The evolution of digital well being applied sciences in heart problems analysis

Utilizing the search technique, 16,699 paperwork have been recognized within the subject of digital well…

The evolution of digital well being applied sciences in heart problems analysis

Utilizing the search technique, 16,699 paperwork have been recognized within the subject of digital well being applied sciences in cardiovascular medication. The primary article on file, printed in 1961 in Circulation is titled ‘Digital system for correct identification of cardiac conduction system- its use in open-heart surgical procedure’9. Within the interval of 30 years to the early 1990’s solely 35 extra related papers have been printed. For the reason that mid-1990’s there was an accelerating publication development till 2021, when over 2,300 articles have been printed in yr (Fig. 1a). Throughout the observable exponential development on this subject, there aren’t any distinct jumps in analysis exercise. Round 60% of the analysis output is within the type of unique analysis articles (together with case research), adopted by convention proceedings papers (14%), assembly abstracts (13%) and evaluate articles (9%).

Fig. 1: Years of publication and main sources.
figure 1

a Distribution of digital know-how analysis articles (in cardiovascular medication) from 1961 to 2021; b Main journals throughout the subject of digital know-how purposes in cardiovascular medication.

The highest globally cited articles have fairly distinct matters (see Supplementary Desk 2). Essentially the most cited paper is “Versatile polymer transistors with excessive strain sensitivity for utility in digital pores and skin and well being monitoring” authored by Schwartz, Tee10. The paper has acquired 1,337 citations in WoS supplies info on the fabrication of a novel versatile pressure-sensitive sensor that has excessive strain and time decision capabilities to constantly monitor the human radial artery pulse wave. It’s a step-change innovation as a result of beforehand, solely complicated devices reminiscent of micromanometers might learn a pulse with such accuracy. Moreover, the versatile strain sensors developed may very well be utilized in cell well being monitoring and distant diagnostics in cardiovascular medication. Different extremely cited papers embody matters about health-related behaviours reminiscent of sedentary existence11, remedy adherence12, robots13, and software program14, which highlights the variety inside this subject.

Particular topic areas have been recognized utilizing WoS Classes. Whereas many of the literature is concentrated in Cardiac and Cardiovascular Methods (n = 4,809, 28%), it reaches throughout a spread of sub-disciplines, together with Well being Care Science Companies (n = 1,643, 10%), Engineering Biomedical (n = 1,449, 9%), Engineering Electrical Digital (n = 1,255, 8%), Medication Basic Inside (n = 1,201, 7%), Peripheral Vascular Illness (n = 1,142, 7%), Medical Informatics (n = 1,118, 7%), Medical Neurosciences (n = 941, 6%) and Rehabilitation (n = 752, 4%). Circulation and European Coronary heart Journal are the dominant retailers for publications on this space of analysis (Fig. 1b), with round 700 paperwork attributed to those two alone.

Writer contributors and networks of collaboration

Over 75,000 authors have contributed to the subject, 2,956 of whom have authored 5 or extra articles. Authors with greater than 45 contributions embody Giuseppe Boriani (College-Hospital Polyclinic of Modena, Italy), Rizwan Sohail (Baylor School of Medication, United States of America [USA]), Tiny Jaarsma (Linkoping College, Sweden), Paul Friedman (Mayo Clinic School of Medication, USA), Bruce Wilkoff (Cleveland Clinic, USA), Larry Baddour (Mayo Clinic, USA), Jinseok Lee (Kyung Hee College, South Korea) Julie Redfern (College of Sydney, Australia) and Jenny Wang (College of Sheffield, England).

Publications originating from the USA have been most frequent (n = 5,493), adopted by England (n = 1,494), Italy (1,338), Germany (n = 1,191), China (n = 1047), Canada (n = 1030), and Australia (n = 908) (Fig. 2). There are fewer contributions from Africa and South America (aside from Brazil). Authors primarily based within the USA are concerned in all of the strongest collaborations; with England (n = 260), Canada (n = 248), China (n = 163), Germany (n = 163), Australia (n = 159) and Italy (n = 146) indicating that lingual similarities and geographical proximity don’t essentially foster larger collaboration. Collaborations between researchers from English-speaking nations reminiscent of Australia, Canada, England and USA and Center Jap nations Iran, Iraq and Saudi Arabia are amongst the most recent. Lastly, we will additionally observe that there are few low and middle-income nations producing scholarly analysis on this space.

