A multi-layer monitoring system for clinical management of Congestive Heart Failure

BACKGROUND: Congestive Heart Failure (CHF) is a serious cardiac condition that brings high risks of urgent hospitalization and death. Remote monitoring systems are well-suited to managing patients suffering from CHF, and can reduce deaths and re-hospitalizations, as shown by the literature, including multiple systematic reviews. METHODS: The monitoring system proposed in this paper aims at helping CHF stakeholders make appropriate decisions in managing the disease and preventing cardiac events, such as decompensation, which can lead to hospitalization or death. Monitoring activities are stratified into three layers: scheduled visits to a hospital following up on a cardiac event, home monitoring visits by nurses, and patient's self-monitoring performed at home using specialized equipment. Appropriate hardware, desktop and mobile software applications were developed to enable a patient's monitoring by all stakeholders. For the first two layers, we designed and implemented a Decision Support System (DSS) using machine learning (Random Forest algorithm) to predict the number of decompensations per year and to assess the heart failure severity based on a variety of clinical data. For the third layer, custom-designed sensors (the Blue Scale system) for electrocardiogram (EKG), pulse transit times, bio-impedance and weight allowed frequent collection of CHF-related data in the comfort of the patient's home. We also performed a short-term Heart Rate Variability (HRV) analysis on electrocardiograms self-acquired by 15 healthy volunteers and compared the obtained parameters with those of 15 CHF patients from PhysioNet's PhysioBank archives. RESULTS: We report numerical performances of the DSS, calculated as multiclass accuracy, sensitivity and specificity in a 10-fold cross-validation. The obtained average accuracies are: 71.9% in predicting the number of decompensations and 81.3% in severity assessment. The most serious class in severity assessment is detected with good sensitivity and specificity (0.87 / 0.95), while, in predicting decompensation, high specificity combined with good sensitivity prevents false alarms. The HRV parameters extracted from the self-measured EKG using the Blue Scale system of sensors are comparable with those reported in the literature about healthy people. CONCLUSIONS: The performance of DSSs trained with new patients confirmed the results of previous work, and emphasizes the strong correlation between some CHF markers, such as brain natriuretic peptide (BNP) and ejection fraction (EF), with the outputs of interest. Comparing HRV parameters from healthy volunteers with HRV parameters obtained from PhysioBank archives, we confirm the literature that considers the HRV a promising method for distinguishing healthy from CHF patients

Case study: IBM Watson Analytics cloud platform as Analytics-as-a-Service system for heart failure early detection

In the recent years the progress in technology and the increasing availability of fast connections have produced a migration of functionalities in Information Technologies services, from static servers to distributed technologies. This article describes the main tools available on the market to perform Analytics as a Service (AaaS) using a cloud platform. It is also described a use case of IBM Watson Analytics, a cloud system for data analytics, applied to the following research scope: detecting the presence or absence of Heart Failure disease using nothing more than the electrocardiographic signal, in particular through the analysis of Heart Rate Variability. The obtained results are comparable with those coming from the literature, in terms of accuracy and predictive power. Advantages and drawbacks of cloud versus static approaches are discussed in the last sections

Prediction Of Heart Failure Decompensations Using Artificial Intelligence - Machine Learning Techniques

