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Heimark S, Hove C, Stepanov A, Boysen ES, Gløersen Ø, Bøtke-Rasmussen KG, Gravdal HJ, Narayanapillai K, Fadl Elmula FEM, Seeberg TM, Larstorp ACK, Waldum-Grevbo B. Accuracy and User Acceptability of 24-hour Ambulatory Blood Pressure Monitoring by a Prototype Cuffless Multi-Sensor Device Compared to a Conventional Oscillometric Device. Blood Press 2023; 32:2274595. [PMID: 37885101 DOI: 10.1080/08037051.2023.2274595] [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: 08/23/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE 24-hour ambulatory blood pressure monitoring (24ABPM) is state of the art in out-of-office blood pressure (BP) monitoring. Due to discomfort and technical limitations related to cuff-based 24ABPM devices, methods for non-invasive and continuous estimation of BP without the need for a cuff have gained interest. The main aims of the present study were to compare accuracy of a pulse arrival time (PAT) based BP-model and user acceptability of a prototype cuffless multi-sensor device (cuffless device), developed by Aidee Health AS, with a conventional cuff-based oscillometric device (ReferenceBP) during 24ABPM. METHODS Ninety-five normotensive and hypertensive adults underwent simultaneous 24ABPM with the cuffless device on the chest and a conventional cuff-based oscillometric device on the non-dominant arm. PAT was calculated using the electrocardiogram (ECG) and photoplethysmography (PPG) sensors incorporated in the chest-worn device. The cuffless device recorded continuously, while ReferenceBP measurements were taken every 20 minutes during daytime and every 30 minutes during nighttime. Two-minute PAT-based BP predictions corresponding to the ReferenceBP measurements were compared with ReferenceBP measurements using paired t-tests, bias, and limits of agreement. RESULTS Mean (SD) of ReferenceBP compared to PAT-based daytime and nighttime systolic BP (SBP) were 129.7 (13.8) mmHg versus 133.6 (20.9) mmHg and 113.1 (16.5) mmHg versus 131.9 (23.4) mmHg. Ninety-five % limits of agreements were [-26.7, 34.6 mmHg] and [-20.9, 58.4 mmHg] for daytime and nighttime SBP respectively. The cuffless device was reported to be significantly more comfortable and less disturbing than the ReferenceBP device during 24ABPM. CONCLUSIONS In the present study, we demonstrated that a general PAT-based BP model had unsatisfactory agreement with ambulatory BP during 24ABPM, especially during nighttime. If sufficient accuracy can be achieved, cuffless BP devices have promising potential for clinical assessment of BP due to the opportunities provided by continuous BP measurements during real-life conditions and high user acceptability.
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Affiliation(s)
- Sondre Heimark
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christine Hove
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Elin Sundby Boysen
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Øyvind Gløersen
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | | | | | | | | | - Trine M Seeberg
- Aidee Health AS, Oslo, Norway
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Cardiovascular and Renal Research, Oslo University Hospital, Ullevål, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Bård Waldum-Grevbo
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
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2
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Hu JR, Park DY, Agarwal N, Herzig M, Ormseth G, Kaushik M, Giao DM, Turkson-Ocran RAN, Juraschek SP. The Promise and Illusion of Continuous, Cuffless Blood Pressure Monitoring. Curr Cardiol Rep 2023; 25:1139-1149. [PMID: 37688763 PMCID: PMC10842120 DOI: 10.1007/s11886-023-01932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE OF REVIEW Blood pressure (BP) fluctuations outside of clinic are increasingly recognized for their role in the development of cardiovascular disease, syncope, and premature death and as a promising target for tailored hypertension treatment. However, current cuff-based BP devices, including home and ambulatory devices, are unable to capture the breadth of BP variability across human activities, experiences, and contexts. RECENT FINDINGS Cuffless, wearable BP devices offer the promise of beat-to-beat, continuous, noninvasive measurement of BP during both awake and sleep periods with minimal patient inconvenience. Importantly, cuffless BP devices can characterize BP variability, allowing for the identification of patient-specific triggers of BP surges in the home environment. Unfortunately, the pace of evidence, regulation, and validation testing has lagged behind the pace of innovation and direct consumer marketing. We provide an overview of the available technologies and devices for cuffless BP monitoring, considerations for the calibration and validation of these devices, and the promise and pitfalls of the cuffless BP paradigm.
