HRS white paper on clinical utilization of digital health technology.

This collaborative statement from the Digital Health Committee of the Heart Rhythm Society provides everyday clinical scenarios in which wearables may be utilized by patients for cardiovascular health and arrhythmia management. We describe herein the spectrum of wearables that are commercially available for patients, and their benefits, shortcomings and areas for technological improvement. Although wearables for rhythm diagnosis and management have not been examined in large randomized clinical trials, undoubtedly the usage of wearables has quickly escalated in clinical practice. This document is the first of a planned series in which we will update information on wearables as they are revised and released to consumers

Design of the phonocardiography appliance for coronary artery disease diagnosing and monitoring : business perspectives analysis of innovative medical technologies for cardiovascular diseases in Finland

The topic of this study is the application of modern medical technology to cardiovascular conditions. The main purpose of that research is to evaluate myocardium disorders from the versatile perspectives and propose the design of a socially-demanding and financially-efficient technological solution targeted to coronary artery disease (CAD) diagnosing and monitoring. Phonocardiography and audial CAD detection are discussed as innovative methods for personalized healthcare applications and based on that, digital product design is developed in the form of functional specification, wearable device model, iOS and WatchOS applications interface architecture. In addition to the diseases study, myocardium signals acquisition discussion and to device design itself, market research is conducted. It is focused on medical technologies segment in general and cardiological systems in particular. Finland and Nordic Europe are the major covered regions, while global trends are outlined to collect the vision on the general market tendency. Core assessment topics are medical technology product distribution models, investment potential and development barriers. The final result could be used as a foundation for further product development and as an overview or guidelines for businesses interested in healthcare Internet-of-Things and cardiological systems