Fig. 2: Patterns of scholarly collaborations between nations.
figure 2

The energy of collaborations between researchers from completely different nations, outlined by variety of paperwork, is indicated by the width of the hyperlink.

Semantic evaluation; key phrases, titles and abstracts

Desk 1 exhibits the highest key phrases (see additionally Supplementary Fig. 1 for density of co-occurrence of key phrases within the literature). In slightly below two years for the reason that time period emerged, Covid-19 (and alternate options e.g. sars-cov-2) have already garnered 270 mentions, reflecting the crucial of managing care when bodily distancing is demanded. Key phrases additionally present perception into the temporal shifts in analysis and scholarly focus. Desk 1 additionally exhibits the highest key phrases with the strongest bursts of quotation and the key phrases with the newest and strongest bursts of quotation. Kids and infants, males, youth, and aged sufferers are the populations of curiosity for students, as proven by bursts. Kids seemed to be a robust analysis curiosity for over twenty years (1991-2013), in parallel with analysis matters reminiscent of blood strain, cardiovascular reactivity and household historical past.

Desk 1 Prime key phrases, high key phrases bursts of citations and up to date key phrase bursts of quotation.

Within the early Nineties, when digital well being improvements have been quickly accelerating in cardiovascular medication analysis within the early Nineties, the key phrase bursts have been usually related to cardiovascular danger components (e.g. blood strain, train). Extra not too long ago, bursts of exercise are associated to trendy terminology affiliated with complicated knowledge and sensors, together with ‘IoT’ (web of issues), ‘neural community’ and ‘photoplethysmography’.

Main divisions of digital applied sciences in cardiovascular analysis

Further perception into subject construction of the subject was discovered by finishing an evaluation of the incidence of phrases within the title and abstracts of articles. Determine 3 exhibits the frequency of the co-occurrence of phrases and is complimented by the averaged publication yr of articles containing these phrases and the common variety of citations articles with these phrases obtain. The evaluation revealed that there are 5 main divisions. Desk 2 exhibits the highest phrases, most cited phrases, and youngest phrases for every cluster.

Fig. 3: Community-view map of time period co-occurrence in titles and abstracts of articles inside digital well being applied sciences in cardiovascular medication.
figure 3

Backside left: map of common publication yr; Backside proper: map of common variety of citations. An interactive on-line map is on the market right here: https://app.vosviewer.com/?json=https://drive.google.com/uc?id=1wo3ylYehGisHVX0CLM49voNitTjKsYOW.

Desk 2 Analysis areas with purposes of digital well being know-how from co-occurrence of phrases in titles and abstracts of articles.

Cluster 1 (Fig. 3; purple, 491 objects) focusses on Cardiac digital implantable units (CIEDs), together with pacemakers, implantable cardioverter-defibrillators and different units used to assist management of monitor heartbeats in people with well being rhythm problems and coronary heart failure (HF).

Cluster 2 (orange, 474 objects) represents the world of Cell well being know-how for secondary prevention of CVD. This consists of strategies of measuring danger components and modes for intervention designed to have an effect on the actions that people take concerning their well being. This division is saturated with phrases reminiscent of bodily exercise, wholesome way of life, Fitbit and step rely, and is related to scientific trials.

Cluster 3 (gray, 441 objects) consists of phrases associated to Wearable applied sciences. A big focus of this clusters is utilizing photoplethysmography – or sensor-technology to measure physiological parameters.

The final of the main divisions, Cluster 4 (yellow, 195 objects) is regarding Expertise purposes in stroke rehabilitation. Potential interventions for post-stroke rehabilitation have included use of immersive applied sciences and gamification reminiscent of Digital Actuality and robotics for growing motion.

