Category: Heart

“Maybe there is a beast… maybe it’s only us” (Golding 183-195). As Humans we fight with doing good and bad constantly, but how does that shape our surroundings? In William Goldings novel Lord of the Flies, a group of young British boys get stranded on an island and are completely isolated from the rest of the world. As Readers, we mostly follow Ralph, as he attempts to bring the boys together and form a civilization. The kids must find ways to survive and face the many struggles added along the way. Golding incorporates the idea that human nature can shape how society functions; he develops this concept all while using strong elements like symbolism and conflict to craft his novel.

One Way Golding shows his idea is through conflict. Golding appears to have aimed to follow society’s imperfections back to their source in human instinct. His story Plotline works perfectly at showing this thought, by leaving a group of English young boys to battle for themselves on a remote island, Golding makes a human instinct like research center to analyze what happens when the requirements of development disappear, and crude human instinct dominates. In Lord of the Flies, Golding contends that human instinct, free from the imperatives of society, draws individuals from reason toward viciousness. “What are we? Humans? Or animals? Or savages?” (Golding 91). Piggy says this to Ralph during one of their gatherings. You can tell the boys are becoming more aware that the situation could become a bigger problem than what it is. The civilization formed by the young men structure in Lord of the Flies crumples under the heaviness of their intrinsic brutality: instead of keeping principles and buckle down, they seek after fun, surrender to dread, and tumble to savagery. “Kill the beast! Cut his throat! Spill his blood” (Golding 152). Golding’s fundamental contention is that people are savage commonly, and are moved by basic inclinations toward narrow-mindedness, fierceness, and predominance over others.

Another way Golding develops his concept is through symbolism. The conch that appears in the begging of the story represents more than what is first thought. When Piggy finds the conch, on the beach and discloses to Ralph what it is. He additionally discloses to him an imaginative thought of how and for what reason to utilize it. It is then used to accumulate young men and call a get together. ‘We can use this to call the others. Have a meeting. They’ll come when they hear us—’ (Golding 16). This citation shows how the young men utilized the conch shell to accumulate every one of the kids on the island. This at last gives Ralph a great deal of power and shows how the young men use resources on the island to impart and endure. In this association, it turns into an image of power, request, and law. It wins regard and dutifulness as well as demonstrates that the individual who is holding the conch has a definitive position. At the point when it is with an individual, each kid will undoubtedly pay regard and obey him. That is the reason Jack assaults conch to end the position and builds up his very own standard. The end of conch is a finish of the time of peace. Another symbol is the Lord of the Flies. Evil (the Beast) is not something physical or external that can be destroyed. Evil existed within the boys and was the reason why they were slowly descending into savagery. “Fancy thinking the Beast was something you could hunt and kill!’ ‘You knew, didn’t you? I’m part of you? Close, close, close! I’m the reason why it’s no go? Why things are what they are?’ (Golding 143). This is the leader of a pig that the trackers from Jack’s gathering pierce and plant on a stick to offer a penance to the animal. They accept that the monster which as far as anyone knows frightens them will be satisfied. It is a physical portrayal of their wonder towards that animal. The expression ‘the ruler of the flies’ allude to their naming it as the master of those flies which swarmed the leader of the dead warrior. It symbolizes something that will be displayed as a blessing to the monster to hold influence over the flies as it is their master.

Overall, Golding presents a clear idea that human instinct can shape how society works by showing the many ways the boys change to due their circumstances shaping the civilization they live in, and we see this in his symbolism and the conflict. In spite of the fact that the young men think the beast lives in the wilderness, it’s clarified that the beast lurks just in their souls.

Medical research

Aside from hearts being used in transplant, they are also commonly used in medical research(Frost and Sullivan 2017). In this paper, I will be evaluating the uses of hearts in drug testing and medical education. Drug testing is where a medical drug goes through a process of trialing to screen for efficacy, dosage, toxicity, and side effects the drug may have(Novartis 2016). Overall drug trials are used to see if a new medicine works as it should (NHS 2019). Medical education refers to where a medical practitioner research and test potential ways to improve care to patients and develop the direction of the medical industry(Lockton Health 2014).

Donor hearts are used in the preclinical stages of drug testing to test drugs for toxicity,efficacy and dosage. In 2020, NHS has announced their collaboration with Novartis, a pharmaceutical company, to create a brand new cholesterol treatment called Inclisiran to aid heart disease patients. So far, from clinical trials results showed that of the 300,000 heart patients supplied annually, it could prevent 55,000 patients from experiencing heart attacks and strokes. Inclisiran is a bi-annual injection which has been approved by the National Institute for Health and Care Excellence’s (NICE) so NHS England and Novartis will be able to make treatment widely available for heart patients as early as in 2021. The National Institute for Health Research (NIHR) supports the planning, preparation and delivery of the clinical research which is projected to cost £300 million each year. (GOV.UK 2020)

Figure 9: Artificial hearts used for drug testing (NovoHeart) (Forbes, 2019)

Artificial organs have began to be used in the world of medical testing. Previously for many years, donor organs and animals have been the subject of drug testing for safety and efficacy. In 2014, Ronald Li, Kevin Costa and Michelle Khine founded NovoHeart, a global biotech firm, where an artificial heart made from stem cells was created to mimic real human heart responses to drugs.

After researching for 20 years, the production of this small-sized “heart-in-a-jar” was created. The way in which this heart was created was that the small jar is replicated to act as one of the chambers that make up the heart. So far, these artificially produced hearts have successfully been able to detect any cardiotoxic effect that heart drugs may have. A major benefit of these artificial hearts is that, NovoHeart have been able to make hearts that can carry genetic abnormalities so that during the clinical trials of the drug testing, pharmaceutical companies can test on hearts that actually require the drug which is usually in short supply, the latter being that actual heart patients are put at risk when testing the drug.

Kevin Costa, Cofounder of NovoHeart, told Forbes that he believed that artificial hearts and other produced organs are the solution to revolutionizing drug testing as the process is made more patient friendly, increases effectiveness and reduces wasted resources, such as donor organs to test drugs on. He also pointed out the lack of predictiveness that cell cultures and small animal have for presenting the effects cardiac drugs would have on human patients.

In comparison to traditional drug testing, using artificial hearts would increase the precision in results of how the drug will react to the heart and reduce drug trial times as result precision will show the accurate effects of the drug immediately and time spent searching for diseased hearts would be reduced as they can also be artificially produced. These are issues that pharmaceutical companies face when testing with real hearts which can now be seen as a waste of potential donatable transplant hearts and dangerous to put real patients at risk when participating in drug trials as testing on animals and donor hearts can prove to be ineffective.

However, donor hearts play a crucial role in educating medical students. In order for aspiring, future doctors to understand the anatomy of the heart and how to deal with heart implications, they would need to be able to study a real one and dissect it. Therefore, to replace donor heart completely would not be realistic as doctors still need to research natural hearts to understand heart related diseases or illnesses that the majority of people who have natural hearts could face.

Summary and Conclusion

Having considering the points above, the advantages and disadvantages of the different types of hearts will be weighted. Considering the positive impact that artificial heart transplants make by reducing the build up of heart transplant waiting lists, it leads to question that when such resources are available instantaneously, could they be used entirely as a replacement to donor hearts. By replacing door heart transplants with artificial hearts, the many people in line for a heart transplant, who expire waiting, would be eradicated as there would not be the need to wait so long. This shows a strong downside in using donor hearts in comparison to artificial hearts since the long waiting time makes donor hearts an unreliable source for transplants, especially with the current fatal complacency the NHS is facing.

On the other hand, it is difficult to say that artificial hearts could fully replace donor hearts as transplant organs since they are on average less efficient. While artificial hearts could, theoretically, have a lifetime of 4.5 years, it is not realistic to assume that they will as the average is much lower (130 days). When looking at the lifetime of donor heart transplants (75% lasting 5 years), it is clear to see that donor hearts are the more time-sustainable option which suggests that they cannot be replaced by artificial hearts. While donor hearts are affected by negative lifestyle factors, these negative factors can be avoided but lifestyle issues caused by an artificial heart, like in Jim Lynskey’s case, cannot be avoided and can make a living with an artificial heart very challenging. In terms of its function, both types of hearts work equally well to ensure the patient’s heart functions normally, as if it weren’t damaged.

