A low-complexity ECG feature extraction algorithm for mobile healthcare applications

ECG-LM: Understanding Electrocardiogram with a Large Language Model

Background: The electrocardiogram (ECG) is a valuable, noninvasive tool for monitoring heart-related conditions, providing critical insights. However, the interpretation of ECG data alongside patient information demands substantial medical expertise and resources. While deep learning methods help streamline this process, they often fall short in integrating patient data with ECG readings and do not provide the nuanced clinical suggestions and insights necessary for accurate diagnosis. Methods: Although recent advancements in multi-modal large language modeling have propelled their application scope beyond the natural language processing domain, their applicability to ECG processing remains largely unexplored, partly due to the lack of text-ECG data. To this end, we develop ECG-Language Model (ECG-LM), the first multi-modal large language model able to process natural language and understand ECG signals. The model employs a specialized ECG encoder that transforms raw ECG signals into a high-dimensional feature space, which is then aligned with the textual feature space derived from the large language model. To address the scarcity of text-ECG data, we generated text-ECG pairs by leveraging detailed ECG pattern descriptions from medical guidelines, creating a robust dataset for pre-training ECG-LM. Additionally, we fine-tune ECG-LM with public clinical conversation datasets and build an additional supervised fine-tuning dataset based on real clinical data from the hospital, aiming to provide a more comprehensive and customized user experience. Results: ECG-LM outperforms existing few-shot and zero-shot solutions in cardiovascular disease detection across all 3 tasks (diagnostic, rhythm, and form) while also demonstrating strong potential in ECG-related question answering. Conclusions: The results across various tasks demonstrate that ECG-LM effectively captures the intricate features of ECGs, showcasing its versatility in applications such as disease prediction and advanced question answering.

Adaptive wavelet base selection for deep learning-based ECG diagnosis: A reinforcement learning approach

Electrocardiogram (ECG) signals are crucial in diagnosing cardiovascular diseases (CVDs). While wavelet-based feature extraction has demonstrated effectiveness in deep learning (DL)-based ECG diagnosis, selecting the optimal wavelet base poses a significant challenge, as it directly influences feature quality and diagnostic accuracy. Traditional methods typically rely on fixed wavelet bases chosen heuristically or through trial-and-error, which can fail to cover the distinct characteristics of individual ECG signals, leading to suboptimal performance. To address this limitation, we propose a reinforcement learning-based wavelet base selection (RLWBS) framework that dynamically customizes the wavelet base for each ECG signal. In this framework, a reinforcement learning (RL) agent iteratively optimizes its wavelet base selection (WBS) strategy based on successive feedback of classification performance, aiming to achieve progressively optimized feature extraction. Experiments conducted on the clinically collected PTB-XL dataset for ECG abnormality classification show that the proposed RLWBS framework could obtain more detailed time-frequency representation of ECG signals, yielding enhanced diagnostic performance compared to traditional WBS approaches.

Predictive models for health-related quality of life built on two telemonitoring datasets

Congestive heart failure (CHF) is an incurable disease where a key objective of the treatment is to maintain the patient's quality of life (QoL) as much as possible. A model that predicts health-related QoL (HRQoL) based on physiological and ambient parameters can be used to monitor these parameters for the patient's benefit. Since it is difficult to predict how CHF progresses, in this study we tried to predict HRQoL for a particular patient as an individual, using two different datasets, collected while telemonitoring CHF patients. We used different types of imputation, classification models, number of classes and evaluation techniques for both datasets, but the main focus is on unifying the datasets, which allowed us to build cross-dataset models. The results showed that using general predictive models intended for previously unseen patients do not work well. Personalization significantly improves the prediction, both personalized models and personalized imputation, which is important due to many missing data in the datasets. However, this implies that applications using such predictive models would also need to collect some self-reported labels of HRQoL to be able to help patients effectively.

Robustness of Deep Learning models in electrocardiogram noise detection and classification

BACKGROUND AND OBJECTIVE

Automatic electrocardiogram (ECG) signal analysis for heart disease detection has gained significant attention due to busy lifestyles. However, ECG signals are susceptible to noise, which adversely affects the performance of ECG signal analysers. Traditional blind filtering methods use predefined noise frequency and filter order, but they alter ECG biomarkers. Several Deep Learning-based ECG noise detection and classification methods exist, but no study compares recurrent neural network (RNN) and convolutional neural network (CNN) architectures and their complexity.

METHODS

This paper introduces a knowledge-based ECG filtering system using Deep Learning to classify ECG noise types and compare popular computer vision model architectures in a practical Internet of Medical Things (IoMT) framework. Experimental results demonstrate that the CNN-based ECG noise classifier outperforms the RNN-based model in terms of performance and training time.

RESULTS

The study shows that AlexNet, visual geometry group (VGG), and residual network (ResNet) achieved over 70% accuracy, specificity, sensitivity, and F1 score across six datasets. VGG and ResNet performances were comparable, but VGG was more complex than ResNet, with only a 4.57% less F1 score.

CONCLUSIONS

This paper introduces a Deep Learning (DL) based ECG noise classifier for a knowledge-driven ECG filtering system, offering selective filtering to reduce signal distortion. Evaluation of various CNN and RNN-based models reveals VGG and Resnet outperform. Further, the VGG model is superior in terms of performance. But Resnet performs comparably to VGG with less model complexity.

