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Smart wristband developed to identify and manage atrial fibrillation

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It’s one of the most common conditions affecting those over 65 and left untreated can lead to stroke, blood clots in the veins and, in the most extreme cases, heart failure.

Atrial fibrillation currently affects more than 40 million people worldwide and the incidence and prevalence of the medical condition have increased three-fold in the past 50 years as populations age and survival rates for chronic diseases increase.

Now thought of as a global epidemic, 16 million people in the United States alone are projected to have been diagnosed with the ailment by 2050. In Europe, the figure among the over 55s is expected to reach 14 million by 2060.

It is estimated that by 2050, AF will be diagnosed in at least 72 million individuals in Asia.

One of the most common symptoms of AF is a pounding, fluttering, or quivering heartbeat, more commonly known as heart palpitations. Other signs include dizziness, fatigue, a fast heart rate of more than 100 beats per minute, breathlessness, and chest pain – many of the classic stress or anxiety signs that characterise a panic attack.

It’s one of the reasons that millions of people are walking around unaware that they are suffering from atrial fibrillation. How many times have you heard someone attribute their racing heartbeat to a caffeine-induced surge brought about by having drunk one too many coffees?

Many more are asymptomatic, meaning they are producing and showing no symptoms at all.

Often the condition will only be picked up when a patient undergoes a health check for an unrelated matter.

However, early detection and treatment of AF are paramount if later complications are to be avoided.

Without treatment, people with AF are up to five times more likely to suffer strokes, leading to the risk of severe disability and even premature death.

But new patient-safe monitoring technology to check and manage individual factors provoking atrial fibrillation, has been invented by Lithuanian researchers that could hold the key to earlier diagnosis and outcomes for the potentially serious heart condition.

A smart wrist-worn bracelet has been developed by Lithuanian scientists to identify atrial fibrillation. Credit: KTU

It involves patients wearing a so-called smart bracelet – already an accepted accessory for many – that uses an algorithm that can detect atrial fibrillation.

Traditional methods of diagnosing AF involve patients having to wear intrusive and uncomfortable sensors. But this new technology incorporates complementary sensors and a signal processing algorithm, with patients also being asked to input potential arrhythmia triggers on a mobile app.

The device is the result of a successful collaboration between the Kaunas University of Technology Biomedical Engineering Institute (KTU BMEI) and Vilnius University’s Santaros Clinics.

Researchers at KTU BMEI have been working in the field of atrial fibrillation monitoring technology development for more than a decade. It was several years ago that they developed the bracelet – the patent application for the device was submitted to the Lithuanian State Patent Bureau at the end of 2018 – which is aimed at older people, who can be especially self-conscious when using technologies and smart devices.

Professor Vaidotas Marozas, director of KTU BMEI, told Agetech World: “We are focusing on developing technologies which are needed for the public and contemporary medicine. For example, due to the prevalence of this condition (AF), every person older than 65 should be checked for atrial fibrillation.

“Non-invasive, compact wearable devices are an attractive solution for monitoring the health status of such high-risk groups.”

The disease usually starts with self-terminating so-called ‘paroxysmal episodes’ which, if recognised in time, can be treated by non-medication means.

These episodes may be different for each patient, however. For some, they may last for a short time and recur infrequently. For others, the episodes can be longer and more frequent.

But untreated AF will eventually develop into a persistent condition, which is more complicated to treat.

The smart wristband developed by Lithuanian scientists. Credit: KTU

The KTU-developed smart bracelet – which Lithuanian company, Teltonika, has stepped in to produce – has been used together with other devices in the TriggersAF project supported by the European Regional Development Fund.

The aim of the project coordinated by the Kaunas University of Technology in partnership with Vilnius University, is to develop and test methods that allow patients to identify their individual arrhythmia triggers via a wrist-wearing device.

It is already known that for some patients, atrial fibrillation episodes can be provoked by certain modifiable factors, such as alcohol, increased physical activity, stress, and sleep disturbance.

Identifying and avoiding individual factors would help determine non-pharmaceutical intervention methods to arrhythmia management.

As the project addresses a clinical problem, it has been important to have on board experienced clinicians who deal with AF daily. One of them is Justinas Bacevičius, a cardiologist at VU Hospital Santaros Clinics.

