=Paper=
{{Paper
|id=Vol-3422/Paper8
|storemode=property
|title=Mobile Cyber-Physical System for Monitoring the Health of Patients with Cardiovascular Diseases
|pdfUrl=https://ceur-ws.org/Vol-3422/Paper8.pdf
|volume=Vol-3422
|authors=Tetiana Hovorushchenko,Illia Hryshchuk,Olha Hovorushchenko,Kostyantyn Rei,Artem Boyarchuk
|dblpUrl=https://dblp.org/rec/conf/citrisk/HovorushchenkoH22
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==Mobile Cyber-Physical System for Monitoring the Health of Patients with Cardiovascular Diseases==
https://ceur-ws.org/Vol-3422/Paper8.pdf
Mobile Cyber-Physical System for Monitoring the Health of
Patients with Cardiovascular Diseases
Tetiana Hovorushchenko1, Illia Hryshchuk1, Olha Hovorushchenko2, Kostyantyn Rei1
and Artem Boyarchuk3
1Khmelnytskyi National University, Institutska str., 11, Khmelnytskyi, 29016, Ukraine
2National Pirogov Memorial Medical University, Pirogova str., 56, Vinnytsya, 21018, Ukraine
3Tallinna Tehhnikaülikool, Ehitajate tee 5, Tallinn, 12616, Estonia
Abstract
Currently, the successfully developed and implemented mobile cyber-physical system for monitoring
the health of patients with cardiovascular diseases is relevant. The conducted review of known cyber-
physical systems for monitoring the health of patients with cardiovascular diseases showed that there
are currently a large number of different solutions, but some of them are expensive, some of them are
not mobile, some of them require the intervention of a specialist for operation and interpretation of
indicators. Therefore, the purpose of this study is to develop a method and a mobile cyber-physical
system for monitoring the health of patients with cardiovascular diseases. The paper developed the
rules and method for monitoring the health of patients with cardiovascular diseases, which ensure:
every minute and every five minutes’ formation of a set of indicators of the user's health status, analysis
of indicators using the developed rules and issuance of a notification to the user about the risk or
issuance of a notification to the user about risk with sending data about the existing risk to the user's
family doctor and/or family member. The architecture of the mobile cyber-physical system for
monitoring the health of patients with cardiovascular diseases is based on the developed method and
rules for monitoring the health of patients with cardiovascular diseases. The proposed mobile cyber-
physical system for monitoring the health of patients with cardiovascular diseases will help many
cardiovascular patients to monitor the health of their heart, and will also help these people to receive
emergency help in the event of a serious threat to their life and health.
Keywords 1
Mobile cyber-physical system, monitoring the health patients, patients with cardiovascular diseases,
sensors for measuring the heart rate, sensors for measuring the blood pressure.
1. Introduction
Cardiovascular diseases are the leading causes of death and one of the main factors of disability
worldwide. Such conclusions are obtained from the Global Burden of Disease study for 2019 [1].
CITRisk’2022: 3rd International Workshop on Computational & Information Technologies for Risk-Informed Systems, January 12,
2023, Neubiberg, Germany
EMAIL: tat_yana@ukr.net (T.Hovorushchenko); illia.hryshchuk@gmail.com (I.Hryshchuk); govorusenkoo@gmail.com
(O.Hovorushchenko); kostia.rei@gmail.com (K.Rei); a.boyarchuk@taltech.ee (A.Boyarchuk)
ORCID: 0000-0002-7942-1857 (T.Hovorushchenko); 0000-0001-8105-9562 (I.Hryshchuk); 0000-0001-6583-5699
(O.Hovorushchenko); 0000-0001-9658-3148 (K.Rei); 0000-0001-7349-1371 (A.Boyarchuk)
© 2022 Copyright for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
CEUR Workshop Proceedings (CEUR-WS.org)
The burden of cardiovascular disease has continued to rise for decades in almost all low- and
middle-income countries. Also alarming is the fact that the age-standardized rate of
cardiovascular disease has begun to rise in some high-income countries, where it had previously
been declining. Cases of CVD have nearly doubled from 271 million in 1990 to 523 million in
2019, and deaths from CVD have increased steadily from 12.1 million in 1990 to 18.6 million in
2019 [1].
In Ukraine, cardiovascular diseases are the main cause of population mortality. According to
this indicator, Ukraine remains one of the world leaders. According to the data of the ranking
compiled on the basis of the number of deaths of the population in Ukraine, the most frequent
causes are: 1) cardiovascular diseases (64.3%); 2) neoplasms (14.1%); 3) diseases of digestive
organs (4.3%); 4) neurological disorders (3.1%); 5) self-harm and interpersonal violence (2.7 %)
[1].
