Heart Rate Variability and the Digital Health Revolution - Voices 2015
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Heart Rate Variability and the Digital Health Revolution - Voices 2015
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Heart Rate Variability and the Digital Health Revolution Ronda Collier, SweetWater Health Voices 2015 www.globaltechwomen.com Thu March 12 13:00 PST Thu March 12 16:00 EST Thu March 12 20:00 UTC Fri March 13 1:30 IST Fri March 13 7:00 Sydney Session Length: 1 Hour According to leading medical institutions such as Stanford, Harvard and the Mayo Clinic, stress is responsible for more than 90% all disease. Most people are stressed to some degree and many are not aware of it. This may be due to the fact that the brain is a giant filter and pattern matcher. When a condition becomes familiar the brain filters it out, even if it is not good for you. HRV is the latest buzz word in the digital health revolution. It provides an objective measure of the stress or “fight or flight” response in your nervous system, and insight into situations, thoughts and behaviors that cause stress. In addition, it is a measure of systemic health and is an early indicator for heart disease and hypertension. Legacy HRV measurement systems were expensive, bulky and did not provide meaningful feedback for the general population. Thanks to mobile platforms such as smart phones and tablets, HRV is available to the consumer, providing an accurate and easy way to measure and manage the weak link in the chain, also known as stress.
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Heart Rate Variability and the Digital Health Revolution - Voices 2015
- 1. Ronda Collier SweetWater Health Global Tech Women March 12, 2015 SweetWater Health LLC 1 TM Heart Rate Variability and the Digital Health Revolution
- 2. Evolution of the Medical Tricorder Science Fiction Got it Wrong 2SweetWater Health LLC 1966 Star Trek 1987 Star Trek Next Generation 2015 SmartPhone + Wearables
- 3. 3 The Digital Health Revolution Growing Ecosystem SweetWater Health LLC Activity Trackers Heart Rate Monitors Sleep Tracking Workout Trackers Calories & Nutrition Blood Pressure Wireless Scales
- 4. 4 Not to Mention….. SweetWater Health LLC Personal Genotyping 24/7 Patch Blood Oxygen Electronic Pills Smartphone ECG Glucose Monitors
- 5. 5 What Does it all Mean?? Am I Healthy? SweetWater Health LLC Typical Dashboards
- 6. SweetWater Health LLC Confidential The Science of HRV What is Heart Rate Variability (HRV)? What does a healthy HRV look like? HRV in the mainstream 6
- 7. HRV and Vagal Tone 7 The vagus nerve is the 10th of 12 paired cranial nerves and controls parasympathetic innervation of the heart and acts to lower the heart rate. Vagal innervation is a mediator of HRV and therefore HRV is an indication of Vagal Tone The higher the HRV, the stronger the Vagal Tone In the past decade, college sports teams and world-class athletes have been increasingly using HRV to monitor fatigue and recovery from workouts. SweetWater Health LLC Confidential
- 8. 8 HRV and the Autonomic Nervous System SweetWater Health LLC Confidential The Autonomic Nervous System (ANS) has two branches: - Sympathetic - Parasympathetic Sympathetic “Fight or Flight” Branch speeds the heart up Parasympathetic “Rest and Digest” Branch slows the heart down
- 9. Fractal Patterns of HRV • Wavelet analysis is used to analyze heart rhythm • It turns out that the a healthy heart rhythm exhibits a fractal structure • Small changes in the “input” (the nervous system) results in larger changes in the fractal structure. – The Butterfly Effect • This fractal structure will reflect small changes in the nervous system – Enables early dis-ease detection SweetWater Health LLC Confidential (TOP) Color-coded wavelet analysis of a heart rate time series in health (Bottom) Color-coded wavelet analysis of a heart rate time series of patient with OSA Goldberger A L et al. PNAS 2002;99:2466-2472
- 10. So What Does This Mean to Me? 10 HRV is an indication of your resilience – the ability of the nervous system to respond and recover from physical or psychological stressors Sympathetic “Fight or Flight” response, also known as Stress, can be measured with HRV According to leading medical experts 90% of diseases and illnesses are due to stress Stress becomes the norm and the brain filters the familiar so we don’t know we are stressed Chronic low HRV is an indication of systemic health (psychological or physical) issues SweetWater Health LLC Confidential
- 11. Other Important Information on HRV • HRV value is dependent on length of measurement • HRV taken at same time each day • First thing in the morning while lying in bed is recommended • Try to keep a blank mind. Thoughts about a busy day can effect the reading – In same position • Lying down • Sitting • Standing – Measurement for same length of time each day (3 minutes typical) HRV has a circadian rhythm HRV is dependent on body position SweetWater Health LLC Confidential 6am 12pm 6pm 12am Circadian Rhythm HRV Time of Day
- 12. Why Don’t I Know About This? HRV Legacy Products 12SweetWater Health LLC Confidential
- 13. SweetWater Health LLC Confidential HRV in 2015 HRV going mainstream with meaningful feedback, Mobile platforms & consumer HRMs Enable early disease detection 13 Increasing number of HRV apps While Doctors are concerned with organ function… You can monitor the system that controls these functions
- 14. 14 Circling Back Around HRV and Digital Health SweetWater Health LLC Number of Steps Estimated Calories Heart Rate Sleep Stage Estimates Distance, Routes Estimated Calories Calories & Nutrition
- 15. 15 In Addition…. Bio-Hacking SweetWater Health LLC Magnetic Brain Stim ……and many, many more
- 16. Which venues, # steps, calories, exercises, ….are making me healthy? 16SweetWater Health LLC Confidential Objective measures of health
- 17. Closing Comments Digital Health, particularly personal mobile health apps and devices, are changing the way we take care of ourselves – We are taking charge of our health and becoming our own and our family’s advocates Personal health monitoring devices are give us data on our habits, including exercise and nutrition “Quantified Self” and “Bio-Hacking” devices and programs provide a plethora of self-improvement venues Because one size does not fit all, we need to monitor actual physiological health metrics such as weight, blood pressure and HRV HRV has emerged as the latest “must know” physiological metric SweetWater Health LLC Confidential
- 18. Thank You!
