AN INVESTIGATION OF A NON-INVASIVE JUGULAR VENOUS PRESSURE POINT OF CARE DEVICE TO DIAGNOSE AND ASSESS HEART FAILURE IN LONG TERM AND PRIMARY CARE: A MIXED METHOD APPROACH

Introduction: There is a need for innovative solutions to better screen and diagnose the 7 million patients with chronic heart failure. A key component of assessing these patients is monitoring fluid status by evaluating for the presence and height of jugular venous distension (JVD). We hypothesize that video analysis of a patient’s neck using machine learning algorithms and image recognition can identify the amount of JVD. We propose the use of high fidelity video recordings taken using a mobile device camera to determine the presence or absence of JVD, which we will use to develop a point of care testing tool for early detection of acute exacerbation of heart failure. Methods: In this feasibility study, patients in the Duke cardiac catheterization lab undergoing right heart catheterization were enrolled. RGB and infrared videos were captured of the patient’s neck to detect JVD and correlated with right atrial pressure on the heart catheterization. We designed an adaptive filter based on biological priors that enhances spatially consistent frequency anomalies and detects jugular vein distention, with implementation done on Python. Results: We captured and analyzed footage for six patients using our model. Four of these six patients shared a similar strong signal outliner within the frequency band of 95bpm – 200bpm when using a conservative threshold, indicating the presence of JVD. We did not use statistical analysis given the small nature of our cohort, but in those we detected a positive JVD signal the RA mean was 20.25 mmHg and PCWP mean was 24.3 mmHg. Conclusions: We have demonstrated the ability to evaluate for JVD via infrared video and found a relationship with RHC values. Our project is innovative because it uses video recognition and allows for novel patient interactions using a non-invasive screening technique for heart failure. This tool can become a non-invasive standard to both screen for and help manage heart failure patients.

Download Full-text

Point-of-care B-type natriuretic peptide and portable echocardiography for assessment of patients with suspected heart failure in primary care: rationale and design of the three-part Handheld-BNP program and results of the training study

Clinical Research in Cardiology ◽

10.1007/s00392-017-1181-3 ◽

2017 ◽

Vol 107 (2) ◽

pp. 95-107 ◽

Cited By ~ 9

Author(s):

Caroline Morbach ◽

◽

Thomas Buck ◽

Christian Rost ◽

Sebastian Peter ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Natriuretic Peptide ◽

Point Of Care ◽

Training Study

Download Full-text

Accuracy, user-friendliness and usefulness of the Cobas h232 point-of-care test for NT-proBNP in primary care

Journal of Clinical Pathology ◽

10.1136/jclinpath-2017-204746 ◽

2017 ◽

Vol 71 (6) ◽

pp. 539-545 ◽

Cited By ~ 1

Author(s):

Chiel Hex ◽

Miek Smeets ◽

Joris Penders ◽

Viviane Van Hoof ◽

Jan Verbakel ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Clinical Decision Making ◽

Point Of Care ◽

Linear Regression Analysis ◽

Clinical Decision ◽

User Friendliness ◽

Point Of Care Test ◽

Percentage Difference ◽

Difference Plot

AimsN-terminal pro-B-type natriuretic peptide (NT-proBNP) has been shown to be useful for ruling out heart failure in primary care. In this study, we examined the accuracy of the Cobas h232 point-of-care (POC) instrument in primary care compared with an in-hospital measurement. Furthermore, we investigated the user-friendliness and usefulness of the POC device.MethodsFive general practitioner (GP) groups were asked to evaluate adult patients who were suspected of having heart failure and to test NT-proBNP with the Cobas h232. The samples were subsequently delivered to and analysed at a central hospital laboratory by the Cobas e602 using conventional transport and storage. Difference between the paired measurements was analysed using a percentage difference plot, and correlation was assessed using Passing-Bablok linear regression analysis. User-friendliness and usefulness were assessed using semistructured questionnaires.ResultsNineteen GPs studied 94 patients. Passing-Bablok analysis showed a slope of 1.05 (95% CI 1.00 to 1.11) (R2=0.97). The percentage difference plot showed a mean difference of 15.7% (95% CI −46.0% to –77.4%). User-friendliness and usefulness had median scores of 4 or 5 on a five-point Likert scale. Eighteen out of 19 GPs confirmed that the device influenced their clinical practice. During the study, GPs’ confidence in using NT-proBNP increased significantly from a mean score of 4.4 (95% CI 3.2 to 5.6) to 7.6 out of 10 (95% CI 7.1 to 8.2).ConclusionsThe Cobas h232 NT-proBNP POC test proved to be an accurate, user-friendly and useful test in primary care. Nearly all participating GPs were convinced that the test could benefit clinical decision making.