Cardiovascular diseases that lead to fatal consequences for both men and women include
arrhythmia and hypertension. Cardiac arrhythmias are a group of disorders of heart activity
associated with disorders of the rhythm, sequence, and strength of heart muscle contractions. The
main forms of cardiac arrhythmias are acceleration of heart contractions over 100 beats per minute
(tachycardia), slowing of heart contractions below 60 beats/minute (bradycardia) [2-4].
Arterial hypertension is a chronic disease, during which the main diagnostic feature is a
persistent increase in hydraulic pressure in the arterial vessels of a large circle of blood circulation.
Two indicators are used to measure blood pressure: systolic and diastolic pressure, depending on
whether the heart muscle contracts between beats (systole) or relaxes (diastole). Normal blood
pressure at rest is in the range of 100-139 mm Hg. Art. for systolic pressure (upper value) and 60-
89 mm Hg. Art. for diastolic pressure (lower value). Blood pressure is considered high if it is
constantly kept at the level of 140/90 mm Hg. Art. or higher [5-7].
Another cardiovascular disease that causes discomfort to a person is arterial hypotension.
Arterial hypotension is a condition determined by a decrease in systolic blood pressure below 100
mm Hg, diastolic blood pressure below 60 mm Hg. Art. [5, 6].
Since cardiovascular diseases are chronic diseases of the circulatory system, they should be
detected and prevented in real time to minimize harm to human health. Vital signs of patients
with cardiovascular disease should be monitored to detect abnormal events before any critical
conditions that could lead to death occur. A pulse oximeter or tonometer is used to assess an
irregular heartbeat (arrhythmia) at home. A tonometer is used to determine high/low blood
pressure at home. Diagnosis of cardiovascular disorders requires constant long-term monitoring
of individuals. That is, a person must have these devices with him all the time to measure pulse
or blood pressure, and he must do it deliberately and constantly. In addition, a person must know
the reference values of heart rate and blood pressure in order to correctly diagnose the existing
problem. Given the uncertainty surrounding where and when immediate diagnosis and treatment
may be needed, the only practical solution is continuous monitoring of heart rate and blood
pressure. Tools for monitoring health-related parameters significantly facilitate patient care and
allow people to identify problems that lead to better management of their own health [8].
Considering the fact that there is currently a tendency to automate the field of medicine, which
increases the efficiency of using modern medical resources [9-12], as well as considering the
importance of constant self-diagnosis and monitoring of the health of patients with cardiovascular
diseases, it is necessary to automate as much as possible and make it permanent such
measurement and monitoring. Currently, medical cyber-physical systems are often used to solve
such problems - unique cyber-physical systems that combine built-in software control devices,
network capabilities and complex physiological dynamics of patients in the modern medical field
[13-15]. In this case, a mobile cyber-physical system for monitoring the health of patients with
cardiovascular diseases in the form of a bracelet that a person can wear constantly, which will
constantly monitor a person's heart rate and blood pressure in real time and will notify a person
of heart failure or deviation from the normal pressure of a person as soon as it notices such
deviations, can come to a person's aid for automation and consistency of heart rate and blood
pressure measurements. So, currently, the successfully developed and implemented mobile cyber-
physical system for monitoring the health of patients with cardiovascular diseases is relevant task.
2. Literature review
Let's review the known cyber-physical systems for monitoring the health of patients with
cardiovascular diseases.
The paper [16] proposed the cloud-based cyber-physical system for identifying the Coronary
Heart Disease risk level at an early stage in real time using adaptive neuro fuzzy inference system.
The paper [17] proposed the general framework for three heart care sensors (ECG
(Electrocardiogram) sensor, PCG (Phonocardiogram) sensor and Lung sound sensor), which is
connected to server that performed the monitoring of heart health and forecasting the
cardiovascular diseases.
The paper [18] proposed the end-to-end cyber-physical system e-Nanoflex that support
nanostructure based flexible sensors for monitoring the variety of conditions such as respiration
air flow, body temperature, oxygen consumption, pulse oximetry, bioelectric signals, neural
activity, muscle activity, etc.
Paper [19] proposed Smart Cardiovascular Disease Detection System (SCDDS) based on
Electrocardiogram for detecting the heart disease in advance.
Paper [20] proposed the IoT enabled, cloud-centric solution for remote monitoring of ECG,
which enables the visualization and analyzed the ECG data over the cloud server, and data is
shared with cardiologist for examination.
