In-Home Cardiovascular Monitoring System for Heart Failure: Comparative Study
In-Home Cardiovascular Monitoring System for Heart Failure: Comparative Study
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DOI：
10.2196/12419
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发表时间：
2019-01-18
影响因子：
5
通讯作者：
Borkholder, David A.
中科院分区：
文献类型：
--
作者：
Conn, Nicholas J.;Schwarz, Karl Q.;Borkholder, David A.
背景：迫切需要降低心力衰竭患者的住院率，以限制不断上升的医疗费用并改善预后。跟踪生理变化以发现家中的早期恶化，有可能通过早期干预降低住院率。然而，传统的家庭监测方法取得了有限的成功，患者的依从性被认为是一个主要障碍。这项工作提出了一种基于马桶座的心血管监测系统，它有可能解决患者依从性低的问题，因为它不需要改变任何习惯或行为。目的：本研究的目的是证明一种基于马桶座的心血管监测系统，该系统集成了心电图、弹道心动图和光电容积描记图，能够测量收缩压和舒张压、卒中容积和外周血氧合。方法：在8周的时间里，将基于马桶座的血压和外周血氧合估计值与医院级生命体征监测仪进行比较。估计的中风量在38名正常受试者和111名在医院诊所接受任何潜在疾病（包括心力衰竭）标准超声心动图的受试者中得到验证。结果：与各自的金标准相比，所有的座椅测量都达到了临床等级的准确性。舒张压和收缩压的准确性分别为1.2 (SD 6.0) mm Hg （N=112）和-2.7 (SD 6.6) mm Hg （N=89）。与超声心动图金标准相比，脑卒中容量的准确性为-2.5 (SD 15.5) mL （N=149）。外周血氧合的RMS误差为2.3% （N=91）。结论：一种基于马桶座圈的心血管监测系统已被成功验证，其血压、脑卒中量和血氧准确度与金标准测量一致。该系统将具有独特的定位，可以捕获以前无法获得的家庭趋势数据。要证明该技术的临床效益，还需要进一步的算法开发和未来的临床试验，包括旨在减少心力衰竭住院率的试验。
Background: There is a pressing need to reduce the hospitalization rate of heart failure patients to limit rising health care costs and improve outcomes. Tracking physiologic changes to detect early deterioration in the home has the potential to reduce hospitalization rates through early intervention. However, classical approaches to in-home monitoring have had limited success, with patient adherence cited as a major barrier. This work presents a toilet seat-based cardiovascular monitoring system that has the potential to address low patient adherence as it does not require any change in habit or behavior.Objective: The objective of this work was to demonstrate that a toilet seat-based cardiovascular monitoring system with an integrated electrocardiogram, ballistocardiogram, and photoplethysmogram is capable of clinical-grade measurements of systolic and diastolic blood pressure, stroke volume, and peripheral blood oxygenation.Methods: The toilet seat-based estimates of blood pressure and peripheral blood oxygenation were compared to a hospital-grade vital signs monitor for 18 subjects over an 8-week period. The estimated stroke volume was validated on 38 normative subjects and 111 subjects undergoing a standard echocardiogram at a hospital clinic for any underlying condition, including heart failure.Results: Clinical grade accuracy was achieved for all of the seat measurements when compared to their respective gold standards. The accuracy of diastolic blood pressure and systolic blood pressure is 1.2 ( SD 6.0) mm Hg ( N=112) and -2.7 ( SD 6.6) mm Hg ( N=89), respectively. Stroke volume has an accuracy of -2.5 ( SD 15.5) mL ( N=149) compared to an echocardiogram gold standard. Peripheral blood oxygenation had an RMS error of 2.3% ( N=91).Conclusions: A toilet seat-based cardiovascular monitoring system has been successfully demonstrated with blood pressure, stroke volume, and blood oxygenation accuracy consistent with gold standard measures. This system will be uniquely positioned to capture trend data in the home that has been previously unattainable. Demonstration of the clinical benefit of the technology requires additional algorithm development and future clinical trials, including those targeting a reduction in heart failure hospitalizations.