Los apartados 4.41, 4.4.2 y 4.4.3 del capítulo 4 están sujetos a confidencialidad por la autora. 203 p.Heart failure (HF) is a major concern in public health. Its total impact is increased by its high incidence and prevalence and its unfavourable medium-term prognosis. In addition, HF leads to huge health care resource consumption. Moreover, efforts to develop a deterministic understanding of rehospitalization have been difficult, as no specific patient or hospital factors have been shown to consistently predict 30-day readmission after hospitalization for HF.Taking all these facts into account, we wanted to develop a project to improve the assistance care of patients with HF. Up to know, we were using telemonitoring with a codification system that generated alarms depending on the received values. However, these simple rules generated large number of false alerts being, hence, not trustworthy. The final aims of this work are: (i) asses the benefits of remote patient telemonitoring (RPT), (ii) improve the results obtained with RPT using ML techniques, detecting which parameters measured by telemonitoring best predict HF decompensations and creating predictive models that will reduce false alerts and detect early decompensations that otherwise will lead to hospital admissions and (iii) determine the influence of environmental factors on HF decompensations.All in all, the conclusions of this study are:1. Asses the benefits of RPT: Telemonitoring has not shown a statistically significant reduction in the number of HF-related hospital admissions. Nevertheless, we have observed a statistically significant reduction in mortality in the intervention group with a considerable percentage of deaths from non-cardiovascular causes. Moreover, patients have considered the RPT programme as a tool that can help them in the control of their chronic disease and in the relationship with health professionals.2. Improve the results obtained with RPT using machine learning techniques: Significant weight increases, desaturation below 90%, perception of clinical worsening, including development of oedema, worsening of functional class and orthopnoea are good predictors of heart failure decompensation. In addition, machine learning techniques have improved the current alerts system implemented in our hospital. The system reduces the number of false alerts notably although it entails a decrement on sensitivity values. The best results are achieved with the predictive model built by applying NB with Bernoulli to the combination of telemonitoring alerts and questionnaire alerts (Weight + Ankle + well-being plus the yellow alerts of systolic blood pressure, diastolic blood pressure, O2Sat and heart rate). 3. Determine the influence of environmental factors on HF decompensations: Air temperature is the most significant environmental factor (negative correlation) in our study, although some other attributes, such as precipitation, are also relevant. This work also shows a consistent association between increasing levels SO2 and NOX air and HF hospitalizations

Prediction Of Heart Failure Decompensations Using Artificial Intelligence - Machine Learning Techniques

Los apartados 4.41, 4.4.2 y 4.4.3 del capítulo 4 están sujetos a confidencialidad por la autora. 203 p.Heart failure (HF) is a major concern in public health. Its total impact is increased by its high incidence and prevalence and its unfavourable medium-term prognosis. In addition, HF leads to huge health care resource consumption. Moreover, efforts to develop a deterministic understanding of rehospitalization have been difficult, as no specific patient or hospital factors have been shown to consistently predict 30-day readmission after hospitalization for HF.Taking all these facts into account, we wanted to develop a project to improve the assistance care of patients with HF. Up to know, we were using telemonitoring with a codification system that generated alarms depending on the received values. However, these simple rules generated large number of false alerts being, hence, not trustworthy. The final aims of this work are: (i) asses the benefits of remote patient telemonitoring (RPT), (ii) improve the results obtained with RPT using ML techniques, detecting which parameters measured by telemonitoring best predict HF decompensations and creating predictive models that will reduce false alerts and detect early decompensations that otherwise will lead to hospital admissions and (iii) determine the influence of environmental factors on HF decompensations.All in all, the conclusions of this study are:1. Asses the benefits of RPT: Telemonitoring has not shown a statistically significant reduction in the number of HF-related hospital admissions. Nevertheless, we have observed a statistically significant reduction in mortality in the intervention group with a considerable percentage of deaths from non-cardiovascular causes. Moreover, patients have considered the RPT programme as a tool that can help them in the control of their chronic disease and in the relationship with health professionals.2. Improve the results obtained with RPT using machine learning techniques: Significant weight increases, desaturation below 90%, perception of clinical worsening, including development of oedema, worsening of functional class and orthopnoea are good predictors of heart failure decompensation. In addition, machine learning techniques have improved the current alerts system implemented in our hospital. The system reduces the number of false alerts notably although it entails a decrement on sensitivity values. The best results are achieved with the predictive model built by applying NB with Bernoulli to the combination of telemonitoring alerts and questionnaire alerts (Weight + Ankle + well-being plus the yellow alerts of systolic blood pressure, diastolic blood pressure, O2Sat and heart rate). 3. Determine the influence of environmental factors on HF decompensations: Air temperature is the most significant environmental factor (negative correlation) in our study, although some other attributes, such as precipitation, are also relevant. This work also shows a consistent association between increasing levels SO2 and NOX air and HF hospitalizations