However, evaluating the costs will give a clearer view as to whether artificial hearts could replace donor hearts. If the average lifetime of a Total Artificial Heart (TAH) was taken and divided by a year, 3 TAHs would be needed. Meaning that in one year, a heart patient using TAHs in America could spend up to $450,000 for regular transplants. If this were to occur for 5 years, the patient would spend $2,250,000. Now, comparing a patient with a donor heart transplant (assuming it lasts for an average of 5 years), they would spend a total of $1,412,500 (cost of heart and 5 years worth of immunosuppressants). Currently, this is not the case as artificial hearts are only used as temporary transplant replacements for donor hearts. Yet, it shows that , overall, to live artificial heart after artificial heart is not financially viable, thus, reduces the idea that artificial hearts could replace donor hearts.

A significant advantage for the use of artificial hearts in transplants is that the major issue in donor heart transplants, organ rejection, is eliminated. This makes artificial heart transplants easier to deal with as the patient with an artificial heart is at a reduced risk of transplant malfunction (body destroying the heart) and avoids the pain and possible seizures that come with it.

Lastly, artificial hearts have begun to play a larger in the development of drugs, with the potential to over take real hearts as they have been proven to be more accurate, cheaper, more sustainable and less likely to put drug testing volunteers at risk. However, without real hearts continuing to be studied, we would cease to understand new developments found in real hearts that could aid to cure cardiac issues like cardiovascular disease. Not only that but there are many non-transplant-related solutions to cardiac issues like getting stents (mesh cages to open the hearts blood vessels). Real hearts (donor hearts) could not be replaced by artificial hearts for medical research as future doctors would need real hearts to practice surgical procedures to treat the vast majority of people who don’t live on artificial hearts.

It can be concluded that, although artificial hearts do play a key role in the development of the drug testing industry and have features that could resolve and simplify implication of heart transplants, they are simply not developed enough in terms of efficiency and the cost of them is currently not proportional to the return people would get from them. The idea that artificial hearts could replace the need to use donor hearts is not lost, as more research and trials could perfect any outstanding issues to make artificial hearts the more suitable option when considering between the two, whether that’s a patient needing a heart transplant or a pharmaceutical company deciding how they plan to put a cardiac treatment through drug trials.

“Can Heart failure be managed effectively with non-pharmacological measures?”

The heart’s main functions are to pump blood, nutrients, oxygen and hormones around the body. There are two types of heart failure; Heart failure with reduced ejection fraction (HFrEF) or systolic failure and Heart failure with preserved ejection fraction (HFpEF) or diastolic failure[9]. 70-75% of cardiac patients suffer from systolic heart failure and this is where the left ventricle loses its ability to contract normally. Diastolic heart failure is where the left ventricle loses its ability to relax normally. Both cases have the same level of danger, however there is no medication to reverse the effects of heart disease – only to slow it down. Symptoms of systolic heart failure are:

• Paroxysmal nocturnal dyspnea (severe shortness of breath and coughing usually at night)
• Orthopnea (shortness of breath when lying flat)
• Tachycardia (when the heart beats more than 100 times per minute)
• Cyanosis (a bluish discolouration to the hands or feet)
• Blood-tinged sputum (coughing up blood)
• Symptoms of diastolic heart failure are:
• Ascites (protein-containing fluid within the abdomen)
• Distended jugular vein (the pressure of the superior vena cava causes the jugular vein to bulge) [8]
• Dependent edema (swelling in the lower body)
• Fatigue
• Weight gain
• Enlarged liver and spleen

In this essay, I will look at managing heart failure effectively with non-pharmacological measures including; diet, salt, fluid, alcohol, smoking, exercise, stress and vaccination.

Diet

For a cardiac patient, they have to increase and decrease a lot of nutrients. For someone suffering from heart failure, doctors recommend 10-35% of their daily calories are proteins (around 46g for women and 56g for men) [14]. Research carried out by doctors have proved that heart failure patients have a higher need for protein intake than those without heart failure. However, generally red meats – such as beef, pork or lamb – have saturated fats in them which can raise the level of the patients blood cholesterol, worsening the effects of heart failure. Nonetheless, lean meats – such as chicken, turkey or fish – have unsaturated fats which actually have health benefits. Lean meats are also a good source of omega-3, vitamin B12, fatty acids, zinc, iron and niacin. Niacin helps increase the levels of HDL (high-density lipids) which is the “good” cholesterol. Vitamin B12 has been shown to decrease levels of homocysteine, a type of amino acid affiliated with heart disease. Patients with heart failure have been seen to have lower levels of zinc, which is essential to the maintenance of normal cellular structures and functions. Iron deficiency raises the risks of heart disease and also worsens the effects of heart failure as it worsens symptoms and increases mortality risk. Iron helps the formation of red blood cells that carry oxygen around the body and also regulates many important sub-cellular functions. Omega-3 fatty acids decreases blood pressure, reduces irregular heart beats and decreases triglycerides (a type of lipid found in the blood)

Salt

One way to effectively manage heart failure without any medication is to reduce the salt in their diet. For a person going through heart failure, it is important to cut out as much salt as possible as having too much can worsen the effect of fluid buildup that happens with heart failure because salt retains water. A low-salt diet can help keep blood pressure and swelling under control [1]. It is good to choose fruits and vegetables, grains and beans, and fresh, frozen, dried fruits, fresh meats, rice and pasta and bread as they are all low in salt[11]. For a cardiac patient, it is recommended to have no more than 2.300 mg (about 1 teaspoon), but it is ideal to have less than 1,500 mg (about ¾ of a teaspoon) of salt per day. It is also important for a cardiac patient to eat fibre-rich foods as it controls blood sugar levels and can reduce the level of cholesterol in the blood [2]. One way to calculate the amount of sodium in foods is by looking at the Nutrition Facts label (some claim to be “sodium free” or “low in salt”). If there is less than 5mg of salt per serving – it is sodium free; if there is very low salt – it would be less than 35mg of salt per serving and if there is reduced salt – it should be less than 140mg per serving. However, salt does occur naturally in foods so it is good to stay away from certain types such as; smoked, cured, salted or canned fish, meat or poultry (ham, sausage, sardines or anchovies); frozen breaded meats or dinners (burritos or pizza); salted nuts and canned entreés such as ravioli, spam or chili; cottage cheese; pizza croutons or salted crackers, olives, pickles or sauerkraut; large portions of ketchup or mustard; salted butter or margarine and instant puddings and cakes [13]. To further reduce salt levels, the patient can avoid instant foods or takeaways and try new cookbooks such as “Dietitians of Canada” [12].

Alcohol

It is also important to cut back on alcohol as it can affect the heart rate and worsen the effects of heart failure. Drinking more than the recommended amount (1 drink a day for women and two for men) can cause abnormal heart rhythms, high blood pressure and cause further damage to the heart [3].

Smoking

Smoking can not only lead to but also worsen cardiovascular diseases. The chemicals in cigarette smoke can cause the cells that line the blood cells to swell up, narrowing the blood cells and leading to many heart diseases. Continuing to smoke once they have heart failure can worsen the effects, so there is no safe amount of cigarettes to smoke. Even smoking versions of cigarettes with reduced tar and nicotine isn’t any better. It still doesn’t reduce the effects of heart failure.

Exercise

Exercising can help a patient suffering from heart failure. In the past, doctors used to think that the best thing to do was to give up physical activities- but it has been proved wrong. Activity including work and exercise is safe for most people with CVD. Exercise can help make the patient feel better, decrease the symptoms and can even improve the heart’s function. There are specialized programs for cardiac patients at health care centres[10]. They have specialized staff to help them exercise safely, frequently monitor the patients health and they can teach them how to maintain a healthy heart lifestyle [4].

Stress

Stress is a normal human emotion, but if left to fester it can lead to many emotional, psychological and physical factors such as; irregular heart beats, chest pains, high blood pressure and even heart disease [5]. Stress increases the risk of heart disease as it leads to an increase in the patients blood pressure. However, scientists are unsure whether stress itself is a risk factor or if it leads to other risk factors like smoking. If stress itself is a risk factor, then chronic stress can expose the body to unhealthy elevated levels of adrenaline and cortisol [6]. To cope with stress, patients can exercise regularly, stop smoking and get enough sleep each night [7]

Vaccination

In America 2010 it was recommended that heart failure patients take the pneumococcal vaccination and influenza vaccination. Complications with the flu (influenza) are more likely to occur in people with heart failure. However, getting the vaccination can reduce the risk of catching or developing complications from influenza.