Persuasive digital health technologies for lifestyle behaviour change

BACKGROUND. Unhealthy lifestyle behaviours such as physical inactivity are global risk factors for chronic disease. Despite this, a substantial proportion of the UK population fail to achieve the recommended levels of physical activity. This may partly be because the health messages presently disseminated are not sufficiently potent to evoke behaviour change. There has been an exponential growth in the availability of digital health technologies within the consumer marketplace. This influx of technology has allowed people to self-monitor a plethora of health indices, such as their physical activity, in real-time. However, changing movement behaviours is difficult and often predicated on the assumption that individuals are willing to change their lifestyles today to reduce the risk of developing disease years or even decades later. One approach that may help overcome this challenge is to present physiological feedback in parallel with physical activity feedback. In combination, this approach may help people to observe the acute health benefits of being more physically active and subsequently translate that insight into a more physically active lifestyle. AIMS. Study One aimed to review existing studies employing fMRI to examine neurological responses to health messages pertaining to physical activity, sedentary behaviour, smoking, diet and alcohol consumption to assess the capacity for fMRI to assist in evaluating health behaviours. Study Two aimed to use fMRI to evaluate physical activity, sedentary behaviour and glucose feedback obtained through wearable digital health technologies and to explore associations between activated brain regions and subsequent changes in behaviour. Study Three aimed to explore engagement of people at risk of type 2 diabetes using digital health technologies to monitor physical activity and glucose levels. METHODS. Study One was a systematic review of published studies investigating health messages relating to physical activity, sedentary behaviour, diet, smoking or alcohol consumption using fMRI. Study Two asked adults aged 30-60 years to undergo fMRI whilst presented personalised feedback on their physical activity, sedentary behaviour and glucose levels, following a 14-day wear protocol of an accelerometer, inclinometer and flash glucose monitor. Study Three was a six-week, three-armed randomised feasibility trial for individuals at moderate-to-high risk of developing type 2 diabetes. The study used commercially available wearable physical activity (Fitbit Charge 2) and flash glucose (Freestyle Libre) technologies. Group 1 were offered glucose feedback for 4 weeks followed by glucose plus physical activity feedback for 2 weeks (G4GPA2). Group 2 were offered physical activity feedback for 4 weeks followed by glucose plus physical activity feedback for 2 weeks (PA4GPA2). Group 3 were offered glucose plus physical activity feedback for six weeks (GPA6). The primary outcome for the study was engagement, measured objectively by time spent on the Fitbit app, LibreLink app (companion app for the Freestyle Libre) as well as the frequency of scanning the Freestyle Libre and syncing the Fitbit. RESULTS. For Study One, 18 studies were included in the systematic review and of those, 15 examined neurological responses to smoking related health messages. The remaining three studies examined health messages about diet (k=2) and physical activity (k=1). Areas of the prefrontal cortex and amygdala were most commonly activated with increased activation of the ventromedial prefrontal cortex predicting subsequent behaviour (e.g. smoking cessation). Study Two identified that presenting people with personalised feedback relating to interstitial glucose levels resulted in significantly more brain activation when compared with feedback on personalised movement behaviours (P<.001). Activations within regions of the prefrontal cortex were significantly greater for glucose feedback compared with feedback on personalised movement behaviours. Activation in the subgyral area was correlated with moderate-to-vigorous physical activity at follow-up (r=.392, P=.043). In Study Three, time spent on the LibreLink app significantly reduced for G4GPA2 and GPA6 (week 1: 20.2±20 versus week 6: 9.4±14.6min/day, p=.007) and significantly fewer glucose scans were recorded (week 1: 9.2±5.1 versus week 6: 5.9±3.4 scans/day, p=.016). Similarly, Fitbit app usage significantly reduced (week 1: 7.1±3.8 versus week 6: 3.8±2.9min/day p=.003). The number of Fitbit syncs did not change significantly (week 1: 6.9±7.8 versus week 6: 6.5±10.2 syncs/day, p=.752). CONCLUSIONS. Study One highlighted the fact that thus far the field has focused on examining neurological responses to health messages using fMRI for smoking with important knowledge gaps in the neurological evaluation of health messages for other lifestyle behaviours. The prefrontal cortex and amygdala were most commonly activated in response to health messages. Using fMRI, Study Two was able to contribute to the knowledge gaps identified in Study One, with personalised glucose feedback resulting in a greater neurological response than personalised feedback on physical activity and sedentary behaviour. From this, Study Three found that individuals at risk of developing type 2 diabetes were able to engage with digital health technologies offering real-time feedback on behaviour and physiology, with engagement diminishing over time. Overall, this thesis demonstrates the potential for digital health technologies to play a key role in feedback paradigms relating to chronic disease prevention

An intelligent mHealth-based adjunct to improve the management of patients with cardiovascular disease

Regular recording of vital signs, modification of lifestyle behaviour and monitoring of health progress has been shown to be effective to better manage patients with cardiovascular disease (CVD). Despite this, there remain significant hospital readmissions due to CVD exacerbations. This thesis investigated if the readmission rate of CVD patients could be reduced through remote longitudinal monitoring of physiological measurements and by offering a mobile health (mHealth)-based adjunct to assist in lifestyle modification. The thesis also investigated if there was a relationship between patient engagement and their clinical outcomes. To improve the remote management of CVD patients, the architecture of an intelligent mHealth adjunct called Total Cardiac Care (TCC) was developed based around a smartphone app and wireless peripherals to record physiological data and patient activity. The system also enabled the clinician to regularly monitor the patients’ condition using a web portal, facilitating the timely interventions when deemed necessary. The proposed system feasibility was investigated in a pilot trial, where it was widely accepted by both younger and older CVD patients with a high satisfaction rate (89.5%). The participants also had a high engagement rate with the different monitoring features (BP 77.2%, weight 74.3% and activity 84.8%). The results of a randomised controlled trial in which CVD patients (n = 164) were randomly assigned to either the mHealth intervention group or a traditional care control group identified a significant reduction in the 6-month all-cause (21 vs 41, risk reduction 49%, p = 0.015) and cardiac readmission (11 vs 25, risk reduction 56%, p = 0.025) risk when comparing the intervention cohort against the control cohort. These results suggest that the mHealth adjunct could increase the CVD patient’s engagement and the monitoring of physiological measurements and activity along with modified lifestyle behaviour over the long term could improve their cardiac health and decrease adverse events. To predict the CVD patient’s exacerbation, a model capable of detecting worsening events based on the critical change in the longitudinal physiological trends was developed using telemonitoring data collected from the intervention cohort. The model correctly predicted the CVD exacerbation events with 86.4% sensitivity, 58.4% specificity and 59.7% accuracy. This highlights that the integration of an exacerbation prediction model with the mHealth adjunct could enhance the quality of remote monitoring care provided to CVD patients

