:563-571. [PMID: 37100995 DOI: 10.1038/s42255-023-00778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/07/2023] [Indexed: 04/28/2023]
Abstract
Cardiometabolic diseases are a major public-health concern owing to their increasing prevalence worldwide. These diseases are characterized by a high degree of interindividual variability with regards to symptoms, severity, complications and treatment responsiveness. Recent technological advances, and the growing availability of wearable and digital devices, are now making it feasible to profile individuals in ever-increasing depth. Such technologies are able to profile multiple health-related outcomes, including molecular, clinical and lifestyle changes. Nowadays, wearable devices allowing for continuous and longitudinal health screening outside the clinic can be used to monitor health and metabolic status from healthy individuals to patients at different stages of disease. Here we present an overview of the wearable and digital devices that are most relevant for cardiometabolic-disease-related readouts, and how the information collected from such devices could help deepen our understanding of metabolic diseases, improve their diagnosis, identify early disease markers and contribute to individualization of treatment and prevention plans.
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Affiliation(s)
- Ayya Keshet
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Lee Reicher
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University (affiliated with Sackler Faculty of Medicine), Tel Aviv, Israel
| | - Noam Bar
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel.
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.
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26
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Neri L, Oberdier MT, Augello A, Suzuki M, Tumarkin E, Jaipalli S, Geminiani GA, Halperin HR, Borghi C. Algorithm for Mobile Platform-Based Real-Time QRS Detection. SENSORS (BASEL, SWITZERLAND) 2023; 23:1625. [PMID: 36772665 PMCID: PMC9920820 DOI: 10.3390/s23031625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Recent advancements in smart, wearable technologies have allowed the detection of various medical conditions. In particular, continuous collection and real-time analysis of electrocardiogram data have enabled the early identification of pathologic cardiac rhythms. Various algorithms to assess cardiac rhythms have been developed, but these utilize excessive computational power. Therefore, adoption to mobile platforms requires more computationally efficient algorithms that do not sacrifice correctness. This study presents a modified QRS detection algorithm, the AccYouRate Modified Pan-Tompkins (AMPT), which is a simplified version of the well-established Pan-Tompkins algorithm. Using archived ECG data from a variety of publicly available datasets, relative to the Pan-Tompkins, the AMPT algorithm demonstrated improved computational efficiency by 5-20×, while also universally enhancing correctness, both of which favor translation to a mobile platform for continuous, real-time QRS detection.
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Affiliation(s)
- Luca Neri
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Matt T. Oberdier
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA
| | | | - Masahito Suzuki
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Ethan Tumarkin
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Sujai Jaipalli
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | | | - Henry R. Halperin
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Radiology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
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27
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Mannhart D, Lischer M, Knecht S, du Fay de Lavallaz J, Strebel I, Serban T, Vögeli D, Schaer B, Osswald S, Mueller C, Kühne M, Sticherling C, Badertscher P. Clinical Validation of 5 Direct-to-Consumer Wearable Smart Devices to Detect Atrial Fibrillation: BASEL Wearable Study. JACC Clin Electrophysiol 2023; 9:232-242. [PMID: 36858690 DOI: 10.1016/j.jacep.2022.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Multiple smart devices capable to detect atrial fibrillation (AF) are presently available. Sensitivity and specificity for the detection of AF may differ between available smart devices, and this has not yet been adequately investigated. OBJECTIVES The aim was to assess the accuracy of 5 smart devices in identifying AF compared with a physician-interpreted 12-lead electrocardiogram as the reference standard in a real-world cohort of patients. METHODS We consecutively enrolled patients presenting to a cardiology service at a tertiary referral center in a prospective, diagnostic study. RESULTS We prospectively analyzed 201 patients (31% women, median age 66.7 years). AF was present in 62 (31%) patients. Sensitivity and specificity for the detection of AF were comparable between devices: 85% and 75% for the Apple Watch 6, 85% and 75% for the Samsung Galaxy Watch 3, 58% and 75% for the Withings Scanwatch, 66% and 79% for the Fitbit Sense, and 79% and 69% for the AliveCor KardiaMobile, respectively. The rate of inconclusive tracings (the algorithm was unable to determine the heart rhythm) was 18%, 17%, 24%, 21%, and 26% for the Apple Watch 6, Samsung Galaxy Watch 3, Withings Scan Watch, Fitbit Sense, and AliveCor KardiaMobile (P < 0.01 for pairwise comparison), respectively. By manual review of inconclusive tracings, the rhythm could be determined in 955 (99%) of 969 single-lead electrocardiograms. Regarding patient acceptance, the Apple Watch was ranked first (39% of participants). CONCLUSIONS In this clinical validation of 5 direct-to-consumer smart devices, we found differences in the amount of inconclusive tracings diminishing sensitivity and specificity of the smart devices. In a clinical setting, manual review of tracings is required in about one-fourth of cases.