A complexity efficient penta-diagonal quantum smoothing filter for bio-medical signal denoising: a study on ECG

Extracting information-bearing signal from a noisy environment has been a practical challenge in both classical and quantum computing formalism, especially in critical signal processing applications. To filter out the effect of noise, we propose a quantum smoothing filter built upon quantum formalism-based circuits applied for electrocardiogram signal denoising. The proposed quantum filter is a conceptually novel framework with an advantage in computational complexity as compared to the existing classical filters, such as discrete wavelet transform and empirical mode decomposition, whereas it achieves similar performance metrics for the accuracy of the filter. Further, we exploit the penta-diagonal Toeplitz structure of the smoothing filter, which gives approximately 48 % gate cost reduction for 10 qubit circuit compared to the standard Hamiltonian simulation without structure. The run-time complexity using the quantum matrix inversion technique for the structured matrix is given byO ~ κ 2 poly ( log N ) ε P for condition number κ of the N × N filter matrix within precision ε P . Embedding fixed sparsity of the banded matrix, the quantum filter shows potentially better run-time complexity than classical filtering techniques. For the quantifiable research results of our work, we have shown several performance metrics, such as mean-square error and peak signal-to-noise ratio analysis, with a bound of error due to observation noise, simulation error and quantum measurement uncertainty.

Electrocardiogram Fiducial Point Detector Using a Bilateral Filter and Symmetrical Point-Filter Structure

The characteristics or aspects of important fiducial points (FPs) in the electrocardiogram (ECG) signal are complicated because of various factors, such as non-stationary effects and low signal-to-noise ratio. Due to the various noises caused by the ECG signal measurement environment and by typical ECG signal deformation due to heart diseases, detecting such FPs becomes a challenging task. In this study, we introduce a novel PQRST complex detector using a one-dimensional bilateral filter (1DBF) and the temporal characteristics of FPs. The 1DBF with noise suppression and edge preservation preserves the P- or T-wave whereas it suppresses the QRS-interval. The 1DBF acts as a background predictor for predicting the background corresponding to the P- and T-waves and the remaining flat interval excluding the QRS-interval. The R-peak and QRS-interval are founded by the difference of the original ECG signal and the predicted background signal. Then, the Q- and S-points and the FPs related to the P- and T-wave are sequentially detected using the determined searching range and detection order based on the detected R-peak. The detection performance of the proposed method is analyzed through the MIT-BIH database (MIT-DB) and the QT database (QT-DB).

A new algorithm to reduce T-wave over-sensing based on phase space reconstruction in S-ICD system

BACKGROUND AND OBJECTIVE

The subcutaneous implantable cardioverter defibrillator (S-ICD) reduces mortality in individuals at high risk of sudden arrhythmic death, by rapid defibrillation of life-threatening arrhythmia. Unfortunately, S-ICD recipients are also at risk of inappropriate shock therapies, which themselves are associated with increased rates of mortality and morbidity. The commonest cause of inappropriate shock therapies is T wave oversensing (TWOS), where T waves are incorrectly counted as R waves leading to an overestimation of heart rate. It is important to develop a method to reduce TWOS and improve the accuracy of R-peak detection in S-ICD system.

METHODS

This paper introduces a novel algorithm to reduce TWOS based on phase space reconstruction (PSR); a common method used to analyse the chaotic characteristics of non-linear signals.

RESULTS

The algorithm was evaluated against 34 records from University Hospital Southampton (UHS) and all 48 records from the MIT-BIH arrhythmia database. In the UHS analysis we demonstrated a sensitivity of 99.88%, a positive predictive value of 99.99% and an accuracy of 99.88% with reductions in TWOS episodes (from 166 to 0). Whilst in the MIT-BIH analysis we demonstrated a sensitivity of 99.87%, a positive predictive value of 99.99% and an accuracy of 99.91% for R wave detection. The average processing time for 1 min ECG signals from all records is 2.9 s.

CONCLUSIONS

Our algorithm is sensitive for R-wave detection and can effectively reduce the TWOS with low computational complexity, and it would therefore have the potential to reduce inappropriate shock therapies in S-ICD recipients, which would significantly reduce shock related morbidity and mortality, and undoubtedly improving patient's quality of life.

Computational Diagnostic Techniques for Electrocardiogram Signal Analysis

Cardiovascular diseases (CVDs), including asymptomatic myocardial ischemia, angina, myocardial infarction, and ischemic heart failure, are the leading cause of death globally. Early detection and treatment of CVDs significantly contribute to the prevention or delay of cardiovascular death. Electrocardiogram (ECG) records the electrical impulses generated by heart muscles, which reflect regular or irregular beating activity. Computer-aided techniques provide fast and accurate tools to identify CVDs using a patient's ECG signal, which have achieved great success in recent years. Latest computational diagnostic techniques based on ECG signals for estimating CVDs conditions are summarized here. The procedure of ECG signals analysis is discussed in several subsections, including data preprocessing, feature engineering, classification, and application. In particular, the End-to-End models integrate feature extraction and classification into learning algorithms, which not only greatly simplifies the process of data analysis, but also shows excellent accuracy and robustness. Portable devices enable users to monitor their cardiovascular status at any time, bringing new scenarios as well as challenges to the application of ECG algorithms. Computational diagnostic techniques for ECG signal analysis show great potential for helping health care professionals, and their application in daily life benefits both patients and sub-healthy people.

Arrhythmia Classification with ECG signals based on the Optimization-Enabled Deep Convolutional Neural Network

Arrhythmia classification is the need of the hour as the world is reporting a higher death troll as a cause of cardiac diseases. Most of the existing methods developed for arrhythmia classification face a hectic challenge of classification accuracy and they raised the challenge of automatic monitoring and classification methods. Accordingly, the paper proposes the automatic arrhythmia classification strategy using the optimization-based deep convolutional neural network (deep CNN). The optimization algorithm named, Bat-Rider optimization algorithm (BaROA) is newly developed using the multi-objective bat algorithm (MOBA) and Rider Optimization Algorithm (ROA).At first, the wave and gabor features are extracted from the ECG signals in such a way that these features represent the individual ECG features. Finally, the signals are provided to the BaROA-based DCNN classifier that identifies conditions of the individual as arrhythmia and no-arrhythmia from the ECG signals. The methods are analyzed using the MIT-BIH Arrhythmia Database and the analysis is performed based on the evaluation parameters, like accuracy, specificity, and sensitivity, which are found to be 93.19 %, 95 %, and 93.98 %, respectively.

