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 Males Total (n) 113 515 186 HR ∆(bpm)

• 1.3
• 1.4*
• 0.4

SD 12.1 12.3 11.3 SBP# ∆(mmHg) 10.6* 1.6*

• 12.0*

SD 17.1 14.4 18.7 DBP# ∆(mmHg) 4.7* 0.1

• 4.3*

SD 11.0 9.8 10.0 Females Total (n) 33 147 79 HR ∆(bpm)

• 2.6
• 2.6*
• 1.2

SD 12.4 14.5 13.1 SBP# ∆(mmHg) 11.3*

• 1.0
• 12.0*

SD 10.4 20.5 15.5 DBP# ∆(mmHg) 8.8*

• 2.0*
• 4.6*

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 22nd to 23rd

Thank you for your time. More info: ehsan@moovpad.com