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Affiliation(s)
- Diego Mannhart
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mirko Lischer
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ivo Strebel
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Teodor Serban
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Vögeli
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Beat Schaer
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
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Nardini S, Corbanese U, Visconti A, Mule JD, Sanguinetti CM, De Benedetto F. Improving the management of patients with chronic cardiac and respiratory diseases by extending pulse-oximeter uses: the dynamic pulse-oximetry. Multidiscip Respir Med 2023; 18:922. [PMID: 38322131 PMCID: PMC10772858 DOI: 10.4081/mrm.2023.922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/21/2023] [Indexed: 02/08/2024] Open
Abstract
Respiratory and cardio-vascular chronic diseases are among the most common noncommunicable diseases (NCDs) worldwide, accounting for a large portion of health-care costs in terms of mortality and disability. Their prevalence is expected to rise further in the coming years as the population ages. The current model of care for diagnosing and monitoring NCDs is out of date because it results in late medical interventions and/or an unfavourable cost-effectiveness balance based on reported symptoms and subsequent inpatient tests and treatments. Health projects and programs are being implemented in an attempt to move the time of an NCD's diagnosis, as well as its monitoring and follow up, out of hospital settings and as close to real life as possible, with the goal of benefiting both patients' quality of life and health system budgets. Following the SARS-CoV-2 pandemic, this implementation received additional impetus. Pulseoximeters (POs) are currently used in a variety of clinical settings, but they can also aid in the telemonitoring of certain patients. POs that can measure activities as well as pulse rate and oxygen saturation as proxies of cardio-vascular and respiratory function are now being introduced to the market. To obtain these data, the devices must be absolutely reliable, that is, accurate and precise, and capable of recording for a long enough period of time to allow for diagnosis. This paper is a review of current pulse-oximetry (POy) use, with the goal of investigating how its current use can be expanded to manage not only cardio-respiratory NCDs, but also acute emergencies with telemonitoring when hospitalization is not required but the patients' situation is debatable. Newly designed devices, both "consumer" and "professional," will be scrutinized, particularly those capable of continuously recording vital parameters on a 24-hour basis and coupling them with daily activities, a practice known as dynamic pulse-oximetry.
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Affiliation(s)
- Stefano Nardini
- Scientific Committee, Italian Multidisciplinary Respiratory Society (SIPI), Milan
| | - Ulisse Corbanese
- Retired - Chief of Department of Anaesthesia and Intensive Care, Hospital of Vittorio Veneto (TV)
| | - Alberto Visconti
- ICT Engineer and Consultant, Italian Multidisciplinary Respiratory Society (SIPI), Milan
| | | | - Claudio M. Sanguinetti
- Chief Editor of Multidisciplinary Respiratory Medicine journal; Member of Steering Committee of Italian Multidisciplinary Respiratory Society (SIPI), Milan
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29
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Javaid A, Zghyer F, Kim C, Spaulding EM, Isakadze N, Ding J, Kargillis D, Gao Y, Rahman F, Brown DE, Saria S, Martin SS, Kramer CM, Blumenthal RS, Marvel FA. Medicine 2032: The future of cardiovascular disease prevention with machine learning and digital health technology. Am J Prev Cardiol 2022; 12:100379. [PMID: 36090536 PMCID: PMC9460561 DOI: 10.1016/j.ajpc.2022.100379] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/21/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022] Open
Abstract
Machine learning (ML) refers to computational algorithms that iteratively improve their ability to recognize patterns in data. The digitization of our healthcare infrastructure is generating an abundance of data from electronic health records, imaging, wearables, and sensors that can be analyzed by ML algorithms to generate personalized risk assessments and promote guideline-directed medical management. ML's strength in generating insights from complex medical data to guide clinical decisions must be balanced with the potential to adversely affect patient privacy, safety, health equity, and clinical interpretability. This review provides a primer on key advances in ML for cardiovascular disease prevention and how they may impact clinical practice.
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30
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Biomechanical Sensing Systems for Cardiac Activity Monitoring. Int J Biomater 2022; 2022:8312564. [PMID: 36438068 PMCID: PMC9699781 DOI: 10.1155/2022/8312564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/20/2022] Open
Abstract
Cardiovascular disease is consistently ranked high among the causes of death on a global scale. Monitoring of cardiovascular signs throughout the course of a long period of time and in real time is necessary in order to discover anomalies and begin early intervention at the appropriate time. To this purpose, a significant amount of interest among researchers has been directed toward the creation of flexible sensors that may be worn or implanted and are capable of constant, immediate observation of a variety of main physiological indicators. The real-time readings of the heart and arteries' pressure fluctuations can be reflected directly by mechanical sensors, which are one of the many types of sensors. Potential benefits of mechanical sensors include excellent accuracy and considerable versatility. Capacitive, piezoresistive, piezoelectric, and triboelectric principles are the foundations of the four types of mechanical sensors that are discussed in this article as recent developments for the purpose of monitoring the cardiovascular system. The biomechanical systems that are present in the cardiovascular system are then detailed, along with their monitoring, and this includes blood and endocardial pressure, pulse wave, and heart rhythm. In conclusion, we examine the usefulness of the use of continuous health monitoring for the treatment of vascular disease and highlight the difficulties associated with its translation into clinical practice.