Accurate Fiducial Point Detection Using Haar Wavelet for Beat-by-Beat Blood Pressure Estimation

Pulse Arrival Time (PAT) derived from Electrocardiogram (ECG) and Photoplethysmogram (PPG) for cuff-less Blood Pressure (BP) measurement has been a contemporary and widely accepted technique. However, the features extracted for it are conventionally from an isolated pulse of ECG and PPG signals. As a result, the estimated BP is intermittent.

OBJECTIVE

This paper presents feature extraction from each beat of ECG and PPG signals to make BP measurements uninterrupted. These features are extracted by employing Haar transformation to adaptively attenuate measurement noise and improve the fiducial point detection precision.

METHOD

the use of only PAT feature as an independent variable leads to an inaccurate estimation of either Systolic Blood Pressure (SBP) or Diastolic Blood Pressure (DBP) or both. We propose the extraction of supplementary features that are highly correlated to physiological parameters. Concurrent data was collected as per the Association for the Advancement of Medical Instrumentation (AAMI) guidelines from 171 human subjects belonging to diverse age groups. An Adaptive Window Wavelet Transformation (AWWT) technique based on Haar wavelet transformation has been introduced to segregate pulses. Further, an algorithm based on log-linear regression analysis is developed to process extracted features from each beat to calculate BP.

RESULTS

The mean error of 0.43 and 0.20 mmHg, mean absolute error of 4.6 and 2.3 mmHg, and Standard deviation of 6.13 and 3.06 mmHg is achieved for SBP and DBP respectively.

CONCLUSIONS

The features extracted are highly precise and evaluated BP values are as per the AAMI standards. Clinical Impact: This continuous real-time BP monitoring technique can be useful in the treatment of hypertensive and potential-hypertensive subjects.

Cuff-less Blood Pressure Measurement Using Supplementary ECG and PPG Features Extracted Through Wavelet Transformation

Cuff-less blood pressure (BP) is essential for continuous health monitoring to prevent diseases such as hypertension. Due to the discomfort caused by inflation and deflation of the cuff, it is not possible to monitor continuously. Although pulse transit time (PTT) based approach is commonly used, other parameters also vary with BP. Multi-parameter models are developed using regression analysis, to estimate systolic blood pressure (SBP) and diastolic blood pressure (DBP). Hence, the correlation of multiple extracted features with the blood pressure is proved. To achieve this, simultaneous electrocardiogram (ECG) and photoplethysmographic (PPG) along with respective BP data were collected. The developed algorithm uses wavelet transformation on ECG and PPG signals for detection of the occurrence of essential wave points precisely, even in the presence of artifacts. Pulse wave analysis (PWA) is performed to create a feature vector. From the experimental results, it is found that, the SBP model gives mean error of 0.4916 mmHg, with standard deviation of 6.3986 mmHg, whereas for DBP model, mean error is 0.2527 mmHg and standard deviation is 3.2835 mmHg which is acceptable as per the British Hypertension Society (BHS) and Association for the Advancement of Medical Instruments (AAMI) standards. After the removal of BP oddities, mean absolute error improves from 5.625 to 3.854 mmHg for SBP and from 2.564 to 2.144 mmHg for DBP.

Brain Tumor Analysis Empowered with Deep Learning: A Review, Taxonomy, and Future Challenges

Deep Learning (DL) algorithms enabled computational models consist of multiple processing layers that represent data with multiple levels of abstraction. In recent years, usage of deep learning is rapidly proliferating in almost every domain, especially in medical image processing, medical image analysis, and bioinformatics. Consequently, deep learning has dramatically changed and improved the means of recognition, prediction, and diagnosis effectively in numerous areas of healthcare such as pathology, brain tumor, lung cancer, abdomen, cardiac, and retina. Considering the wide range of applications of deep learning, the objective of this article is to review major deep learning concepts pertinent to brain tumor analysis (e.g., segmentation, classification, prediction, evaluation.). A review conducted by summarizing a large number of scientific contributions to the field (i.e., deep learning in brain tumor analysis) is presented in this study. A coherent taxonomy of research landscape from the literature has also been mapped, and the major aspects of this emerging field have been discussed and analyzed. A critical discussion section to show the limitations of deep learning techniques has been included at the end to elaborate open research challenges and directions for future work in this emergent area.

Phase Space Reconstruction Based CVD Classifier Using Localized Features

This paper proposes a generalized Phase Space Reconstruction (PSR) based Cardiovascular Diseases (CVD) classification methodology by exploiting the localized features of the ECG. The proposed methodology first extracts the ECG localized features including PR interval, QRS complex, and QT interval from the continuous ECG waveform using features extraction logic, then the PSR technique is applied to get the phase portraits of all the localized features. Based on the cleanliness and contour of the phase portraits CVD classification will be done. This is first of its kind approach where the localized features of ECG are being taken into considerations unlike the state-of-art approaches, where the entire ECG beats have been considered. The proposed methodology is generic and can be extended to most of the CVD cases. It is verified on the PTBDB and IAFDB databases by taking the CVD including Atrial Fibrillation, Myocardial Infarction, Bundle Branch Block, Cardiomyopathy, Dysrhythmia, and Hypertrophy. The methodology has been tested on 65 patients’ data for the classification of abnormalities in PR interval, QRS complex, and QT interval. Based on the obtained statistical results, to detect the abnormality in PR interval, QRS complex and QT interval the Coefficient Variation (CV) should be greater than or equal to 0.1012, 0.083, 0.082 respectively with individual accuracy levels of 95.3%, 96.9%, and 98.5% respectively. To justify the clinical significance of the proposed methodology, the Confidence Interval (CI), the p-value using ANOVA have been computed. The p-value obtained is less than 0.05, and greater F-statistic values reveal the robust classification of CVD using localized features.