1. “Heart failure and a low-salt diet” https://www.webmd.com/heart-disease/heart-failure/low-sodium-eating#1 [6th December 2019]
2. “Diet and Heart failure” https://www.webmd.com/heart-disease/heart-failure/dietary-guidelines-heart-failure [6th December 2019]
3. “Alcohol” https://www.bhf.org.uk/informationsupport/support/healthy-living/healthy-eating/alcohol [6th December 2019]
4. “Exercise and activity with heart failure” https://www.hfsa.org/patient/patient-tools/educational-modules/module-5/ [6th December 2019]
5. “Heart disease and stress” https://www.medicinenet.com/stress_and_heart_disease/article.htm#heart_disease_and_stress_introduction [6th December 2019]
6. “Heart disease and stress” https://www.medicinenet.com/stress_and_heart_disease/article.htm#heart_disease_and_stress_introduction [6th December 2019]
7. “Heart disease and stress” https://www.medicinenet.com/stress_and_heart_disease/article.htm#heart_disease_and_stress_introduction [6th December 2019]
8. https://www.researchgate.net/figure/Marked-bilateral-distention-of-external-jugular-veins-clearly-evident-in-patient_fig1_328832580 [11th December 2019]
9. http://www.globalsciencejournals.com/article/10.7603/s40602-015-0004-x [11th December 2019]
10. https://www.mfa.net/center/guilford-health-care-center [11th December 2019]
11. https://www.ottawaheart.ca/heart-failure-patient-guide/nutrition-guide-heart-failure [18th December 2019]
12. https://www.ottawaheart.ca/heart-failure-patient-guide/nutrition-guide-heart-failure
13. https://www.ucsfhealth.org/education/guidelines-for-a-low-sodium-diet [1st January 2020]
14. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/protein-and-heart-health [1st January 2020]
15. https://www.nia.nih.gov/health/heart-health-and-aging [1st January 2020]

Abstract

Wearable heart rate monitors are widely used these days due to its easy mobility and sleekness. There are a lot of different heart rate monitors available in the market and consumers generally don’t have a clear idea about which device would be better. Objective: Compare the accuracy of heart rate monitoring technology in 4 different watches. Method: Heart rate monitoring feature of four latest models of smartwatches from different brands were compared with a clinical ECG device. These devices are: Fitbit Charge 3, Garmin Forerunner 235, Apple Watch series 5 and Polar Vantage V. Results: The Apple Watch series 5, which uses the ECG technology gave the most accurate reading. Conclusions: ECG based technology gives better results as compared to PPG based technology. Clinical Impact: This study will be helpful for individuals in specifically choosing the best training device for their health-related uses.

Index Terms—Heart rate monitor watch, Electrocardiography, Photoplethysmography, Heartbeat, Fitbit, Garmin, Polar, Apple

I. Introduction

With the advancement in technology, recent developments have been seen in different fields of study such as education, communication, health, etc. In this fast-paced world, it is necessary to keep one’s heart rate in check in order to avoid any problems in the future. Since the world is developing, these days it is easy to measure the heart rate using the different devices available in the market. These devices may include many different types of activity trackers and heart rate monitors which are inbuilt in smartwatches to monitor various activities. However, there is no certainty whether these devices give accurate readings or not. The heart rate which give accurate readings are generally those used commercially in clinics. These are used for medical purposes. They are, however, too bulky to be used in everyday life since it consists of a lot of wires and circuits.[1] Presently, modern wearable devices are able of providing a lot of important health metrics such as step count, activity reports, Heart Rate Variability (HRV), sleep insights, glucose measure in the body, blood pressure readings, oxygen level of the body, etc.[2] Heart rate monitors are mostly used by sports persons and individuals who practice rigorous exercise. These individuals need to keep a regular check of their heart rate to avoid any harm. For such individuals, smartwatches would be the perfect alternative to the clinical equipment. This report analyses 4 different commercially available heart rate monitoring smartwatches.

A. Heart rate monitor

A heart rate monitor is a device through which one can measure their heart rate instantly and can also record this data. The recorded data can used to study for any discrepancies in the body since hate rate gives data relating to other different parts of the body too. A term relating to heart rate is Electrocardiography (ECG or EKG). It can be referred to as the computing of electrical heart data. [3] Electrical and optical are the two most common methods to record heart signals.

In the electrical methods, the heart rate is calculated by measuring the expansion and contraction of heart chambers which is controlled by electrical signals. These electrical signals generate bio-potential which is measured by ECG (Electrocardiography) sensors. [5]

In optical methods, light-based technology, also known as PPG (Photoplethysmography) is used to measure the blood volume controlled by the expansion and contraction of the heart. [5]

The heart rate data provided by these two methods is basically the same. The heart rate in both these methods is measured using computerized algorithms such as the Pan-Tompkins algorithm. [4]

B. Electrical HRM: Working

Chest straps are the main device employed to implement the electrical HRM. Chest straps work on the principle of ECG. It consists of an electrode pad which is activated when it comes in contact with moisture such as sweat or water. [6]

Figure 2: ECG components

When the individual is doing heavy exercise which results in sweating, the electrodes are activated and they grasp the electrical signals exuded by their heartbeat and send it to microprocessor where this data is analyzed for heart rate. There is a transmitter which serves the purpose of transferring this signal data to the mobile devices. It executes this using Bluetooth and chips. The individual gets the heart rate data on their mobile via the transmitter. Here, the smartphone acts as a receiver.

C. Optical monitors

Optical heart-rate monitors employ the principle of “photoplethysmography’ (PPG). It measures the flow of blood using light. The main components of a PPG device are a light source and a photodetector. The light source emits light. This light is reflected to a tissue and then measured by the photodetector. The reflected light gives the data of the blood volume.[7] This data, along with motion information detected by the device’s accelerometer, is later processed with algorithms to generate the comprehensible pulse readings. [6]

The light source in PPG sensor may be an infrared light emitting diode or a green LED. Infrared LEDs are generally used to measure the blood flow concentrated intensely in certain parts of body whereas green light calculates the absorption of oxygen in oxygenated and deoxygenated blood.[8]

Figure 3: Working of Optical heart rate monitor technology

The wearable PPG sensors can only be positioned at certain body locations such as the finger, earlobe and forehead. However, as the measurement sites are sites, their degree of accuracy may also change.[9] The most common wearable PPG sensor available in the market is positioned on the wrist. There are a few variations too, such as Moov’s latest fitness[10] tracker which consists of the optical heart-rate monitor on the temple.

D. Bioimpedance technology

Apart from the above discussed two technologies, there has been introduction of a new technology to measure the heart rate. It is known as bioimpedance technology. Bioimpedance measures the resistance of body tissue to minute electric current. This enables the capture of a wide range of physiological signals including the heart rate. This technique is similar to the measuring of the body composition such as fat content. Bioimpedance fundamentally tests the amount of opposition to the electrical current sent through your body tissues. [11]

Figure 4: Fig: measurement of resistance by body tissues in (a) vertical and (b) horizontal direction

The heart pressure is measurement of pulse wave velocity (PWV), i.e. the measurement of the distance and the transit time of the pulse between two arterial sites. [12]

This bioimpedance technology was used by a brand Jawbone for measuring the heart rate. However, the device only measures resting heart rate (just after you wake up) and passive heart rate throughout the day. There’s no option to track the active heart rate during a workout. [10]

This company was shut down in 2017 due to financial issues. The bioimpedance technology is still however, experimented and improvements are being made.

