Utilizing the search technique, 16,699 paperwork had been recognized within the subject of digital well being applied sciences in cardiovascular medication. The primary article on document, revealed in 1961 in Circulation is titled ‘Digital machine for correct identification of cardiac conduction system- its use in open-heart surgical procedure’9. Within the interval of 30 years to the early 1990’s solely 35 extra related papers had been revealed. For the reason that mid-1990’s there was an accelerating publication pattern till 2021, when over 2,300 articles had been revealed in 12 months (Fig. 1a). Throughout the observable exponential pattern on this subject, there aren’t any distinct jumps in analysis exercise. Round 60% of the analysis output is within the type of authentic analysis articles (together with case research), adopted by convention proceedings papers (14%), assembly abstracts (13%) and overview articles (9%).
The highest globally cited articles have fairly distinct subjects (see Supplementary Desk 2). Probably the most cited paper is “Versatile polymer transistors with excessive strain sensitivity for software in digital pores and skin and well being monitoring” authored by Schwartz, Tee10. The paper has obtained 1,337 citations in WoS gives data on the fabrication of a novel versatile pressure-sensitive sensor that has excessive strain and time decision capabilities to repeatedly monitor the human radial artery pulse wave. It’s a step-change innovation as a result of beforehand, solely complicated devices resembling micromanometers might learn a pulse with such accuracy. Moreover, the versatile strain sensors developed could possibly be utilized in cell well being monitoring and distant diagnostics in cardiovascular medication. Different extremely cited papers embody subjects about health-related behaviours resembling sedentary existence11, remedy adherence12, robots13, and software program14, which highlights the variety inside this subject.
Particular topic areas had been recognized utilizing WoS Classes. Whereas a lot of the literature is concentrated in Cardiac and Cardiovascular Techniques (n = 4,809, 28%), it reaches throughout a spread of sub-disciplines, together with Well being Care Science Companies (n = 1,643, 10%), Engineering Biomedical (n = 1,449, 9%), Engineering Electrical Digital (n = 1,255, 8%), Medication Normal Inside (n = 1,201, 7%), Peripheral Vascular Illness (n = 1,142, 7%), Medical Informatics (n = 1,118, 7%), Medical Neurosciences (n = 941, 6%) and Rehabilitation (n = 752, 4%). Circulation and European Coronary heart Journal are the dominant shops for publications on this space of analysis (Fig. 1b), with round 700 paperwork attributed to those two alone.
Creator contributors and networks of collaboration
Over 75,000 authors have contributed to the subject, 2,956 of whom have authored 5 or extra articles. Authors with greater than 45 contributions embody Giuseppe Boriani (College-Hospital Polyclinic of Modena, Italy), Rizwan Sohail (Baylor Faculty of Medication, United States of America [USA]), Tiny Jaarsma (Linkoping College, Sweden), Paul Friedman (Mayo Clinic Faculty of Medication, USA), Bruce Wilkoff (Cleveland Clinic, USA), Larry Baddour (Mayo Clinic, USA), Jinseok Lee (Kyung Hee College, South Korea) Julie Redfern (College of Sydney, Australia) and Jenny Wang (College of Sheffield, England).
Publications originating from the USA have been most frequent (n = 5,493), adopted by England (n = 1,494), Italy (1,338), Germany (n = 1,191), China (n = 1047), Canada (n = 1030), and Australia (n = 908) (Fig. 2). There are fewer contributions from Africa and South America (aside from Brazil). Authors based mostly within the USA are concerned in all of the strongest collaborations; with England (n = 260), Canada (n = 248), China (n = 163), Germany (n = 163), Australia (n = 159) and Italy (n = 146) indicating that lingual similarities and geographical proximity don’t essentially foster higher collaboration. Collaborations between researchers from English-speaking nations resembling Australia, Canada, England and USA and Center Japanese nations Iran, Iraq and Saudi Arabia are amongst the latest. Lastly, we are able to additionally observe that there are few low and middle-income nations producing scholarly analysis on this space.