He said: “Although we see a wide variety of atrial fibrillation patients in our hospital, two types can be distinguished. The first group includes older, overweight, diabetic, hypertensive patients or those having sleep apnoea.

“The second group is the complete opposite – often they are young, professional sportspersons, businesspeople or performers who are experiencing a lot of stress.”

Mr Bacevičius said the data from the patients suggests a link between the onset of arrhythmia and sleep disorders.

He added that interestingly, even in patients who are not diagnosed with sleep apnoea, a correlation between snoring during sleep and the onset of atrial fibrillation in the morning, or later in the day, had been identified.

But with no objective methods to identify individual factors influencing the arrythmia in patients, KTU BMEI researchers in collaboration with cardiologists from VU Hospital Santara Clinics and their long-term partner Leif Sörnmo from Lund University in Sweden, have proposed one.

It assumes that arrythmia parameters, such as the relative duration of an episode, increase after an arrythmia-provoking factor.

Vilma Pluščiauskaitė, a PhD student at KTU and a junior researcher on the project, explained: “The essence of our proposed approach is that the patient uses a wearable bio signal-recording device for a set monitoring period, e.g. two weeks, and enters potential triggers for atrial fibrillation into a mobile app.

“For the next two weeks, the patient avoids the identified potential triggers, and the relation is assessed by an equation proposed by KTU BMEI researcher Dr Andrius Petrėnas.

“If a correlation between the influencing factor and the occurrence of arrhythmia is detected, the patient is advised to avoid the specific identified factor.”

The project’s database is the first of its kind in the world. It includes the recorded patients’ physiological signals, such as electrocardiogram and photoplethysmogram (a simple and low-cost technique that sends light pulses through the skin into the blood vessels to detect blood volume changes), and potential arrythmia provoking factors entered in a person’s mobile app.

The database collected by the researchers has allowed them to test the developed method and identify arrythmia-provoking factors in individual patients.

Professor Vaidotas Marozas. Credit: KTU

Project leader, Professor Marozas, is understandably delighted with its success, which will allow further development of the smart bracelet technology.

He said: “The database generated by the project is a unique result. We have managed to interest an international consortium funded by the European Metrology Association in this data. This consortium has invited us to join their new project as a partner and we will continue our work.”

The lack of technology currently available to individually identify arrythmia-provoking factors is probably due to the fact that monitoring has traditionally been inconvenient. Patients usually have to have an electrocardiogram (ECG), which is an electrical recording of their heart rhythm.

If that doesn’t identify a problem, then further monitoring will be needed, involving having to wear a portable ECG recording device for 24 hours or more.

Patients may also be required to fill in numerous questionnaires to pinpoint trigger factors, which can be subject to recall bias, where they either forget about a potential arrhythmia provoking stimulus or are reluctant to acknowledge the presence of certain influences, such as alcohol intake.

Mr Pluščiauskaitė said: “Certain influencing factors for arrythmia, such as increased exercise, stress, or sleep disturbances, can be identified from physiological signals by the dedicated algorithms. However, other influencing factors, such as alcohol consumption, are difficult to identify in the signals, so it is best if the patient has the opportunity to indicate when he or she consumed alcohol.”

He added that it is hoped that in the future, identifying these arrythmia triggers will only require a smart bracelet incorporating complementary sensors and signal processing algorithm.

 

 

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Sitting still for long periods increases mortality risk, says study

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Sitting for long hours without breaks can increase risk mortality risk in older women, a new study shows.

The research, published in the Journal of the American Heart Association (JAHA), has data showing that older women who sat for 11.7 hours or more per day increased their risk of death by 30 percent, regardless of whether they exercised vigorously.

The study examined measurements of sitting and daily activity collected from hip devices worn for up to seven days by 6,489 women, aged 63 to 99, who were followed for eight years for mortality outcomes.

This data was collected  as part of a long-term national project known as the Women’s Health Initiative (WHI), which began in 1991 and is ongoing, led by Andrea LaCroix, Ph.D., M.P.H., Distinguished Professor at the Herbert Wertheim School of Public Health.

The paper is the first to apply a novel and validated machine-learned algorithm called CHAP to examine total sitting time and length of sitting bouts in relation to the risk of death.