II. Mechanism

A. Fitbit charge 3

Characteristics:

1. Technology name: PurePulse – PPG. Although Fitbit doesn’t mention photoplethysmography, but the technology uses optical heart rate sensors that maintain extended battery life. [13]
2. SpO2 pulse oximetry sensor for sleep insights.. This sensor is useful in making Pulse oximetry, which is a test that measures what proportion of the oxygen-carrying molecules in the blood (called haemoglobin) are actually carrying oxygen. This is known as oxygen saturation or SpO2. Fitbit uses this sensor to generate the readings while sleeping and reports of any abnormality in the oxygen saturation while sleeping.[14]
3. Heart rate zones such as fat burn, cardio or peak zone
4. Automatic exercise recognition
5. All-day calorie burn
6. Real-time pace and distance: connect with phone’s GPS to see pace and distance during outdoor runs.
7. Wireless sync to android, iOS and windows devices.
8. 24X7 Heart rate tracking

B. Apple watch series 5

Characteristics:

1. Technology name: ECG App. The Apple watch uses ECG app to measure heart rate. This feature replicates a single-lead ECG with a titanium electrode in the watch’s Digital Crown and a layer of chromium silicon carbon nitride on the back of the watch. When you place your fingertip on the electrode, it creates a closed circuit from finger to heart to wrist and allows the watch to record the electrical impulses that make your heart beat. [15]
2. Alerts when noise level increases.
3. Compass and ground alleviation
4. Fall detection
5. International SOS trigger
6. Apps designed to keep health conditions like diabetes, stress in control
7. Advanced workout metrics

C. Garmin forerunner 235

Characteristics:

1. Technology name: Elevate- PPG [16]. Garmin works on the PPG technology to measure the heart rate.
2. Smartphone compatibility with iOS and Android
3. Live track
4. Step counter
5. Move bar: to alert period of inactivity
6. Sleep monitoring
7. Calories burned
8. Distance travelled
9. GPS based distance, time and pace
10. HR Zones

D. Polar vantage V

Characteristics:

1. Technology name: Precision Prime- PPG. Polar technology also works using the optical HRM technology. Its technology uses three methods to provide accurate heart rate: nine optical channels using several colors and wavelengths of light, 3D acceleration and an electrical sensor that measures the quality of sensor-skin contact. [17]
2. 9 LED Optical HR sensors
3. Electronic sensors for skin contact measurement
4. Extensive fitness features
5. Multisport mode to track several different sports in one session
6. Support for swimming metrics and cycling sensors
7. Bluetooth Connectivity

Comparision of heart rate monitors

The heart rate measurements of Fitbit Charge 3, Apple Watch Series 5, Garmin Forerunner 325, Polar Vantage V watch were compared with an ECG device. The ECG device gives readings with an accuracy of about 98%. These readings are compiled from various sources. [18][19][20]

Graph description: Mean changes in heart rate (HR) over time. Time represented in mins vs mean HR bpm on y-axis for both HRM watch and ECG device.

1. Fitbit Charge 3

Figure 5: image source: researchgate.net

Observation: We can see from the graph that the readings of FB Charge 3 are not in sync with that of the ECG device though it has a similar pattern like that of the ECG device.

2. Apple Watch Series 5

Figure 6: image source: exist.io

Observation: We can see from the graph that the readings of the Apple watch are quite in sync with that of the ECG device (Mio Alpha). This may be due to the fact that Apple watch uses the same technology as the ECG device. Therefore, their readings are similar.

3. Garmin Forerunner 325

Figure 7: image source: cnet.com

Observation: We can see from the graph that the Garmin Forerunner cannot cope up with readings of the ECG device under extreme conditions. The average reading is almost close to the ECG readings.

4. Polar Vantage V

Figure 8: image source: gadget.fitness

Observation: We can infer from the graph that the Polar Vantage V is lagging and takes time to warm up. The readings are, however, similar to the ECG readings.

III. Results and discussion

Comparing the accuracy rate and features of the four watches, we observe the following.

FITBIT CHARGE 3 APPLE WATCH SERIES 5 GARMIN FORERUNNER 325 POLAR VANTAGE V

HRM technology PPG ECG PPG PPG

Connectivity iOS and Android iOS iOS and Android Bluetooth

Accuracy Not very accurate Accurate Accurate only for normal activities Accurate but slow

Sleep insight SpO2 pulse oximetry Sleep tracking Sleep monitor Sleep tracking

Problems occurred Incorrect active heart rate reading Can only connect to iOS. Slow heart rate monitor, cannot cope up with chest strap. Lagging heart rate monitor. Takes time to warm up.

Additional features Heart rate zones, all day calorie burn Noise level alertness, Fall detection Move bar, Heart rate zones 9 LED Optical HR sensors

From the result table and graphs, we could observe that all the systems were capable of generating the accurate reading under normal circumstances, i.e. when the user is not doing any heavy exercise. However, some of the watches show inaccurate readings when the user is doing heavy exercise.

Apple Watch Series 5 has stood out among the other 3 with accurate readings even under extreme circumstances.

The heart rate monitoring accuracy of the four devices can be ranked in the following order:

1. Apple watch series 5
2. Polar Vantage V
3. Garmin Forerunner 235
4. Fitbit Charge 3

Challenges in measuring heart rate using wrist-based devices:

Since wrist-based HRM devices mainly depend on testing the light absorption of skin to determine the heart rate, it may face some challenges in order to get an accurate reading. The following are a few such challenges: [21]

• The light of the heart rate sensors may be blocked due to tattoos.
• It may not give accurate reading for dark skinned people since light sensors may not be able to penetrate through the skin.
• Wrong positioning of the band may result in incorrect readings.
• The band needs to be tightly worn around the skin
• Cold weather may infer with the readings of the device

IV. Conclusion

The present study compared four commercially available online heart rate monitoring systems with its main focus on their use in daily life of individuals. The Apple Watch series 5, which uses ECG technology gave the most accurate reading. The athletes and other individuals competing in extremely vigorous activity need to be able to track exertion levels and design training plans that are appropriate, in order to avoid injury, leading a healthy lifestyle and improving their fitness training.

References

1. Duarte Dias, and João Paulo Silva Cunha, “Wearable Health Devices—Vital Sign Monitoring, Systems and Technologies” 2018. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111409/
2. Denisse Castaneda, Aibhlin Esparza, Mohammad Ghamari, Cinna Soltanpur, and Homer Nazeran, “A review on wearable photoplethysmography sensors and their potential future applications in health care”, 2018. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426305/
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5. Neurosky, “ECG vs PPG for Heart Rate Monitoring: Which is Best?” Available: http://neurosky.com/2015/01/ecg-vs-ppg-for-heart-rate-monitoring-which-is-best/
6. Valentina Palladino , “How wearable heart-rate monitors work, and which is best for you”, 2017 Available: https://arstechnica.com/gadgets/2017/04/how-wearable-heart-rate-monitors-work-and-which-is-best-for-you/
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Research report

Claim: Stems cells have the potential to improve life.

Research question: Does umbilical cord stem cells or 3D printed mini heart have the most potential to repair or replace damaged cardiac tissue in vascular disease patients?

Rationale

Cristy Lytal from the Keck School of Medicine of USC claimed that ‘if you lose a limb, it’s lost for life. If you damage a kidney, you won’t grow a new one. And if you have a heart attack, the scars are there to stay’. ‘But regenerative medicine is poised to change all of this. Building new tissue is within sight’. The article discussed how much potential stems cells have in regenerative medicine and how they could be used to grow or repair new organs. The article talked about various potential stem cell treatments, including ‘healing hearts’ and how they stem cells are still in the very early stages of research. (Growing hope: New organs? Not yet, but stem cell research is getting closer, 2020).

Consequently, a broad research question of “which potential stem cell treatment has the most potential to improve the heart” was created based on the research claim. This was further refined to detail two specific stem cell treatments and was limited to “damaged cardiac tissue in vascular disease patients”.

This report investigates which future treatment either using umbilical cord stem cells, or 3D printed mini hearts has the most potential to repair or replace damaged cardiac tissue in vascular disease patients. It explains both treatment options in detail and evaluates which is the more effective option to potentially repair or replace damaged cardiac tissue. It was found in this report that the 3D mini heart has the most potential then the Intravenous infusions with umbilical cord-derived stem cells. A potential problem with the research of this report was that the treatment of the heart using stem cells is still young does not have a large amount of clinical trials involving repairing or replacing damaged cardiac tissue. Conducting this investigation again when there is further research and clinical trials around stem cells plus the treatment of damaged cardiac tissue would fix this problem.

