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邰 美, 金 至, 王 浩, 郭 豫. [Application of photoplethysmography for atrial fibrillation in early warning, diagnosis and integrated management]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2023; 40:1102-1107. [PMID: 38151932 PMCID: PMC10753309 DOI: 10.7507/1001-5515.202206005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/07/2023] [Indexed: 12/29/2023]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Early diagnosis and effective management are important to reduce atrial fibrillation-related adverse events. Photoplethysmography (PPG) is often used to assist wearables for continuous electrocardiograph monitoring, which shows its unique value. The development of PPG has provided an innovative solution to AF management. Serial studies of mobile health technology for improving screening and optimized integrated care in atrial fibrillation have explored the application of PPG in screening, diagnosing, early warning, and integrated management in patients with AF. This review summarizes the latest progress of PPG analysis based on artificial intelligence technology and mobile health in AF field in recent years, as well as the limitations of current research and the focus of future research.
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Affiliation(s)
- 美慧 邰
- 中国人民解放军总医院 第六医学中心 肺血管与血栓性疾病科 (北京 100048)Department of Cardiopulmonary vascular and Thrombotic Diseases, Sixth Medical Department, Chinese PLA General Hospital, Beijing 100048, P. R. China
- 中国人民解放军医学院(北京 100853)Chinese PLA Medical College, Beijing 100853, P. R. China
| | - 至赓 金
- 中国人民解放军总医院 第六医学中心 肺血管与血栓性疾病科 (北京 100048)Department of Cardiopulmonary vascular and Thrombotic Diseases, Sixth Medical Department, Chinese PLA General Hospital, Beijing 100048, P. R. China
| | - 浩 王
- 中国人民解放军总医院 第六医学中心 肺血管与血栓性疾病科 (北京 100048)Department of Cardiopulmonary vascular and Thrombotic Diseases, Sixth Medical Department, Chinese PLA General Hospital, Beijing 100048, P. R. China
| | - 豫涛 郭
- 中国人民解放军总医院 第六医学中心 肺血管与血栓性疾病科 (北京 100048)Department of Cardiopulmonary vascular and Thrombotic Diseases, Sixth Medical Department, Chinese PLA General Hospital, Beijing 100048, P. R. China
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Application of smart devices in investigating the effects of air pollution on atrial fibrillation onset. NPJ Digit Med 2023; 6:42. [PMID: 36918625 PMCID: PMC10015044 DOI: 10.1038/s41746-023-00788-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
Few studies have examined the link between short-term exposure to air pollutants and atrial fibrillation (AF) episodes. This study aims to examine the association of hourly criteria air pollutants with AF episodes. We employ a smart device-based photoplethysmography technology to screen AF from 2018 to 2021. Hourly concentrations of six criteria air pollutants are matched to the onset hour of AF for each participant. We adopt a time-stratified case-crossover design to capture the acute effects of air pollutants on AF episodes, using conditional logistic regression models. Subgroup analyses are conducted by age, gender, and season. A total of 11,906 episodes of AF are identified in 2976 participants from 288 Chinese cities. Generally, the strongest associations of air pollutants are present at lag 18-24 h, with positive and linear exposure-response relationships. For an interquartile range increase in inhalable particles, fine particles, nitrogen dioxide, and carbon monoxide, the odds ratio (OR) of AF is 1.19 [95% confidential interval (CI): 1.03, 1.37], 1.38 (95%CI: 1.14, 1.67), 1.60 (95%CI: 1.16, 2.20) and 1.48 (95%CI: 1.19, 1.84), respectively. The estimates are robust to the adjustment of co-pollutants, and they are larger in females, older people, and in cold seasons. There are insignificant associations for sulfur dioxide and ozone. This nationwide case-crossover study demonstrates robust evidence of significant associations between hourly exposure to air pollutants and the onset of AF episodes, which underscores the importance of ongoing efforts to further improve air quality as an effective target for AF prevention.
