Name: hydra, a computer-based platform for aiding clinicians in cardiovascular analysis and diagnosis
Uploaded: 2018-09-26T13:45:00
Description: Watch this Scientific Journal Video about Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis at JoVE.com

This work is supported by the Instituto de Salud Carlos III of the Spanish Government and the European Regional Development Fund (ERDF) through the PI14/02161 and the DTS15/00153 research projects and Xunta de Galicia, Centro singular de investigaci&#243;n de Galicia accreditation 2016-2019 Ref. ED431G/01; and Grupos de Referencia Competitiva, Ref. ED431C 2016-047.

All procedures were conducted under institutionally approved protocols with patient consent.
1. Patient and Checkup Registration
Note: See Figure 1.
<ol>
	<li>Go to http://www.varpa.es/Hydra/&#160;using any modern web browser.</li>
	<li>Use an existing account associated with a doctor to Log In to the Hydra web tool.</li>
	<li>Fill in the patient registration form including patient code, date of birth, gender and ethn...

<ol>
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G., Campilho, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Wivern:+a+Web-Based+System+Enabling+Computer-Aided+Diagnosis+and+Interdisciplinary+Expert+Collaboration+for+Vascular+Research.">Wivern: a Web-Based System Enabling Computer-Aided Diagnosis and Interdisciplinary Expert Collaboration for Vascular Research.</a> Journal of Medical and Biological Engineering. 37 (6), 920-935 (2017).</li><li>Paredes, S., Rocha, T., de Carvalho, P., Henriques, J., Morais, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Matlab+tool+for+cardiovascular+disease+risk+prediction.">Matlab tool for cardiovascular disease risk prediction.</a> Experiment@ International Conference (exp.at' 13). , 190-191 (2013).</li><li>Goff, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=2013+ACC/AHA+Guideline+on+the+Assessment+of+Cardiovascular+Risk.">2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk.</a> Circulation. 137 (11), (2013).</li><li>Sufi, F., Khalil, I., Tari, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+cardiod+based+technique+to+identify+cardiovascular+diseases+using+mobile+phones+and+body+sensors.">A cardiod based technique to identify cardiovascular diseases using mobile phones and body sensors.</a> Conference Proceedings IEEE Engineering in Medicine and Biology Society. 2010, 5500-5503 (2010).</li><li>Lin, C. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+intelligent+telecardiology+system+using+a+wearable+and+wireless+ECG+to+detect+atrial+fibrillation.">An intelligent telecardiology system using a wearable and wireless ECG to detect atrial fibrillation.</a> IEEE Transactions on Information Technology in Biomedicine. 14 (3), 726-733 (2010).</li><li>Lee, H., Wang, W., Lu, S., Wu, B., Ko, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Home-based+mobile+cardio-pulmonary+rehabilitation+consultant+system.">Home-based mobile cardio-pulmonary rehabilitation consultant system.</a> Conference Proceedings IEEE Engineering in Medicine and Biology Society. , 989-992 (2011).</li><li>Kang, H., Park, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+hypertension+management+mobile+application+based+on+clinical+practice+guidelines.">Development of hypertension management mobile application based on clinical practice guidelines.</a> Studies in Health Technology and Informatics. 210, 602-606 (2015).</li><li>Novo, J., Hermida, A., Ortega, M., Barreira, N., Penedo, M. G., L&#243;pez, J. E., Calvo, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hydra:+A+web-based+system+for+cardiovascular+analysis,+diagnosis+and+treatment.">Hydra: A web-based system for cardiovascular analysis, diagnosis and treatment.</a> Computer methods and programs in biomedicina. 139, 61-81 (2017).</li><li>Janes, H., Pepe, M., Gu, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+the+value+of+risk+predictions+by+using+risk+stratification+tables.">Assessing the value of risk predictions by using risk stratification tables.</a> Annals of Internal Medicine. 149 (10), 751-760 (2008).</li><li>Mancia, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=2007+Guidelines+for+the+management+of+arterial+hypertension:+the+Task+Force+for+the+Management+of+Arterial+Hypertension+of+the+European+Society+of+Hypertension+(ESH)+and+of+the+European+Society+of+Cardiology+(ESC).">2007 Guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).</a> Journal of Hypertension. 25 (6), 1105-1187 (2007).</li><li>Grundy, S., Brewer, H., Cleeman, J., Smith, S., Lenfant, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Definition+of+metabolic+syndrome:+report+of+the+National+Heart,+Lung,+and+Blood+Institute/American+Heart+Association+Conference+on+scientific+issues+related+to+definition.">Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on scientific issues related to definition.</a> Circulation. 109 (3), 433-438 (2004).</li><li>Conroy, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Estimation+of+ten-year+risk+of+fatal+cardiovascular+disease+in+Europe:+the+SCORE+project.">Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.</a> European Heart Journal. 24 (11), 987-1003 (2003).</li><li>Kannel, W., McGee, D., Gordon, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+general+cardiovascular+risk+profile:+the+Framingham+study.">A general cardiovascular risk profile: the Framingham study.</a> American Journal of Cardiology. 38 (1), 46-51 (1976).</li></ol>