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Affiliation(s)
- Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Nikita Agarwal
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthew Herzig
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - George Ormseth
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Milan Kaushik
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Ruth-Alma N Turkson-Ocran
- Section for Research, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stephen P Juraschek
- Section for Research, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- , 330 Brookline Avenue, CO-1309, #204, MA, 02215, USA.
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3
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Ju F, Wang Y, Yin B, Zhao M, Zhang Y, Gong Y, Jiao C. Microfluidic Wearable Devices for Sports Applications. MICROMACHINES 2023; 14:1792. [PMID: 37763955 PMCID: PMC10535163 DOI: 10.3390/mi14091792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
This study aimed to systematically review the application and research progress of flexible microfluidic wearable devices in the field of sports. The research team thoroughly investigated the use of life signal-monitoring technology for flexible wearable devices in the domain of sports. In addition, the classification of applications, the current status, and the developmental trends of similar products and equipment were evaluated. Scholars expect the provision of valuable references and guidance for related research and the development of the sports industry. The use of microfluidic detection for collecting biomarkers can mitigate the impact of sweat on movements that are common in sports and can also address the issue of discomfort after prolonged use. Flexible wearable gadgets are normally utilized to monitor athletic performance, rehabilitation, and training. Nevertheless, the research and development of such devices is limited, mostly catering to professional athletes. Devices for those who are inexperienced in sports and disabled populations are lacking. Conclusions: Upgrading microfluidic chip technology can lead to accurate and safe sports monitoring. Moreover, the development of multi-functional and multi-site devices can provide technical support to athletes during their training and competitions while also fostering technological innovation in the field of sports science.
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Affiliation(s)
- Fangyuan Ju
- College of Physical Education, Yangzhou University, Yangzhou 225127, China; (F.J.); (Y.W.); (M.Z.); (Y.Z.)
| | - Yujie Wang
- College of Physical Education, Yangzhou University, Yangzhou 225127, China; (F.J.); (Y.W.); (M.Z.); (Y.Z.)
| | - Binfeng Yin
- School of Mechanical Engineering, Yangzhou University, Yangzhou 225127, China;
| | - Mengyun Zhao
- College of Physical Education, Yangzhou University, Yangzhou 225127, China; (F.J.); (Y.W.); (M.Z.); (Y.Z.)
| | - Yupeng Zhang
- College of Physical Education, Yangzhou University, Yangzhou 225127, China; (F.J.); (Y.W.); (M.Z.); (Y.Z.)
| | - Yuanyuan Gong
- Institute of Physical Education, Shanghai Normal University, Shanghai 200234, China;
| | - Changgeng Jiao
- Institute of Physical Education, Shanghai Normal University, Shanghai 200234, China;
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4
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van Melzen R, Haveman ME, Schuurmann RCL, Struys MMRF, de Vries JPPM. Implementing Wearable Sensors for Clinical Application at a Surgical Ward: Points to Consider before Starting. SENSORS (BASEL, SWITZERLAND) 2023; 23:6736. [PMID: 37571519 PMCID: PMC10422413 DOI: 10.3390/s23156736] [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: 06/09/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
Incorporating technology into healthcare processes is necessary to ensure the availability of high-quality care in the future. Wearable sensors are an example of such technology that could decrease workload, enable early detection of patient deterioration, and support clinical decision making by healthcare professionals. These sensors unlock continuous monitoring of vital signs, such as heart rate, respiration rate, blood oxygen saturation, temperature, and physical activity. However, broad and successful application of wearable sensors on the surgical ward is currently lacking. This may be related to the complexity, especially when it comes to replacing manual measurements by healthcare professionals. This report provides practical guidance to support peers before starting with the clinical application of wearable sensors in the surgical ward. For this purpose, the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of technology adoption and innovations in healthcare organizations is used, combining existing literature and our own experience in this field over the past years. Specifically, the relevant topics are discussed per domain, and key lessons are subsequently summarized.