Utilizing the interactive hyperlink to the visible illustration (see caption of Fig. 3), it’s decided that a number of the latest phrases in Cluster 1 are associated to the Covid-19 pandemic (‘lockdown’, ‘pandemic’, ‘sars cov’). All through the clusters, there may be lowered incidence of phrases associated to minority populations reminiscent of ‘incapacity’, ‘rural’ and ‘culturally various’.

The smaller division, Cluster 5 (purple, 57 objects) consists of phrases associated to Emergency cardiovascular care. The care and administration of out-of-hospital cardiac arrest (OHCA) is evolving and is strongly influenced by rising digital applied sciences. Examples embody wearable life detection applied sciences to enhance survival, drones delivering automated defibrillators to the scene of the arrest, and developments in cell and digital know-how used to leverage bystander response15.

Writer collaboration

Analyzing collaboration, Fig. 4 exhibits clusters of authors who ceaselessly work collectively to supply scholarly analysis. This determine doesn’t symbolize all 75,000 authors who’ve contributed to this subject general, solely those that have contributed to the central community of analysis (see Supplementary Desk 1 for particulars of every cluster). There are ten clusters with ten or extra authors.

Fig. 4: Clusters of creator collaboration by whole hyperlink energy.
figure 4

Co-authorship hyperlink energy is used to supply a sign of what number of publications two researchers have co-authored. Interactive map out there right here: https://app.vosviewer.com/?json=https://drive.google.com/uc?id=129YuMxn-9sn-ht5mCd88-ADpbh6nX0v5.

Clusters 1, 2, 3, 6, and 10 are teams of students researching cardiac electrophysiology. Nonetheless, there are some minor variations in analysis subject, for instance, clusters 3 and 6 is targeted on cardiac resynchronisation remedy, while clusters 2 and 6 are lead extraction and administration, and cluster 10 is related to analysis in infections related CIEDs. Cluster 1 could be very homogenous and primarily based in Western Europe, with few exceptions. Equally, Cluster 6 relies in North America, with a number of authors affiliated with Cleveland Clinic. Cluster 5, one other group researching thromboembolic illnesses and telecardiology, is unique to Italian affiliations. Except for matters associated to CIEDs, 4 of the opposite main collaborative teams are researching cardiopulmonary resuscitation (cluster #4), telemonitoring in HF and stroke prevention (cluster #7), mHealth and telemonitoring in HF (cluster #8) and secondary prevention of coronary coronary heart illness (CHD) (cluster #9).

The strongest hyperlinks inside this central creator community are between Ewa Piotrowicz and Ryszard Piotrowicz (cluster 7, hyperlink energy = 23.73), Friedrich Koehler and Kerstin Koehler (cluster 18, 13.50), and Clara Chow and Julie Redfern (cluster 9, 13.78). Nearly all of the strongest hyperlinks are between authors in the identical cluster, aside from frequent collaboration between Julie Redfern and Lis Neubeck (cluster 9 and 15 respectively, hyperlink energy = 7.33), which hyperlinks two teams of multidisciplinary clinician researchers who’re focussed on secondary prevention of CHD and CR.

Influential references of digital know-how and cardiovascular science literature

Influential articles related to the particular subject, ranked by native quotation rely, are listed in Supplementary Desk 3. This metric considers the reference lists of paperwork within the general dataset and what number of citations the references obtain. Primarily based on this metric, ‘Telemonitoring in Sufferers with Coronary heart Failure’16 is essentially the most influential research on this subject. The research indicated that the appliance of telemonitoring for sufferers not too long ago hospitalized for HF didn’t enhance outcomes. The opposite two most influential papers inside this subject are ‘2016 ESC Pointers for the analysis and therapy of acute and power coronary heart failure’17 and ‘Replace on Cardiovascular Implantable Digital Machine Infections and Their Administration: A Scientific Assertion From the American Coronary heart Affiliation’18. The final of which supplies an vital replace on suggestions for the care of sufferers with infections as a consequence of CIEDs, in addition to highlighting the analysis gaps. Research, opinions, and pointers focussed on HF, telemonitoring and CIEDs dominate the listing of high ten regionally cited articles.