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31
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Alugubelli N, Abuissa H, Roka A. Wearable Devices for Remote Monitoring of Heart Rate and Heart Rate Variability-What We Know and What Is Coming. SENSORS (BASEL, SWITZERLAND) 2022; 22:8903. [PMID: 36433498 PMCID: PMC9695982 DOI: 10.3390/s22228903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 11/15/2022] [Indexed: 05/26/2023]
Abstract
Heart rate at rest and exercise may predict cardiovascular risk. Heart rate variability is a measure of variation in time between each heartbeat, representing the balance between the parasympathetic and sympathetic nervous system and may predict adverse cardiovascular events. With advances in technology and increasing commercial interest, the scope of remote monitoring health systems has expanded. In this review, we discuss the concepts behind cardiac signal generation and recording, wearable devices, pros and cons focusing on accuracy, ease of application of commercial and medical grade diagnostic devices, which showed promising results in terms of reliability and value. Incorporation of artificial intelligence and cloud based remote monitoring have been evolving to facilitate timely data processing, improve patient convenience and ensure data security.
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Affiliation(s)
| | | | - Attila Roka
- Division of Cardiology, Creighton University and CHI Health, 7500 Mercy Rd, Omaha, NE 68124, USA
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32
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Huang JD, Wang J, Ramsey E, Leavey G, Chico TJA, Condell J. Applying Artificial Intelligence to Wearable Sensor Data to Diagnose and Predict Cardiovascular Disease: A Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:8002. [PMID: 36298352 PMCID: PMC9610988 DOI: 10.3390/s22208002] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 06/06/2023]
Abstract
Cardiovascular disease (CVD) is the world's leading cause of mortality. There is significant interest in using Artificial Intelligence (AI) to analyse data from novel sensors such as wearables to provide an earlier and more accurate prediction and diagnosis of heart disease. Digital health technologies that fuse AI and sensing devices may help disease prevention and reduce the substantial morbidity and mortality caused by CVD worldwide. In this review, we identify and describe recent developments in the application of digital health for CVD, focusing on AI approaches for CVD detection, diagnosis, and prediction through AI models driven by data collected from wearables. We summarise the literature on the use of wearables and AI in cardiovascular disease diagnosis, followed by a detailed description of the dominant AI approaches applied for modelling and prediction using data acquired from sensors such as wearables. We discuss the AI algorithms and models and clinical applications and find that AI and machine-learning-based approaches are superior to traditional or conventional statistical methods for predicting cardiovascular events. However, further studies evaluating the applicability of such algorithms in the real world are needed. In addition, improvements in wearable device data accuracy and better management of their application are required. Lastly, we discuss the challenges that the introduction of such technologies into routine healthcare may face.
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Affiliation(s)
- Jian-Dong Huang
- School of Computing, Engineering and Intelligent Systems, Ulster University at Magee, Londonderry BT48 7JL, UK
| | - Jinling Wang
- School of Computing, Engineering and Intelligent Systems, Ulster University at Magee, Londonderry BT48 7JL, UK
| | - Elaine Ramsey
- Department of Global Business & Enterprise, Ulster University at Magee, Londonderry BT48 7JL, UK
| | - Gerard Leavey
- School of Psychology, Ulster University at Coleraine, Londonderry BT52 1SA, UK
| | - Timothy J. A. Chico
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
| | - Joan Condell
- School of Computing, Engineering and Intelligent Systems, Ulster University at Magee, Londonderry BT48 7JL, UK
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Wearables in Cardiovascular Disease. J Cardiovasc Transl Res 2022:10.1007/s12265-022-10314-0. [PMID: 36085432 DOI: 10.1007/s12265-022-10314-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
Wearable devices stand to revolutionize the way healthcare is delivered. From consumer devices that provide general health information and screen for medical conditions to medical-grade devices that allow collection of larger datasets that include multiple modalities, wearables have a myriad of potential uses, especially in cardiovascular disorders. In this review, we summarize the underlying technologies employed in these devices and discuss the regulatory and economic aspects of such devices as well as the future implications of their use.
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Tang C, Liu Z, Li L. Mechanical Sensors for Cardiovascular Monitoring: From Battery-Powered to Self-Powered. BIOSENSORS 2022; 12:bios12080651. [PMID: 36005046 PMCID: PMC9405976 DOI: 10.3390/bios12080651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
Cardiovascular disease is one of the leading causes of death worldwide. Long-term and real-time monitoring of cardiovascular indicators is required to detect abnormalities and conduct early intervention in time. To this end, the development of flexible wearable/implantable sensors for real-time monitoring of various vital signs has aroused extensive interest among researchers. Among the different kinds of sensors, mechanical sensors can reflect the direct information of pressure fluctuations in the cardiovascular system with the advantages of high sensitivity and suitable flexibility. Herein, we first introduce the recent advances of four kinds of mechanical sensors for cardiovascular system monitoring, based on capacitive, piezoresistive, piezoelectric, and triboelectric principles. Then, the physio-mechanical mechanisms in the cardiovascular system and their monitoring are described, including pulse wave, blood pressure, heart rhythm, endocardial pressure, etc. Finally, we emphasize the importance of real-time physiological monitoring in the treatment of cardiovascular disease and discuss its challenges in clinical translation.