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Affiliation(s)
- Rianne van Melzen
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.C.L.S.); (J.-P.P.M.d.V.)
| | - Marjolein E. Haveman
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.E.H.); (M.M.R.F.S.)
| | - Richte C. L. Schuurmann
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.C.L.S.); (J.-P.P.M.d.V.)
| | - Michel M. R. F. Struys
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.E.H.); (M.M.R.F.S.)
| | - Jean-Paul P. M. de Vries
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.C.L.S.); (J.-P.P.M.d.V.)
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5
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Bergholz A, Greiwe G, Kouz K, Saugel B. Continuous Blood Pressure Monitoring in Patients Having Surgery: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1299. [PMID: 37512110 PMCID: PMC10385393 DOI: 10.3390/medicina59071299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/11/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
Hypotension can occur before, during, and after surgery and is associated with postoperative complications. Anesthesiologists should thus avoid profound and prolonged hypotension. A crucial part of avoiding hypotension is accurate and tight blood pressure monitoring. In this narrative review, we briefly describe methods for continuous blood pressure monitoring, discuss current evidence for continuous blood pressure monitoring in patients having surgery to reduce perioperative hypotension, and expand on future directions and innovations in this field. In summary, continuous blood pressure monitoring with arterial catheters or noninvasive sensors enables clinicians to detect and treat hypotension immediately. Furthermore, advanced hemodynamic monitoring technologies and artificial intelligence-in combination with continuous blood pressure monitoring-may help clinicians identify underlying causes of hypotension or even predict hypotension before it occurs.
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Affiliation(s)
- Alina Bergholz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Gillis Greiwe
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Karim Kouz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- Outcomes Research Consortium, Cleveland, OH 44195, USA
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6
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Litvinova O, Bilir A, Parvanov ED, Niebauer J, Kletecka-Pulker M, Kimberger O, Atanasov AG, Willschke H. Patent landscape review of non-invasive medical sensors for continuous monitoring of blood pressure and their validation in critical care practice. Front Med (Lausanne) 2023; 10:1138051. [PMID: 37497278 PMCID: PMC10366595 DOI: 10.3389/fmed.2023.1138051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/20/2023] [Indexed: 07/28/2023] Open
Abstract
Objectives Continuous non-invasive monitoring of blood pressure is one of the main factors in ensuring the safety of the patient's condition in anesthesiology, intensive care, surgery, and other areas of medicine. The purpose of this work was to analyze the current patent situation and identify directions and trends in the application of non-invasive medical sensors for continuous blood pressure monitoring, with a focus on clinical experience in critical care and validation thereof. Materials and methods The research results reflect data collected up to September 30, 2022. Patent databases, Google Scholar, the Lens database, Pubmed, Scopus databases were used to search for patent and clinical information. Results An analysis of the patent landscape indicates a significant increase in interest in the development of non-invasive devices for continuous blood pressure monitoring and their implementation in medical practice, especially in the last 10 years. The key players in the intellectual property market are the following companies: Cnsystems Medizintechnik; Sotera Wireless INC; Tensys Medical INC; Healthstats Int Pte LTD; Edwards Lifesciences Corp, among others. Systematization of data from validation and clinical studies in critical care practice on patients with various pathological conditions and ages, including children and newborns, revealed that a number of non-invasive medical sensor technologies are quite accurate and comparable to the "gold standard" continuous invasive blood pressure monitoring. They are approved by the FDA for medical applications and certified according to ISO 81060-2, ISO 81060-3, and ISO/TS 81060-5. Unregistered and uncertified medical sensors require further clinical trials. Conclusion Non-invasive medical sensors for continuous blood pressure monitoring do not replace, but complement, existing methods of regular blood pressure measurement, and it is expected to see more of these technologies broadly implemented in the practice in the near future.