Diagram 1: coronary artery disease

Background

Cardiovascular disease refers to conditions such as heart attacks, chest pain, strokes, congenital heart disease (which a person is born with), coronary artery disease, among others. Cardiovascular disease can affect the body and heart in many different ways depending on the condition.

The following effects can be caused by heart disease: less blood flow which means that the heart doesn’t get the oxygen it needs which causes chest pain, affecting how well your heart pumps making the rest of the body short on oxygen which means your cells don’t work as well as they should causing shortness of breath or feeling tired. Having swollen legs, feet, ankles, or stomach because your body cannot get blood back to your heart. The heart muscle can become thick, stiff, or larger than normal which over time makes the heart get weaker which makes it harder for it to pump blood and keep its regular rhythm. If Heart muscle thickens then blood flow is limited, so the patient is short on oxygen which can cause problems like dizziness, fainting, and shortness of breath. Heart defects often make your heart work harder, which can cause heart failure. Some of these effects can be seen in diagram 1 (shown above).https://www.verywellhealth.com/coronary-artery-disease-symptoms-1745924

Cardiovascular disease is the leading cause of death in Australia. According to the Australian Bureau of Statistics in 2017 ‘there were 160,909 deaths in Australia (82,858 males and 78,051 females) …18,590 of those deaths were due to heart disease’. (3303.0 – Causes of Death, Australia, 2017, 2020). In 2017-2018 ‘An estimated 1.2 million (6%) Australian adults aged 18 years and over had 1 or more conditions related to heart or vascular disease, including stroke, in 2017–18’. (Cardiovascular disease, How many Australians have cardiovascular disease? – Australian Institute of Health and Welfare, 2020). Because cardiovascular disease is not yet treatable, affects 6% of the Australian population and, is the leading cause of death in Australia a potential treatment needs to be found.

Analysis

Intravenous infusion of umbilical cord mesenchymal stem cells:

As there is no cure or treatment for heart disease there have been many different trials investigating whether various stem cells could improve or replace damaged heart cells. A clinical trial using umbilical cord mesenchymal stem cells conducted by Circulation Research (Safety and Efficacy of the Intravenous Infusion of Umbilical Cord Mesenchymal Stem Cells in Patients With Heart Failure, 2020) ‘showed promise’ as a heart failure treatment. This trial involved giving 30 patients aged 18-75 with HFrEF (appendix A1) intravenous infusions (appendix A2) with either umbilical cord-derived stem cells or placebo. The patients treated with umbilical cord mesenchymal stem cells (UC-MSC) presented no adverse events related to the cell infusion and there were no alloantibodies (appendix A6) present at 0, 15 and 90 days. This means that the UC-MSC treatment is safe for any future clinical trials. (Umbilical cord stem cells show promise as heart failure treatment, 2020)

The trial also showed that at 3, 6 and 12 months the UC-MSC treated patients showed improvements in left ventricular ejection fraction (appendix A4 and A5) as seen in the table below, whereas the placebo treated group did not.

As shown by the table above this treatment improves left ventricular ejection fraction (LVEF) of UC-MSC treated patients but not the placebo treated patients. Therefore, this means that the amount of blood being pumped out of the left ventricle of the heart, the main pumping chamber is increased, thus helping to counteract HF-rEF (a lower than normal ejection fraction, Appendix A1).

US-MSC patients also answered multiple quality of life questionaries at flow-up points to assess their perception of the effects of heart failure on: physical, socioeconomic, psychological aspects of their life, physical limitation, symptoms, quality of life, social limitation, symptom stability, and self-efficacy. As shown in the table below, in the ‘Minnesota Living with Heart Failure Questionnaire’, the UC-MSC treated group showed a higher baseline and efficacy outcomes. Therefor this means that the UC-MSC treated patients’ quality of life improved due to the treatment whereas the placebo treated group did not. (Safety and Efficacy of the Intravenous Infusion of Umbilical Cord Mesenchymal Stem Cells in Patients With Heart Failure, 2020)

3D printed mini heart

Researchers from Aviv University have printed a 3D heart using a patient’s own cells. ‘Although the heart is about 2.5 centimetres and is too small for humans’ researchers say that it has great potential and could be used to patch diseased hearts and in full transplants. The heart is printed with blood vessels, ventricles and chambers using the cells from the patient’s own biological materials (Dr. Edith Bracho-Sanchez, 2020). This means that the heart is completely biocompatible and matches the patient, reducing the risk of rejection inside the body, and removing the need for the patient to take medication to prevent rejection. It is also believed that instead of printing full 3D hearts perhaps patches can be printed which can improve or remove the diseased areas of the heart and replace them with something that works. (Arnold, 2020)

The process of printing the mini heart is comprised of millions of cells and takes about three hours to print. The process works by taking fatty tissue from a patient, then separating it into cellular and non-cellular components. After this the cells are reprogrammed to become stem cells which are turned into heart cells. Finally, the cells mature for a month or so after being printed to allow them to beat and contract.

Although the mini heart has the potential to replace damaged hearts, they are not ready for humans and there is no set schedule for when they will be ready for clinical trials or even to be tested on animals. It is also unclear whether a 3D printer can produce hearts superior to human ones or not.

Conclusion

It was found in this report that both the 3D mini heart and the Intravenous infusions with umbilical cord-derived stem cells both have potential to repair or replace damaged cardiac tissue in vascular patients. However, the 3D mini heart has the most potential to replace and improve damaged cardiac tissue in vascular disease patients. Although the 3D mini heart is has not yet made it to clinical trials and is still in the initial stage or testing/research it is likely to be the effective option to go with as it has a higher chance of working. This is based on the proposed potential positive effects it could have on patients with vascular diseases in the future. As cardiovascular disease is the leading cause of death in Australia the mini heart could potentially save the lives of those inflicted with heart disease. If the mini heart is printed at the actual size of a human heart, then the research could lead to being able to 3D print any part of the body which could cure many other diseases or slow them down.

The Intravenous infusions with umbilical cord-derived stem cells has potential but does not have as much potential as the 3D mini heart to repair or replace damaged cardiac tissue in vascular disease patients. This treatment did show significant improvements in left ventricular ejection fraction and quality of life, but it cannot replace or repair the heart like the 3D printed mini heart has the potential to.

Overall it was found in this investigation that stems cells have the potential to improve life as the 3D mini heart (which is made from stem cells) has the potential to repair and replace damaged cardiac tissue in vascular patients, thus ‘improving life’.

Evaluate

All of the sources used in this investigation can be considered reliable and trustworthy. This is because all of the sites were fully referenced and sourced from a published study or trial. However, there are also issues associated with the sources. Ahajournals.org. 2020. Safety And Efficacy Of The Intravenous Infusion Of Umbilical Cord Mesenchymal Stem Cells In Patients With Heart Failure was the only source of information found that had conducted a trial on the heart using Intravenous infusion of umbilical cord mesenchymal stem cells. Another issue with the evidence is that there were no clinical trials for the 3D mini heart as it is still in the initial stages of research and not yet ready to be tested.

Suggestions, improvements, and extensions to the investigation

The 3D printed heart is still in the early stages of research/testing so if more research was conducted. For example testing the mini heart on an animal to see if the heart could actually work then if it does work moving onto the next stage – figuring out how to successfully print the 3D heart to the size of a human heart. After figuring out how to print a human sized heart a clinical trial should be conducted. The results of this clinical trial would allow for a more detailed research investigation to take place, providing more information on the heart and if it could actually repair or replace damaged heart or cardiac tissue.

An extension to this investigation would be adding more stem cell treatments. In this investigation only two stem cell treatments were researched, thus not all of the options were researched, so a better stem cell treatment could be out there. A larger range of stem cell treatments with clinical trials for each new option would allow for a better decision to be made on what stem cell treatment option has the most potential to repair or replace damaged cardiac tissue. A potential treatment that could be added is embryonic stem cells in cardiac repair and regeneration (appendix A3).

Appendix

Source 1 (code A1) – HfrEF definition

‘Reduced ejection fraction (HFrEF) – also referred to as systolic heart failure. The heart muscle does not contract effectively, and therefore less oxygen-rich blood is pumped out to the body’

Cleveland Clinic. 2020. Heart Failure: Types, Symptoms, Causes & Treatments. [online] Available at: [Accessed 4 June 2020].