The early identification and monitoring of various cardiovascular risk factors together with an appropriate treatment are critical for the prevention of cardiovascular diseases and premature deaths. In the daily clinical routine, clinicians have to handle large amounts of diverse information to check all the different variables and parameters that affect the circulatory system. Hence, it is a tedious and time-consuming task that complicates diagnosis and treatment prescription.
The proposed pr...

Cardiovascular diseases (CVDs) are a group of disorders of the circulatory system that constitute the leading cause of disability and premature death throughout the world1,2. According to the World Health Organization (WHO), an estimated 17.7 million people died from CVDs in 2015, representing 31% of all global deaths1,2. There are many risk factors for CVDs, including behavioral factors such as tobacco use, an unhealthy diet, harmful use of alcohol and inadequate physical activity as well as physiological factors, including raised blood pressure (hypertension), high cholesterol or elevated blood glucose, among others2,3. Hypertension represents a major risk factor for premature cardiovascular disease, being responsible for a high level of cardiovascular morbidity and mortality4,5. Furthermore, it is estimated that the incidence of hypertension among adults in developed countries is almost 40%6,7,8. However, it remains widely undetected, undertreated and poorly controlled3,4.
CVD is a major public health problem which imposes a significant economic burden on any given health-care system6. Early identification of the highest cardiovascular risks and appropriate treatment can prevent clinical events and premature deaths4,5. Hence, there are noticeable health and economic gains attached to comprehensively and thoroughly tracking all these factors. The total risk of developing a CVD is determined by the combined effect of cardiovascular risk factors2,4,5, which commonly coexist and act multiplicatively. Therefore, a total-risk approach is advisable for early detection, as well as for clinical decision-making on the intensity of preventive interventions. Thus, morbidity, early mortality and disability could be reduced and the quality of life could be improved in individuals with an elevated total CVD risk2.
The diagnosis of CVDs is determined by the analysis of a wide range of parameters that are gathered by different procedures used by physicians in their clinical practice. The assessment of these parameters allows the computation of a total CV risk factor which is useful for diagnostic and treatment purposes2,4,5. In addition to the stratification of CV risks, ambulatory blood pressure monitoring (ABPM)9 also provides valuable information. The ABPM test allows the tracking of the patient&#39;s blood pressure (BP) during their daily routine, avoiding the influence of the clinical setting (white coat syndrome). Thus, a reliable set of measurements is obtained, allowing the extraction of additional information that supports the clinical decision-making process.
Therefore, the analysis of the cardiovascular system involves a large amount of data, entailing a tedious and time-consuming task that complicates diagnosis and treatment prescription. In this regard, the availability of a patient&#39;s full profile that gathers all the required data together with a set of automated services to extract the necessary information would be a significant improvement to guide clinicians in their decision-making process. Apart from this, the availability of an accessible platform that centralizes all patient information not only enables collaboration among different specialists from different locations but also allows discussion of debatable cases and provides reliable diagnoses.
In recent years, the use of computer-based applications and telemedicine has increased considerably, playing an important role in improving public health and welfare in all sectors of the population. This is due to their ability to extract relevant and useful information for the early diagnosis and treatment of several diseases10. The use of these tools improves the quality of health-care services, thus conveniently and reliably satisfying patient demand as well as reducing costs11. As a reference, the number of global imaging-based procedures has risen considerably, given the increasing availability of medical equipment and more sophisticated capture devices. Therefore, Lundberg et al.12 proposed a telemedicine tool to assess digital image quality and agreement between examiners in the field of the otorhinolaryngology. Ortega et al.13 developed SIRIUS, a computer-aided diagnosis framework for the analysis of retinal images. Novo et al.14 also presented their platform for the analysis of retinal microcirculation in combination with carotid macrocirculation.
With regard to CV assessment, there has been a steady increase in the number of tools available throughout the years. Some of the utilities are designed to predict cardiovascular disease risk &#8212; such as the tool proposed by Paredes et al.15 &#8212; or to calculate risk online by implementing the algorithm proposed by Goff et al.16 according to a guideline on the assessment of cardiovascular risk to calculate the 10-year risk of heart disease. Other systems are designed to be used with mobile phones, such as the proposal of Sufi et al.17 that identifies diseases from body sensors, the device designed by Lin et al.18 for tracking the electrocardiogram in order to detect the presence of abnormal rhythms and send an alarm, the app from Lee et al.19 for monitoring breathing and heart rate values while a person exercising or the application implemented by Kang and Park20 to manage raised blood pressure on the basis of clinical guidelines.
The available utilities are mainly designed to satisfy patient demand in specific scenarios. On the other hand, this article describes a protocol based on Hydra21, a platform focused on the analysis of the cardiovascular system, that is designed entirely to support specialists in their clinical decision-making process. This tool incorporates a set of functionalities and services that physicians require for reliable cardiovascular analysis including risk assessment, early diagnosis, treatment prescription and the monitoring of patients over time. Therefore, there is a tool for the input and management of patient data recorded in different checkups. Then, a risk stratification tool automatically provides a CV risk factor based on different risk stratification tables of reference. In addition to this, the ABPM analysis tool allows the extraction of valuable information from the analysis of blood pressure recordings over a specific period of time. Finally, the most relevant information is summarized in a set of reports that guide clinicians in diagnosis and proper treatment prescription. In this way, the described protocol leads to an improvement in complete cardiovascular analysis supporting a reliable diagnosis and proper treatment. Furthermore, the presented platform allows collaboration among experts, thereby promoting clinical research.