Editor's Notes
- 1. In 1966 it was a big klunky thing that hung around Dr. McKoy’s neck, in 1987 it was a flip phone like device and in 2012 it is a smartphone
- Jo Beth Dow and I founded SWH in Feb, 2011 While we develop apps as part of our product, we are a software technology company Our mission is to analyze the patterns of the heart beat, known as Heart Rate Variability, AND the patterns of Heart Rate Variability to detect onset of specific conditions The app and mobile platform serves as a real time detection device and as a data collection platform that utilizes 3rd party sensors and heart rate monitors. Our backend database is mined and advanced analytics are utilized to detect disease specific patterns in the data A rich and graphical tool suite brings the data to life with application specific functionality and user interfaces
- Jo Beth Dow and I founded SWH in Feb, 2011 While we develop apps as part of our product, we are a software technology company Our mission is to analyze the patterns of the heart beat, known as Heart Rate Variability, AND the patterns of Heart Rate Variability to detect onset of specific conditions The app and mobile platform serves as a real time detection device and as a data collection platform that utilizes 3rd party sensors and heart rate monitors. Our backend database is mined and advanced analytics are utilized to detect disease specific patterns in the data A rich and graphical tool suite brings the data to life with application specific functionality and user interfaces
- Jo Beth Dow and I founded SWH in Feb, 2011 While we develop apps as part of our product, we are a software technology company Our mission is to analyze the patterns of the heart beat, known as Heart Rate Variability, AND the patterns of Heart Rate Variability to detect onset of specific conditions The app and mobile platform serves as a real time detection device and as a data collection platform that utilizes 3rd party sensors and heart rate monitors. Our backend database is mined and advanced analytics are utilized to detect disease specific patterns in the data A rich and graphical tool suite brings the data to life with application specific functionality and user interfaces
- HRV is The variation between each heart beat and is a view into the ANS 30 years of research validates HRV as a significant metric for measuring health HRV is a mainstream topic of research Some HRV metrics SDNN – Standard Deviation of RR intervals pNN50 – Percentage of RR intervals/hour in which change in normal intervals exceeds 50msec rMSSD – Root Mean Square of Successive Differences of RR intervals SDNN, pNN50, rMSSD all have published cutoff points for risk of sudden death from MI HRV provides insight into the nature of heart-related diseases While there is still a gap in awareness of HRV between researchers and doctors in the medical community, HRV is an emerging biometric Insurance reimbursement codes accept HRV as a metric for measuring ANS Monitoring HRV allows individual to modify behavior, leading to positive change throughout the body’s tightly coupled system HRV measurements. CPT Coding 95921 and 95922 Two reimbursable CPT codes allow physicians to be paid for autonomic nervous system monitoring. These two reimbursable CPT codes for autonomic nervous system monitoring (95921 and 95922) were established in 1999. These CPT codes enable health care providers to be reimbursed for monitoring the autonomic nervous systems of patients where such monitoring is indicated. The reason for two CPT codes is simple. In order for physicians to get a complete look at autonomic nervous system functioning they must read both of its branches (Sympathetic and Parasympathetic) independently. CPT code 95921 is coded for parasympathetic nervous system monitoring and 95922 is coded for sympathetic nervous system monitoring. HRV measurements. CPT Coding 95921 and 95922 357.2 Polyneuropathy in Diabetes V628.9 Psychological Stress or Physical Stress not elsewhere classified 308 Stress Reactional Emotional 308.1 Predominant disturbance of consciousness 308.3 Other acute reactions to Stress 308.4 Mixed disorders as reaction to stress 308.9 Unspecified acute reaction to stress 458 Orthostatic Hypotension 458.1 Chronic Hypotension 429.9 Heart Disease unspecified
- Jo Beth Dow and I founded SWH in Feb, 2011 While we develop apps as part of our product, we are a software technology company Our mission is to analyze the patterns of the heart beat, known as Heart Rate Variability, AND the patterns of Heart Rate Variability to detect onset of specific conditions The app and mobile platform serves as a real time detection device and as a data collection platform that utilizes 3rd party sensors and heart rate monitors. Our backend database is mined and advanced analytics are utilized to detect disease specific patterns in the data A rich and graphical tool suite brings the data to life with application specific functionality and user interfaces