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Leung T, Ding EY, Cho C, Jung H, Dickson EL, Mohagheghian F, Peitzsch AG, DiMezza D, Tran KV, McManus DD, Chon KH. A Smartwatch System for Continuous Monitoring of Atrial Fibrillation in Older Adults After Stroke or Transient Ischemic Attack: Application Design Study. JMIR Cardio 2023; 7:e41691. [PMID: 36780211 PMCID: PMC9972205 DOI: 10.2196/41691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/21/2022] [Accepted: 12/31/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The prevalence of atrial fibrillation (AF) increases with age and can lead to stroke. Therefore, older adults may benefit the most from AF screening. However, older adult populations tend to lag more than younger groups in the adoption of, and comfort with, the use of mobile health (mHealth) apps. Furthermore, although mobile apps that can detect AF are available to the public, most are designed for intermittent AF detection and for younger users. No app designed for long-term AF monitoring has released detailed system design specifications that can handle large data collections, especially in this age group. OBJECTIVE This study aimed to design an innovative smartwatch-based AF monitoring mHealth solution in collaboration with older adult participants and clinicians. METHODS The Pulsewatch system is designed to link smartwatches and smartphone apps, a website for data verification, and user data organization on a cloud server. The smartwatch in the Pulsewatch system is designed to continuously monitor the pulse rate with embedded AF detection algorithms, and the smartphone in the Pulsewatch system is designed to serve as the data-transferring hub to the cloud storage server. RESULTS We implemented the Pulsewatch system based on the functionality that patients and caregivers recommended. The user interfaces of the smartwatch and smartphone apps were specifically designed for older adults at risk for AF. We improved our Pulsewatch system based on feedback from focus groups consisting of patients with stroke and clinicians. The Pulsewatch system was used by the intervention group for up to 6 weeks in the 2 phases of our randomized clinical trial. At the conclusion of phase 1, 90 trial participants who had used the Pulsewatch app and smartwatch for 14 days completed a System Usability Scale to assess the usability of the Pulsewatch system; of 88 participants, 56 (64%) endorsed that the smartwatch app is "easy to use." For phases 1 and 2 of the study, we collected 9224.4 hours of smartwatch recordings from the participants. The longest recording streak in phase 2 was 21 days of consecutive recordings out of the 30 days of data collection. CONCLUSIONS This is one of the first studies to provide a detailed design for a smartphone-smartwatch dyad for ambulatory AF monitoring. In this paper, we report on the system's usability and opportunities to increase the acceptability of mHealth solutions among older patients with cognitive impairment. TRIAL REGISTRATION ClinicalTrials.gov NCT03761394; https://www.clinicaltrials.gov/ct2/show/NCT03761394. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.cvdhj.2021.07.002.
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Affiliation(s)
| | - Eric Y Ding
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Chaeho Cho
- Zebra Technologies Inc, Holtsville, NY, United States
| | - Haewook Jung
- SSP, Seoul, Republic of Korea.,Mediporte Co, Ltd, Gyeonggi-do, Republic of Korea
| | - Emily L Dickson
- College of Osteopathic Medicine, Des Moines University, Des Moines, IA, United States
| | - Fahimeh Mohagheghian
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, United States
| | - Andrew G Peitzsch
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, United States
| | | | - Khanh-Van Tran
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - David D McManus
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ki H Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, United States
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Kalarus Z, Mairesse GH, Sokal A, Boriani G, Średniawa B, Casado-Arroyo R, Wachter R, Frommeyer G, Traykov V, Dagres N, Lip GYH. Searching for atrial fibrillation: looking harder, looking longer, and in increasingly sophisticated ways. An EHRA position paper. Europace 2023; 25:185-198. [PMID: 36256580 PMCID: PMC10112840 DOI: 10.1093/europace/euac144] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zbigniew Kalarus
- Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Georges H Mairesse