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Affiliation(s)
- Chuyu Tang
- School of Physical Science and Technology, Guangxi University, Nanning 530004, China
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China
- School of Nanoscience and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhirong Liu
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China
- School of Nanoscience and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
- Correspondence: (Z.L.); (L.L.)
| | - Linlin Li
- School of Physical Science and Technology, Guangxi University, Nanning 530004, China
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China
- School of Nanoscience and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
- Correspondence: (Z.L.); (L.L.)
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35
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Beavers DL, Chung EH. Wearables in Sports Cardiology. Clin Sports Med 2022; 41:405-423. [PMID: 35710269 DOI: 10.1016/j.csm.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The expanding array and adoption of consumer health wearables is creating a new dynamic to the patient-health-care provider relationship. Providers are increasingly tasked with integrating the biometric data collected from their patients into clinical care. Further, a growing body of evidence is supporting the provider-driven utility of wearables in the screening, diagnosis, and monitoring of cardiovascular disease. Here we highlight existing and emerging wearable health technologies and the potential applications for use within sports cardiology. We additionally highlight how wearables can advance the remote cardiovascular care of patients within the context of the COVID-19 pandemic. Finally, despite these promising advances, we acknowledge some of the significant challenges that remain before wearables can be routinely incorporated into clinical care.
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Affiliation(s)
- David L Beavers
- Department of Internal Medicine, Division of Cardiac Electrophysiology, University of Michigan, 1500 East Medical Center Drive, SPC 5853, Ann Arbor, MI 48109-5853, USA.
| | - Eugene H Chung
- Department of Internal Medicine, Division of Cardiac Electrophysiology, University of Michigan, 1500 East Medical Center Drive, SPC 5853, Ann Arbor, MI 48109-5853, USA
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36
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Tiwari A, Cassani R, Kshirsagar S, Tobon DP, Zhu Y, Falk TH. Modulation Spectral Signal Representation for Quality Measurement and Enhancement of Wearable Device Data: A Technical Note. SENSORS 2022; 22:s22124579. [PMID: 35746361 PMCID: PMC9229858 DOI: 10.3390/s22124579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
Wearable devices are burgeoning, and applications across numerous verticals are emerging, including human performance monitoring, at-home patient monitoring, and health tracking, to name a few. Off-the-shelf wearables have been developed with focus on portability, usability, and low-cost. As such, when deployed in highly ecological settings, wearable data can be corrupted by artifacts and by missing data, thus severely hampering performance. In this technical note, we overview a signal processing representation called the modulation spectrum. The representation quantifies the rate-of-change of different spectral magnitude components and is shown to separate signal from noise, thus allowing for improved quality measurement, quality enhancement, and noise-robust feature extraction, as well as for disease characterization. We provide an overview of numerous applications developed by the authors over the last decade spanning different wearable modalities and list the results obtained from experimental results alongside comparisons with various state-of-the-art benchmark methods. Open-source software is showcased with the hope that new applications can be developed. We conclude with a discussion on possible future research directions, such as context awareness, signal compression, and improved input representations for deep learning algorithms.
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Affiliation(s)
- Abhishek Tiwari
- Institut National de la Recherche Scientifique, University of Quebec, Montréal, QC H5A 1K6, Canada; (A.T.); (S.K.); (Y.Z.)
- Myant Inc., Toronto, ON M9W 1B6, Canada
| | - Raymundo Cassani
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montréal, QC H3A 2B4, Canada;
| | - Shruti Kshirsagar
- Institut National de la Recherche Scientifique, University of Quebec, Montréal, QC H5A 1K6, Canada; (A.T.); (S.K.); (Y.Z.)
| | - Diana P. Tobon
- Faculty of Engineering, Universidad de Medellín, Medellín 050026, Colombia;
| | - Yi Zhu
- Institut National de la Recherche Scientifique, University of Quebec, Montréal, QC H5A 1K6, Canada; (A.T.); (S.K.); (Y.Z.)
| | - Tiago H. Falk
- Institut National de la Recherche Scientifique, University of Quebec, Montréal, QC H5A 1K6, Canada; (A.T.); (S.K.); (Y.Z.)