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Affiliation(s)
- Olena Litvinova
- National University of Pharmacy of the Ministry of Health of Ukraine, Kharkiv, Ukraine
| | - Aylin Bilir
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Emil D. Parvanov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Translational Stem Cell Biology, Research Institute of the Medical University of Varna, Varna, Bulgaria
| | - Josef Niebauer
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
- REHA Zentrum Salzburg, Salzburg, Austria
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
| | - Oliver Kimberger
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Warsaw, Poland
| | - Harald Willschke
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
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7
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Sharabi I, Merin R, Gluzman Y, Grinshpan R, Shtivelman A, Eisenkraft A, Rubinshtein R. Assessing the use of a noninvasive monitoring system providing multiple cardio-pulmonary parameters following revascularization in STEMI patients. Digit Health 2023; 9:20552076231179014. [PMID: 37312950 PMCID: PMC10259125 DOI: 10.1177/20552076231179014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/12/2023] [Indexed: 06/15/2023] Open
Abstract
Background Continuous monitoring of ECG, respiratory rate, systolic and diastolic blood pressure, pulse rate, cardiac output, and cardiac index is important in patients with ST-elevation myocardial infarction (STEMI) admitted to the intensive cardiac care unit (ICCU). However, monitoring these parameters in this setting and in these patients using noninvasive, wireless devices has not been conducted so far. We aimed to assess the use of a novel noninvasive continuous monitoring device in STEMI patients admitted to the ICCU. Methods Participants included STEMI patients that were admitted to the ICCU after primary percutaneous coronary intervention (PPCI). Patients were continuously monitored using a novel wearable chest patch monitor. Results Fifteen patients with STEMI who underwent PPCI were included in this study. The median age was 52.8 years, the majority were males, and the median body mass index (BMI) was 25.7. Monitoring lasted for 66 ± 16 hours, and included the automatic collection and recording of all vitals, freeing the nursing staff to focus on other tasks. The user experience of nurses as reflected in filled questionnaires showed high satisfaction rates in all aspects. Conclusion A novel noninvasive, wireless device showed high feasibility in continuously monitoring multiple crucial parameters in STEMI patients admitted to the ICCU after PPCI.
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Affiliation(s)
- Itzhak Sharabi
- The Edith Wolfson Medical Center, Holon, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roei Merin
- Faculty of medicine, Technion Israel Institute of Technology, Haifa, Israel
| | | | | | | | - Arik Eisenkraft
- The Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the IDF Medical Corps, Jerusalem, Israel
| | - Ronen Rubinshtein
- The Edith Wolfson Medical Center, Holon, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Nachman D, Eisenkraft A, Kolben Y, Carmon E, Hazan E, Goldstein N, Ben Ishay A, Hershkovitz M, Fons M, Merin R, Amir O, Asleh R, Gepner Y. Diurnal cardio-respiratory changes in ambulatory individuals deciphered using a multi-parameter wearable device. Digit Health 2023; 9:20552076231218885. [PMID: 38053733 PMCID: PMC10695076 DOI: 10.1177/20552076231218885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
Background Recent technological developments enable big data-driven insights on diurnal changes. This study aimed to describe the trajectory of multiple and advanced parameters using a medical-grade wearable remote patient monitor. Methods Parameters were monitored for 24 h in 256 ambulatory participants who kept living their normal life. Parameters included heart rate, blood pressure, stroke volume, cardiac index, systemic vascular resistance, blood oxygen saturation, and respiratory rate. Diurnal variations were evaluated, and analyses were stratified based on sex, age, and body mass index. Results All parameters showed diurnal changes (p < 0.001). Females demonstrated higher heart rate and cardiac index with lower systemic vascular resistance. Obese participants had a higher blood pressure, and lower stroke volume and cardiac index. Systemic vascular resistance was higher among the elderly. Diurnal changes corresponded with awake-sleep hours and differed between sex, age, and body mass index groups. Conclusion Wearable monitoring platforms could decipher hemodynamic changes in subgroups of individuals, and might help with efforts to provide personalized medicine, pre-symptomatic diagnosis and prevention, and drug development.