- Department of Cardiology and Electrophysiology, Cliniques du Sud Luxembourg—Vivalia, Arlon, Belgium
| | - Adam Sokal
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Beata Średniawa
- Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Münster, Germany
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Sun N, Wang L, Xi Y, Wang H, Yang F, Chen Y, Liu J, Cui Y, Zeng Z. Accuracy Evaluation of Carotid-Femoral Pulse Wave Velocity Estimated by Smart Terminal Watch. Front Cardiovasc Med 2022; 9:893557. [PMID: 35935640 PMCID: PMC9353553 DOI: 10.3389/fcvm.2022.893557] [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: 03/10/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
To evaluate the accuracy of the smartwatch in estimating carotid-femoral pulse wave velocity (cfPWV). A cohort of gender-matched volunteers aged 18–80 years were recruited. At the sitting and supine positions, cfPWV was measured alternately by smartwatch and CompliorAnalyse, for each participant, and nine sets of data were collected from each participant with a 60 s interval between measurements. The accuracy of cfPWV measurement for smartwatches was assessed using mean error (ME) and mean absolute error (MAE), while the consistency of the two methods was assessed using the Bland-Altman analysis and concordance class correlation. A total of 347 participants were enrolled. The mean cfPWV was 9.01 ± 2.29 m/s measured by CompliorAnalyse and 9.06 ± 1.94 m/s by smartwatch. The consistency correlation coefficient (CCC) was 0.9045 (95% CI 0.8853–0.9206), the ME was 0.046 ± 0.92, and the MAE was 0.66 (95% CI 0.59–0.73). Bland-Altman analysis showed that the error of 95% samples was in the range between −1.77 m/s and 1.86 m/s. The Kappa value of cfPWV greater than 10 m/s was 0.79, the area under the ROC curve was 0.97 (P < 0.001), sensitivity was 0.90, specificity was 0.93, positive predictive value was 0.83 and negative predictive value was 0.96. Smartwatch can accurately estimate cfPWV to evaluate arterial stiffness. This method is simple and feasible and is suitable for people to actively and early monitor vascular elasticity.
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Affiliation(s)
- Ningling Sun
- Department of Hypertension, Peking University People’s Hospital, Beijing, China
- *Correspondence: Ningling Sun,
| | - Luyan Wang
- Department of Hypertension, Peking University People’s Hospital, Beijing, China
| | - Yang Xi
- Department of Hypertension, Peking University People’s Hospital, Beijing, China
| | - Hongyi Wang
- Department of Hypertension, Peking University People’s Hospital, Beijing, China
| | - Fan Yang
- Department of Hypertension, Peking University People’s Hospital, Beijing, China
| | - Yuanyuan Chen
- Department of Hypertension, Peking University People’s Hospital, Beijing, China
| | - Jing Liu
- Department of Hypertension, Peking University People’s Hospital, Beijing, China
| | - Yuxian Cui
- Department of Hypertension, Peking University People’s Hospital, Beijing, China
| | - Zhechun Zeng
- Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Bonini N, Vitolo M, Imberti JF, Proietti M, Romiti GF, Boriani G, Paaske Johnsen S, Guo Y, Lip GYH. Mobile health technology in atrial fibrillation. Expert Rev Med Devices 2022; 19:327-340. [PMID: 35451347 DOI: 10.1080/17434440.2022.2070005] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Mobile health (mHealth) solutions in atrial fibrillation (AF) are becoming widespread, thanks to everyday life devices such as smartphones. Their use is validated both in monitoring and in screening scenarios. In the published literature, the diagnostic accuracy of mHealth solutions wide differs, and their current clinical use is not well established in principal guidelines. AREAS COVERED mHealth solutions have progressively built an AF-detection chain to guide patients from the device's alert signal to the health care practitioners' (HCPs) attention. This review aims to critically evaluate the latest evidence regarding mHealth devices and the future possible patient's uses in everyday life. EXPERT OPINION The patients are the first to be informed of the rhythm anomaly, leading to the urgency of increasing the patients' AF self-management. Furthermore, HCPs need to update themselves about mHealth devices use in clinical practice. Nevertheless, these are promising instruments in specific populations, such as post-stroke patients, to promote an early arrhythmia diagnosis in the post-ablation/cardioversion period, allowing checks on the efficacy of the treatment or intervention.
