MyHeart Counts20/11/2015 Dario Salvi

Acknowledgements

Aleksandra Pavlovic, Michael V. McConnell, Martin Landray,

Elizabeth Orchard, Lionel Tarassenko, Carmelo Velardo

Introduction

We know that being active helps to prevent heart disease

However, this knowledge is largely based on survey data

Thanks to smartphones and wearable devices we can now measure activity in greater detail

Can we use smartphones to identify what type and what amount of activity are best for the heart to stay healthy?

MyHeart Counts

• One of the 5 apps launched with Apple’s Research Kit

• Aim: to study activity, fitness, and cardiovascular health in the general population

• Collaboration between the University of Oxford and Stanford University

https://med.stanford.edu/myheartcounts.html

Study description

• Participants:• Adults, 18 and over

• Protocol:• Answer validated questionnaires about diet, cardiovascular health, sleep

quality, physical activity, wellbeing and risk perception, “heart age”• Perform 6-minute walk test• Measure daily activity for a week• Use the app for a week every three months

• Goals:• Compare measured activity to markers of cardiovascular health (fitness, risk

factors, disease status)• Follow for changes in cardiovascular health status to understand the types of

activity and other factors most predictive of improvement• Study behavioral interventions for modifying activity and ultimately

cardiovascular health (TBD)

Collaboration between Oxford and Stanford• A first version of the app was launched by Stanford

University for iPhones only

• University of Oxford is developing a version for Android phones

(Partially) based on Google Fit

Based on Apple HealthKit and Research Kit

Functionalities: consent and registration• Year-long discussions between ethicists and lawyers to

develop and approve a consent process on a smartphone

• Offers an introduction to the tasks to be performed by the participant and the legal and ethical consequences of the study

Functionalities: questionnaires

• Diet, Physical Activity Readiness, Activity and Sleep, Well-Being & Risk Perception, General Blood Pressure, Cardiovascular Health• Most sources are derived from AHA’s “MyLifeCheck”

toolkit

Functionalities: education

• Available educational content:• Information about the study

• Symptoms

• Treatments

• Online resources and news feed

Functionalities: 7-day activity assessment

• HealthKit and Google Fit provide activity detection based on accelerometry, wearable devices and manual input from the user

• The app sends a report about the activities performed in a week

Functionalities: heart age

• Uses the 2013 AHA/ACC ASCVD risk score system to provide 10-year and lifetime risks of having a heart attack or stroke

• Requires blood pressure and cholesterol data (manually input)

Functionalities: 6MWT

• Uses the pedometer and GPS to calculate distance

• HR is also captured if the appropriate device is connected

Issues about 6MWT

• Outdoor:• GPS signal is not always

available or reliable

• Indoor:• Counting steps can only

roughly approximate distance

• University of Oxford is developing an improved version of both measurements (higher accuracy)

Improved 6MWT: Indoor

• Counts lapses around two points at known distance

• Uses compass to detect U-turns

• Additional movement sensors and step counters are used to improve accuracy

• Error: 3% (5-20 meters)

Improved 6MWT: Outdoor

• Uses all means of localisation (GPS, WiFi, cell towers)

• Filters out unstable signal

• Additional movement sensor and step counter for increased accuracy

• Error: 4% (10-20 meters)

Android version

• Mostly similar, but some design aspects are adapted to Google’s recommendations

• Uses Google Fit instead of HealthKit for activity detection

• Still under development

Backend

• Managed by Sage Bionetworks

• Synapse: a tool to collect genomics, molecular, and imaging data.• Used for annonating data, tracking the relationship between

digital assets and sharing data. Integrates with R, Python and Linux shell.

• BRIDGE: a web-based, open-source tool that collects data from patients’ phones and feeds them into Synapse

Research Kit, experience so far

• We have used it only partially at University of Oxford• Offers a set of use cases already implemented *:

• Surveys• Consent• Gait and Balance• Tapping speed• Fitness (e.g. 6MWT)• Spatial memory• Sustained phonation

• Uses HealthKit as a personal health record and for activity recognition

• Open Source, SW framework, used by developers

* http://researchkit.org/docs/docs/ActiveTasks/ActiveTasks.html

Results

• The study was launched in March 2015 and is still ongoing

• More than 47000 participants joined

• Oxford improved 6MWT accuracy

Open questions

• How reliable are Apple Health Kit and Google Fit?

• How measurements vary among different devices?

• How to engage users in the long term?

Thank you

https://med.stanford.edu/myheartcounts.html