<table>
	<tbody>
		<tr>
			<td>Computer with color screen</td>
			<td>N/A</td>
			<td>N/A</td>
			<td></td>
		</tr>
		<tr>
			<td>Internet connection</td>
			<td>N/A</td>
			<td>N/A</td>
			<td></td>
		</tr>
		<tr>
			<td>Modern web broser</td>
			<td>N/A</td>
			<td>N/A</td>
			<td>Google Chrome, Internet Explorer, Safari, Fierfox, etc.</td>
		</tr>
		<tr>
			<td>Blood pressure monitor</td>
			<td>Spacelabs</td>
			<td>N/A</td>
			<td>Spacelabs 90217</td>
		</tr>
	</tbody>
</table>

hydra, a computer-based platform for aiding clinicians in cardiovascular analysis and diagnosis

Cardiovascular diseases (CVDs) are the leading cause of death throughout the world. The total risk of developing CVD is determined by the combined effect of different cardiovascular risk factors (e.g., diabetes, raised blood pressure, unhealthy diet, tobacco use, stress, etc.) that commonly coexist and act multiplicatively. Most CVDs can be prevented by an early identification of the highest risk factors and an appropriate treatment. The stratification of cardiovascular risk factors involves a wide range of parameters and tests that specialists use in their clinical practice. In addition to cardiovascular (CV) risk stratification, ambulatory blood pressure monitoring (ABPM) also provides relevant information for diagnostic and treatment purposes. This work presents a list of protocols based on the Hydra platform, a web-based system for clinical decision support which incorporates a set of functionalities and services that are required for complete cardiovascular analysis, risk assessment, early diagnosis, treatment and monitoring of patients over time. The program includes tools for inputting and managing comprehensive patient data, organized into different checkups to track the evolution over time. It also has a risk stratification tool to compute a CV risk factor based upon several risk stratification tables of reference. Additionally, the program includes a tool that incorporates ABPM analysis and allows the extraction of valuable information by monitoring blood pressure over a specific period of time. Finally, the reporting service summarizes the most relevant information in a set of reports that aid clinicians in their clinical decision-making process.

The patient registration described in step 1 is carried out by filling in the form presented in Figure 1. Once the user registers a new patient, the application moves forward to introduce the first checkup, which allows the input of comprehensive patient data. Figure 2 shows a screenshot of the first form of the checkup information. Once the Next button is clicked, the application moves forward to the second chec...

Watch this Scientific Journal Video about Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis at JoVE.com

Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis

This article presents a protocol based on Hydra &#8212; a web-based system for clinical decision support that integrates a full and detailed set of functionalities and services required by physicians for complete cardiovascular analysis, risk assessment, early diagnosis, treatment, and monitoring over time.

Cardiovascular diseases (CVDs) are the leading cause of death throughout the world. The total risk of developing CVD is determined by the combined effect ...

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