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Affiliation(s)
- Niccolò Bonini
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Jacopo Francesco Imberti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Department of Translational and Precision Medicine, Sapienza-University of Rome, Rome, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Yutao Guo
- Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Rasmussen LF, Andreasen JJ, Lundbye-Christensen S, Riahi S, Johnsen SP, Lip GY. Using the C2HEST score for predicting postoperative atrial fibrillation after cardiac surgery: A report from the Western Denmark Heart Registry, the Danish National Patient Registry, and the Danish National Prescription Registry. J Cardiothorac Vasc Anesth 2022; 36:3730-3737. [DOI: 10.1053/j.jvca.2022.03.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/11/2022] [Accepted: 03/30/2022] [Indexed: 11/11/2022]
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Almarshad MA, Islam MS, Al-Ahmadi S, BaHammam AS. Diagnostic Features and Potential Applications of PPG Signal in Healthcare: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10030547. [PMID: 35327025 PMCID: PMC8950880 DOI: 10.3390/healthcare10030547] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023] Open
Abstract
Recent research indicates that Photoplethysmography (PPG) signals carry more information than oxygen saturation level (SpO2) and can be utilized for affordable, fast, and noninvasive healthcare applications. All these encourage the researchers to estimate its feasibility as an alternative to many expansive, time-wasting, and invasive methods. This systematic review discusses the current literature on diagnostic features of PPG signal and their applications that might present a potential venue to be adapted into many health and fitness aspects of human life. The research methodology is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020. To this aim, papers from 1981 to date are reviewed and categorized in terms of the healthcare application domain. Along with consolidated research areas, recent topics that are growing in popularity are also discovered. We also highlight the potential impact of using PPG signals on an individual’s quality of life and public health. The state-of-the-art studies suggest that in the years to come PPG wearables will become pervasive in many fields of medical practices, and the main domains include cardiology, respiratory, neurology, and fitness. Main operation challenges, including performance and robustness obstacles, are identified.
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Affiliation(s)
- Malak Abdullah Almarshad
- Computer Science Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia; (M.S.I.); (S.A.-A.)
- Computer Science Department, College of Computer and Information Sciences, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
- Correspondence:
| | - Md Saiful Islam
- Computer Science Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia; (M.S.I.); (S.A.-A.)
| | - Saad Al-Ahmadi
- Computer Science Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia; (M.S.I.); (S.A.-A.)
| | - Ahmed S. BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11324, Saudi Arabia;
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Burdett P, Lip GYH. Targeted vs. full population screening costs for incident atrial fibrillation and AF-related stroke for a healthy population aged 65 years in the United Kingdom. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:892-898. [PMID: 35138372 PMCID: PMC9670327 DOI: 10.1093/ehjqcco/qcac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/29/2022]
Abstract
AIMS Atrial Fibrillation (AF) is the most common sustained heart arrhythmia and a major preventable cause of stroke. Stroke accounts for a large amount of health and social care funding and over the coming years is likely to place an increasing cost burden on the wider UK health care system. We therefore need to understand how an opportunistic AF screening programme would impact on healthcare costs of AF (and AF-related stroke) for the NHS. METHODS AND RESULTS Using UK population forecasts and prior published data we initially calculated the number of people to be screened, newly-diagnosed and treated for Atrial Fibrillation (AF), and the associated costs of such a programme for all 65 year olds and for just a 'high risk' group. The reduction in the number of stroke cases recorded and the associated cost savings were subsequently calculated, for 2020 and the projected estimates over the following decade. The number of newly diagnosed AF patients at 65 years old for the two groups (all 65 year olds and for just a 'high risk' group) would be in 6754 and 797 in 2020, rising to 9200 and 1086 in 2030, respectively. In 2020 the cost of the screening programme for the two options would be £14.3m and £1.7m. If AF is medicated and monitored then there would be a subsequent reduction in the number of stroke cases in 2020 by 4323 or 510 depending on the group screened, with associated savings of £394.2m and £46.5m, respectively. Focussing on 2030 and should opportunistic screenings for AF be introduced at age 65, with subsequent treatment, it is predicted to reduce the number of stroke cases over the decade by 5888 if all 65 year olds are screened and 695 if just the high risk group are screened. If the number of strokes can be reduced by treating these screened AF patients, we would substantially reduce the health and social care costs of stroke by £654.6m and £77.3m, respectively. CONCLUSION The number of newly diagnosed AF patients at age 65 will rise over the decade between 2020 and 2030. Screening and treatment of AF will substantially reduce the health and social care costs of AF-related stroke in the NHS.