Study co-author Steve Nguyen, PhD., M.P.H., a postdoctoral fellow at the University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science, said: “Sedentary behaviour is defined as any waking behaviour involving sitting or reclining with low energy expenditure.

“Previous techniques for calculating sedentary behaviour used cut points that identified low or absent movement. The CHAP algorithm was developed using machine-learning, a type of artificial intelligence, that enhanced its ability to accurately distinguish between standing and sitting.”

Fine-tuning “sitting” enabled Nguyen to parse total sitting time and usual sitting bout durations.

Sedentary behaviour is a health risk because it reduces muscle contractions, blood flow and glucose metabolism.

Exercise cannot undo these negative effects, according to the study, whether women participated in low or high amounts of moderate-to-vigorous intensity physical activity, they showed the same heightened risk if they sat for long hours.

LaCroix explained: “When you’re sitting, the blood flow throughout your body slows down, decreasing glucose uptake. Your muscles aren’t contracting as much, so anything that requires oxygen consumption to move the muscles diminishes, and your pulse rate is low.

“If I take a brisk long walk for an hour but sit the rest of the day, I’m still accruing all the negative effects on my metabolism.”

Based on the research, LaCroix makes the following recommendation: “The risk starts climbing when you’re sitting about 11 hours per day, combined with the longer you sit in a single session. For example, sitting more than 30 minutes at a time is associated with higher risk than sitting only 10 minutes at a time. Most people aren’t going to get up six times an hour, but maybe people could get up once an hour, or every 20 minutes or so. They don’t have to go anywhere, they can just stand for a little while.”

However, Nguyen points out that not all sitting is the same.

“Looking beyond conditions like cardiovascular disease, we start thinking about cognitive outcomes, including dementia,” he said.

“There are cognitively stimulating activities that can result in sedentary behavior, like sitting while studying a new language. Is sedentary behavior in that context overall bad for a person? I think it’s hard to say.” Nguyen has recently received a National Institute of General Medical Sciences K99 award for 12 months of mentored research to look at protein signatures of physical activity and how they relate to dementia.

LaCroix added: “We’ve created this world in which it’s so fascinating to sit and do things. You can be engrossed by TV or scroll on your Instagram for hours. But sitting all the time isn’t the way we were meant to be as humans, and we could reverse all of that culturally just by not being so attracted to all the things that we do while sitting.”

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High risk of hospital readmission after surgery among older Americans

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A study finds an increased risk of hospital readmission for older Americans within 180 days of undergoing major surgery — a risk that is particularly acute for individuals who are frail or have dementia.

The findings from researchers at the University of Yale, were published in the journal JAMA Network Open.

Previous research by the same team demonstrated that major surgery is a common event for older Americans and also demonstrated a heightened mortality risk within one year of major surgery for people who are age 65 and older.

The new study is the first to describe both the short-term risk (within 30 days) and longer-term risk (within 180 days) of hospital readmission for older Americans who have recently had major surgery.

The study looked at hospital readmission among a nationally representative sample of 1,477 older Americans, not living in nursing homes, who had at least one major surgery between 2011 and 2018. More than one in four (27.6 per cent) had a readmission to the hospital within 180 days after major surgery; nearly one in eight (11.6 per cent) were readmitted within just 30 days.

Dr. Robert D. Becher, associate professor of surgery at Yale School of Medicine and co-senior author of the study, commented: “Prior to now, data on longer-term readmissions after major surgery in older persons have been lacking. This is problematic, as older persons undergoing major surgery represent a large and growing population.

“These readmission rates are high. And this study adds to our understanding of what it means to recover from major surgery as an older person.”

The numbers are even higher for those with geriatric-specific conditions such as frailty and dementia. Frail patients were readmitted within 180 days at a rate of 36.9 per cent; patients with probable dementia were readmitted at a rate of 39 per cent; and patients 90 years old and older were readmitted at a rate of 36.8 per cent.

Dr. Thomas M. Gill, the Humana Foundation Professor of Geriatric Medicine at Yale and co-senior author of the study, said: “These findings reenforce the importance of enhanced preoperative recognition of frailty and dementia in older persons and may inform patient and family expectations — and surgical decision making — about postoperative trajectories in the setting of these geriatric conditions.”

The issue of hospital readmission looms large in the USS health care system for a variety of reasons.