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Affiliation(s)
- Dean Nachman
- Heart Institute, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
- Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem, Israel
| | - Arik Eisenkraft
- Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem, Israel
- Biobeat Technologies Ltd., Petah Tikva, Israel
| | - Yotam Kolben
- Heart Institute, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | | | | | - Mor Hershkovitz
- Biobeat Technologies Ltd., Petah Tikva, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Fons
- Biobeat Technologies Ltd., Petah Tikva, Israel
| | - Roei Merin
- Biobeat Technologies Ltd., Petah Tikva, Israel
| | - Offer Amir
- Heart Institute, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat-Gan, Israel
| | - Rabea Asleh
- Heart Institute, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yftach Gepner
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv, Israel
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9
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Heimark S, Bøtker-Rasmussen KG, Stepanov A, Haga ØG, Gonzalez V, Seeberg TM, Fadl Elmula FEM, Waldum-Grevbo B. Accuracy of non-invasive cuffless blood pressure in the intensive care unit: Promises and challenges. Front Med (Lausanne) 2023; 10:1154041. [PMID: 37138759 PMCID: PMC10150697 DOI: 10.3389/fmed.2023.1154041] [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: 01/30/2023] [Accepted: 03/14/2023] [Indexed: 05/05/2023] Open
Abstract
Objective Continuous non-invasive cuffless blood pressure (BP) monitoring may reduce adverse outcomes in hospitalized patients if accuracy is approved. We aimed to investigate accuracy of two different BP prediction models in critically ill intensive care unit (ICU) patients, using a prototype cuffless BP device based on electrocardiogram and photoplethysmography signals. We compared a pulse arrival time (PAT)-based BP model (generalized PAT-based model) derived from a general population cohort to more complex and individualized models (complex individualized models) utilizing other features of the BP sensor signals. Methods Patients admitted to an ICU with indication of invasive BP monitoring were included. The first half of each patient's data was used to train a subject-specific machine learning model (complex individualized models). The second half was used to estimate BP and test accuracy of both the generalized PAT-based model and the complex individualized models. A total of 7,327 measurements of 15 s epochs were included in pairwise comparisons across 25 patients. Results The generalized PAT-based model achieved a mean absolute error (SD of errors) of 7.6 (7.2) mmHg, 3.3 (3.1) mmHg and 4.6 (4.4) mmHg for systolic BP, diastolic BP and mean arterial pressure (MAP) respectively. Corresponding results for the complex individualized model were 6.5 (6.7) mmHg, 3.1 (3.0) mmHg and 4.0 (4.0) mmHg. Percentage of absolute errors within 10 mmHg for the generalized model were 77.6, 96.2, and 89.6% for systolic BP, diastolic BP and MAP, respectively. Corresponding results for the individualized model were 83.8, 96.2, and 94.2%. Accuracy was significantly improved when comparing the complex individualized models to the generalized PAT-based model in systolic BP and MAP, but not diastolic BP. Conclusion A generalized PAT-based model, developed from a different population was not able to accurately track BP changes in critically ill ICU patients. Individually fitted models utilizing other cuffless BP sensor signals significantly improved accuracy, indicating that cuffless BP can be measured non-invasively, but the challenge toward generalizable models remains for future research to resolve.