- Correspondence:
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37
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Wearable Devices for Physical Monitoring of Heart: A Review. BIOSENSORS 2022; 12:bios12050292. [PMID: 35624593 PMCID: PMC9138373 DOI: 10.3390/bios12050292] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 12/19/2022]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death globally. An effective strategy to mitigate the burden of CVDs has been to monitor patients’ biomedical variables during daily activities with wearable technology. Nowadays, technological advance has contributed to wearables technology by reducing the size of the devices, improving the accuracy of sensing biomedical variables to be devices with relatively low energy consumption that can manage security and privacy of the patient’s medical information, have adaptability to any data storage system, and have reasonable costs with regard to the traditional scheme where the patient must go to a hospital for an electrocardiogram, thus contributing a serious option in diagnosis and treatment of CVDs. In this work, we review commercial and noncommercial wearable devices used to monitor CVD biomedical variables. Our main findings revealed that commercial wearables usually include smart wristbands, patches, and smartwatches, and they generally monitor variables such as heart rate, blood oxygen saturation, and electrocardiogram data. Noncommercial wearables focus on monitoring electrocardiogram and photoplethysmography data, and they mostly include accelerometers and smartwatches for detecting atrial fibrillation and heart failure. However, using wearable devices without healthy personal habits will cause disappointing results in the patient’s health.
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38
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Closed-Loop Systems in Neuromodulation. Neurosurg Clin N Am 2022; 33:297-303. [DOI: 10.1016/j.nec.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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39
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Convolutional Neural Networks for Mechanistic Driver Detection in Atrial Fibrillation. Int J Mol Sci 2022; 23:ijms23084216. [PMID: 35457044 PMCID: PMC9032062 DOI: 10.3390/ijms23084216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 02/04/2023] Open
Abstract
The maintaining and initiating mechanisms of atrial fibrillation (AF) remain controversial. Deep learning is emerging as a powerful tool to better understand AF and improve its treatment, which remains suboptimal. This paper aims to provide a solution to automatically identify rotational activity drivers in endocardial electrograms (EGMs) with convolutional recurrent neural networks (CRNNs). The CRNN model was compared with two other state-of-the-art methods (SimpleCNN and attention-based time-incremental convolutional neural network (ATI-CNN)) for different input signals (unipolar EGMs, bipolar EGMs, and unipolar local activation times), sampling frequencies, and signal lengths. The proposed CRNN obtained a detection score based on the Matthews correlation coefficient of 0.680, an ATI-CNN score of 0.401, and a SimpleCNN score of 0.118, with bipolar EGMs as input signals exhibiting better overall performance. In terms of signal length and sampling frequency, no significant differences were found. The proposed architecture opens the way for new ablation strategies and driver detection methods to better understand the AF problem and its treatment.
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40
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Xintarakou A, Sousonis V, Asvestas D, Vardas PE, Tzeis S. Remote Cardiac Rhythm Monitoring in the Era of Smart Wearables: Present Assets and Future Perspectives. Front Cardiovasc Med 2022; 9:853614. [PMID: 35299975 PMCID: PMC8921479 DOI: 10.3389/fcvm.2022.853614] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
Remote monitoring and control of heart function are of primary importance for patient evaluation and management, especially in the modern era of precision medicine and personalized approach. Breaking technological developments have brought to the frontline a variety of smart wearable devices, such as smartwatches, chest patches/straps, or sensors integrated into clothing and footwear, which allow continuous and real-time recording of heart rate, facilitating the detection of cardiac arrhythmias. However, there is great diversity and significant differences in the type and quality of the information they provide, thus impairing their integration into daily clinical practice and the relevant familiarization of practicing physicians. This review will summarize the different types and dominant functions of cardiac smart wearables available in the market. Furthermore, we report the devices certified by official American and/or European authorities and the respective sources of evidence. Finally, we comment pertinent limitations and caveats as well as the potential answers that flow from the latest technological achievements and future perspectives.
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Affiliation(s)
| | | | | | - Panos E Vardas
- Heart Sector, Hygeia Hospitals Group, HHG, Athens, Greece.,European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | - Stylianos Tzeis
- Department of Cardiology, Hygeia Group, Mitera Hospital, Athens, Greece
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41
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Wang YC, Xu X, Hajra A, Apple S, Kharawala A, Duarte G, Liaqat W, Fu Y, Li W, Chen Y, Faillace RT. Current Advancement in Diagnosing Atrial Fibrillation by Utilizing Wearable Devices and Artificial Intelligence: A Review Study. Diagnostics (Basel) 2022; 12:diagnostics12030689. [PMID: 35328243 PMCID: PMC8947563 DOI: 10.3390/diagnostics12030689] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 02/04/2023] Open
Abstract
Atrial fibrillation (AF) is a common arrhythmia affecting 8–10% of the population older than 80 years old. The importance of early diagnosis of atrial fibrillation has been broadly recognized since arrhythmias significantly increase the risk of stroke, heart failure and tachycardia-induced cardiomyopathy with reduced cardiac function. However, the prevalence of atrial fibrillation is often underestimated due to the high frequency of clinically silent atrial fibrillation as well as paroxysmal atrial fibrillation, both of which are hard to catch by routine physical examination or 12-lead electrocardiogram (ECG). The development of wearable devices has provided a reliable way for healthcare providers to uncover undiagnosed atrial fibrillation in the population, especially those most at risk. Furthermore, with the advancement of artificial intelligence and machine learning, the technology is now able to utilize the database in assisting detection of arrhythmias from the data collected by the devices. In this review study, we compare the different wearable devices available on the market and review the current advancement in artificial intelligence in diagnosing atrial fibrillation. We believe that with the aid of the progressive development of technologies, the diagnosis of atrial fibrillation shall be made more effectively and accurately in the near future.