- These images represent the capability of HRV analysis for detecting variance of the ANS. These sorts of analysis are being performed within research institutions today and are not proprietary to SWH. To our knowledge, these analyses are not part of any commercially available HRV measurement system. This research provides a proof of concept for an HRV product in the predictive diagnostic segment. SWH is seeking funds to develop such a system. Based on research and our knowledge of information contained in time series, we assert that at the onset of disease, and through its progression, new patterns will emerge in HRV, patterns that will be unique for different conditions. Existing research, in general, has looked at static HRV numbers and often results in tables of Time, Frequency and Non-Linear HRV values correlated with the disease being explored. The result has been a generic “Low HRV is associated with….[Heart disease, stress, diabetes, OSA, COPD, etc.] and a table with HRV values published in the results section of the clinical trials. SWH believes that because of the rich and dynamic nature of the ANS, HRV must be analyzed as a pattern rather than as a static number and that the analysis should include the patterns between time, frequency and complex calculations for a given measurement as well as through measurements taken over time. Just like Apple did not invent the MP3 player, we did not invent HRV Analysis. The SWH plan is to take existing technology and made it useable and accessible to a wide range of customers while at the same time collecting vital signs and demographics. We envision a novel application of HRV that provides meaningful and actionable user feedback. Our technology contribution is that we analyze HRV data for patterns rather than data points The challenge is how to collect the data needed for such an endeavor and how to make money during the extensive R&D phase. We have a strategy to do both.
- Jo Beth Dow and I founded SWH in Feb, 2011 While we develop apps as part of our product, we are a software technology company Our mission is to analyze the patterns of the heart beat, known as Heart Rate Variability, AND the patterns of Heart Rate Variability to detect onset of specific conditions The app and mobile platform serves as a real time detection device and as a data collection platform that utilizes 3rd party sensors and heart rate monitors. Our backend database is mined and advanced analytics are utilized to detect disease specific patterns in the data A rich and graphical tool suite brings the data to life with application specific functionality and user interfaces
- HRV is computationally intensive So before powerful mobile platforms…. Priced from $1,500 to $42k require proprietary EKG Circadian rhythm, body position, length of measurement not generally taken into account thus results were hard to interpret These systems produce standard HRV parameters presented in graphical and numeric formats SweetBeat differentiates through: Mobile Cost effective Leverage advances in 3rd party sensors Artificial Intelligence to detect specific conditions Meaningful and actionable feedback for a wide range of users
- Underutilization of HRV in Mainstream HRV is a reliable reflection of the Autonomic Nervous System (ANS) HRV is a mainstream topic of research and yet is not part of mainstream medicine HRV viewed as a number 30 years of research has identified HRV as a systemic health metric Medicine has tried to associate disease with a “value” of HRV The nervous system is dynamic and non-linear so the patterns of HRV need to be studied and correlated with specific diseases Current HRV systems are lacking Current HRV systems are >$2500 and do not provide meaningful feedback SW runs on PCs; no mobile solutions available outside of a medical Holter Monitor Symptom driven medical culture Medical tests and treatment are sought once symptoms appear Few consumer friendly objective measurement tools for early detection and health improvement monitoring Stress, obesity, diabetes are epidemic It’s estimated that 90% of disease is caused by preventable stress 68% of adults are overweight or obese 26 million children and adults have diabetes and 79 million have pre-diabetes
- Jo Beth Dow and I founded SWH in Feb, 2011 While we develop apps as part of our product, we are a software technology company Our mission is to analyze the patterns of the heart beat, known as Heart Rate Variability, AND the patterns of Heart Rate Variability to detect onset of specific conditions The app and mobile platform serves as a real time detection device and as a data collection platform that utilizes 3rd party sensors and heart rate monitors. Our backend database is mined and advanced analytics are utilized to detect disease specific patterns in the data A rich and graphical tool suite brings the data to life with application specific functionality and user interfaces
- HRV is computationally intensive So before powerful mobile platforms…. Priced from $1,500 to $42k require proprietary EKG Circadian rhythm, body position, length of measurement not generally taken into account thus results were hard to interpret These systems produce standard HRV parameters presented in graphical and numeric formats SweetBeat differentiates through: Mobile Cost effective Leverage advances in 3rd party sensors Artificial Intelligence to detect specific conditions Meaningful and actionable feedback for a wide range of users