Download Full-text

Prognostic Importance of Elevated Jugular Venous Pressure and a Third Heart Sound in Patients with Heart Failure

New England Journal of Medicine ◽

10.1056/nejm200112273452610 ◽

2001 ◽

Vol 345 (26) ◽

pp. 1912-1913 ◽

Cited By ~ 4

Keyword(s):

Heart Failure ◽

Heart Sound ◽

Venous Pressure ◽

Jugular Venous Pressure ◽

Patients With Heart Failure ◽

Third Heart Sound ◽

Prognostic Importance

Download Full-text

An unusual suspect for heart failure

Acute Medicine Journal ◽

10.52964/amja.0797 ◽

2020 ◽

Vol 19 (1) ◽

pp. 42-42

Author(s):

Christianne Tan ◽

◽

Hitesh C Patel ◽

Justin Mariani ◽

◽

...

Keyword(s):

Heart Failure ◽

Medical History ◽

Clinical Examination ◽

Venous Pressure ◽

Heart Sounds ◽

Past Medical History ◽

Jugular Venous Pressure ◽

Significant Past Medical History ◽

Chest Auscultation ◽

History Of

A 71-year old retired missionary presented with a 2- week history of increasing dyspnoea, orthopnoea, and peripheral oedema. The patient had no previous significant past medical history. On clinical examination, his heart sounds were dual and his jugular venous pressure was elevated to 7cm. On chest auscultation there were bilateral crepitations at his lung bases.

Download Full-text

The epidemiology of heart failure in the general Australian community - Study of Heart failure in the Australian Primary carE setting (SHAPE): methods

10.21203/rs.2.17929/v2 ◽

2020 ◽

Author(s):

Richard Whaddon Parsons ◽

Danny Liew ◽

A Munro Neville ◽

Ralph G Audehm ◽

Deepak Haikerwal ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Medical Records ◽

Care Setting ◽

Primary Care Setting ◽

Venous Pressure ◽

Community Setting ◽

Annual Incidence ◽

Free Text ◽

Australian Community

Abstract There is a paucity of information on the epidemiology of heart failure (HF) in Australia. The Study of Heart failure in the Australian Primary carE setting (SHAPE) study aims to estimate the prevalence and annual incidence of HF in the general Australian community and to describe the demographic and key clinical profile of Australians with HF. Methods : We undertook a retrospective cohort study based on analysis of non-identifiable medical records of adult patients cared for at 43 general practices between 1 July 2013 and 30 June 2018. Data were extracted from coded (diagnosis, pathology and prescription fields) and uncoded fields (clinical notes) in the medical records. The latter searches of free text looked for common synonyms relevant to HF. The population was stratified into three groups based on a hierarchy of selection criteria: (1) definite HF, (2) probable HF and (3) possible HF. The prevalence and annual incidence of HF were calculated, along with 95% confidence intervals. Results: The practices provided care to 2.3 million individual patients over the five-year study period, of whom 1.93 million were aged 18 years and above. Of these patients 16,930 were classified as having ‘definite HF’, 4873 as having ‘probable HF’ and 36,517 as having ‘possible HF’. A further 40,992 were identified as having an aetiological condition associated with HF. A formal HF diagnosis, HF terms recorded as text in the notes and HF-specific medication were the most common methods to identify ‘definite’ HF patients. Typical signs and symptoms in combination with a diuretic prescription was the most common method to identify ‘probable HF’ patients. The majority of ‘possible’ HF patients were identified by the presence of 2 or more of the typical signs or symptoms. Dyspnoea was the commonest recorded symptom and an elevated jugular venous pressure the commonest recorded sign. Conclusions: This novel approach to undertaking retrospective research of primary care data successfully analysed a combination of coded and uncoded data from the electronic medical records of patients routinely managed in the GP setting. SHAPE is the first real-world study of the epidemiology of HF in the general Australian community setting.

