HeartWays

HeartWays is a research project in the area of healthcare and ICT, performed by four SMEs from Italy, Spain and Croatia, and four research centres from these same three countries and Portugal. Starting in 2012, the project had a duration of 24 months and was funded by the European Union's Programme “Research for the benefit of SMEs“ - Call ID “” and managed by REA Research Executive Agency.
The purpose of the project is to develop an advanced modular solution for supporting cardiac patients in rehabilitation outside a medical centre with the aid of wearable sensors and intelligent algorithms that personalize the management and the follow-up for patients and professionals.
The area of research, applied methods and techniques are described in the public deliverables which are available to the public on the project's website. Only documents that comprise information related to financial data or information that could negatively influence the competitiveness and law enforcement capabilities of parties involved in the project are not published. This follows regulations and practices applied in EU research projects.
Background
Chronic diseases are diseases of long duration and generally slow progression, which are by far the leading cause of mortality in the world. Among all chronic illnesses, cardiovascular diseases (CVDs) are the number one cause of global deaths (more people die annually from CVDs than from any other cause). Furthermore, studies related to economic burden of cardiovascular diseases reveal that CVDs costs to the Health Care Systems of the EU just under 110 billion € in 2006, representing around 10% of the total EU Health Care expenditure.
Recent research is supportive of the beneficial effects of exercise based cardiac rehabilitation in patients with heart failure as well as in older patients. Unfortunately, exercise based cardiac rehabilitation continues to be considerably underutilized with poor referral and enrolment rates, especially in phase III of the rehabilitation model. Implementing quality performance measures, automated referral systems, and the option of home-based cardiac rehabilitation for some patients may all help to increase participation. In addition, innovative exercise training regimens may help to enhance the beneficial effects of cardiac rehabilitation.
HeartWays technical solution
The proposed solution is structured in three different layers:
* A monitoring layer, integrating a combination of smart and wearable sensors, specialized in the monitoring of the vital signs to be used for the diagnosis of targeted patients.
* A multi-parametric analysis and processing layer that processes and enriches the information provided by monitoring layer, allowing a multi-parametric assessment of the patient’s status, evolution, performance and predicted CV risk.
* A management layer, which provides tools to improve the way patients are managed by healthcare professionals and that support a personalized care delivery to the patient.
** Management tools for healthcare professionals allow a simpler control of patients increasing the possibilities of handling more patients at the same time and allowing a better adjustment of the available resources to the specific needs of each individual patient.
** Management tools for patients combine the medical needs with the patient’s preferences, incorporating a comprehensive motivation and psychological support strategy that complements and reinforces the treatment guidelines.
Project results
Monitoring Layer
Wearable Multi-parametric Exercise Shirt
This result is composed by a smart garment and an electronic processing module.
* The smart garment integrates a series of ECG and respiratory sensors woven directly into the shirt. These textile sensors provide a 1-lead ECG and monitors the chest movements due to breathing.
* The electronic module records and processes the raw signals acquired from the textile sensors in the shirt and computes the heart rate and HR variability from the ECG signal, and respiratory rate from the chest movement. Additionally, the module contains a 3D accelerometer which is used to calculate the physical activity and estimate calories burned and VO2. This electronic module can stream all these data to a computer or a mobile device using Bluetooth.
Wearable Multi-parametric Vital Signs Monitor
This result integrates a 24-bit multi-lead ECG monitor, which streams live the ECG signal through a WiFi connection, and a special glove that monitors SpO2, galvanic skin response (GSR) and skin surface temperature. The glove has a processing unit, which minimizes motion artefacts on the recorded signals.
Multi-parametric Body Sensing Wireless Network
This result contains a set of wearable sensors nodes in a body area network (BAN) able to acquire physiological and kinetic information. The main node processes the signals to extract the trunk position, mobility of body parts and perform an assessment of physical activity.
To keep this result at a low weight and price for peripheral and powerful hardware for signal processing, the BAN consist of two kinds of devices: central and peripheral nodes. The central node collects the data recorded by peripheral nodes and also provides interfaces to integrate audio, ECG and file transfer. All nodes communicate with a proprietary communication interface called WOLC (Wireless of Low Complexity).