Input Clinical Parameters for Cardiac Heart Failure Characterization Using Machine Learning

Congestive Heart Failure (CHF) is a serious chronic cardiac condition that brings high risk of urgent hospi- talization and could lead to death. In this work we show how all the input clinical parameters for classifying CHF using Machine Learning can be acquired. The requested input are Blood Pres- sure, Heart Rate, Brain Natriuretic Peptide, Electrocardio- gram, Blood Oxygen Saturation, Height, Weight and Ejection Fraction. The next step will be designing a novel device and con- necting it to our Machine Learning classifier. A particular at- tention will be put to the assessment of electromagnetic compat- ibility (EMC) with other devices, taking into account that this new device will be used in many different settings (home, out- door, etc.

A convolutional neural network approach to detect congestive heart failure

Congestive Heart Failure (CHF) is a severe pathophysiological condition associated with high prevalence, high mortality rates, and sustained healthcare costs, therefore demanding efficient methods for its detection. Despite recent research has provided methods focused on advanced signal processing and machine learning, the potential of applying Convolutional Neural Network (CNN) approaches to the automatic detection of CHF has been largely overlooked thus far. This study addresses this important gap by presenting a CNN model that accurately identifies CHF on the basis of one raw electrocardiogram (ECG) heartbeat only, also juxtaposing existing methods typically grounded on Heart Rate Variability. We trained and tested the model on publicly available ECG datasets, comprising a total of 490,505 heartbeats, to achieve 100% CHF detection accuracy. Importantly, the model also identifies those heartbeat sequences and ECG’s morphological characteristics which are class-discriminative and thus prominent for CHF detection. Overall, our contribution substantially advances the current methodology for detecting CHF and caters to clinical practitioners’ needs by providing an accurate and fully transparent tool to support decisions concerning CHF detection

Randomized controlled trial evaluating the benefit of a novel clinical decision support system for the management of COVID-19 patients in home quarantine: A study protocol

Producción Científica(1) Background: We present the protocol of a randomized controlled trial designed to evaluate the benefit of a novel clinical decision support system for the management of patients with COVID-19. (2) Methods: The study will recruit up to 500 participants (250 cases and 250 controls). Both groups will receive the conventional telephone follow-up protocol by primary care and will also be provided with access to a mobile application, in which they will be able to report their symptoms three times a day. In addition, patients in the active group will receive a wearable smartwatch and a pulse oximeter at home for real-time monitoring. The measured data will be visualized by primary care and emergency health service professionals, allowing them to detect in real time the progression and complications of the disease in order to promote early therapeutic interventions based on their clinical judgement. (3) Results: Ethical approval for this study was obtained from the Drug Research Ethics Committee of the Valladolid East Health Area (CASVE-NM-21-516). The results obtained from this study will form part of the thesis of two PhD students and will be disseminated through publication in a peer-reviewed journal. (4) Conclusions: The implementation of this telemonitoring system can be extrapolated to patients with other similar diseases, such as chronic diseases, with a high prevalence and need for close monitoring.Junta de Castilla y León e Instituto de Salud Carlos III - (grant COV20/00539