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Affiliation(s)
- Sondre Heimark
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- *Correspondence: Sondre Heimark,
| | | | | | | | - Victor Gonzalez
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Trine M. Seeberg
- Aidee Health AS, Oslo, Norway
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | | | - Bård Waldum-Grevbo
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
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10
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Long-term stability of over-the-counter cuffless blood pressure monitors: a proposal. HEALTH AND TECHNOLOGY 2023; 13:53-63. [PMID: 36713070 PMCID: PMC9870659 DOI: 10.1007/s12553-023-00726-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/17/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023]
Abstract
Blood pressure is an important cardiovascular parameter. Currently, the cuff-based sphygmomanometer is a popular, reliable, measurement method, but blood pressure monitors without cuffs have become popular and are now available without a prescription. Blood pressure monitors must be approved by regulatory authorities. Current cuffless blood pressure (CL-BP) monitors are not suitable for at-home management and prevention of hypertension. This paper proposes simple criteria for over-the-counter CL-BP monitoring. First, the history of the sphygmomanometer and current standard blood pressure protocol are reviewed. The main components of CL-BP monitoring are accuracy during the resting condition, accuracy during dynamic blood pressure changes, and long-term stability. In this proposal we recommend intermittent measurement to ensure that active measurement accuracy mirrors resting condition accuracy. A new experimental protocol is proposed to maintain long-term stability. A medically approved automated sphygmomanometer was used as the standard device in this study. The long-term accuracy of the test device is based on the definition of propagation error, i.e., for an oscillometric automated sphygmomanometer (5 ± 8 mmHg) ± the error for the test device static accuracy (-0.12 ± 5.49 mmHg for systolic blood pressure and - 1.17 ± 5.06 mmHg for diastolic blood pressure). Thus, the long-term stabilities were - 3.38 ± 7.1 mmHg and - 1.38 ± 5.4 mmHg, which satisfied propagation error. Further research and discussion are necessary to create standards for use by manufacturers; such standards should be readily evaluated and ensure high-quality evidence. Supplementary information The online version contains supplementary material available at 10.1007/s12553-023-00726-6.
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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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Bradley CK, Shimbo D, Colburn DA, Pugliese DN, Padwal R, Sia SK, Anstey DE. Cuffless Blood Pressure Devices. Am J Hypertens 2022; 35:380-387. [PMID: 35136906 PMCID: PMC9088838 DOI: 10.1093/ajh/hpac017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 12/28/2022] Open
Abstract
Hypertension is associated with more end-organ damage, cardiovascular events, and disability-adjusted life years lost in the United States compared with all other modifiable risk factors. Several guidelines and scientific statements now endorse the use of out-of-office blood pressure (BP) monitoring with ambulatory BP monitoring or home BP monitoring to confirm or exclude hypertension status based on office BP measurement. Current ambulatory or home BP monitoring devices have been reliant on the placement of a BP cuff, typically on the upper arm, to measure BP. There are numerous limitations to this approach. Cuff-based BP may not be well-tolerated for repeated measurements as is utilized with ambulatory BP monitoring. Furthermore, improper technique, including incorrect cuff placement or use of the wrong cuff size, may lead to erroneous readings, affecting diagnosis and management of hypertension. Compared with devices that utilize a cuff, cuffless BP devices may overcome challenges related to technique, tolerability, and overall utility in the outpatient setting. However, cuffless devices have several potential limitations that limit its routine use for the diagnosis and management of hypertension. The review discusses the different approaches for determining BP using various cuffless devices including engineering aspects of cuffless device technologies, validation protocols to test accuracy of cuffless devices, potential barriers to widespread implementation, and future areas of research. This review is intended for the clinicians who utilize out-of-office BP monitoring for the diagnosis and management of hypertension.
