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Evaluation of Wrist-Worn Photoplethysmography Trackers with an Electrocardiogram in Patients with Ischemic Heart Disease: A Validation Study

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Abstract

Purpose

Photoplethysmography measurement of heart rate with wrist-worn trackers has been introduced in healthy individuals. However, additional consideration is necessary for patients with ischemic heart disease, and the available evidence is limited. The study aims to evaluate the validity and reliability of heart rate measures by a wrist-worn photoplethysmography (PPG) tracker compared to an electrocardiogram (ECG) during incremental treadmill exercise among patients with ischemic heart disease.

Methods

Fifty-one participants performed the standard incremental treadmill exercise in a controlled laboratory setting with 12-lead ECG attached to the patient's body and wearing wrist-worn PPG trackers.

Results

At each stage, the absolute percentage error of the PPG was within 10% of the standard acceptable range. Further analysis using a linear mixed model, which accounts for individual variations, revealed that PPG yielded the best performance at the baseline low-intensity exercise. As the stages progressed, heart rate validity decreased but was regained during recovery. The reliability was moderate to excellent.

Conclusions

Low-cost trackers AMAZFIT Cor and Bip validity and reliability were within acceptable ranges, especially during low-intensity exercise among patients with ischemic heart disease recovering from cardiac procedures. Though using the tracker as part of the diagnosis tool still requires more supporting studies, it can potentially be used as a self-monitoring tool with precautions.

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Acknowledgements

The study was partially funded by a Research Grant from the Universiti Malaya (RF009C-2018). Any other parties provided no other grants or funds. Special thanks to all the participants from the Universiti Malaya Medical Centre (UMMC) Rehabilitation Medicine Clinic and the UMMC Stress Test Lab physicians and technicians for their assistance in data collection.

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia

    Nur Syazwani Ibrahim, Eu Way Pek & Anwar Suhaimi

  2. Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia

    Sanjay Rampal

  3. Department of Nursing Science, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia

    Wan Ling Lee

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  1. Nur Syazwani Ibrahim
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Contributions

AS, RS, WLL, and NSI have contributed substantially to the research design, NSI collecting of the data, NSI and RS analyzing and interpreting the data. NSI and EWP have participated in drafting the manuscript. All authors have read and approved the final version.

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Correspondence to Sanjay Rampal or Anwar Suhaimi.

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Ibrahim, N.S., Rampal, S., Lee, W.L. et al. Evaluation of Wrist-Worn Photoplethysmography Trackers with an Electrocardiogram in Patients with Ischemic Heart Disease: A Validation Study. Cardiovasc Eng Tech 15, 12–21 (2024). https://doi.org/10.1007/s13239-023-00693-z

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