Real-Time Remote-Health Monitoring Systems: a Review on Patients Prioritisation for Multiple-Chronic Diseases, Taxonomy Analysis, Concerns and Solution Procedure

Remotely monitoring a patient's condition is a serious issue and must be addressed. Remote health monitoring systems (RHMS) in telemedicine refers to resources, strategies, methods and installations that enable doctors or other medical professionals to work remotely to consult, diagnose and treat patients. The goal of RHMS is to provide timely medical services at remote areas through telecommunication technologies. Through major advancements in technology, particularly in wireless networking, cloud computing and data storage, RHMS is becoming a feasible aspect of modern medicine. RHMS for the prioritisation of patients with multiple chronic diseases (MCDs) plays an important role in sustainably providing high-quality healthcare services. Further investigations are required to highlight the limitations of the prioritisation of patients with MCDs over a telemedicine environment. This study introduces a comprehensive and inclusive review on the prioritisation of patients with MCDs in telemedicine applications. Furthermore, it presents the challenges and open issues regarding patient prioritisation in telemedicine. The findings of this study are as follows: (1) The limitations and problems of existing patients' prioritisation with MCDs are presented and emphasised. (2) Based on the analysis of the academic literature, an accurate solution for remote prioritisation in a large scale of patients with MCDs was not presented. (3) There is an essential need to produce a new multiple-criteria decision-making theory to address the current problems in the prioritisation of patients with MCDs.

CorNET: Deep Learning Framework for PPG-Based Heart Rate Estimation and Biometric Identification in Ambulant Environment

Advancements in wireless sensor network technologies have enabled the proliferation of miniaturized body-worn sensors, capable of long-term pervasive biomedical signal monitoring. Remote cardiovascular monitoring has been one of the beneficiaries of this development, resulting in non-invasive, photoplethysmography (PPG) sensors being used in ambulatory settings. Wrist-worn PPG, although a popular alternative to electrocardiogram, suffers from motion artifacts inherent in daily life. Hence, in this paper, we present a novel deep learning framework (CorNET) to efficiently estimate heart rate (HR) information and perform biometric identification (BId) using only a wrist-worn, single-channel PPG signal collected in ambulant environment. We have formulated a completely personalized data-driven approach, using a four-layer deep neural network. Two convolution neural network layers are used in conjunction with two long short-term memory layers, followed by a dense output layer for modeling the temporal sequence inherent within the pulsatile signal representative of cardiac activity. The final dense layer is customized with respect to the application, functioning as: regression layer-having a single neuron to predict HR; classification layer-two neurons that identify a subject among a group. The proposed network was evaluated on the TROIKA dataset having 22 PPG records collected during various physical activities. We achieve a mean absolute error of 1.47 ± 3.37 beats per minute for HR estimation and an average accuracy of 96% for BId on 20 subjects. CorNET was further evaluated successfully in an ambulant use-case scenario with custom sensors for two subjects.

AUTOMATIC DETECTION OF CARDIOVASCULAR DISEASE USING DEEP KERNEL EXTREME LEARNING MACHINE

The electrocardiogram (ECG) is a principal signal employed to automatically diagnose cardiovascular disease in shallow and deep learning models. However, ECG feature extraction is required and this may reduce diagnosis accuracy in traditional shallow learning models, while backward propagation (BP) algorithm used by the traditional deep learning models has the disadvantages of local minimization and slow convergence rate. To solve these problems, a new deep learning algorithm called deep kernel extreme learning machine (DKELM) is proposed by combining the extreme learning machine auto-encoder (ELM-AE) and kernel ELM (KELM). In the new DKELM architecture with [Formula: see text] hidden layers, ELM-AEs are employed by the front [Formula: see text] hidden layers for feature extraction in the unsupervised learning process, which can effectively extract abstract features from the original ECG signal. To overcome the “dimension disaster” problem, the kernel function is introduced into ELM to act as classifier by the [Formula: see text]th hidden layer in the supervised learning process. The experiments demonstrate that DKELM outperforms the BP neural network, support vector machine (SVM), extreme learning machine (ELM), deep auto-encoder (DAE), deep belief network (DBN) in classification accuracy. Though the accuracy of convolutional neural network (CNN) is almost the same as DKELM, the computing time of CNN is much longer than DKELM.

A Nanowatt Real-Time Cardiac Autonomic Neuropathy Detector

This paper presents an electrocardiogram (ECG) processor on chip for full ECG feature extraction and cardiac autonomic neuropathy (CAN) classification. Full ECG extraction is performed using absolute value curve length transform (A-CLT) for $\text{QRS}_{\text{peak}}$ detection and using low-pass differentiation for other ECG features such as $\text{QRS}_{\text{on}}$, $\text{QRS}_{\text{off}}$, Pwave, and Twave. The proposed QRS detector attained a sensitivity of 99.37% and predictivity of 99.38%. The extracted $\text{QRS}_{\text{peak}}$ to $\text{QRS}_{\text{peak}}$ intervals (RR intervals) along with QT intervals enable CAN severity detection, which is a cardiac arrhythmia usually seen in diabetic patients leading to increased risk of sudden cardiac death. This paper presents the first hardware real-time implementation of CAN severity detector that is based on RR variability and QT variability analysis. RR variability metrics are based on mean RR interval and root mean square of standard differences of the RR intervals. The proposed architecture was implemented in 65-nm technology and consumed 75 nW only at 0.6 V, when operating at 250 Hz. Ultralow power dissipation of the system enables it to be integrated into wearable healthcare devices.