The review [21] conducted a literature search on measurement of blood pressure using only a
smartphone, and analyzed the validation of the methods against reference measurements of blood
pressure. The conclusion of authors – no established protocol for the validation of measuring
technologies of blood pressure using only a smartphone.
Paper [22] analyzed the publications on the wearable and portable systems for continuous
monitoring the health of patients with cardiovascular diseases.
The paper [23] proposed the framework for early detection of cardiovascular events based on
the deep learning architecture in IoT environments, that have better performance.
The paper [24] proposed the computer vision system, which remotely measures the blood
pressure using a digital camera on the basis of the optical properties of photoplethysmographic
signals in the forehead and calculates blood pressure measures based on specific formulas.
Paper [25] proposed the smart stethoscope on the basis of the technology of multimodal
physiological signal measurement for personal cardiovascular health monitoring in the shape of
the compact computer mouse.
The conducted review of known cyber-physical systems for monitoring the health of patients
with cardiovascular diseases showed that there are currently a large number of different solutions,
but some of them are expensive, some of them are not mobile, some of them require the
intervention of a specialist for operation and interpretation of indicators. Therefore, the purpose
of this study is to develop a method and a mobile cyber-physical system for monitoring the health
of patients with cardiovascular diseases.
For development of the mobile cyber-physical system for monitoring the health of patients with
cardiovascular diseases, the following tasks should be solved: the rules for monitoring the health
of patients with cardiovascular diseases were developed; the method for monitoring the health of
patients with cardiovascular diseases was developed; the architecture of a mobile cyber-physical
system for monitoring the health of patients with cardiovascular diseases was designed.
3. Mobile cyber-physical system for monitoring the health of patients
with cardiovascular diseases
Let's develop the rules for monitoring the health of patients with cardiovascular diseases.
Rules for monitoring the health of patients with cardiovascular diseases:
1. if within 5 minutes the heart rate (indicators hri, hri+1, hri+2, hri+3, hri+4 at the same time)
is more than 100 beats per minute, then the user receives the message: "Tachycardia" and
j=j+1
2. if within 5 minutes the heart rate (indicators hri, hri+1, hri+2, hri+3, hri+4 at the same time)
is less than 60 beats per minute, then the user receives the message: "Bradycardia" and
j=j+1
3. if within 5 minutes the systolic pressure (indicators spi, spi+1, spi+2, spi+3, spi+4 at the same
time) is more than 140 mm Hg. Art., then the user receives the message: "Arterial
hypertension" and j=j+1
4. if within 5 minutes the diastolic pressure (indicators dpi, dpi+1, dpi+2, dpi+3, dpi+4 at the
same time) is more than 90 mm Hg. Art., then the user receives the message: "Arterial
hypertension" and j=j+1
5. if within 5 minutes the systolic pressure (indicators spi, spi+1, spi+2, spi+3, spi+4 at the same
time) is less than 100 mm Hg. Art., then the user receives the message: "Arterial
hypotension" and j=j+1
6. if within 5 minutes the diastolic pressure (indicators dpi, dpi+1, dpi+2, dpi+3, dpi+4 at the
same time) is less than 60 mm Hg. Art., then the user receives the message: "Arterial
hypotension" and j=j+1
7. if within 5 minutes the heart rate (indicators hri, hri+1, hri+2, hri+3, hri+4 at the same time)
is more than 150 beats per minute, and the user has not confirmed that he saw the message
within 30 seconds about tachycardia, then the message "Tachycardia, critical indicators"
together with the user's first and last name and geolocation is transmitted from the user's
mobile phone to his family doctor and/or family member and j=j+1
8. if within 5 minutes the heart rate (indicators hri, hri+1, hri+2, hri+3, hri+4 at the same time)
is less than 45 beats per minute, and the user has not confirmed that he saw the message
within 30 seconds about bradycardia, then the message "Bradycardia, critical indicators"
together with the user's first and last name and geolocation is transmitted from the user's
mobile phone to his family doctor and/or family member and j=j+1
9. if within 5 minutes the systolic pressure (indicators spi, spi+1, spi+2, spi+3, spi+4 at the same
time) is more than 180 mm Hg. Art., and the user has not confirmed within 30 seconds
that he has seen a message about arterial hypertension, then the message "Arterial
hypertension, critical indicators" together with the user's name and surname and
geolocation is transmitted from the user's mobile phone to his family doctor and/or family
member and j=j+1
10. if within 5 minutes the diastolic pressure (indicators dpi, dpi+1, dpi+2, dpi+3, dpi+4 at the