Personal Healthcare Agents for Monitoring and Predicting Stress and Hypertension from Biosignals

We live in exciting times. The fast paced growth in mobile computers has put powerful computational devices in the palm of our hands. Blazing fast connectivity has made human-human, human-machine, and machine-machine communication effortless. Wearable devices and the internet of things have made monitoring every aspect of our lives easier. This has given rise to the domain of quantified self where we can continuous record and quantify the various signals generated in everyday life. Sensors on smartphones can continuously record our location and motion profile. Sensors on wearable devices can track changes in our bodies’ physiological responses. This monitoring also has the capability to revolutionise the health care domain by creating more informed and involved patients. This has the potential to shift care-management from a physician-centric approach to a patient-centric approach allowing individuals to create more empowered patients and individuals who are in better control of their health. However, the data deluge from all these sources can sometimes be overwhelming. There is a need for intelligent technology that can help us navigate the data and take informed decisions. The goal of this work is to develop a mobile, personal intelligent agent platform that can become a digital companion to live with the user. It can monitor the covert and overt signal streams of the user, identify activity and stress levels to help the users’ make healthy choices regarding their lives. This thesis particularly targets patients suffering from or at-risk of essential hypertension since its a difficult condition to detect and manage. This thesis delivers the following contributions: 1) An intelligent personal agent platform for on-the-go continuous monitoring of covert and overt signals. 2) A machine learning algorithm for accurate recognition of activities using smartphone signals recorded from in-the-wild scenarios. 3) A machine learning pipeline to combine various physiological signal streams, motion profiles, and user annotations for on-the-go stress recognition. 4) We design and train a complete signal processing and classification system for hypertension prediction. 5) Through a small pilot study we demonstrate that this system can distinguish between hypertensive and normotensive subjects with high accuracy

Health State Estimation

Life's most valuable asset is health. Continuously understanding the state of our health and modeling how it evolves is essential if we wish to improve it. Given the opportunity that people live with more data about their life today than any other time in history, the challenge rests in interweaving this data with the growing body of knowledge to compute and model the health state of an individual continually. This dissertation presents an approach to build a personal model and dynamically estimate the health state of an individual by fusing multi-modal data and domain knowledge. The system is stitched together from four essential abstraction elements: 1. the events in our life, 2. the layers of our biological systems (from molecular to an organism), 3. the functional utilities that arise from biological underpinnings, and 4. how we interact with these utilities in the reality of daily life. Connecting these four elements via graph network blocks forms the backbone by which we instantiate a digital twin of an individual. Edges and nodes in this graph structure are then regularly updated with learning techniques as data is continuously digested. Experiments demonstrate the use of dense and heterogeneous real-world data from a variety of personal and environmental sensors to monitor individual cardiovascular health state. State estimation and individual modeling is the fundamental basis to depart from disease-oriented approaches to a total health continuum paradigm. Precision in predicting health requires understanding state trajectory. By encasing this estimation within a navigational approach, a systematic guidance framework can plan actions to transition a current state towards a desired one. This work concludes by presenting this framework of combining the health state and personal graph model to perpetually plan and assist us in living life towards our goals.Comment: Ph.D. Dissertation @ University of California, Irvin