Deep Learning with Multimodal Data for Healthcare

Healthcare plays a significant role in communities in promoting and maintaining health, preventing and managing the disease, reducing health disability and premature death, and educating a healthy lifestyle. However, healthcare information is well known for its big data that is too vast and complex to manage manually. The healthcare data is heterogeneous, containing different modalities or types of information such as text, audio, images, and multi-type. Over the last few years, the Deep Learning (DL) approach has successfully solved many issues. The primary structure of DL lies in the Artificial Neural Network (ANN). It is also known as representation learning techniques as these approaches can effectively identify hidden patterns of the data without requiring any explicit feature extraction mechanism. In other words, DL architectures also support automatic feature extraction. It is different than machine learning techniques, where there is no need to extract features separately in DL. In this dissertation, we proposed three DL architectures to handle multiple modalities data in healthcare. We systematically develop prediction models for identifying health conditions in several groups, including Post-Traumatic Stress Disorder (PTSD), Parkinson's Disease (PD), and PD with Dementia (PD-Dementia). First, we designed the DL framework for identifying PTSD among cancer survivors via social media. After that, we apply the DL time series approach to forecast PD patients' future health status. Last, we build DL architecture to identify dementia in diagnosed PD patients. All these work are motivated by several medical theories and health informatics perspectives. We have handled multimodal healthcare data information throughout these years, including text, audio features, and multivariate data. We also carefully studied each disease's background, including the symptoms and test assessment run by healthcare. We explored the online social media potential and medical applications capability for disease diagnosis and a health monitoring system to employ the developed models in a real-world scenario. The DL for healthcare can become very helpful for supporting clinician's decisions and improving patient care. The leading institutions and medical bodies have recognized the benefits it brings, and the popularity of the solutions are well known. With support from a reliable computational system, it could help healthcare decide particular needs and environments and reduce the stresses that medical professionals may experience daily. Healthcare has high hopes for the role of DL in clinical decision support and predictive analytics for a wide variety of conditions

Evidence-based clinical engineering : machine learning algorithms for prediction of defibrillator performance

Poorly regulated and insufficiently supervised medical devices (MDs) carry high risk of performance accuracy and safety deviations effecting the clinical accuracy and efficiency of patient diagnosis and treatments. Even with the increase of technological sophistication of devices, incidents involving defibrillator malfunction are unfortunately not rare. To address this, we have developed an automated system based on machine learning algorithms that can predict performance of defibrillators and possible performance failures of the device which can affect performance. To develop an automated system, with high accuracy, overall dataset containing safety and performance measurements data was acquired from periodical safety and performance inspections of 1221 defibrillator. These inspections were carried out in period 2015–2017 in private and public healthcare institutions in Bosnia and Herzegovina by ISO 17,020 accredited laboratory. Out of overall number of samples, 974 of them were used during system development and 247 samples were used for subsequent validation of system performance. During system development, 5 different machine learning algorithms were used, and resulting systems were compared by obtained performance

The reality of home remote patient monitoring: A thesis on the nature, dynamics and effects of telehealth

Chronic diseases are very complex conditions in which two or m ore disease processes may coexist. Managing patients with chronic conditions represents a major challenge to public health, since eighty per cent of GP consultations are related to these groups. Further more, five per cent of them represent roughly forty two per cent of the total acute day bed occupancy. Nowadays, the tendency is to bring patients from high levels of care to primary care and home settings. In this scenario, telehealth is one of the methods that can be used to improve and provide access to remote patient monitoring at home. This is important for patients with chronic diseases as it can help to recognise any signs of deterioration, provide health education and support management of their condition. Potentially, telehealth can reduce deaths, emergency visits, A&E visits, elective admissions, bed stays and costs. This can be done by designing and implementing telehealth interventions that help reduce unnecessary referrals to specialised services and monitor patients remotely at home. However, there is not a unique framework for designing telehealth interventions. In order to design a robust, accurate and reliable telehealth intervention, a number of important factors have to be taken into account. A review of three systematic reviews, and an in-depth investigation of a case study based on an EU funded project, were used to gather the evidence for telehealth interventions. These were used to identify the main components of the framework proposed. The investigation focused primarily on home monitoring for patients with diabetes, asthma, hypertension and COPD. We concluded that factors such as usability, safe intervention, patients’ individual requirements, training, safe interventions, ease of use, data integration, development of procedures and allocation of appropriate staff are important components that need to be considered in order to satisfy a robust framework