Search

In the past few decades heart sound signals (i.e., phono-cardiograms or PCGs) have been widely studied. Automated heart sound segmentation and classification techniques have the potential to screen for pathologies in a variety of clinical applications. However, comparative analyses of algorithms in the literature have been hindered by the lack of a large and open database of heart sound recordings. The PhysioNet/Computing in Cardiology (CinC) Challenge 2016 addresses this issue by assembling the largest public heart sound database, aggregated from eight sources obtained by seven independent research groups around the world. The database includes 4,430 recordings taken from 1,072 subjects, totalling 233,512 heart sounds collected from both healthy subjects and patients with a variety of conditions such as heart valve disease and coronary artery disease. These recordings were collected using heterogeneous equipment in both clinical and nonclinical (such as in-home visits). The length of recording varied from several seconds to several minutes. Additional data provided include subject demographics (age and gender), recording information (number per patient, body location, and length of recording), synchronously recorded signals (such as ECG), sampling frequency and sensor type used. Participants were asked to classify recordings as normal, abnormal, or not possible to evaluate (noisy/uncertain). The overall score for an entry was based on a weighted sensitivity and specificity score with respect to manual expert annotations. A brief description of a baseline classification method is provided, including a description of open source code, which has been provided in association with the Challenge. The open source code provided a score of 0.71 (Se=0.65 Sp=0.76). During the official phase of the competition, a total of 48 teams submitted 348 open source entries, with a highest score of 0.86 (Se=0.94 Sp=0.78).

BACKGROUND: Recent telehealth studies have demonstrated minor impact on patients affected by long-term conditions. The use of technology does not guarantee the compliance required for sustained collection of high-quality symptom and physiological data. Remote monitoring alone is not sufficient for successful disease management. A patient-centred design approach is needed in order to allow the personalisation of interventions and encourage the completion of daily self-management tasks.METHODS: A digital health system was designed to support patients suffering from chronic obstructive pulmonary disease in self-managing their condition. The system includes a mobile application running on a consumer tablet personal computer and a secure backend server accessible to the health professionals in charge of patient management. The patient daily routine included the completion of an adaptive, electronic symptom diary on the tablet, and the measurement of oxygen saturation via a wireless pulse oximeter.RESULTS: The design of the system was based on a patient-centred design approach, informed by patient workshops. One hundred and ten patients in the intervention arm of a randomised controlled trial were subsequently given the tablet computer and pulse oximeter for a 12-month period. Patients were encouraged, but not mandated, to use the digital health system daily. The average used was 6.0 times a week by all those who participated in the full trial. Three months after enrolment, patients were able to complete their symptom diary and oxygen saturation measurement in less than 1 m 40s (96% of symptom diaries). Custom algorithms, based on the self-monitoring data collected during the first 50 days of use, were developed to personalise alert thresholds.CONCLUSIONS: Strategies and tools aimed at refining a digital health intervention require iterative use to enable convergence on an optimal, usable design. 'Continuous improvement' allowed feedback from users to have an immediate impact on the design of the system (e.g., collection of quality data), resulting in high compliance with self-monitoring over a prolonged period of time (12-month). Health professionals were prompted by prioritisation algorithms to review patient data, which led to their regular use of the remote monitoring website throughout the trial.TRIAL REGISTRATION: Trial registration: ISRCTN40367841 . Registered 17/10/2012.