Download Full-text

The epidemiology of heart failure in the general Australian community - Study of Heart failure in the Australian Primary carE setting (SHAPE): methods

10.21203/rs.2.17929/v3 ◽

2020 ◽

Author(s):

Richard Whaddon Parsons ◽

Danny Liew ◽

A Munro Neville ◽

Ralph G Audehm ◽

Deepak Haikerwal ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Medical Records ◽

Care Setting ◽

Primary Care Setting ◽

Venous Pressure ◽

Community Setting ◽

Annual Incidence ◽

Free Text ◽

Australian Community

Abstract Background: There is a paucity of information on the epidemiology of heart failure (HF) in Australia. The Study of Heart failure in the Australian Primary carE setting (SHAPE) study aims to estimate the prevalence and annual incidence of HF in the general Australian community and to describe the demographic and key clinical profile of Australians with HF.Methods: We undertook a retrospective cohort study based on analysis of non-identifiable medical records of adult patients cared for at 43 general practices between 1 July 2013 and 30 June 2018. Data were extracted from coded (diagnosis, pathology and prescription fields) and uncoded fields (clinical notes) in the medical records. The latter searches of free text looked for common synonyms relevant to HF. The population was stratified into three groups based on a hierarchy of selection criteria: (1) definite HF, (2) probable HF and (3) possible HF. The prevalence and annual incidence of HF were calculated, along with 95% confidence intervals.Results: The practices provided care to 2.3 million individual patients over the five-year study period, of whom 1.93 million were aged 18 years and above. Of these patients 16,930 were classified as having ‘definite HF’, 4873 as having ‘probable HF’ and 36,517 as having ‘possible HF’. A further 40,992 were identified as having an aetiological condition associated with HF. A formal HF diagnosis, HF terms recorded as text in the notes and HF-specific medication were the most common methods to identify ‘definite’ HF patients. Typical signs and symptoms in combination with a diuretic prescription was the most common method to identify ‘probable HF’ patients. The majority of ‘possible’ HF patients were identified by the presence of 2 or more of the typical signs or symptoms. Dyspnoea was the commonest recorded symptom and an elevated jugular venous pressure the commonest recorded sign.Conclusions: This novel approach to undertaking retrospective research of primary care data successfully analysed a combination of coded and uncoded data from the electronic medical records of patients routinely managed in the GP setting. SHAPE is the first real-world study of the epidemiology of HF in the general Australian community setting.

Download Full-text

Abstract 14972: Sub-clinical Atrial Fibrillation in Elderly Primary Care Patients Without Clinical Atrial Fibrillation

Circulation ◽

10.1161/circ.132.suppl_3.14972 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Jeff S Healey ◽

Stuart J Connolly ◽

Veena Manja ◽

Yan Liu ◽

Kim D Simek ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Primary Care ◽

Coronary Disease ◽

Cryptogenic Stroke ◽

Left Ventricular ◽

Ecg Monitoring ◽

High Background ◽

Non Invasive ◽

History Of

Introduction: Sub-clinical AF has been reported in 10% of pacemaker patients (≥ 6 minutes, with 3 months of monitoring) and 16% of patients following cryptogenic stroke (≥ 30 seconds, with 1 month of monitoring). It is unknown how common sub-clinical AF is among other patient groups, including the elderly. These data are needed to give context to the detection of sub-clinical AF in clinical practice. Methods: We prospectively investigated the prevalence of sub-clinical AF among individuals ≥ 80 years, without known AF or symptoms of arrhythmia, attending primary care clinics. Subjects had a history of hypertension and at least one of the following: diabetes, BMI ≥ 30, sleep apnea, smoking, coronary disease, heart failure or left ventricular hypertrophy. Patients were recruited from 7 Ontario family practice clinics (n=119) and one general medicine clinic (n=10). Patients underwent 30 days of continuous, non-invasive ambulatory ECG monitoring using a device with automatic AF detection (Vitaphone 3100). The primary outcome was a composite of atrial flutter (AFL) or AF ≥ 6 minutes in duration. Those without AF were invited to complete an additional 30 days of monitoring. Results: Of 129 patients screened and consented, 100 patients initiated monitoring for an average monitoring duration of 36± 21 days. The mean (SD) age was 84 ± 3 years and systolic blood pressure was 138 ± 17 mmHg; 50% had coronary disease, 28% had diabetes and 6% had heart failure. Only 4% had a history of prior stroke. Thirty days of monitoring was completed by 57% of patients and 31% completed an additional 30 days. AFL or AF ≥ 30 seconds duration was documented in 19/100 patients; ≥ 6 minutes in 15; ≥ 30 minutes in 12; ≥ 6 hours in 8 and ≥ 24 hours in 2. Shorter episodes of atrial tachycardia lasting less than 30 seconds were observed in 47 patients. Conclusions: In this prospective, outpatient study, using non-invasive ECG monitoring, we found AFL or AF ≥ 6 minutes in 15% of elderly individuals with stroke risk factors. This high background prevalence of AFL/AF among elderly patients suggests a possible role for AF screening in this population; but also should be taken into consideration when interpreting the prevalence of AFL/AF in other populations.

Download Full-text