Real-Time Remote Health-Monitoring Systems in a Medical Centre: A Review of the Provision of Healthcare Services-Based Body Sensor Information, Open Challenges and Methodological Aspects

Promoting patient care is a priority for all healthcare providers with the overall purpose of realising a high degree of patient satisfaction. A medical centre server is a remote computer that enables hospitals and physicians to analyse data in real time and offer appropriate services to patients. The server can also manage, organise and support professionals in telemedicine. Therefore, a remote medical centre server plays a crucial role in sustainably delivering quality healthcare services in telemedicine. This article presents a comprehensive review of the provision of healthcare services in telemedicine applications, especially in the medical centre server. Moreover, it highlights the open issues and challenges related to providing healthcare services in the medical centre server within telemedicine. Methodological aspects to control and manage the process of healthcare service provision and three distinct and successive phases are presented. The first phase presents the identification process to propose a decision matrix (DM) on the basis of a crossover of 'multi-healthcare services' and 'hospital list' within intelligent data and service management centre (Tier 4). The second phase discusses the development of a DM for hospital selection on the basis of integrated VIKOR-Analytic Hierarchy Process (AHP) methods. Finally, the last phase examines the validation process for the proposed framework.

A Speed- and Power-Efficient SPIHT Design for Wearable Quality-On-Demand ECG Applications

In this paper, a speed and power-efficient set partitioning in hierarchical trees (SPIHT) design is introduced for one-dimensional (1-D) wavelet-based electrocardiography (ECG) compression systems with quality guarantee. To achieve real-time and low-power design objectives toward wearable quality-on-demand (QoD) ECG applications, we first propose a coding-time- and computation-efficient SPIHT algorithm using various types of coding status register files to overcome the disadvantages of low coding speeds and complicated hardware architectures characterizing prior SPIHT algorithms resulting from the necessity of dynamic computation and arrangement in the sorting and refinement processing phase. Second, a highly pipelined and power-efficient very large scale integration (VLSI) architecture is developed to implement a high-performance and low-power SPIHT design based on the proposed algorithm. The final simulation results demonstrate that our proposed algorithm can speed up the average coding time 1.52 to 2.74 times compared to prior work with an identical compression ratio for an 11-level $1024\times 1\,1-{\rm{D}}$ discrete wavelet transform at diverse target percentage root-mean-square differences (PRDT) on various MIT-BIH arrhythmia datasets. Applied to wearable wavelet-based QoD ECG applications, our proposed VLSI architecture attains a working frequency of 740 MHz and consumes an average of $\text{23}\ \mu {\text{W}}$ of power with Taiwan Semiconductor Manufacturing Company 90-nm CMOS technology, which shows the effectiveness of speed and power over the state-of-the-art designs.

Sensor Based Smart Real Time Monitoring of Patients Conditions Using Wireless Protocol

This article describes how physiological signal monitoring plays an important role in identifying the health condition of heart. In recent years, online monitoring and processing of biomedical signals play a major role in accurate clinical diagnosis. Therefore, there is a requirement for the developing of online monitoring systems that will be helpful for physicians to avoid mistakes. This article focuses on the method for real time acquisition of an ECG and PPG signal and it's processing and monitoring for tele-health applications. This article also presents the real time peak detection of ECG and PPG for vital parameters measurement. The implementation and design of the proposed wireless monitoring system can be done using a graphical programming environment that utilizes less power and a minimized area with reasonable speed. The advantages of the proposed work are very simple, low cost, easy integration with programming environment and continuous monitoring of physiological signals.

Real-Time Fault-Tolerant mHealth System: Comprehensive Review of Healthcare Services, Opens Issues, Challenges and Methodological Aspects

The burden on healthcare services in the world has increased substantially in the past decades. The quality and quantity of care have to increase to meet surging demands, especially among patients with chronic heart diseases. The expansion of information and communication technologies has led to new models for the delivery healthcare services in telemedicine. Therefore, mHealth plays an imperative role in the sustainable delivery of healthcare services in telemedicine. This paper presents a comprehensive review of healthcare service provision. It highlights the open issues and challenges related to the use of the real-time fault-tolerant mHealth system in telemedicine. The methodological aspects of mHealth are examined, and three distinct and successive phases are presented. The first discusses the identification process for establishing a decision matrix based on a crossover of 'time of arrival of patient at the hospital/multi-services' and 'hospitals' within mHealth. The second phase discusses the development of a decision matrix for hospital selection based on the MAHP method. The third phase discusses the validation of the proposed system.

Mobile GPU-based implementation of automatic analysis method for long-term ECG

Background

Long-term electrocardiogram (ECG) is one of the important diagnostic assistant approaches in capturing intermittent cardiac arrhythmias. Combination of miniaturized wearable holters and healthcare platforms enable people to have their cardiac condition monitored at home. The high computational burden created by concurrent processing of numerous holter data poses a serious challenge to the healthcare platform. An alternative solution is to shift the analysis tasks from healthcare platforms to the mobile computing devices. However, long-term ECG data processing is quite time consuming due to the limited computation power of the mobile central unit processor (CPU).

Methods

This paper aimed to propose a novel parallel automatic ECG analysis algorithm which exploited the mobile graphics processing unit (GPU) to reduce the response time for processing long-term ECG data. By studying the architecture of the sequential automatic ECG analysis algorithm, we parallelized the time-consuming parts and reorganized the entire pipeline in the parallel algorithm to fully utilize the heterogeneous computing resources of CPU and GPU.

Results

The experimental results showed that the average executing time of the proposed algorithm on a clinical long-term ECG dataset (duration 23.0 ± 1.0 h per signal) is 1.215 ± 0.140 s, which achieved an average speedup of 5.81 ± 0.39× without compromising analysis accuracy, comparing with the sequential algorithm. Meanwhile, the battery energy consumption of the automatic ECG analysis algorithm was reduced by 64.16%. Excluding energy consumption from data loading, 79.44% of the energy consumption could be saved, which alleviated the problem of limited battery working hours for mobile devices.