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Affiliation(s)
- Paul Burdett
- Liverpool Centre for Cardiovascular Science, University of Liverpool, L7 8TX, United Kingdom
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10
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Huhn S, Axt M, Gunga HC, Maggioni MA, Munga S, Obor D, Sié A, Boudo V, Bunker A, Sauerborn R, Bärnighausen T, Barteit S. The Impact of Wearable Technologies in Health Research: Scoping Review. JMIR Mhealth Uhealth 2022; 10:e34384. [PMID: 35076409 PMCID: PMC8826148 DOI: 10.2196/34384] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background Wearable devices hold great promise, particularly for data generation for cutting-edge health research, and their demand has risen substantially in recent years. However, there is a shortage of aggregated insights into how wearables have been used in health research. Objective In this review, we aim to broadly overview and categorize the current research conducted with affordable wearable devices for health research. Methods We performed a scoping review to understand the use of affordable, consumer-grade wearables for health research from a population health perspective using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. A total of 7499 articles were found in 4 medical databases (PubMed, Ovid, Web of Science, and CINAHL). Studies were eligible if they used noninvasive wearables: worn on the wrist, arm, hip, and chest; measured vital signs; and analyzed the collected data quantitatively. We excluded studies that did not use wearables for outcome assessment and prototype studies, devices that cost >€500 (US $570), or obtrusive smart clothing. Results We included 179 studies using 189 wearable devices covering 10,835,733 participants. Most studies were observational (128/179, 71.5%), conducted in 2020 (56/179, 31.3%) and in North America (94/179, 52.5%), and 93% (10,104,217/10,835,733) of the participants were part of global health studies. The most popular wearables were fitness trackers (86/189, 45.5%) and accelerometer wearables, which primarily measure movement (49/189, 25.9%). Typical measurements included steps (95/179, 53.1%), heart rate (HR; 55/179, 30.7%), and sleep duration (51/179, 28.5%). Other devices measured blood pressure (3/179, 1.7%), skin temperature (3/179, 1.7%), oximetry (3/179, 1.7%), or respiratory rate (2/179, 1.1%). The wearables were mostly worn on the wrist (138/189, 73%) and cost <€200 (US $228; 120/189, 63.5%). The aims and approaches of all 179 studies revealed six prominent uses for wearables, comprising correlations—wearable and other physiological data (40/179, 22.3%), method evaluations (with subgroups; 40/179, 22.3%), population-based research (31/179, 17.3%), experimental outcome assessment (30/179, 16.8%), prognostic forecasting (28/179, 15.6%), and explorative analysis of big data sets (10/179, 5.6%). The most frequent strengths of affordable wearables were validation, accuracy, and clinical certification (104/179, 58.1%). Conclusions Wearables showed an increasingly diverse field of application such as COVID-19 prediction, fertility tracking, heat-related illness, drug effects, and psychological interventions; they also included underrepresented populations, such as individuals with rare diseases. There is a lack of research on wearable devices in low-resource contexts. Fueled by the COVID-19 pandemic, we see a shift toward more large-sized, web-based studies where wearables increased insights into the developing pandemic, including forecasting models and the effects of the pandemic. Some studies have indicated that big data extracted from wearables may potentially transform the understanding of population health dynamics and the ability to forecast health trends.
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Affiliation(s)
- Sophie Huhn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Miriam Axt
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Hanns-Christian Gunga
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environment, Berlin, Germany
| | - Martina Anna Maggioni
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environment, Berlin, Germany.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | - David Obor
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Ali Sié
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.,Centre de Recherche en Santé Nouna, Nouna, Burkina Faso
| | | | - Aditi Bunker
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.,Harvard Center for Population and Development Studies, Cambridge, MA, United States.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Sandra Barteit
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
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Haybar H, Shirbandi K, Rahim F. C 2HEST score for atrial fibrillation risk prediction models: a Diagnostic Accuracy Tests meta-analysis. Egypt Heart J 2021; 73:104. [PMID: 34862957 PMCID: PMC8643379 DOI: 10.1186/s43044-021-00230-0] [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] [Received: 05/20/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This meta-analysis aimed to assess the value of the C2HEST score to facilitate population screening and detection of AF risk in millions of populations and validate risk scores and their composition and discriminatory power for identifying people at high or low risk of AF. We searched major indexing databases, including Pubmed/Medline, ISI web of science, Scopus, Embase, and Cochrane central, using ("C2HEST" OR "risk scoring system" OR "risk score") AND ("atrial fibrillation (AF)" OR "atrial flutter" OR "tachycardia, supraventricular" OR "heart atrium flutter") without any language, study region or study type restrictions between 1990 and 2021 years. Analyses were done using Meta-DiSc. The title and abstract screening were conducted by two independent investigators. RESULTS Totally 679 records were found through the initial search, of which ultimately, nine articles were included in the qualitative and quantitative analyses. The risk of AF accompanied every one-point increase of C2HEST score (OR 1.03, 95% CI 1.01-1.05, p < 0.00001), with a high heterogeneity across studies (I2 = 100%). The SROC for C2HEST score in the prediction of AF showed that the overall area under the curve (AUC) was 0.91 (95% CI 0.85-0.96), AUC in Asian population was 0.87 (95% CI: 0.78-0.95) versus non-Asian 0.95 (95% CI 0.91-0.99), and in general population was 0.92 (95% CI 0.85-0.99) versus those with chronic conditions 0.83 (95% CI 0.71-0.95), respectively. CONCLUSIONS The results of this research support the idea that this quick score has the opportunity for use as a risk assessment in patients' AF screening strategies.