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Affiliation(s)
- Corey K Bradley
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York, USA
| | - Daichi Shimbo
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Daniel N Pugliese
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York, USA
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Samuel K Sia
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - D Edmund Anstey
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York, USA
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13
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Charlton PH, Kyriacou PA, Mant J, Marozas V, Chowienczyk P, Alastruey J. Wearable Photoplethysmography for Cardiovascular Monitoring. PROCEEDINGS OF THE IEEE. INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS 2022; 110:355-381. [PMID: 35356509 PMCID: PMC7612541 DOI: 10.1109/jproc.2022.3149785] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/06/2022] [Accepted: 01/27/2022] [Indexed: 05/29/2023]
Abstract
Smart wearables provide an opportunity to monitor health in daily life and are emerging as potential tools for detecting cardiovascular disease (CVD). Wearables such as fitness bands and smartwatches routinely monitor the photoplethysmogram signal, an optical measure of the arterial pulse wave that is strongly influenced by the heart and blood vessels. In this survey, we summarize the fundamentals of wearable photoplethysmography and its analysis, identify its potential clinical applications, and outline pressing directions for future research in order to realize its full potential for tackling CVD.
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Affiliation(s)
- Peter H. Charlton
- Department of Biomedical EngineeringSchool of Biomedical Engineering and Imaging SciencesKing’s College London, King’s Health PartnersLondonSE1 7EUU.K.
- Research Centre for Biomedical Engineering, CityUniversity of LondonLondonEC1V 0HBU.K.
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeCB1 8RNU.K.
| | - Panicos A. Kyriacou
- Research Centre for Biomedical Engineering, CityUniversity of LondonLondonEC1V 0HBU.K.
| | - Jonathan Mant
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeCB1 8RNU.K.
| | - Vaidotas Marozas
- Department of Electronics Engineering and the Biomedical Engineering Institute, Kaunas University of Technology44249KaunasLithuania
| | - Phil Chowienczyk
- Department of Clinical PharmacologyKing’s College LondonLondonSE1 7EHU.K.
| | - Jordi Alastruey
- Department of Biomedical EngineeringSchool of Biomedical Engineering and Imaging SciencesKing’s College London, King’s Health PartnersLondonSE1 7EUU.K.
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14
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Eisenkraft A, Maor Y, Constantini K, Goldstein N, Nachman D, Levy R, Halberthal M, Horowitz NA, Golan R, Rosenberg E, Lavon E, Cohen O, Shapira G, Shomron N, Ishay AB, Sand E, Merin R, Fons M, Littman R, Gepner Y. Continuous Remote Patient Monitoring Shows Early Cardiovascular Changes in COVID-19 Patients. J Clin Med 2021; 10:4218. [PMID: 34575328 PMCID: PMC8468944 DOI: 10.3390/jcm10184218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/23/2022] Open
Abstract
COVID-19 exerts deleterious cardiopulmonary effects, leading to a worse prognosis in the most affected. This retrospective multi-center observational cohort study aimed to analyze the trajectories of key vitals amongst hospitalized COVID-19 patients using a chest-patch wearable providing continuous remote patient monitoring of numerous vital signs. The study was conducted in five COVID-19 isolation units. A total of 492 COVID-19 patients were included in the final analysis. Physiological parameters were measured every 15 min. More than 3 million measurements were collected including heart rate, systolic and diastolic blood pressure, cardiac output, cardiac index, systemic vascular resistance, respiratory rate, blood oxygen saturation, and body temperature. Cardiovascular deterioration appeared early after admission and in parallel with changes in the respiratory parameters, showing a significant difference in trajectories within sub-populations at high risk. Early detection of cardiovascular deterioration of COVID-19 patients is achievable when using frequent remote patient monitoring.