Source 2 (code A2) – Intravenous infusion

Intravenous infusion is the ‘administration of fluids into a vein by means of a steel needle or plastic catheter.

TheFreeDictionary.com. 2020. Intravenous Infusion.. [online] Available at: [Accessed 4 June 2020].

Source 3 (code A3) – Embryonic stem cells in cardiac repair and regeneration

Clinical trial for embryonic stem cells in cardiac repair and regeneration. For more information visit the link below.

www.ncbi.nlm.nih.gov. 2020. Embryonic stem cells in cardiac repair and regeneration. [online] Available at: [Accessed 4 June 2020].

Source 4 (code A4) – EF

‘EF that is below normal can be a sign of heart failure. If you have heart failure and a lower-than-normal (reduced) EF (HF-rEF), your EF helps your doctor know how severe your condition is’.

www.heart.org. 2020. Ejection Fraction Heart Failure Measurement. [online] Available at: [Accessed 4 June 2020].

Source 5 (code A5) – Left ventricular ejection fraction (LVEF)

‘Left ventricular ejection fraction (LVEF) is the measurement of how much blood is being pumped out of the left ventricle of the heart (the main pumping chamber) with each contraction’.

Cleveland Clinic. 2020. Ejection Fraction. [online] Available at: [Accessed 4 June 2020].

Source 6 (code A6) – Alloantibodies

‘Alloantibodies are immune antibodies that are only produced following exposure to foreign red blood cell antigens. Produced by exposure to foreign red cell antigens which are non-self antigens but are of the same species. They react only with allogenic cells. Exposure occurs through pregnancy or transfusion’.

Labce.com. 2020. Alloantibodies Vs. Autoantibodies – Labce.Com, Laboratory Continuing Education. [online] Available at: [Accessed 4 June 2020].

References

1. Ahajournals.org. 2020. Safety And Efficacy Of The Intravenous Infusion Of Umbilical Cord Mesenchymal Stem Cells In Patients With Heart Failure | Circulation Research. [online] Available at: [Accessed 23 May 2020].
2. Australian Institute of Health and Welfare. 2020. Cardiovascular Disease, How Many Australians Have Cardiovascular Disease? – Australian Institute Of Health And Welfare. [online] Available at: [Accessed 25 May 2020].
3. Abs.gov.au. 2020. 3303.0 – Causes Of Death, Australia, 2017. [online] Available at:

Abstract-

In the current era deaths due to heart disease have become a major issue. Approximately one person dies per minute due to heart disease. Data is generated and has to be stored daily because of fast growth in Information Technology. The data which is collected is converted into knowledge by data analysis by using various combinations of algorithms. Medical professionals working in the field of heart disease have their own limitations, they cannot predict the chance of getting heart disease up to high accuracy.

This paper aims to improve Heart Disease predict accuracy using the Logistic Regression model of machine learning considering the health care dataset which classifies the patients whether they are having heart diseases or not according to the information in the record.

Keywords:-Heart Diseases; Data Analysis; Machine Learning; Logistic Regression Algorithms.

I. Introduction

The load of cardiovascular diseases is rapidly increasing all over the world from the past few years. Even if these diseases has found as the most important source of death, it has been announced as the most manageable and avoidable disease [1]. Mainly, blockage in arteries causes heart stroke. It occurs when heart does not pump the blood around the body efficiently.

Having high blood pressure is also one of the main causes of getting a heart disease. A survey says that, in 2011 to 2014, the commonness of hypertension in the world was about 35%, which is also a cause of heart disease. Similarly, there are many more reasons for getting a heart disease such as obesity, not taking in proper nutrition, increased cholesterol and lack of physical activity. So, prevention is very necessary. For prevention, awareness of heart diseases is important. Around 47% of people dies outside the hospital and it shows that they don’t act on early warning signs.

Nowadays, the lifespan of a human being is reduced because of heart diseases. So, World Health Organization (WHO) developed targets for prevention of non-communicable diseases (NCDs) in 2013, in which, 25% of relative reduction is from cardiovascular diseases and it is being ensured that at least 50% of patients with cardiovascular diseases have access to relevant drugs and medical counseling by 2025 [2]. Around 17.9 million people died just because of cardiovascular diseases in 2016, which is 31% of deaths around the world.

A major challenge in heart diseases is its detection [3]. It is difficult to predict that a person has a heart disease or not. There are instruments available which can predict heart diseases but either they are expensive or are not efficient to calculate the chance of heart disease in human [4]. A survey of World Health Organization (WHO) says that medical professionals are able to predict just 67% of heart disease, so there is a vast scope of research in this field [5]. In case of India, access to good doctors and hospitals in rural areas is very low. A 2016 WHO report says that, just 58% of the doctors have a medical degree in urban areas and 19% in rural areas.

In USA, someone has a heart attack every 40 seconds, that is, more than one person dies in USA due to heart attack. Apart from this, Turkmenistan have the highest rate of deaths till 2012, with 712 deaths per 100,000 people. Whereas, Kazakhstan have the second highest rate of deaths due to heart diseases. India holds 56th position in this series [6]. Study also shows that, at ages 30-69 years, 1.3 million cardiovascular deaths, 0.9 million (68.4%) were caused by coronary heart disease and 0.4 million (28.0 %) by stroke

Heart diseases are a major challenge in medical science, Machine Learning could be a good choice for predicting any heart disease in humans [7]. Heart diseases can be predicted using Neural Network, Decision Tree, KNN, etc. Later in this paper, we will see that how Logistic Regression is used to find the accuracy for heart disease. It also shows that how ML will help in our future for heart disease.

II. Existing system

Heart Disease is even highlighted as a silent killer which leads to the death of the person without obvious symptoms. The before all existing system [6] works on sets of both Deep learning and data mining [7]. Medical diagnosis plays a vital role and yet complicated task that needs to be executed efficiently and accurately. To reduce the cost for achieving clinical tests appropriate computer-based information and decision support should be aided. Data mining is the use of software techniques for finding patterns and consistency in sets of data. Also, with the advent of data mining in the last two decades, there is a big opportunity to allow computers to directly construct and classify the different attributes or classes. Learning of the risk components connected with heart disease helps medicinal services experts to recognize patients at high risk of having Heart Disease. Statistical analysis has identified risk factors associated with heart disease to be age, blood pressure, total cholesterol, diabetes, hypertension, family history of heart disease, obesity and lack of physical exercise, fasting blood sugar, etc. but by using all the existing systems the accuracy is very less.[8]

III. Proposed system

This proposed system has data which classified if patients have heart disease or not according to features in it. This proposed system can try to use this data to create a model that tries to predict (reading data and data Exploration) [9] if a patient has this disease or not. In this proposed system, using a logistic regression (classification) algorithm. By using sklearn library to calculate the score. Random search is a technique where random combinations of the hyperparameters are used to find the best solution for the built model. Finally, analyzing the results with the help of Comparing Models and Confusion Matrix. From the data we are having, it should be classified into different structured data based on the features of the patient heart. From the availability of the data, we have to create a model that predicts the patient’s disease using a logistic regression algorithm. First, we have to import datasets. Read the datasets, the data should contain different variables like age, gender, sex, chest pain, slope, target. The data should be explored so that the information is verified. Create a temporary variable and also build a model for logistic regression. Here, we use a sigmoid function which helps in the graphical representation of the classified data. By using logistic regression, the accuracy is increased as compared to the previous work done in the existing systems.

[image: ]Source: Reddy Prasad, Pidaparthi Anjali, S. Adil, N.Deepa (Feb 2019) Heart Disease Prediction using Logistic Regression Algorithm using Machine Learning

IV. Approach and methodology

[image: ]Introduction World Health Organization has estimated 12 million deaths occur worldwide; every year due to Heart diseases. Half the deaths in the United States and other developed countries are due to cardio vascular diseases. The early prognosis of cardiovascular diseases can aid in making decisions on lifestyle changes in high risk patients and in turn reduce the complications. This research intends to pinpoint the most relevant/risk factors of heart disease as well as predict the overall risk using logistic regression Data Preparation. Logistic Regression is a type of regression analysis in statistics used for prediction of outcome of a categorical dependent variable from a set of predictor or independent variables. In logistic regression the dependent variable is always binary. Logistic regression is mainly used to for prediction and also calculating the probability of success.