Conclusion

The reduction of response time and battery energy consumption in ECG analysis not only bring better quality of experience to holter users, but also make it possible to use mobile devices as ECG terminals for healthcare professions such as physicians and health advisers, enabling them to inspect patient ECG recordings onsite efficiently without the need of a high-quality wide-area network environment.

Alexander fractional differential window filter for ECG denoising

The electrocardiogram (ECG) non-invasively monitors the electrical activities of the heart. During the process of recording and transmission, ECG signals are often corrupted by various types of noises. Minimizations of these noises facilitate accurate detection of various anomalies. In the present paper, Alexander fractional differential window (AFDW) filter is proposed for ECG signal denoising. The designed filter is based on the concept of generalized Alexander polynomial and the R-L differential equation of fractional calculus. This concept is utilized to formulate a window that acts as a forward filter. Thereafter, the backward filter is constructed by reversing the coefficients of the forward filter. The proposed AFDW filter is then obtained by averaging of the forward and backward filter coefficients. The performance of the designed AFDW filter is validated by adding the various type of noise to the original ECG signal obtained from MIT-BIH arrhythmia database. The two non-diagnostic measure, i.e., SNR, MSE, and one diagnostic measure, i.e., wavelet energy based diagnostic distortion (WEDD) have been employed for the quantitative evaluation of the designed filter. Extensive experimentations on all the 48-records of MIT-BIH arrhythmia database resulted in average SNR of 22.014 ± 3.806365, 14.703 ± 3.790275, 13.3183 ± 3.748230; average MSE of 0.001458 ± 0.00028, 0.0078 ± 0.000319, 0.01061 ± 0.000472; and average WEDD value of 0.020169 ± 0.01306, 0.1207 ± 0.061272, 0.1432 ± 0.073588, for ECG signal contaminated by the power line, random, and the white Gaussian noise respectively. A new metric named as morphological power preservation measure (MPPM) is also proposed that account for the power preservance (as indicated by PSD plots) and the QRS morphology. The proposed AFDW filter retained much of the original (clean) signal power without any significant morphological distortion as validated by MPPM measure that were 0.0126, 0.08493, and 0.10336 for the ECG signal corrupted by the different type of noises. The versatility of the proposed AFDW filter is also validated by its application on the ECG signal from MIT-BIH database corrupted by the combination of the noises as well as on the real noisy ECG signals are taken from MIT-BIH ID database. Furthermore, the comparative study has also been done between the proposed AFDW filter and existing state of the art denoising algorithms. The results clearly prove the supremacy of our proposed AFDW filter.

ECG fiducial point extraction using switching Kalman filter

In this paper, we propose a novel method for extracting fiducial points (FPs) of the beats in electrocardiogram (ECG) signals using switching Kalman filter (SKF). In this method, according to McSharry's model, ECG waveforms (P-wave, QRS complex and T-wave) are modeled with Gaussian functions and ECG baselines are modeled with first order auto regressive models. In the proposed method, a discrete state variable called "switch" is considered that affects only the observation equations. We denote a mode as a specific observation equation and switch changes between 7 modes and corresponds to different segments of an ECG beat. At each time instant, the probability of each mode is calculated and compared among two consecutive modes and a path is estimated, which shows the relation of each part of the ECG signal to the mode with the maximum probability. ECG FPs are found from the estimated path. For performance evaluation, the Physionet QT database is used and the proposed method is compared with methods based on wavelet transform, partially collapsed Gibbs sampler (PCGS) and extended Kalman filter. For our proposed method, the mean error and the root mean square error across all FPs are 2 ms (i.e. less than one sample) and 14 ms, respectively. These errors are significantly smaller than those obtained using other methods. The proposed method achieves lesser RMSE and smaller variability with respect to others.

Mining telemonitored physiological data and patient-reported outcomes of congestive heart failure patients

This paper addresses patient-reported outcomes (PROs) and telemonitoring in congestive heart failure (CHF), both increasingly important topics. The interest in CHF trials is shifting from hard end-points such as hospitalization and mortality, to softer end-points such health-related quality of life. However, the relation of these softer end-points to objective parameters is not well studied. Telemonitoring is suitable for collecting both patient-reported outcomes and objective parameters. Most telemonitoring studies, however, do not take full advantage of the available sensor technology and intelligent data analysis. The Chiron clinical observational study was performed among 24 CHF patients (17 men and 7 women, age 62.9 ± 9.4 years, 15 NYHA class II and 9 class III, 10 of ishaemic, aetiology, 6 dilated, 2 valvular, and 6 of multiple aetiologies or cardiomyopathy) in Italy and UK. A large number of physiological and ambient parameters were collected by wearable and other devices, together with PROs describing how well the patients felt, over 1,086 days of observation. The resulting data were mined for relations between the objective parameters and the PROs. The objective parameters (humidity, ambient temperature, blood pressure, SpO2, and sweeting intensity) could predict the PROs with accuracies up to 86% and AUC up to 0.83, making this the first report providing evidence for ambient and physiological parameters to be objectively related to PROs in CHF patients. We also analyzed the relations in the predictive models, gaining some insights into what affects the feeling of health, which was also generally not attempted in previous investigations. The paper strongly points to the possibility of using PROs as primary end-points in future trials.

