Predicting adherence to use of remote health monitoring systems in a cohort of patients with chronic heart failure

Predicting Adherence to Behavior Change Support Systems Using Machine Learning: Systematic Review

BACKGROUND

There is a dearth of knowledge on reliable adherence prediction measures in behavior change support systems (BCSSs). Existing reviews have predominately focused on self-reporting measures of adherence. These measures are susceptible to overestimation or underestimation of adherence behavior.

OBJECTIVE

This systematic review seeks to identify and summarize trends in the use of machine learning approaches to predict adherence to BCSSs.

METHODS

Systematic literature searches were conducted in the Scopus and PubMed electronic databases between January 2011 and August 2022. The initial search retrieved 2182 journal papers, but only 11 of these papers were eligible for this review.

RESULTS

A total of 4 categories of adherence problems in BCSSs were identified: adherence to digital cognitive and behavioral interventions, medication adherence, physical activity adherence, and diet adherence. The use of machine learning techniques for real-time adherence prediction in BCSSs is gaining research attention. A total of 13 unique supervised learning techniques were identified and the majority of them were traditional machine learning techniques (eg, support vector machine). Long short-term memory, multilayer perception, and ensemble learning are currently the only advanced learning techniques. Despite the heterogeneity in the feature selection approaches, most prediction models achieved good classification accuracies. This indicates that the features or predictors used were a good representation of the adherence problem.

CONCLUSIONS

Using machine learning algorithms to predict the adherence behavior of a BCSS user can facilitate the reinforcement of adherence behavior. This can be achieved by developing intelligent BCSSs that can provide users with more personalized, tailored, and timely suggestions.

Virtual healthcare solutions in heart failure: a literature review

The widespread adoption of mobile technologies offers an opportunity for a new approach to post-discharge care for patients with heart failure (HF). By enabling non-invasive remote monitoring and two-way, real-time communication between the clinic and home-based patients, as well as a host of other capabilities, mobile technologies have a potential to significantly improve remote patient care. This literature review summarizes clinical evidence related to virtual healthcare (VHC), defined as a care team + connected devices + a digital solution in post-release care of patients with HF. Searches were conducted on Embase (06/12/2020). A total of 171 studies were included for data extraction and evidence synthesis: 96 studies related to VHC efficacy, and 75 studies related to AI in HF. In addition, 15 publications were included from the search on studies scaling up VHC solutions in HF within the real-world setting. The most successful VHC interventions, as measured by the number of reported significant results, were those targeting reduction in rehospitalization rates. In terms of relative success rate, the two most effective interventions targeted patient self-care and all-cause hospital visits in their primary endpoint. Among the three categories of VHC identified in this review (telemonitoring, remote patient management, and patient self-empowerment) the integrated approach in remote patient management solutions performs the best in decreasing HF patients' re-admission rates and overall hospital visits. Given the increased amount of data generated by VHC technologies, artificial intelligence (AI) is being investigated as a tool to aid decision making in the context of primary diagnostics, identifying disease phenotypes, and predicting treatment outcomes. Currently, most AI algorithms are developed using data gathered in clinic and only a few studies deploy AI in the context of VHC. Most successes have been reported in predicting HF outcomes. Since the field of VHC in HF is relatively new and still in flux, this is not a typical systematic review capturing all published studies within this domain. Although the standard methodology for this type of reviews was followed, the nature of this review is qualitative. The main objective was to summarize the most promising results and identify potential research directions.

Feasibility, Acceptability, and Intervention Description of a Mobile Health Intervention in Patients With Heart Failure

Mobile health (mHealth) is used to encourage and support self-management skills in patients with heart failure. The purpose of the study was to describe the feasibility, fidelity, usability, and acceptability of mHealth interventions. This pilot study used a randomized 3-group (enhanced usual care, mHealth, and mHealth plus, which included a nurse practitioner and community health worker) repeated-measure design to determine the feasibility of using a self-management behavior app and a Bluetooth-enabled scale for daily self-monitoring of weights and medications. In the 2 mHealth groups, of the 48 patients, 38 (79%) engaged partially in recording daily weights and medications, and of the 74 patients in the sample, we obtained partial to complete data on 63 (85%) of the patients during follow-up outcome phone calls. Most patients found the intervention to be feasible, usable, and acceptable, and (93%) patients in the mHealth group and 100% of patients in the mHealth plus group agreed or strongly agreed that they learned how to self-manage their heart failure using the app. The intervention was reasonable to implement and provided insight for future intervention improvements.

Automatic Detection of Seismocardiogram Sensor Misplacement for Robust Pre-Ejection Period Estimation in Unsupervised Settings

Seismocardiography (SCG), the measurement of the local chest vibrations due to the movements of blood and the heart, is a non-invasive technique for assessing myocardial contractility via the pre-ejection period (PEP). Recently, SCG-based extraction of PEP has been shown to be an effective means of classifying decompensated from compensated heart failure patients, and thus can be potentially used for monitoring such patients at home. Accurate extraction of PEP from SCG signals hinges on lab-based population data (i.e., regression curves) linking particular time-domain features of the SCG signal to corresponding features from reference standard bulky instruments such as impedance cardiography (ICG). Such regression curves, in the case of SCG, have always been estimated based on the "ideal" positioning of the SCG sensor on the chest. However, in settings such as the home where users may position the SCG measurement hardware on the chest without supervision, it is likely that the sensor will not always be placed exactly on this "ideal" location on the sternum, but rather on other positions on the chest as well. In this study, we show for the first time that the regression curve for estimating PEP from SCG signals differs significantly as the position of the sensor changes. We further devise a method to automatically detect when the sensor is placed in any position other than the desired one in order to avoid inaccurate systolic time interval estimation. Our classification algorithm for this purpose resulted in 0.83 precision and 0.82 recall when classifying whether the sensor is placed in the desired position or not. The classifier was tested with heartbeats taken both at rest, and also during exercise recovery to ensure that waveform changes due to positioning could be accurately discriminated from those due to physiological effects.