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Affiliation(s)
- Habib Haybar
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kimia Shirbandi
- Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fakher Rahim
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Kotalczyk A, Lip GY, Calkins H. The 2020 ESC Guidelines on the Diagnosis and Management of Atrial Fibrillation. Arrhythm Electrophysiol Rev 2021; 10:65-67. [PMID: 34401177 PMCID: PMC8335854 DOI: 10.15420/aer.2021.07] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Hugh Calkins
- Electrophysiology Laboratory and Arrhythmia Service, Johns Hopkins Hospital, Baltimore, MD, US
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Li YG, Bai J, Zhou G, Li J, Wei Y, Sun L, Zu L, Liu S. Refining age stratum of the C 2HEST score for predicting incident atrial fibrillation in a hospital-based Chinese population. Eur J Intern Med 2021; 90:37-42. [PMID: 33975769 DOI: 10.1016/j.ejim.2021.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND The C2HEST score (C2: coronary artery disease [CAD] / chronic obstructive pulmonary disease [COPD] (1 point each); H: Hypertension; E: Elderly (Age≥75, doubled); S: Systolic heart failure (doubled); T: Thyroid disease (hyperthyroidism)) has been validated to predict incident atrial fibrillation (AF). Its performance in the hospital-based Chinese population has never been evaluated. METHODS Risk factors for incident AF were investigated in a hospital-based population. Comparison of the C2HEST score and other clinical scores with the capacity of predicting incident AF was conducted using area under the curves (AUC), net reclassification index (NRI), integrated discriminative improvement (IDI), and decision curve analysis (DCA). An age-stratified criterion was used to refine the C2HEST score to form a modified C2HEST score (mC2HEST). The performance of the mC2HEST score was also evaluated. RESULTS A total of 23,523 patients entered the study with 520 developed AF during 2.84 ± 3.56 years of follow-up. Risk factors for incident AF included age, male sex, hypertension, CAD, COPD, previous ischemic stroke, hyperthyroidism, and heart failure. Age ≥65 years has significantly increased the risk of AF, which was considered as the age cutoff for a modified C2HEST score (mC2HEST). The risk of AF increased by 89% per one-point increase of the mC2HEST score. The mC2HEST score showed better predictive performance (AUC of 0.809) compared with the original C2HEST (AUC of 0.752), CHA2DS2-VASc (0.756), HATCH (0.722), and HAVOC (0.758) scores, also as estimated by IDI, NRI and DCA. Among those enrolled after 2012, the mC2HEST score had numerically higher AUC (0.849) compared with the C2HEST score (0.826) and the other scores. CONCLUSION In a hospital-based Chinese population, by refining the age strata of the original C2HEST score, the mC2HEST score had significantly increased predictive accuracy and discriminative capability for incident AF. The clinical benefits of the application of novel mC2HEST score needs further validation in multiple settings.
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Affiliation(s)
- Yan-Guang Li
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Jin Bai
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Gongbu Zhou
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Juan Li
- Department Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yi Wei
- Pharmacy Department, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Lijie Sun
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Lingyun Zu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Shuwang Liu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China;.