SVD and ASCII Character Encoding-Based Compression of Multiple Biosignals for Remote Healthcare Systems

Advancements in electronics and miniaturized device fabrication technologies have enabled simultaneous acquisition of multiple biosignals (MBioSigs), but the area of compression of MBioSigs remains unexplored to date. This paper presents a robust singular value decomposition (SVD) and American standard code for information interchange (ASCII) character encoding-based algorithm for compression of MBioSigs for the first time to the best of our knowledge. At the preprocessing stage, MBioSigs are denoised, down sampled and then transformed to a two-dimensional (2-D) data array. SVD of the 2-D array is carried out and the dimensionality of the singular values is reduced. The resulting matrix is then compressed by a lossless ASCII character encoding-based technique. The proposed compression algorithm can be used in a variety of modes such as lossless, with or without using the down sampling operation. The compressed file is then uploaded to a hypertext preprocessor (PHP)-based website for remote monitoring application. Evaluation results show that the proposed algorithm provides a good compression performance; in particular, the mean opinion score of the reconstructed signal falls under the category "very good" as per the gold standard subjective measure.

Improving Remote Health Monitoring: A Low-Complexity ECG Compression Approach

Recent advances in mobile technology have created a shift towards using battery-driven devices in remote monitoring settings and smart homes. Clinicians are carrying out diagnostic and screening procedures based on the electrocardiogram (ECG) signals collected remotely for outpatients who need continuous monitoring. High-speed transmission and analysis of large recorded ECG signals are essential, especially with the increased use of battery-powered devices. Exploring low-power alternative compression methodologies that have high efficiency and that enable ECG signal collection, transmission, and analysis in a smart home or remote location is required. Compression algorithms based on adaptive linear predictors and decimation by a factor B / K are evaluated based on compression ratio (CR), percentage root-mean-square difference (PRD), and heartbeat detection accuracy of the reconstructed ECG signal. With two databases (153 subjects), the new algorithm demonstrates the highest compression performance ( CR = 6 and PRD = 1.88 ) and overall detection accuracy (99.90% sensitivity, 99.56% positive predictivity) over both databases. The proposed algorithm presents an advantage for the real-time transmission of ECG signals using a faster and more efficient method, which meets the growing demand for more efficient remote health monitoring.

Based Real Time Remote Health Monitoring Systems: A Review on Patients Prioritization and Related "Big Data" Using Body Sensors information and Communication Technology

The growing worldwide population has increased the need for technologies, computerised software algorithms and smart devices that can monitor and assist patients anytime and anywhere and thus enable them to lead independent lives. The real-time remote monitoring of patients is an important issue in telemedicine. In the provision of healthcare services, patient prioritisation poses a significant challenge because of the complex decision-making process it involves when patients are considered 'big data'. To our knowledge, no study has highlighted the link between 'big data' characteristics and real-time remote healthcare monitoring in the patient prioritisation process, as well as the inherent challenges involved. Thus, we present comprehensive insights into the elements of big data characteristics according to the six 'Vs': volume, velocity, variety, veracity, value and variability. Each of these elements is presented and connected to a related part in the study of the connection between patient prioritisation and real-time remote healthcare monitoring systems. Then, we determine the weak points and recommend solutions as potential future work. This study makes the following contributions. (1) The link between big data characteristics and real-time remote healthcare monitoring in the patient prioritisation process is described. (2) The open issues and challenges for big data used in the patient prioritisation process are emphasised. (3) As a recommended solution, decision making using multiple criteria, such as vital signs and chief complaints, is utilised to prioritise the big data of patients with chronic diseases on the basis of the most urgent cases.

A 410-nW Efficient QRS Processor for Mobile ECG Monitoring in 0.18-μm CMOS

This paper proposes a low power and efficient QRS processor for real-time and continuous mobile ECG monitoring. The QRS detector contains the wavelet transform (WT), the modulus maxima pair identification (MMPI), and the R position modification (RPM). In order to reduce power consumption, we choose the Haar function as the mother wavelet of WT. It is implemented by an optimized FIR filter structure where none of the multiplier is used. The MMPI processes the wavelet coefficients at scale 2⁴ and provides candidate R peak positions for the RPM. To improve the accuracy and robust performance, a number of modules have been designed in MMPI, including the preprocessing unit, the automatic threshold updating, and the decision state machine. The RPM is designed to eliminate digital time delay in wavelet transform and locate the R peak position precisely. Raw ECG signals and QRS detection results are output simultaneously. Fabricated in 0.18-μm N-well CMOS 1P6M technology, the power consumption of this chip is only about 410 nW in 1 V voltage supply. Validated by all 48 sets of data in the MIT-BIH arrhythmia database, the sensitive and the positive prediction are 99.60% and 99.77% respectively.

Detection of Stress Levels from Biosignals Measured in Virtual Reality Environments Using a Kernel-Based Extreme Learning Machine

Virtual reality (VR) is a computer technique that creates an artificial environment composed of realistic images, sounds, and other sensations. Many researchers have used VR devices to generate various stimuli, and have utilized them to perform experiments or to provide treatment. In this study, the participants performed mental tasks using a VR device while physiological signals were measured: a photoplethysmogram (PPG), electrodermal activity (EDA), and skin temperature (SKT). In general, stress is an important factor that can influence the autonomic nervous system (ANS). Heart-rate variability (HRV) is known to be related to ANS activity, so we used an HRV derived from the PPG peak interval. In addition, the peak characteristics of the skin conductance (SC) from EDA and SKT variation can also reflect ANS activity; we utilized them as well. Then, we applied a kernel-based extreme-learning machine (K-ELM) to correctly classify the stress levels induced by the VR task to reflect five different levels of stress situations: baseline, mild stress, moderate stress, severe stress, and recovery. Twelve healthy subjects voluntarily participated in the study. Three physiological signals were measured in stress environment generated by VR device. As a result, the average classification accuracy was over 95% using K-ELM and the integrated feature (IT = HRV + SC + SKT). In addition, the proposed algorithm can embed a microcontroller chip since K-ELM algorithm have very short computation time. Therefore, a compact wearable device classifying stress levels using physiological signals can be developed.

