Health Informatics Conference 2018 Ehsan M Hamdy, PhD Adjunct - PowerPoint PPT Presentation

Health Informatics Conference 2018 Ehsan M Hamdy, PhD Adjunct Fellow (Research) School of Science and Health Western Sydney University

It began with...  Started 11 years ago in 2007, during my Bachelor  I ludicrously announced Prof Lexin Wang that I had observed cardiac rehabilitation, it was all wrong, and I could fix it if he supported my Honours as Supervisor for 2009  I had actually observed patients suffer severe reactions to exercise, inappropriately prescribed by nursing staff In my defence, I wasn’t the only insane science geek emerging that year...

What happened next was weird...  He didn’t throw me out: “I believe you”, he said  My mind... blown!  Went on to my PhD, with Prof Wang as Supervisor then too  The first part of that huge project addressed a series of 12 retrospective data reviews  We’ll consider the first of these today

Intervention & Patients  Cardiac rehabilitation at Westmead hospital in Sydney  Between the years 2000 to 2011  Program: High-intensity aerobic interval training  Patients: Following some kind of serious cardiac event (4,202 total) We reviewed 1,703 patients who didn’t have a myocardial infarction (“heart attack”) in this particular review

Outcomes & Corrections  Total of 1,073 patients without MI completed the program  Majority were males (N = 814, 75.86%), which was the first important finding (confirmed earlier results elsewhere)  This study reviewed resting values for:  heart rate (HR)  systolic blood pressure (SBP)  diastolic blood pressure (DBP).

Outcomes & Corrections  Records were grouped into SB subgroups based on their measured blood pressure at pre-program assessment:  SB1 – resting SBP below 100 mmHg  SB2 – resting SBP between 100 to 130 mmHg  SB3 – resting SBP greater than 130 mmHg  Note: this is different to a pre-program diagnosis of hypertension by referring cardiologist

Outcomes & Corrections  SB subgroups were further divided into comorbidity subgroups (in males only, insufficient female numbers)  Based on the number of conditions including hypertension, hypercholesterolemia, diabetes and overweight/obesity:  MC0 – no conditions  MC1 – one condition  MC2 – two conditions  MC3 – three conditions  MC4 – four conditions

Outcomes & Corrections Table 1 – Resting physiologic outcomes in males and females SB1 SB2 SB3 Total (n) 113 515 186 ∆(bpm) -1.3 -1.4* -0.4 HR SD 12.1 12.3 11.3 ∆(mmHg) Males 10.6* 1.6* -12.0* SBP # SD 17.1 14.4 18.7 ∆(mmHg) 4.7* 0.1 -4.3* DBP # SD 11.0 9.8 10.0 Total (n) 33 147 79 ∆(bpm) -2.6 -2.6* -1.2 HR SD 12.4 14.5 13.1 ∆(mmHg) Females 11.3* -1.0 -12.0* SBP # SD 10.4 20.5 15.5 ∆(mmHg) 8.8* -2.0* -4.6* DBP # SD 10.8 10.9 9.5

Novel Trends  First, it’s not accurate to simply state that “exercise reduces blood pressure”, but rather exercise actually “CORRECTS” blood pressure  Those with low BP (hypotensives) achieve increases  Patients with high BP (hypertensives) show reduced BP  Second, comorbidities significantly impact resting physiology  Hypotensives with HIGHER MC comorbidity may show greater outcomes  Hypertensives with LOWER MC comorbidity may achieve greater changes

Implications: Clinical & Informatics  No longer acceptable to look at outcomes “in bulk”  Factors which influence outcomes should be effectively corrected for during analysis  Most importantly, we need to start classifying CR patients appropriately, in order to prescribe exercise safely and more effectively

Other parts of the project  There were 11 other retrospective reviews  Clinical CR program including novel elements based on the principles of exercise science  Patient classification  Patient motivation and education  Exercise assessment and prescription But the most important novel element was...

First use of “physiologic efficiency”  Framework of novel algorithms  “Physiologic algorithms of physical exertion” (PAPE)  Physiologic efficiency (equivalent of miles-to-the-gallon)  This concept of physiologic efficiency was developed and applied here for the first time in any context  PAPE was extended in follow-up patents for new IP work (ongoing)  Exhaustion, first- and second-order adaptation  Also includes “ mechano- physiologic” aspects of all the above

Follow-up  Full discussion and references in the linked paper  Discussion of extended PAPE framework in tomorrow’s poster session  Presenting at Health Data Analytics 2018  Full coverage of the extended PAPE framework and IP development  Melbourne – October 22 nd to 23 rd Thank you for your time. More info: ehsan@moovpad.com