same time) is more than 120 mm Hg. Art., and the user has not confirmed within 30
seconds that he has seen a message about arterial hypertension, then the message "Arterial
hypertension, critical indicators" together with the user's name and surname and
geolocation is transmitted from the user's mobile phone to his family doctor and/or family
member and j=j+1
11. if within 5 minutes the systolic pressure (indicators spi, spi+1, spi+2, spi+3, spi+4 at the same
time) is less than 80 mm Hg. Art., and the user has not confirmed within 30 seconds that
he saw a message about arterial hypotension, then the message "Arterial hypotension,
critical indicators" together with the user's name and surname and geolocation is
transmitted from the user's mobile phone to his family doctor and/or family member and
j=j+1
12. if within 5 minutes the diastolic pressure (indicators dpi, dpi+1, dpi+2, dpi+3, dpi+4 at the
same time) is less than 55 mm Hg. Art., and the user has not confirmed within 30 seconds
that he saw a message about arterial hypotension, then the message "Arterial hypotension,
critical indicators" together with the user's name and surname and geolocation is
transmitted from the user's mobile phone to his family doctor and/or family member and
j=j+1
Then the method for monitoring the health of patients with cardiovascular diseases consists of the
following steps:
1. reset the counter of used rules: j=0
2. minute-by-minute formation of a set of indicators of the user's state of health (set IUH):
heart rate (indicator hr), systolic pressure (indicator sp), diastolic pressure (indicator dp):
IUH={hri, spi, dpi}, i=1..∞
3. formation of a set of indicators of the user's health every 5 minutes (set IUH5): IUH5={hri,
spi, dpi, hri+1, spi+1, dpi+1, hri+2, spi+2, dpi+2, hri+3, spi+3, dpi+3, hri+4, spi+4, dpi+4}, i=1..∞
4. analysis of the set of indicators of the user’s health every 5 minutes (set IUH5) – using
each of the developed rules for monitoring the health of patients with cardiovascular
diseases
5. if after the analysis j=0, then the user’s condition is normal, and no action is taken,
otherwise actions are taken (issuing a notification about the risk; or issuing a notification
about the risk and sending the data to the family doctor and/or a member of the user’s
family) according to the triggered rule(s)
The developed rules and method for monitoring the health of patients with cardiovascular diseases
ensure: every minute and every five minutes’ formation of a set of indicators of the user's health
status, analysis of indicators using the developed rules and issuance of a notification to the user
about the risk or issuance of a notification to the user about risk with sending data about the
existing risk to the user's family doctor and/or family member.
The architecture of the mobile cyber-physical system for monitoring the health of patients with
cardiovascular diseases is based on the developed method and rules for monitoring the health of
patients with cardiovascular diseases.
The architecture of the mobile cyber-physical system for monitoring the health of patients with
cardiovascular diseases is presented in Figure 1.
Figure 1: Architecture of the mobile cyber-physical system for monitoring the health of patients with
cardiovascular diseases
Mobile cyber-physical system for monitoring the health of patients with cardiovascular diseases
includes a set of sensors for measuring the necessary indicators - sensors for measuring heart rate
and sensors for measuring blood pressure. Mobile cyber-physical system for monitoring the health
of patients with cardiovascular diseases is a bracelet in which these sensors are installed, as well
as a specially developed mobile application on the user's smartphone. In the mobile application,
when registering, the user indicates his first and last name, gives the application access to
geolocation data, and notes the mobile phone numbers of people to whom the data should be
transferred in the event of a serious threat to the life and health of the user (family doctor and/or
member(s) the user's family). With the help of the bracelet, a set of indicators of the user's health
is formed every minute and every five minutes, as well as the analysis of the indicators using the
above developed rules for monitoring the health of patients with cardiovascular diseases. If the
heart rate and/or blood pressure readings exceed the reference values (rules 1-6), the user receives
a message on the smartphone in the mobile application about the corresponding risk according to
the rule(s) that has been triggered. The user must confirm that he received the message within 30
seconds on the smartphone. If the heart rate and/or blood pressure readings are critical (rules 7-
12) and the user has not confirmed the receipt of the relevant risk message on the smartphone
within 30 seconds, the user data (name, surname and emerging threat) is transmitted along with
geolocation to the phone of the family doctor and/or family member, so that they can quickly call
an ambulance based on the provided geolocation.