Intelligent Analysis Layer
Intelligent Multi-parametric Analysis Middleware, composed by:
Algorithm for the assessment of the physiological response to physical activity
The goal of this algorithm is to evaluate the physiological capacity of patient to perform the rehabilitation sessions designed in the system and prescribed by the medical doctor. This assessment is done computing the level of compliance for each individual exercise sessions compared to the original prescription in terms of HR values.
Algorithm for the multiparametric analysis for continuous monitoring of vital signs in cardiac patients
This algorithm combines medical rules, patient anagraphical data and physiological measurements (ECG, ECG events, ECG features, HR, skin temperature, skin conductivity and SpO2) to provide a multi-parametric assessment of the patient performance during physical exercise.
Algorithm for the analysis of the quality of the performed exercise
This algorithm uses the signals acquired from the 'Multi-parametric Body Sensing Wireless Network' and the prescription information for strength exercises. The signals are processed and segmented into individual repetitions, determining then the movement execution and pause times. Features of every individual repetition (repetition duration, pause duration, maximum accelerometer amplitude, absolute derivation value and described angle) are compared to reference values in the prescription. The difference between features is an error used as an input for Exercise Quality Index (EQI) calculation. As EQI aims to 1, quality of performed exercise is higher.
Rehabilitation evaluation index (REI)
The rehabilitation evaluation index REI is a concept of a measurable parameter that the health professional uses to check if the rehabilitation plan is doing successfully. The index is set as a measure of success of a patient in achieving the goals of regaining the physical condition through physical activity. The goal for a particular patient is set by the medical doctor and transferred into a measurable value by physical rehabilitation specialist and/or trainer using the Exercise Quality Index for both, resistance and strength exercising. REI is a long-term measure and is set for a three-month period of rehabilitation/physical activity. The rehabilitation evaluation index REI is calculated from the Exercise Quality Index for resistance training and Exercise Quality Index for strength training on a weekly basis.
Personalized CV Risk Predictor
The main goals of the Personalized Cardiovascular Risk Predictor are the development of models for (i) patient stratification based on short term Cardiovascular Risk Assessment and (ii) alarm detection based on trends as well as on patient status. The output is expressed by a qualitative index, which enables the characterization of the current short-term cardiovascular risk level. The output of this predictor can be used to stratify patients based on these risks and identify the most pertinent modifiable variables as well as to provide useful indications and practical alarms that enable an efficient and effective management by the healthcare system.
Management Layer
On the Move Patient Support: continuous and ubiquitous support to the patient during his normal day activities and while practicing the personalized exercise prescriptions, by means of a mobile device with a specific interface for easy communication while exercising
Patient Portal & Social Communities: patients’ access to their Personal Health Record, and channel for connecting and sharing experiences with peer patients and promote healthy competitiveness and team cooperation between fellow patients.
Health Professional Management Platform: tool for professionals to easily follow-up the patients in rehabilitation. It highlights the relevant information and it is also able to handle dynamic care and exercise plans, that can automatically adjust to the patient’s performance, and that provide the professional with treatment and adjustment suggestions.
Expected impact
Despite the documented evidences of the benefits of cardiac rehabilitation only about 33% of patients in developed countries participate in such programs and only about one third maintains attendance after 6 months. It is also known that those who receive and practice cardiac rehabilitation at home are more likely to stick to their rehabilitation regime. HeartWays impacts in the following way:
# Availability of an acceptable, safety, cost-effective health care solution for managing CVD patients at home and covering outdoors experiences reducing physical inactivity, as one of the major modifiable risk factors (inactivity increases risk of heart disease and stroke by 50%).
# Reintegration of CVDs patients and their families into the society
# Reduction of stress associated to the management of the disease.
# Family, friends and other fellow patients could be more involved providing support to the patient (social support).
# Economic savings thanks to the reduction of hospitalizations and acute events, as a result of the continuous monitoring which is less expensive.
External Resources
* Official HeartWays website
* Project details at Cordis
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* Research Executive Agency

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