NP Bidargaddi and A Sarela, "Ambulatory monitor derived clinical measures for continuous assessment of cardiac rehabilitation patients in community care model", Proc. 2nd Intl Conf. Pervasive Computing Technologies for Healthcare (Pervasive Health 2008), Tampere, Finland

1. Ambulatory monitor derived clinical measures for continuous assessment of cardiac rehabilitation patients Dr Niranjan P Bidargaddi Research Scientist 28 th August 2008 Patient centred health care

4. CSIRO – 80 years of achievement

7. Care Assessment Platform project aims to develop and show evidence of IT/ telemonitoring tools in supporting Community Care teams focused on secondary prevention of Cardiovascular Diseases

19. Why Trials? New Technology Relevance Positive Outcomes Uptake Phase 1 trial Phase 2 trial

23. Ambulatory Monitoring Technology in Phase 1: Waist worn movement activity monitor records X-, Y- and Z- acceleration and 1 lead ECG Sit to stand transition Walking Important movement patterns can be automatically detected:

24. Cardiac rehabilitation exercise program

28. Metabolic expenditure, daily profile Cardiac Rehabilitation aims at an accumulation of 30 minutes or more of light to moderate (3.2 – 4.7 MET) physical activity on most days of the week Minute by minute metabolic expenditure can be calculated from the accelerometer signal

29. Metabolic expenditure trend during 6 week CR

30. Active/Inactive Ratio trend during 6 weeks of CR Active (Running, Walking, working, etc) (Moderate and Vigorous intensity activities > 3MET) Inactive (Sleep, Lying down, Sitting) Days

31. Sleep Distribution, daily profile

32. Sleep Distribution,daily profile

33. Gait stability trend during 6 weeks of CR

34. Walking duration trend during 6 weeks of CR

35. Ambulatory ECG Derived features

36. Exercise heart rate distribution

37. Continuous heart rate, daily profile

38. Exercise respiratory rate distribution

39. Continuous respiratory rate, daily profile

40. Respiratory rate regularity (Smoothness)

41. Heart rate variability (RMSSD) during exercise Resting – Parasympathetic/vagal tone active Exercise – Sympathetic > Parasympathetic

43. Human Factors Unacceptable Poor Average Good Excellent Comfortness of monitor on waist Comfortness ECG leads Trial satisfaction

44. Human Factors No Sometimes Yes Disruption to Normal activities? Wear monitors During sleep? Did wearing monitor Encourage in setting exercise goals?

46. CAP phase 2 (2008): objectives Establish a sustainable and comprehensive home-based care process assisted with IT solutions and show its benefits compared to conventional approaches through a randomized controlled clinical trial Create new clinical information on the behavioural and exercise patterns of the home-care patients through dynamic analysis of free living unconstrained physiological data To develop data analysis tools and a software framework to process clinically relevant information from the home-monitoring systems.

48. Phase 2, Clinical study setup Patient Consent Test Group 2 Randomization Test Group 1 Control Group Pre- assessment of outcome measures Evaluation, analysis, reporting Hospital rehabilitation without IT, N=80 Test Group 3 Hospital rehabilitation using IT, N=80 Home-based care without IT N=80 Home-based care using IT N=80 Post- assessment of outcome measures Cost-effectiveness analysis Site1 Site2 No rehabilitation - self care, N=80 Test Group 4 6 months follow-up Drop out Evaluation, analysis, reporting

49. Thank you Contact Us Phone: 1300 363 400 or +61 3 9545 2176 Email: enquiries@csiro.au Web: www.csiro.au e-Health Research Centre/ICT Centre Phone: +61 7 3024 1651 Email: niranjan.bidargaddi@csiro.au Web: http://e-hrc.net/cap/index.html