Fig.1 Dataset

[image: ]Source: The dataset is from an ongoing cardiovascular study on residents of the town of Framingham, Massachusetts. The classification goal is to predict whether the patient has 10-year risk of future coronary heart disease (CHD). There are both demographic, behavioral and medical risk factors.

Fig.2 10-year risk of coronary heart disease CHD

Fig.3 Patient’s hypertensive nature

[image: ]Hypertension was the most important single identifiable risk factor for heart failure until the last few decades. The issue has become less clear over recent years, in part, because of uncertainties in the documentation of heart failure, the lack of systematic recordings of arterial pressure prior to the onset of, and treatment for, heart failure, and the absence of systematic visualization of epicardial coronary arteries.[12]

Fig.4 Cigarettes Per Day

Smoking damages the heart and blood vessels very quickly, but the damage is repaired quickly for most smokers who stop smoking. Even a few cigarettes now and then damage the heart, so the only proven strategy to keep your heart safe from the effects of smoking is to quit.

Fig.5 Glucose level

[image: ]Researchers found that high blood sugar (glucose) causes stronger contraction of blood vessels and also identified a protein associated with this increased contraction. The findings could lead to new treatments to improve outcomes after heart attack or stroke.

Fig.6 Age of the patient

[image: ]Age is the most important risk factor in developing cardiovascular or heart diseases, with approximately a tripling of risk with each decade of life. Coronary fatty streaks can begin to form in adolescence. It is estimated that 82 percent of people who die of coronary heart disease are 65 and older. Simultaneously, the risk of stroke doubles every decade after age 55.

Fig.7 Dataset after Wrangling

Fig.8 Before Data Wrangling

Fig.9 After Data Wrangling

Fig.10 Accuracy Result

V. Result

From the above statistics it is clear that the model is highly specific than sensitive. Men seem to be more susceptible to heart disease than women. Increase in age, number of cigarettes smoked per day and systolic Blood Pressure also show increasing odds of having heart disease. Total cholesterol shows no significant change in the odds of CHD. This could be due to the presence of good cholesterol (HDL) in the total cholesterol reading. Glucose too causes a very negligible change in odds (0.2%). The model predicted with 0.85 accuracy. The model is more specific than sensitive. Overall model could be improved with more data.

VI. Conclusion

The amount of Heart diseases can exceed the control line and reach to maximum point. Heart disease are complicated and each and every year lots of people are dying with this disease It is difficult to manually determine the odds of getting heart disease based on risk factors. By using this system one of the major drawbacks of this work is that it’s main focus is aimed only to the application of classifying techniques and algorithms for heart disease prediction, by studying various data cleaning and mining techniques that prepare and build a dataset appropriate for data mining so that we can use this Machine Learning in that logistic regression algorithms by predicting if patient has heart disease or not. Any non-medical employee can use this software and predict the heart disease and reduce the time complexity of the doctors. It is still an open domain waiting to get implemented in heart disease predication.

VII. Future work

Today’s, world most of the data is computerized, the data is distributed and it is not utilizing properly. By analyzing the available data, we can also use for unknown patterns. The primary motive of this research is the prediction of heart diseases with high rate of accuracy. For predicting the heart disease, we can use logistic regression algorithm, sklearn in machine learning. The future scope of the paper is the prediction of heart diseases by using advanced techniques and algorithms in less time complexity.

VIII. Related work

There are many works in literature which diagnoses heart diseases using machine learning as well as data mining. A brief survey of that is presented here. A paper named ‘A review of heart disease using machine learning and analytics approach’ by M. Marimuthu, M. Abinaya, K.S. Hariesh, K Mandhankumar and V. Pavithra was published on September 2018. The result shows that, through the literature survey, they concluded that, there is a need of combinational and more complex models to increase the accuracy of prediction of heart diseases.

Some papers which were published around 2 to 3 years back have a less accuracy for the prediction of heart diseases as compared to today’s need. ‘Efficient heart disease prediction system using decision tree’ by Sharma Purshottam et al, it was published in 2015. They have used decision tree classifier as their technique and getting 86.3% accuracy. Similarly we have, ‘Prediction of heart disease using modified K-means and by using naïve byes’ by Sairabi H Mujawar et al. This paper was published on 2015. Their accuracy percentage for detection of heart disease was 93% and for undetection it was 89% [10]. This shows that the accuracy percentage depends on the technique which you are using.

Another example is of ‘heart disease prediction using machine learning and data mining techniques’ by Jaymin Patel, Prof. Tejpal Upadhyay and Dr. Sameer Patel from Nirma University, Gujarat. Their study shows that J4t tree is the best classifier for heart disease prediction as compared to logistic model tree algorithm and random forest tree algorithm because it gives more accuracy and reduces the errors [11].

IX. References

1. Avinash Golande, Pavan Kumar T. Heart disease prediction using effective machine learning techniques.
2. The Lancet Global Health. The changing patterns of cardiovascular diseases and their risk factors in the states of India: The global burden of disease study 1990-2016.
3. Himanshu Sharma, M A Rizvi. Prediction of heart disease using machine learning algorithms: A survey.
4. World health ranking.
5. Himanshu Sharma, M A Rizvi. Prediction of heart disease using machine learning algorithms: A survey.
6. Sana Bharti,2015. Analytical study of heart disease prediction comparing with different algorithms; International conference on computing, communication, and automation (ICCA2015).
7. Monika Gandhi,2015. Prediction in heart disease using techniques of data mining, International conference on futuristic trend in computational analysis and knowledge management (ABLAZE- 2015)
8. Sarath Babu, 2017.Heart disease diagnosis using data mining technique, international conference on electronics, communication and aerospace technology (ICECA2017)
9. A H Chen, 2011. HDPS: heart disease prediction system; 2011 computing in cardiology
10. Reddy Prasad,Pidaparthi Anjali, S.Adil, N.Deepa
11. Feb 2019) Heart Disease Prediction using Logistic Regression Algorithm using Machine Learning
12. Gritsenko, Elena. ‘Health Care Analytics: Modeling Behavioral Risk Factors Associated With Disease.’ (2019).
13. Kazzam, E., Ghurbana, B., Obineche, E. et al. Hypertension — still an important cause of heart failure?. J Hum Hypertens 19, 267–275 (2005) doi:10.1038/sj.jhh.1001820

Coronary ailments (i.e., CHD) is a major reason for death in the top advanced countries and is swiftly expanding in frequency among developing nations. Death rates from cardiovascular problems surpass one million deaths every year in United States of America and record for biggest ailment related expenses to health with the approximate expenses evaluated to surpass 120 dollars billion with reference to each fiscal year. Numerous diet-related factors, including saturated and total fat utilisation, fruits and vegetable intake ratios, are scientifically proven to subsidise to the risks with reference to coronary ailments.

Several experimental studies have coupled high-fibre diets with an attenuated risk of cardiovascular issues. Food articles which tend to possess high contents of the dietary fibre, chiefly counting pulses, fruits, whole-grain cereals and veges, alongside dietary fibre, tend to possess high proportions of raw materials, vitamins, phytochemicals, antioxidants and trace elements. All these factors, as suggested by studies, may be contributing independently to cardiovascular defensive actions of the food items that exhibit high ratios of the dietary fibre. One small, recent study reported an immense decrease in cholesterol levels after consuming these components on a daily basis for a three-week time period. In addition to this, no reduction in “good” cholesterol was found.

Research recommends that diets high in these bran cell wall components could slightly lower blood triglycerides. Higher levels of triglycerides are a proven factor related to elevated risks of heart conditions.

A few of the nutriments in cereal grains are recognised to possess potential with reference to lowering the hazard factors with reference to coronary ailments: fibre, linoleic acid, Vit. E, folate and selenium. Cereal grains, in addition to this, possess phytoestrogens that belong to the lignin family and some other phenolic acids that have antioxidizing properties. Handling and processing with reference to the most parts decrease the levels and contents of these components and bioprotective substances. Regardless of the way that the raw cereal grains at the ranch door are low in salt, cereal-based processed foods, e.g., bread and some other foods, have high salt contents and in this manner can possibly affect the blood pressure.

