I recently had the opportunity to interview Dr. Matthew Harris, a senior scientist in the Medical Signal Processing Department at Philips Research.

Since 2003, he has been involved in the MyHeart and HeartCycle projects—major European initiatives funded in part by the European Commission and that are led by Philips.  These projects are focused on improving cardiovascular treatment in the telemonitoring domain.

Currently, he leads a work package in the HeartCycle project concentrating on multiparametric analysis of telemonitoring data and decision support. 

Below are details he shared in our interview about a current home telemonitoring project aimed at detecting cardiac decompensation.

Q. Home telemonitoring has made significant strides in saving the lives of heart failure patients and in keeping them out of the hospital. But one heart failure complication that is more challenging to predict is decompensation, the deterioration of the heart that can lead to extensive fluid accumulation in the body and the lungs. Why is this condition difficult to detect through telemedicine?

A. Dr. Harris: Many of the measurement technologies available to the specialist are not available for use at home by untrained personnel. Current telemonitoring systems for heart failure rely on regular measurements of weight and blood pressure (easy to use at home) to follow the patient's health status. Some patients gain weight several days before decompensation due to excessive fluid accumulation in the lungs.  However, this trend is not seen before all decompensation, so it is not always easy to detect at home.

Currently, measurements of more advanced and possibly more informative parameters can only be carried out by trained medical staff in a medical setting. One challenge in home telemonitoring is enabling such advanced measurements to be carried out at home, thus allowing dangerous trends in these parameters to be detected at an early stage.

Q. Philips is currently developing two heart failure management techniques, an upper-body vest and a bed-monitoring technique with sensors weaved into the pillowcase, both designed to measure the heart rate. Can you elaborate on how these two techniques will operate in identifying decompensation symptoms and in alerting medical professionals?

A. Dr. Harris: As part of an advanced heart failure management system Philips has developed a vest with integrated textile electrodes and an attachable measurement unit which measures a patient one-lead ECG. The vest has been specially designed to be easily used by the non-medically trained, typically elderly, heart failure patients. The design ensures repeatable electrode positioning, which results in reliable ECG measurements. Further information on the cardiac status of the patient can be gleaned by analyzing the ECG, which could lead to earlier detection of decompensation.

Furthermore, Philips has developed a prototype system using two unobtrusive technologies, both of which can be used for measuring the heart rate of the patient during sleep.

• A polyolefin film which measures movement is placed under the patient's mattress. Movement from breathing and tiny movements from the pumping of the heart are detected. Advanced algorithms developed at Philips are able to extract the heart rate and breathing rate of the patient throughout the night.

• ECG electrodes weaved into the pillowcase and sheets are used to measure an ECG between the head and the foot while the patient is sleeping. From this ECG, a heart rate can be extracted throughout the night. These sensors provide valuable information (previously only available in the clinical setting) that can be used for the detection of an upcoming decompensation.

Q. What have been the major triumphs and challenges in developing these techniques and when do you believe they will be available to patients?

A. Dr. Harris: For use in a home telemonitoring system, the technologies need to be easy to use and unobtrusive in order to minimize the inconvenience to the patient. At the same time, they need to give accurate measurements that are useful in the monitoring of heart failure. The systems were specifically designed to be used by elderly patients with limited experience using technology.

The technologies are still in the research stage, and they are currently being used in a clinical study for data collection at home by heart failure patients. We have confidence in the technologies, but further studies will be needed to prove the clinical value of our proposed solution. In the end, this is what it is all about.

Q. The research for detecting decompensation came from an initiative called MyHeart, funded in part by the European Union.  How else is Philips Research contributing to MyHeart, and what other research projects are currently underway?

A. Dr. Harris: Philips led the MyHeart project, one of the most successful and visible projects in its area which has resulted in many contributions to cardiovascular healthcare. Among the other contributions, Philips has worked in MyHeart developing a prototype system for the management of cardiovascular risk factors such as stress, sleep problems, lack of exercise, and others.

Philips is now leading the HeartCycle project - a follow-up project funded in part by the European Union. HeartCycle aims to 'close the loop' using telemonitoring technologies that enable patient measurements and analysis, to give feedback, when appropriate, to the patient at home, and to the physician.

With cardiovascular disease as the leading cause of death in the Western world, the efforts of MyHeart and HeartCycle are making important strides not only to increase early detection in cardiac disease but to improve overall heart health.

Eric