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14
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Imberti JF, Boriani G, Lip GYH. Updating a simple clinical score predicting incident atrial fibrillation: The C 2HEST score or more (mC 2HEST)? Eur J Intern Med 2021; 90:27-29. [PMID: 34167875 DOI: 10.1016/j.ejim.2021.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Jacopo Francesco Imberti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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15
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Imberti JF, Boriani G, Gupta D, Lip GYH. Procedural complications in patients undergoing catheter ablation for atrial fibrillation: Let's talk about sex. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:427-428. [PMID: 34169982 DOI: 10.1093/ehjqcco/qcab046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jacopo Francesco Imberti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Mitrega K, Lip GYH, Sredniawa B, Sokal A, Streb W, Przyludzki K, Zdrojewski T, Wierucki L, Rutkowski M, Bandosz P, Kazmierczak J, Grodzicki T, Opolski G, Kalarus Z. Predicting Silent Atrial Fibrillation in the Elderly: A Report from the NOMED-AF Cross-Sectional Study. J Clin Med 2021; 10:jcm10112321. [PMID: 34073411 PMCID: PMC8199269 DOI: 10.3390/jcm10112321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Silent atrial fibrillation (SAF) is common and is associated with poor outcomes. Aims: to study the risk factors for AF and SAF in the elderly (≥65 years) general population and to develop a risk stratification model for predicting SAF. Methods: Continuous ECG monitoring was performed for up to 30 days using a vest-based system in a cohort from NOMED-AF, a cross-sectional study based on a nationwide population sample. The independent risk factors for AF and SAF were determined using multiple logistic regression. ROC analysis was applied to validate the developed risk stratification score. Results: From the total cohort of 3014 subjects, AF was diagnosed in 680 individuals (mean age, 77.5 ± 7.9; 50.1% men) with AF, and, of these, 41% had SAF. Independent associations with an increased risk of AF were age, male gender, coronary heart disease, thyroid diseases, prior ischemic stroke or transient ischemic attack (ICS/TIA), diabetes, heart failure, chronic kidney disease (CKD), obesity, and NT-proBNP >125 ng/mL. The risk factors for SAF were age, male gender, ICS/TIA, diabetes, heart failure, CKD, and NT-proBNP >125 ng/mL. We developed a clinical risk scale (MR-DASH score) that achieved a good level of prediction in the derivation cohort (AUC 0.726) and the validation cohort (AUC 0.730). Conclusions: SAF is associated with various clinical risk factors in a population sample of individuals ≥65 years. Stratifying individuals from the general population according to their risk for SAF may be possible using the MR-DASH score, facilitating targeted screening programs of individuals with a high risk of SAF.
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Affiliation(s)
- Katarzyna Mitrega
- Department of Cardiology, Silesian Centre of Heart Diseases, 41-800 Zabrze, Poland; (B.S.); (A.S.); (W.S.); (K.P.); (Z.K.)
- Correspondence: ; Tel.: +48-322713414; Fax: +48-323733792
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool 14 3PE, UK;
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, DK-9100 Aalborg, Denmark
| | - Beata Sredniawa
- Department of Cardiology, Silesian Centre of Heart Diseases, 41-800 Zabrze, Poland; (B.S.); (A.S.); (W.S.); (K.P.); (Z.K.)
- Department of Cardiology, Medical University of Silesia, DMS in Zabrze, 40-055 Katowice, Poland
- Silesian Park of Medical Technology Kardio-Med Silesia in Zabrze, 41-800 Zabrze, Poland
| | - Adam Sokal
- Department of Cardiology, Silesian Centre of Heart Diseases, 41-800 Zabrze, Poland; (B.S.); (A.S.); (W.S.); (K.P.); (Z.K.)
| | - Witold Streb
- Department of Cardiology, Silesian Centre of Heart Diseases, 41-800 Zabrze, Poland; (B.S.); (A.S.); (W.S.); (K.P.); (Z.K.)
| | - Karol Przyludzki
- Department of Cardiology, Silesian Centre of Heart Diseases, 41-800 Zabrze, Poland; (B.S.); (A.S.); (W.S.); (K.P.); (Z.K.)