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Affiliation(s)
- Arik Eisenkraft
- Institute for Research in Military Medicine, The Hebrew University Faculty of Medicine, P.O. Box 12272, Jerusalem 9112102, Israel;
- The Israel Defense Force Medical Corps, P.O. Box 12272, Jerusalem 9112102, Israel
- Biobeat Technologies Ltd., 22 Efal St., Petah Tikva 4951122, Israel; (A.B.I.); (E.S.); (R.M.); (M.F.); (R.L.)
| | - Yasmin Maor
- Wolfson Medical Center, 62 Ha-Lokhamim St. 62, Holon 58100, Israel; (Y.M.); (O.C.)
- The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.S.); (N.S.)
| | - Keren Constantini
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (K.C.); (N.G.); (Y.G.)
| | - Nir Goldstein
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (K.C.); (N.G.); (Y.G.)
| | - Dean Nachman
- Institute for Research in Military Medicine, The Hebrew University Faculty of Medicine, P.O. Box 12272, Jerusalem 9112102, Israel;
- The Israel Defense Force Medical Corps, P.O. Box 12272, Jerusalem 9112102, Israel
- Heart Institute, Hadassah Ein Kerem Medical Center, P.O. Box 911201, Jerusalem 9112102, Israel
| | - Ran Levy
- Maccabi Healthcare Services, P.O. Box 50493, Tel Aviv 68125, Israel;
| | - Michael Halberthal
- General Directorate Rambam Health Care Campus, P.O. Box 9602, Haifa 3109601, Israel; (M.H.); (N.A.H.)
- The Bruce Rappaport Faculty of Medicine, Technion, P.O. Box 9649, Haifa 3525433, Israel
| | - Netanel A. Horowitz
- General Directorate Rambam Health Care Campus, P.O. Box 9602, Haifa 3109601, Israel; (M.H.); (N.A.H.)
- The Bruce Rappaport Faculty of Medicine, Technion, P.O. Box 9649, Haifa 3525433, Israel
| | - Ron Golan
- The Baruch Padeh Medical Center Poriya, The Faculty of Medicine in Galilee, Bar Ilan University, Upper Galilee, Poria 1528001, Israel;
| | - Elli Rosenberg
- Internal Medicine A, The Soroka University Medical Center, Ben-Gurion University of the Negev, P.O. Box 151, Be’er Sheva 84101, Israel;
| | - Eitan Lavon
- The Kaplan Medical Center, The Hebrew University Faculty of Medicine, P.O. Box 1, Rehovot 76100, Israel;
| | - Ornit Cohen
- Wolfson Medical Center, 62 Ha-Lokhamim St. 62, Holon 58100, Israel; (Y.M.); (O.C.)
- The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.S.); (N.S.)
- Faculty of Health Science, Ben-Gurion University of the Negev, P.O. Box 653, Be’er Sheva 8410501, Israel
| | - Guy Shapira
- The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.S.); (N.S.)
| | - Noam Shomron
- The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.S.); (N.S.)
| | - Arik Ben Ishay
- Biobeat Technologies Ltd., 22 Efal St., Petah Tikva 4951122, Israel; (A.B.I.); (E.S.); (R.M.); (M.F.); (R.L.)
| | - Efrat Sand
- Biobeat Technologies Ltd., 22 Efal St., Petah Tikva 4951122, Israel; (A.B.I.); (E.S.); (R.M.); (M.F.); (R.L.)
| | - Roei Merin
- Biobeat Technologies Ltd., 22 Efal St., Petah Tikva 4951122, Israel; (A.B.I.); (E.S.); (R.M.); (M.F.); (R.L.)
| | - Meir Fons
- Biobeat Technologies Ltd., 22 Efal St., Petah Tikva 4951122, Israel; (A.B.I.); (E.S.); (R.M.); (M.F.); (R.L.)
| | - Romi Littman
- Biobeat Technologies Ltd., 22 Efal St., Petah Tikva 4951122, Israel; (A.B.I.); (E.S.); (R.M.); (M.F.); (R.L.)
| | - Yftach Gepner
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (K.C.); (N.G.); (Y.G.)
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