An Adaptive and Time-Efficient ECG R-Peak Detection Algorithm

R-peak detection is crucial in electrocardiogram (ECG) signal analysis. This study proposed an adaptive and time-efficient R-peak detection algorithm for ECG processing. First, wavelet multiresolution analysis was applied to enhance the ECG signal representation. Then, ECG was mirrored to convert large negative R-peaks to positive ones. After that, local maximums were calculated by the first-order forward differential approach and were truncated by the amplitude and time interval thresholds to locate the R-peaks. The algorithm performances, including detection accuracy and time consumption, were tested on the MIT-BIH arrhythmia database and the QT database. Experimental results showed that the proposed algorithm achieved mean sensitivity of 99.39%, positive predictivity of 99.49%, and accuracy of 98.89% on the MIT-BIH arrhythmia database and 99.83%, 99.90%, and 99.73%, respectively, on the QT database. By processing one ECG record, the mean time consumptions were 0.872 s and 0.763 s for the MIT-BIH arrhythmia database and QT database, respectively, yielding 30.6% and 32.9% of time reduction compared to the traditional Pan-Tompkins method.

Time-Frequency Distribution of Seismocardiographic Signals: A Comparative Study

Accurate estimation of seismocardiographic (SCG) signal features can help successful signal characterization and classification in health and disease. This may lead to new methods for diagnosing and monitoring heart function. Time-frequency distributions (TFD) were often used to estimate the spectrotemporal signal features. In this study, the performance of different TFDs (e.g., short-time Fourier transform (STFT), polynomial chirplet transform (PCT), and continuous wavelet transform (CWT) with different mother functions) was assessed using simulated signals, and then utilized to analyze actual SCGs. The instantaneous frequency (IF) was determined from TFD and the error in estimating IF was calculated for simulated signals. Results suggested that the lowest IF error depended on the TFD and the test signal. STFT had lower error than CWT methods for most test signals. For a simulated SCG, Morlet CWT more accurately estimated IF than other CWTs, but Morlet did not provide noticeable advantages over STFT or PCT. PCT had the most consistently accurate IF estimations and appeared more suited for estimating IF of actual SCG signals. PCT analysis showed that actual SCGs from eight healthy subjects had multiple spectral peaks at 9.20 ± 0.48, 25.84 ± 0.77, 50.71 ± 1.83 Hz (mean ± SEM). These may prove useful features for SCG characterization and classification.

A Modular Low-Complexity ECG Delineation Algorithm for Real-Time Embedded Systems

This work presents a new modular and low-complexity algorithm for the delineation of the different ECG waves (QRS, P and T peaks, onsets, and end). Involving a reduced number of operations per second and having a small memory footprint, this algorithm is intended to perform real-time delineation on resource-constrained embedded systems. The modular design allows the algorithm to automatically adjust the delineation quality in runtime to a wide range of modes and sampling rates, from a ultralow-power mode when no arrhythmia is detected, in which the ECG is sampled at low frequency, to a complete high-accuracy delineation mode, in which the ECG is sampled at high frequency and all the ECG fiducial points are detected, in the case of arrhythmia. The delineation algorithm has been adjusted using the QT database, providing very high sensitivity and positive predictivity, and validated with the MIT database. The errors in the delineation of all the fiducial points are below the tolerances given by the Common Standards for Electrocardiography Committee in the high-accuracy mode, except for the P wave onset, for which the algorithm is above the agreed tolerances by only a fraction of the sample duration. The computational load for the ultralow-power 8-MHz TI MSP430 series microcontroller ranges from 0.2% to 8.5% according to the mode used.

ECG segmentation and fiducial point extraction using multi hidden Markov model

In this paper, we propose a novel method for extracting fiducial points (FPs) of electrocardiogram (ECG) signals. We propose the use of multi hidden Markov model (MultiHMM) as opposed to the traditional use of Classic HMM. In the MultiHMM method, each segment of an ECG beat is represented by a separate ergodic continuous density HMM. Each HMM has different state number and is trained separately. In the test step, the log-likelihood of two consecutive HMMs is compared and a path is estimated, which shows the correspondence of each part of the ECG signal to the HMM with the maximum log-likelihood. Fiducial points are estimated from the obtained path. For performance evaluation, the Physionet QT database and a Swine ECG database are used and the proposed method is compared with the Classic HMM and a method based on partially collapsed Gibbs sampler (PCGS). In our evaluation using the QT database, we also compare the results with low-pass differentiation, hybrid feature extraction algorithm, a method based on the wavelet transform and three HMM-based approaches. For the Swine database, the root mean square error (RMSE) values, across all FPs for MultiHMM, Classic HMM and PCGS methods are 13, 21 and 40ms, respectively and the MultiHMM exhibits smaller error variability than other methods. For the QT database, RMSE values for MultiHMM, Classic HMM, Wavelet and PCGS methods are 10, 17, 26 and 38ms, respectively. Our results demonstrate that our proposed MultiHMM approach outperforms other benchmark methods that exist in the literature; therefore can be used in practical ECG fiducial point extraction.

Robust cardiac event change detection method for long-term healthcare monitoring applications

A long-term continuous cardiac health monitoring system highly demands more battery power for real-time transmission of electrocardiogram (ECG) signals and increases bandwidth, treatment costs and traffic load of the diagnostic server. In this Letter, the authors present an automated low-complexity robust cardiac event change detection (CECD) method that can continuously detect specific changes in PQRST morphological patterns and heart rhythms and then enable transmission/storing of the recorded ECG signals. The proposed CECD method consists of four stages: ECG signal quality assessment, R-peak detection and beat waveform extraction, temporal and RR interval feature extraction and cardiac event change decision. The proposed method is tested and validated using both normal and abnormal ECG signals including different types of arrhythmia beats, heart rates and signal quality. Results show that the method achieves an average sensitivity of 99.76%, positive predictivity of 94.58% and overall accuracy of 94.32% in determining the changes in heartbeat waveforms of the ECG signals.