In 2018 alone, readmission costs totalled more than $50 billion, the researchers said. This was driven, in part, by the nearly 3.8 million 30-day hospital readmissions that year. The vast majority of those patients are Medicare beneficiaries aged 65 and older.

“From a patient perspective, the most important outcome among older persons with multiple conditions is maintaining independence and function. And we know that being readmitted to the hospital after major surgery can negatively impact that independence and function,” Becher said.

“So these new data put into perspective just how common hospital readmissions, and their negative downstream consequences, are to older persons.”

The researchers said the next steps in their examination of the issue will be to further understand why vulnerable older persons have such high readmission rates and suggest meaningful ways to minimise the risk of readmission.

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Risk factors for frailty in old age different in men and women, finds study

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A study conducted by researchers at the Federal University of São Carlos (UFSCar) in Brazil and University College London (UCL), found the factors that increase the risk of frailty in old age to be different in men and women.

The study, which was funded by FAPESP, is published in the journal Archives of Gerontology and Geriatrics.

According to the results, osteoporosis, low weight, heart disease, and poor hearing increased the risk of frailty in men, while a high level of fibrinogen (a marker of cardiovascular disease) in the blood, diabetes and stroke were associated with a higher risk of frailty in women.

The findings were based on an analysis of data from 1,747 participants in the English Longitudinal Study of Ageing (ELSA), an ongoing population survey that explores the dynamic relationships between health, functioning, social networks and economic status in people aged 50 and over who reside in England. ELSA began in 2002. These participants were interviewed and assessed every four years between 2004 and 2016.

The researchers selected participants aged 60 or more who initially did not have frailty syndrome and were not classified as pre-frailty (with only one or two of the above factors).

Frailty syndrome is characterised by the presence of three or more of the following factors: involuntary weight loss, fatigue, muscle weakness, slow gait, and a low level of physical activity. It is more common in women than men, partly because of women’s greater life expectancy.

Tiago da Silva Alexandre, last author of the article and a professor in UFSCar’s Department of Gerontology, explained: “Frailty syndrome serves as a warning sign of the possibility of a negative outcome in an older person. We used to think of frailty as having a single pathway in the elderly, but our study shows there are several routes. The differences between men and women in this regard are important for policymakers to take into account. They should influence primary health care and could result in more gender-specific action plans and intervention for older people.”

Frailty syndrome has a phenotype, he explained – a set of easily identifiable signs and symptoms designed to identify older people with a heightened risk of falls, hospitalisations, incapacitation, and early death.

“Our study went back a few steps before this process begins to find out which characteristics may lead to frailty during the lives of these older people. When we think about aging and the quality of life in old age, it’s very important to identify the main risk factors so as to be able to foresee problems and formulate public policy for men and women,” he added.

According to Dayane Capra de Oliveira, first author of the article, although frailty as a tool is based on biology, sex-related differences in risk factors for development of the syndrome are mainly associated with the different social roles of men and women, and with their different degrees of access to resources during their lives.

“Another key aspect is that frailty is a multifactorial condition. While socioeconomic factors, skeletal muscle disorders, heart disease and low weight appear to underlie frailty in men, in women the process appears to be driven mainly by cardiovascular and neuroendocrine disturbances,” Oliveira said.

Differences and similarities

According to the researchers, while some risk factors for frailty are the same for men and women – including old age, low educational attainment, sedentarism and depression, for example – differences in body composition and fat deposition throughout life and especially in old age may lead directly or indirectly to the appearance of components of frailty, such as metabolic alterations that culminate in the development of diseases, which in turn increase the risk of frailty.

Alexandre said: “Our study is based on data for people now aged 60 or more and living in England. We don’t know how these sex-based differences will play out in future generations. However, the fact is that the men in the cohort we studied were more exposed to several kinds of working conditions considered risk factors for diseases. Their diet was less healthy. They didn’t go to the doctor as much as the women [so that there was less early diagnosis]. They drank more and were more exposed to other substances that increased the risk of cardiovascular disease and heart attack.”

Women are more affected by chronic diseases, which are not as lethal but can be incapacitating.

He added: “The sex-based differences are a lifelong backdrop and culminate in different ageing processes, different causes of death or disability, and different kinds of frailty in men and women.”

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