Validation of Heart Rate Extracted From Wrist-Based Photoplethysmography in the Perioperative Setting: Prospective Observational Study

Eveline Mestrom; Ruben Deneer; Alberto G Bonomi; Jenny Margarito; Jos Gelissen; Reinder Haakma; Hendrikus H M Korsten; Volkher Scharnhorst; R Arthur Bouwman

doi:10.2196/27765

Validation of Heart Rate Extracted From Wrist-Based Photoplethysmography in the Perioperative Setting: Prospective Observational Study

JMIR Cardio. 2021 Nov 4;5(2):e27765. doi: 10.2196/27765.

Authors

Eveline Mestrom¹, Ruben Deneer^{2

3

4}, Alberto G Bonomi⁵, Jenny Margarito⁵, Jos Gelissen⁵, Reinder Haakma⁵, Hendrikus H M Korsten^{1

6}, Volkher Scharnhorst^{2

3

4}, R Arthur Bouwman^{1

6}

Affiliations

¹ Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, Netherlands.
² Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, Netherlands.
³ Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.
⁴ Expert Center Clinical Chemistry Eindhoven, Eindhoven, Netherlands.
⁵ Department of Personal Health, Philips Research, Eindhoven, Netherlands.
⁶ Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.

PMID: 34734834
PMCID: PMC8603171
DOI: 10.2196/27765

Abstract

Background: Measurement of heart rate (HR) through an unobtrusive, wrist-worn optical HR monitor (OHRM) could enable earlier recognition of patient deterioration in low acuity settings and enable timely intervention.

Objective: The goal of this study was to assess the agreement between the HR extracted from the OHRM and the gold standard 5-lead electrocardiogram (ECG) connected to a patient monitor during surgery and in the recovery period.

Methods: In patients undergoing surgery requiring anesthesia, the HR reported by the patient monitor's ECG module was recorded and stored simultaneously with the photopletysmography (PPG) from the OHRM attached to the patient's wrist. The agreement between the HR reported by the patient's monitor and the HR extracted from the OHRM's PPG signal was assessed using Bland-Altman analysis during the surgical and recovery phase.

Results: A total of 271.8 hours of data in 99 patients was recorded simultaneously by the OHRM and patient monitor. The median coverage was 86% (IQR 65%-95%) and did not differ significantly between surgery and recovery (Wilcoxon paired difference test P=.17). Agreement analysis showed the limits of agreement (LoA) of the difference between the OHRM and the ECG HR were within the range of 5 beats per minute (bpm). The mean bias was -0.14 bpm (LoA between -3.08 bpm and 2.79 bpm) and -0.19% (LoA between -5 bpm to 5 bpm) for the PPG- measured HR compared to the ECG-measured HR during surgery; during recovery, it was -0.11 bpm (LoA between -2.79 bpm and 2.59 bpm) and -0.15% (LoA between -3.92% and 3.64%).

Conclusions: This study shows that an OHRM equipped with a PPG sensor can measure HR within the ECG reference standard of -5 bpm to 5 bpm or -10% to 10% in the perioperative setting when the PPG signal is of sufficient quality. This implies that an OHRM can be considered clinically acceptable for HR monitoring in low acuity hospitalized patients.

Keywords: heart rate; perioperative patients; photoplethysmography; unobtrusive sensing; validation.

©Eveline Mestrom, Ruben Deneer, Alberto G Bonomi, Jenny Margarito, Jos Gelissen, Reinder Haakma, Hendrikus H M Korsten, Volkher Scharnhorst, R Arthur Bouwman. Originally published in JMIR Cardio (https://cardio.jmir.org), 04.11.2021.