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Affiliation(s)
- Yu-Chiang Wang
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
- Correspondence:
| | - Xiaobo Xu
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Adrija Hajra
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Samuel Apple
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Amrin Kharawala
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Gustavo Duarte
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Wasla Liaqat
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Yiwen Fu
- Department of Medicine, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA 95051, USA;
| | - Weijia Li
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Yiyun Chen
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Robert T. Faillace
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
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Accuracy of heart rate measurements of three smartwatch models in dogs. Top Companion Anim Med 2022; 49:100654. [PMID: 35276420 DOI: 10.1016/j.tcam.2022.100654] [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: 11/11/2021] [Revised: 01/14/2022] [Accepted: 03/01/2022] [Indexed: 11/23/2022]
Abstract
This study was aimed to evaluate the accuracy of heart rate (HR) measurements using three smartwatch models designed for human use when applied to dogs. A group of 15 mixed breed dogs, ages ranging from 2 to 3 years, weighing between 20 and 30 kg were used. The Garmin Fenix 5X plus (GF5Xp), Samsung Gear S3 (SGS3), and Polygold A-6 (PDA6), were randomly placed on the tibia of dogs to collect the HR recordings every 5 minutes for 1 hour. A veterinary patient monitor (VPM) was used as the reference method. A Bland-Altman plot was applied to determine the difference between smartwatches. The receiver operating characteristic curves were developed analysis for sensitivity and specificity. The HR measured by VPM ranged from 65 to 200 bpm (mean, 149.3 ± 28.1 bpm; median, 154 bpm). Among the smartwatches, the lowest (44 bpm) HR was measured by PDA6, while the highest (201 bpm) was measured by SGS3. Among the smartwatches; GF5Xp and SGS3 had slopes equal to 1 and residual standard deviation closer to 0, in agreement with VPM. At the cut-off HR (160 bpm), SGS3 had the highest sensitivity (97.4%), whereas PDA6 had the lowest sensitivity (68.0%). The specificity of GF5Xp, SGS3, and PDA6 was 97.1%, 98.0%, and 98.0%, respectively. The SGS3 and GF5Xp can be ideal tools for veterinarians to monitor the HR of dogs without requiring an additional device.
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mHealth Apps for Self-Management of Cardiovascular Diseases: A Scoping Review. Healthcare (Basel) 2022; 10:healthcare10020322. [PMID: 35206936 PMCID: PMC8872534 DOI: 10.3390/healthcare10020322] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
The use of mHealth apps for the self-management of cardiovascular diseases (CVDs) is an increasing trend in patient-centered care. In this research, we conduct a scoping review of mHealth apps for CVD self-management within the period 2014 to 2021. Our review revolves around six main aspects of the current status of mHealth apps for CVD self-management: main CVDs managed, main app functionalities, disease stages managed, common approaches used for data extraction, analysis, management, common wearables used for CVD detection, monitoring and/or identification, and major challenges to overcome and future work remarks. Our review is based on Arksey and O’Malley’s methodological framework for conducting studies. Similarly, we adopted the PRISMA model for reporting systematic reviews and meta-analyses. Of the 442 works initially retrieved, the review comprised 38 primary studies. According to our results, the most common CVDs include arrhythmia (34%), heart failure (32%), and coronary heart disease (18%). Additionally, we found that the majority mHealth apps for CVD self-management can provide medical recommendations, medical appointments, reminders, and notifications for CVD monitoring. Main challenges in the use of mHealth apps for CVD self-management include overcoming patient reluctance to use the technology and achieving the interoperability of mHealth applications with other systems.
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Dervieux E, Théron M, Uhring W. Carbon Dioxide Sensing-Biomedical Applications to Human Subjects. SENSORS (BASEL, SWITZERLAND) 2021; 22:188. [PMID: 35009731 PMCID: PMC8749784 DOI: 10.3390/s22010188] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 02/06/2023]
Abstract
Carbon dioxide (CO2) monitoring in human subjects is of crucial importance in medical practice. Transcutaneous monitors based on the Stow-Severinghaus electrode make a good alternative to the painful and risky arterial "blood gases" sampling. Yet, such monitors are not only expensive, but also bulky and continuously drifting, requiring frequent recalibrations by trained medical staff. Aiming at finding alternatives, the full panel of CO2 measurement techniques is thoroughly reviewed. The physicochemical working principle of each sensing technique is given, as well as some typical merit criteria, advantages, and drawbacks. An overview of the main CO2 monitoring methods and sites routinely used in clinical practice is also provided, revealing their constraints and specificities. The reviewed CO2 sensing techniques are then evaluated in view of the latter clinical constraints and transcutaneous sensing coupled to a dye-based fluorescence CO2 sensing seems to offer the best potential for the development of a future non-invasive clinical CO2 monitor.