Tests and experiments conducted on humans have demonstrated that undoubtedly oat fibre has the tendency to lower the LDL cholesterol levels. However, wheat fibre does not show this property. Rice, wheat and barley do help lower cholesterol, but their effect is less as compared to oat and a great many people do not eat sufficient quantities of these cereals to have any considerable impact. Sorghum-based foods, as revealed by the studies have visibly low glycaemic indexes and are highly advantageous with reference to individuals with diabetes and tend to bring down plasma lipid levels.

Therefore, elucidating the impression that adding bran to a daily diet can increase overall fibre intake to assist prevent heart condition.

On account of above-discussed facts, it will be totally acceptable to brand health claims on labels or these cereals’-based foods (as at the present time permitted by the US Food and Drug Authority) that whole-grain cereal-based foods and oatmeal or bran might be capable of reducing the risk of CHD.

Cardiovascular diseases are the leading cause of death worldwide, according to WHO report as of today. This has led to the fact that there are currently many investigations aimed at better understanding them in order to guide an appropriate treatment, which allows us to reduce a significant way this type of pathologies. Within these pathologies we find heart attacks, strokes (strokes), high blood pressure among others. These require a large number of drugs for optimal control.

The human being is defined by the WHO as a biopsychosocial being, because it has a biological component (cells, organs, etc.), as well as psychological and social. Therefore, the pathologies that affect it compromise not only one of these aspects but also involve everyone. For example, a heart attack compromises heart cells in the biological aspect of the human being; but also in the psychological aspect it affects the way in which this patient visualizes life, in the sense that after this event you must make some changes in lifestyle that if they are not assumed with maturity could trigger an important psychological disorder, in the social aspect is also compromised since it will not be able to relate to their friendships in some situations that previously if they could, there are more limitations for the sports and physical aspect.

For all the above, studies are being developed that are based on both psychological and social aspects of cardiovascular pathologies in order to complement the treatment that patients are currently receiving. Within these studies are those that have pets as a beneficial element for the treatment of some cardiovascular diseases.

Human-Animal Relationship

Since the beginning of time man has had the need to relate to animals; relationship that not only occurred in the food field, but also in the sentimental and spiritual field. The origin of this relationship between humans and animals has been tried to explain in various ways throughout history, but there are currently 2 theories that are the strongest and are the following:

• Biophilia theory: the main argument of this theory is based on the fact that the human being has an innate affinity with animals and living beings. Therefore, human beings will always have the need to interact with the environment, among them animals, plants, etc.
• Social support theory: this theory is based on the benefits that humans acquire when interacting with animals. According to this theory, this relationship provides social support by itself and also facilitates relationships with other human beings. All this is possible thanks to the unconditional love manifested by pets towards their owners, which makes them see a figure of friendship and support; In addition to this, pets have constant availability and there will be no judgments, which will help reinforce the psychological component of the owner. Pet owners will show a decrease in the feeling of loneliness. Many want them so many that they even consider them members of their family.

Cardiovascular Benefits of Pets in Humans

Currently, therapeutic plans are used in various diseases in which animals have the main role, these are called animal-assisted interventions. These can be of two types: animal-assisted therapy, in which animals are used therapeutically for a specific purpose or goal, and animal-assisted activities, in which pets are used in the same way in various patients and the purpose. It is the same in several cases, the company and the company’s own benefits with pets.

The benefits of pets in cardiovascular diseases have been studied more deeply in patients suffering from high blood pressure, as well as those suffering from heart failure. It is known that these patients present a series of common alterations in neuroendocrine systems such as the renin angiotensin aldosterone system, as well as an increase in the tone of the sympathetic nervous system and a loss of the autonomic nervous system (dysautonomia). The benefit of pets in these pathologies has been shown to be due to a decrease in the action of the sympathetic nervous system, which is mediated by two neurotransmitters that are epinephrine and norepinephrine, which are released in stressful situations.

Pets provide their owners with an environment of tranquility that makes them less exposed to stressful situations and also provide better management of stress situations, which would help in the hemodynamic variables of patients. In addition to this, pets facilitate relationships with other people and by themselves are a company that would help in an important way in the social aspect.

There are psychosocial and emotional benefits evidenced in studies where assisted therapy with animals was performed for 15 to 30 minutes. Psychological benefits include decreased anxiety, isolation, improvement in social interaction, social support, communication, happiness.

The studies that have provided the above information are the following:

• The company of pets has increased the survival rate in coronary heart disease and has improved mental and physical health compared to patients who do not have the possibility of sharing with pets (Friedmann et al., 1980; Headey, 1999).
• One more year of life after a heart attack in patients who own the pet company compared to those who do not; this effect is independent of the physiological severity of AMI, demographic characteristics of the patient, and psychosocial factors (Friedmann, Katcher, Lynch, Thomas, 1900: Friedmann and Thomas, 1995).
• Older people with pets handle stressful life situations in a better way when they have a pet and this is reflected in a decrease in doctor visits (Siegel, 1990).
• Owning pets has been associated with low blood lipid levels and other cardiovascular risk factors (Anderson, Reid and Jennings, 1992).
• Patients who have pronounced and frequent changes in both heart rate and blood pressure are more predisposed to suffer from heart disease (Gullette et al., 1997).
• It was compared in women performing arithmetic operations, stress, in the presence of friends, pets and alone. The presence of friends was thought to reduce stress levels but did not, the patients said it was because the friends could judge them. Unlike pets, I do improve stress levels (Allen, Blascovich and Mendes, 2002).
• Study of heart failure and animal-assisted therapy evidenced the decrease in physiological and psychological stress and demonstrated the decrease of hemodynamic parameters such as blood pressure, heart rate, pulmonary blood pressure, neurohormonal levels, anxiety parameters, systemic vascular resistance, epinephrine levels norepinephrine. In the group of animal-assisted therapy compared to the one that did not receive this therapy (Kathie Cole, Anna. Gawlinski, Neil Steers and Jenny Kotleman, 2007).

Obstacles Interaction Man-Pet

Currently the possibilities of interaction with animals in this society are increasingly scarce. Thanks to the industrialization and urbanization that has occurred in recent times, people have less and less space to share with nature, and of course, there is an obvious decrease in space and time that could be shared with pets. In addition to this the company with animals are banned in places where their utility is greater as are hospitals, educational institutions, among others.

Other possible obstacles to such interventions associated with animals include zoonotic infections (infections that can pass from animals to humans). Within the strategies to avoid these zoonotic infections we find good hand washing and the development of guidelines that include adequate health criteria for patients and animals, infection control practices, among others. Thanks to the possible zoonotic infections produced by the pet-man interaction, studies have been conducted that have shown a low frequency of these in patients receiving animal-assisted therapy. This makes it clear that the beneficial effect prevails over the possible adverse events resulting from this relationship.

For some patients, pets may be a source of stress or they may be indifferent. Which would mean more prejudices than benefits for patients. Those who identify pets as a source of stress would increase the risk factors for cardiovascular disease, while for those pets are indifferent, they could provide a source of infection.

Perspective

The benefit of mental and physical health has been demonstrated, but there are still more studies to be able to reach an objective conclusion of the real benefits of pets. Important points to be discussed in subsequent research would be the magnitude and type of benefits obtained from human interaction with animals, the population that would mainly benefit, as well as the implications in the public health of communities and cultures. These studies require the interaction of various branches among which are psychology, veterinary medicine, biology, law, medicine. Which makes an interdisciplinary study necessary.

In existing studies, they have demonstrated the beneficial effect of pets on reducing stress managed by people; but no studies have been done in which the possibility of pets themselves becoming a source of stress for patients is evaluated. In addition to this, the physiological implications of the disappearance of the link created between the pet and the owner in terms of lost situations have not been evaluated.

The association between pets and cardiovascular diseases has proven beneficial in the few studies that have been conducted throughout history. This beneficial effect is predominantly in the psychosocial aspect, but at the same time it is evidenced at the biological level. Not all pets can have a beneficial effect on the hemodynamic figures of the patient, it must be a pet that has a sentimental bond with its owner. Although pets are a mechanism attached to treatment with very beneficial drugs, pharmacological treatment can never be replaced by pets.