Moreover, we will observe the articles which have had the strongest burst of citations since publication (see Supplementary Desk 4). The themes of all of articles with the strongest bursts are associated to telemonitoring or distant monitoring. The highest two are ‘Noninvasive residence telemonitoring for sufferers with coronary heart failure at excessive danger of recurrent admission and loss of life: the Trans-European Community-Residence-Care Administration System (TEN-HMS) research’ (energy = 36.55)19 and ‘Structured phone help or telemonitoring programmes for sufferers with power coronary heart failure’ (energy = 31.81)20.

Temporal evolution of digital well being applied sciences in cardiovascular analysis

The expansion and temporal evolution of this subject was visualized utilizing doc co-citation methodology. Determine 5 exhibits a birds-eye view of the twenty main divisions – or analysis streams – through which digital applied sciences have been utilized in cardiovascular analysis (Supplementary Fig. 2 exhibits the analysis streams in a timeline format).

Fig. 5: Birds-eye view of the analysis areas that digital applied sciences have been utilized in cardiovascular medication.
figure 5

A dynamic visualisation of the interaction between the analysis areas (from 1990 to 2021) is accessible through this hyperlink Temporal map_digital health_CVD.mp4.

Determine 6 supplies a visible illustration of the extent of analysis exercise inside every stream of digital well being purposes inside cardiovascular medication (1990-2021) (see Supplementary Fig. 3 for deeper perception into the twenty analysis streams). It’s evident that throughout the main streams, blood strain reactivity, bypass surgical procedure, cardiac reactivity to gaming and gamification are not lively analysis areas in digital well being purposes. We are able to clearly see that there are rising and heightened analysis actions within the areas of cardiac rehabilitation and out-of-hospital cardiac arrest. Analysis in distant monitoring, Digital Actuality, HF, transvenous lead extraction, distant monitoring, and arrythmias emerged between 2000-2010 and have maintained a excessive degree of scholarly curiosity since. Analysis into the appliance of wearables (smartwatches, physique sensors and so on.) and exercise monitoring for cardiovascular care, and eMRs, appeared to peak between 2015-2020 however at the moment are exhibiting indicators of slowing down. The oldest clusters, as decided by the imply yr of article publication are Cardiac reactivity (1981), and equally Blood strain reactivity (1984), and Software program evaluation of cardiac output (1989). The typical yr the citing articles are 1991, 1993 and 2007 respectively, exhibiting that there’s little or no trendy analysis being carried out in these areas. Contrastingly, analysis exercise we will see that essentially the most trendy matters are Cardiac rehabilitation (imply citing yr 2018), Exercise monitoring (2018), Radiology in sufferers with CIEDs, (2018), Arrythmias (2019) and Out-of-hospital cardiac arrest (2020).

Fig. 6: Variety of citations (orange datapoints) and variety of citing articles (blue datapoints) for every cluster.
figure 6

Left axis: whole variety of citations; Proper axis: whole variety of citing articles. Observe: scale is completely different for every cluster.

Cardiac rehabilitation is an fascinating cluster in that it has a few of oldest articles, relationship from 1954, but it surely nonetheless a modern-day analysis space. The sooner papers from mid-1970’s-1980’s have a give attention to behavioural change and self-efficacy21,22.

A paper by Chow, Redfern23, titled ‘Impact of Way of life-Centered Textual content Messaging on Threat Issue Modification in Sufferers With Coronary Coronary heart Illness A Randomized Medical Trial’ has acquired essentially the most native citations (n = 131, and globally n = 554) in addition to having the strongest burst of quotation (13.05) between 2017-2021. Chow, Redfern23, whose focus is secondary prevention of CHD, exhibits that utilizing a text-message intervention could enhance cardiovascular danger components reminiscent of blood lipids, bodily exercise, blood strain, BMI and tobacco consumption; a transparent instance of a easy digital well being utility for bettering cardiovascular care outcomes. Lastly, analysis associated to HF, CIEDs and distant monitoring make an look in additional than half of the analysis.