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Affiliation(s)
- Emmanuel Dervieux
- BiOSENCY, 1137a Avenue des Champs Blancs, 35510 Cesson-Sévigné, France
| | - Michaël Théron
- ORPHY, Université de Bretagne Occidentale, 6 Avenue Victor le Gorgeu, 29238 Brest, France;
| | - Wilfried Uhring
- ICube, University of Strasbourg and CNRS, 23 rue du Loess, CEDEX, 67037 Strasbourg, France;
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Dagher L, Nedunchezhian S, El Hajjar AH, Zhang Y, Deffer O, Russell A, Pottle C, Marrouche N. A Cardiovascular Clinic Patients' Survey to Assess Challenges and Opportunities of Digital Health Adoption During the COVID-19 Pandemic Digital Health Survey During COVID-19. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 3:31-39. [PMID: 34812430 PMCID: PMC8600804 DOI: 10.1016/j.cvdhj.2021.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background COVID-19 boosted healthcare digitalization and personalization in cardiology. However, understanding patient attitudes and engagement behaviors is essential to achieve successful acceptance and implementation of digital health technologies in personalized care. Objective This study aims to understand current and future trends in wearable device and telemedicine use in the cardiology clinic patient population, recognize patients’ attitude towards digital health before and after COVID-19, and identify potential socioeconomic and racial/ethnic differences in adoption of digital health tools in a New Orleans patient population. Methods A cross-sectional survey was distributed to Tulane Cardiology Clinic patients between September 2020 and January 2021. Basic demographic information, medical comorbidities, device usage, and opinions on digital health tools were collected. Results Survey responses from 299 participants (average age = 54 years, 50.8% female, 24.4% African American) showed that digital health use was more prevalent in younger, healthier, and more educated individuals. Wearable use was also higher among White patients compared to African American patients. Patients cited costs and technology knowledge as primary deterrents for using wearables, despite being more inclined to use wearables for disease monitoring (41%). While wearable use did not increase after COVID-19 (36.6% pre-COVID vs 35.4% post-COVID, P = .77), telemedicine use rose significantly (10.8% pre-COVID vs 24.3% during COVID, P < .0001). Patients mostly noted telemedicine’s effectiveness in overcoming difficult healthcare access barriers. Additionally, most patients are in support of wearables and telemedicine either complementing or replacing routine tests and traditional clinical visits. Conclusion Demographic and socioeconomic disparities negatively impact wearable health device and telemedicine adoption within cardiovascular clinic patients. Although telemedicine use increased after COVID-19, this effect was not observed for wearables, reflecting significant economic and digital literacy challenges underlying wearable acceptance.
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Affiliation(s)
- Lilas Dagher
- Tulane Research Innovation and Arrhythmia Discoveries- TRIAD Center. Tulane University School of Medicine, New Orleans, LA, USA
| | - Saihariharan Nedunchezhian
- Tulane Research Innovation and Arrhythmia Discoveries- TRIAD Center. Tulane University School of Medicine, New Orleans, LA, USA
| | - Abdel Hadi El Hajjar
- Tulane Research Innovation and Arrhythmia Discoveries- TRIAD Center. Tulane University School of Medicine, New Orleans, LA, USA
| | - Yichi Zhang
- Tulane Research Innovation and Arrhythmia Discoveries- TRIAD Center. Tulane University School of Medicine, New Orleans, LA, USA
| | - Orlando Deffer
- Tulane Research Innovation and Arrhythmia Discoveries- TRIAD Center. Tulane University School of Medicine, New Orleans, LA, USA
| | - Ashley Russell
- Tulane Research Innovation and Arrhythmia Discoveries- TRIAD Center. Tulane University School of Medicine, New Orleans, LA, USA
| | - Christopher Pottle
- Tulane Research Innovation and Arrhythmia Discoveries- TRIAD Center. Tulane University School of Medicine, New Orleans, LA, USA
| | - Nassir Marrouche
- Tulane Research Innovation and Arrhythmia Discoveries- TRIAD Center. Tulane University School of Medicine, New Orleans, LA, USA
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Buhr L, Kaufmann PLM, Jörß K. Chronic Heart Failure Patients’ Attitudes towards Digital Device Data for Self-Documentation and Research in Germany: A Cross-Sectional Survey Study (Preprint). JMIR Cardio 2021; 6:e34959. [PMID: 35921134 PMCID: PMC9386578 DOI: 10.2196/34959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/24/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022] Open
Abstract
Background In recent years, the use of digital mobile measurement devices (DMMDs) for self-documentation in cardiovascular care in Western industrialized health care systems has increased. For patients with chronic heart failure (cHF), digital self-documentation plays an increasingly important role in self-management. Data from DMMDs can also be integrated into telemonitoring programs or data-intensive medical research to collect and evaluate patient-reported outcome measures through data sharing. However, the implementation of data-intensive devices and data sharing poses several challenges for doctors and patients as well as for the ethical governance of data-driven medical research. Objective This study aims to explore the potential and challenges of digital device data in cardiology research from patients’ perspectives. Leading research questions of the study concerned the attitudes of patients with cHF toward health-related data collected in the use of digital devices for self-documentation as well as sharing these data and consenting to data sharing for research purposes. Methods A cross-sectional survey of patients of a research in cardiology was conducted at a German university medical center (N=159) in 2020 (March to July). Eligible participants were German-speaking