4. Results & Discussion
Let's consider the functioning of the developed method for monitoring the health of patients with
cardiovascular diseases and mobile cyber-physical system for monitoring the health of patients with
cardiovascular diseases.
For the first example, we will consider the use of the proposed mobile cyber-physical system
for monitoring the health of patients with cardiovascular diseases by a 73-year-old woman who is
a patient of the outpatient clinic of family medicine in the Ozerna microdistrict (Khmelnytskyi)
and who suffers from frequent attacks of tachycardia and arterial hypertension.
The woman was put on a bracelet with sensors mobile cyber-physical system for monitoring
the health of patients with cardiovascular diseases and the developed mobile application was
installed on her smartphone. The family doctor helped the patient register in the mobile application
– enter her first and last name, give the application access to geolocation data, and specify the
mobile phone numbers of people to whom the data should be transferred in the event of a serious
threat to the life and health of the user (the family doctor and the patient's son). After three days
of wearing the bracelet, the family doctor and the patient's son received the message
"Hypertension, critical indicators" on their phones, along with the patient's first and last name and
her geolocation. The family doctor immediately called an ambulance at the indicated geolocation
– the ambulance doctors found the patient unconscious in the yard of her house, the patient had a
hypertensive crisis, the systolic pressure was 200 mm Hg. Art., diastolic pressure was 140 mm
Hg. Art. In this case, the developed mobile cyber-physical system for monitoring the health of
patients with cardiovascular diseases helped to save the patient and prevent her stroke.
For the second example, we will consider the use of the proposed mobile cyber-physical system
for monitoring the health of patients with cardiovascular diseases by a 45-year-old man, who is
also a patient of the outpatient clinic of family medicine in the Ozerna microdistrict
(Khmelnytskyi) and who suffers from frequent attacks of bradycardia, which must be detected in
time with for the purpose of timely use of the necessary medical drugs.
The man was put on a bracelet with sensors mobile cyber-physical system for monitoring the
health of patients with cardiovascular diseases and a developed mobile application was installed
on a smartphone. The family doctor helped the patient register in the mobile application – enter
his first and last name, give the application access to geolocation data, and specify the mobile
phone numbers of people to whom the data should be transferred in the event of a serious threat
to the life and health of the user (the family doctor and the patient's wife). During the next visit to
the family doctor, the patient said that thanks to the bracelet, he has much easier attacks of
bradycardia, because the bracelet informs him of the onset of an attack even before he feels
significantly worse, and he immediately uses the medical drugs recommended by the doctor, so
the attack can be stopped at its beginning. In this case, the developed mobile cyber-physical system
for monitoring the health of patients with cardiovascular diseases helps the patient in self-diagnosis
and monitoring of his state of health and timely use of the necessary medical drugs in the event of
a risk.
So, the proposed mobile cyber-physical system for monitoring the health of patients with
cardiovascular diseases will help many cardiovascular patients to monitor the health of their heart,
and will also help these people to receive emergency help in the event of a serious threat to their
life and health.
5. Conclusions
Currently, the successfully developed and implemented mobile cyber-physical system for
monitoring the health of patients with cardiovascular diseases is relevant.
The conducted review of known cyber-physical systems for monitoring the health of patients
with cardiovascular diseases showed that there are currently a large number of different solutions,
but some of them are expensive, some of them are not mobile, some of them require the
intervention of a specialist for operation and interpretation of indicators. Therefore, the purpose of
this study is to develop a method and a mobile cyber-physical system for monitoring the health of
patients with cardiovascular diseases For development of the mobile cyber-physical system for
monitoring the health of patients with cardiovascular diseases, the following tasks were solved:
the rules for monitoring the health of patients with cardiovascular diseases were developed; the
method for monitoring the health of patients with cardiovascular diseases was developed; the
architecture of a mobile cyber-physical system for monitoring the health of patients with
cardiovascular diseases was designed.
The paper developed the rules and method for monitoring the health of patients with
cardiovascular diseases, which ensure: every minute and every five minutes’ formation of a set of
indicators of the user's health status, analysis of indicators using the developed rules and issuance
of a notification to the user about the risk or issuance of a notification to the user about risk with
sending data about the existing risk to the user's family doctor and/or family member.
The architecture of the mobile cyber-physical system for monitoring the health of patients with
cardiovascular diseases is based on the developed method and rules for monitoring the health of
patients with cardiovascular diseases.
The proposed mobile cyber-physical system for monitoring the health of patients with
cardiovascular diseases will help many cardiovascular patients to monitor the health of their heart,
and will also help these people to receive emergency help in the event of a serious threat to their
life and health.
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