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdansk, 80-210 Gdansk, Poland; (T.Z.); (L.W.); (M.R.); (P.B.)
| | - Lukasz Wierucki
- Department of Preventive Medicine and Education, Medical University of Gdansk, 80-210 Gdansk, Poland; (T.Z.); (L.W.); (M.R.); (P.B.)
| | - Marcin Rutkowski
- Department of Preventive Medicine and Education, Medical University of Gdansk, 80-210 Gdansk, Poland; (T.Z.); (L.W.); (M.R.); (P.B.)
| | - Piotr Bandosz
- Department of Preventive Medicine and Education, Medical University of Gdansk, 80-210 Gdansk, Poland; (T.Z.); (L.W.); (M.R.); (P.B.)
| | - Jaroslaw Kazmierczak
- Department of Cardiology, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 31-007 Krakow, Poland;
| | - Grzegorz Opolski
- First Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Zbigniew Kalarus
- Department of Cardiology, Silesian Centre of Heart Diseases, 41-800 Zabrze, Poland; (B.S.); (A.S.); (W.S.); (K.P.); (Z.K.)
- Department of Cardiology, Medical University of Silesia, DMS in Zabrze, 40-055 Katowice, Poland
- Silesian Park of Medical Technology Kardio-Med Silesia in Zabrze, 41-800 Zabrze, Poland
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17
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Gue YX, Potpara TS, Lip GY. Detection of Atrial Fibrillation on Stroke Units: Look Harder, Look Longer, Look in More Sophisticated Ways. Cerebrovasc Dis 2020; 49:656-658. [DOI: 10.1159/000512205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/20/2020] [Indexed: 11/19/2022] Open
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18
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Han D, Bashar SK, Mohagheghian F, Ding E, Whitcomb C, McManus DD, Chon KH. Premature Atrial and Ventricular Contraction Detection using Photoplethysmographic Data from a Smartwatch. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5683. [PMID: 33028000 PMCID: PMC7582300 DOI: 10.3390/s20195683] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/19/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022]
Abstract
We developed an algorithm to detect premature atrial contraction (PAC) and premature ventricular contraction (PVC) using photoplethysmographic (PPG) data acquired from a smartwatch. Our PAC/PVC detection algorithm is composed of a sequence of algorithms that are combined to discriminate various arrhythmias. A novel vector resemblance method is used to enhance the PAC/PVC detection results of the Poincaré plot method. The new PAC/PVC detection algorithm with our automated motion and noise artifact detection approach yielded a sensitivity of 86% for atrial fibrillation (AF) subjects while the overall sensitivity was 67% when normal sinus rhythm (NSR) subjects were also included. The specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy values for the combined data consisting of both NSR and AF subjects were 97%, 81%, 94% and 92%, respectively, for PAC/PVC detection combined with our automated motion and noise artifact detection approach. Moreover, when AF detection was compared with and without PAC/PVC, the sensitivity and specificity increased from 94.55% to 98.18% and from 95.75% to 97.90%, respectively. For additional independent testing data, we used two datasets: a smartwatch PPG dataset that was collected in our ongoing clinical study, and a pulse oximetry PPG dataset from the Medical Information Mart for Intensive Care III database. The PAC/PVC classification results of the independent testing on these two other datasets are all above 92% for sensitivity, specificity, PPV, NPV, and accuracy. The proposed combined approach to detect PAC and PVC can ultimately lead to better accuracy in AF detection. This is one of the first studies involving detection of PAC and PVC using PPG recordings from a smartwatch. The proposed method can potentially be of clinical importance as this enhanced capability can lead to fewer false positive detections of AF, especially for those NSR subjects with frequent episodes of PAC/PVC.
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Affiliation(s)
- Dong Han
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA; (D.H.); (S.K.B.); (F.M.)
| | - Syed Khairul Bashar
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA; (D.H.); (S.K.B.); (F.M.)
| | - Fahimeh Mohagheghian
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA; (D.H.); (S.K.B.); (F.M.)
| | - Eric Ding
- Division of Cardiology, University of Massachusetts Medical School, Worcester, MA 01655, USA; (E.D.); (C.W.); (D.D.M.)
| | - Cody Whitcomb
- Division of Cardiology, University of Massachusetts Medical School, Worcester, MA 01655, USA; (E.D.); (C.W.); (D.D.M.)
| | - David D. McManus
- Division of Cardiology, University of Massachusetts Medical School, Worcester, MA 01655, USA; (E.D.); (C.W.); (D.D.M.)
| | - Ki H. Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA; (D.H.); (S.K.B.); (F.M.)
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