adult patients with cHF at that center. A pen-and-pencil questionnaire was sent by mail. Results Most participants (77/105, 73.3%) approved digital documentation, as they expected the device data to help them observe their body and its functions more objectively. Digital device data were believed to provide cognitive support, both for patients’ self-assessment and doctors’ evaluation of their patients’ current health condition. Interestingly, positive attitudes toward DMMD data providing cognitive support were, in particular, voiced by older patients aged >65 years. However, approximately half of the participants (56/105, 53.3%) also reported difficulty in dealing with self-documented data that lay outside the optimal medical target range. Furthermore, our findings revealed preferences for the self-management of DMMD data disclosed for data-intensive medical research among German patients with cHF, which are best implemented with a dynamic consent model. Conclusions Our findings provide potentially valuable insights for introducing DMMD in cardiovascular research in the German context. They have several practical implications, such as a high divergence in attitudes among patients with cHF toward different data-receiving organizations as well as a large variance in preferences for the modes of receiving information included in the consenting procedure for data sharing for research. We suggest addressing patients’ multiple views on consenting and data sharing in institutional normative governance frameworks for data-intensive medical research.
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Affiliation(s)
- Lorina Buhr
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
- Faculty of Economics, Law and Social Sciences, University of Erfurt, Erfurt, Germany
| | - Pauline Lucie Martiana Kaufmann
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Katharina Jörß
- Department of Medical Informatics, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
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Current and Potential Applications of Wearables in Sports Cardiology. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23. [DOI: 10.1007/s11936-021-00942-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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48
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Baygin M, Tuncer T, Dogan S, Tan RS, Acharya UR. Automated arrhythmia detection with homeomorphically irreducible tree technique using more than 10,000 individual subject ECG records. Inf Sci (N Y) 2021. [DOI: 10.1016/j.ins.2021.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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49
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Bayoumy K, Gaber M, Elshafeey A, Mhaimeed O, Dineen EH, Marvel FA, Martin SS, Muse ED, Turakhia MP, Tarakji KG, Elshazly MB. Smart wearable devices in cardiovascular care: where we are and how to move forward. Nat Rev Cardiol 2021; 18:581-599. [PMID: 33664502 PMCID: PMC7931503 DOI: 10.1038/s41569-021-00522-7] [Citation(s) in RCA: 224] [Impact Index Per Article: 74.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/31/2023]
Abstract
Technological innovations reach deeply into our daily lives and an emerging trend supports the use of commercial smart wearable devices to manage health. In the era of remote, decentralized and increasingly personalized patient care, catalysed by the COVID-19 pandemic, the cardiovascular community must familiarize itself with the wearable technologies on the market and their wide range of clinical applications. In this Review, we highlight the basic engineering principles of common wearable sensors and where they can be error-prone. We also examine the role of these devices in the remote screening and diagnosis of common cardiovascular diseases, such as arrhythmias, and in the management of patients with established cardiovascular conditions, for example, heart failure. To date, challenges such as device accuracy, clinical validity, a lack of standardized regulatory policies and concerns for patient privacy are still hindering the widespread adoption of smart wearable technologies in clinical practice. We present several recommendations to navigate these challenges and propose a simple and practical 'ABCD' guide for clinicians, personalized to their specific practice needs, to accelerate the integration of these devices into the clinical workflow for optimal patient care.
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Affiliation(s)
- Karim Bayoumy
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Mohammed Gaber
- Department of Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | | | - Omar Mhaimeed
- Department of Medical Education, Weill Cornell Medicine, Doha, Qatar
| | - Elizabeth H Dineen
- Department of Cardiovascular Medicine, University of California Irvine, Irvine, CA, USA
| | - Francoise A Marvel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Evan D Muse
- Scripps Research Translational Institute and Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA
| | - Mintu P Turakhia
- Center for Digital Health, Stanford University, Stanford, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed B Elshazly
- Department of Medical Education, Weill Cornell Medicine, Doha, Qatar.
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA.
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
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Baka T, Simko F. Monitoring Non-dipping Heart Rate by Consumer-Grade Wrist-Worn Devices: An Avenue for Cardiovascular Risk Assessment in Hypertension. Front Cardiovasc Med 2021; 8:711417. [PMID: 34368261 PMCID: PMC8342801 DOI: 10.3389/fcvm.2021.711417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/30/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Tomas Baka
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Fedor Simko
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,3rd Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
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