Semantic evaluation; key phrases, titles and abstracts
Desk 1 reveals the highest key phrases (see additionally Supplementary Fig. 1 for density of co-occurrence of key phrases within the literature). In slightly below two years because the time period emerged, Covid-19 (and options e.g. sars-cov-2) have already garnered 270 mentions, reflecting the crucial of managing care when bodily distancing is demanded. Key phrases additionally present perception into the temporal shifts in analysis and scholarly focus. Desk 1 additionally reveals the highest key phrases with the strongest bursts of quotation and the key phrases with the latest and strongest bursts of quotation. Youngsters and infants, males, youth, and aged sufferers are the populations of curiosity for students, as proven by bursts. Youngsters seemed to be a robust analysis curiosity for over twenty years (1991-2013), in parallel with analysis subjects resembling blood strain, cardiovascular reactivity and household historical past.
Within the early Nineteen Nineties, when digital well being improvements had been quickly accelerating in cardiovascular medication analysis within the early Nineteen Nineties, the key phrase bursts had been usually related to cardiovascular threat components (e.g. blood strain, train). Extra just lately, bursts of exercise are associated to fashionable terminology affiliated with complicated information and sensors, together with ‘IoT’ (web of issues), ‘neural community’ and ‘photoplethysmography’.
Main divisions of digital applied sciences in cardiovascular analysis
Extra perception into subject construction of the subject was discovered by finishing an evaluation of the prevalence of phrases within the title and abstracts of articles. Determine 3 reveals the frequency of the co-occurrence of phrases and is complimented by the averaged publication 12 months of articles containing these phrases and the typical variety of citations articles with these phrases obtain. The evaluation revealed that there are 5 main divisions. Desk 2 reveals the highest phrases, most cited phrases, and youngest phrases for every cluster.
Cluster 1 (Fig. 3; purple, 491 gadgets) focusses on Cardiac digital implantable units (CIEDs), together with pacemakers, implantable cardioverter-defibrillators and different units used to assist management of monitor heartbeats in people with well being rhythm problems and coronary heart failure (HF).
Cluster 2 (orange, 474 gadgets) represents the world of Cell well being know-how for secondary prevention of CVD. This contains strategies of measuring threat components and modes for intervention designed to have an effect on the actions that people take relating to their well being. This division is saturated with phrases resembling bodily exercise, wholesome life-style, Fitbit and step depend, and is related to medical trials.
Cluster 3 (gray, 441 gadgets) consists of phrases associated to Wearable applied sciences. A big focus of this clusters is utilizing photoplethysmography – or sensor-technology to measure physiological parameters.
The final of the key divisions, Cluster 4 (yellow, 195 gadgets) is regarding Know-how purposes in stroke rehabilitation. Attainable interventions for post-stroke rehabilitation have included use of immersive applied sciences and gamification resembling Digital Actuality and robotics for rising motion.
Utilizing the interactive hyperlink to the visible illustration (see caption of Fig. 3), it’s decided that among the latest phrases in Cluster 1 are associated to the Covid-19 pandemic (‘lockdown’, ‘pandemic’, ‘sars cov’). All through the clusters, there may be decreased prevalence of phrases associated to minority populations resembling ‘incapacity’, ‘rural’ and ‘culturally numerous’.
The smaller division, Cluster 5 (pink, 57 gadgets) consists of phrases associated to Emergency cardiovascular care. The care and administration of out-of-hospital cardiac arrest (OHCA) is evolving and is strongly influenced by rising digital applied sciences. Examples embody wearable life detection applied sciences to enhance survival, drones delivering automated defibrillators to the scene of the arrest, and developments in cell and digital know-how used to leverage bystander response15.
Inspecting collaboration, Fig. 4 reveals clusters of authors who continuously work collectively to supply scholarly analysis. This determine doesn’t symbolize all 75,000 authors who’ve contributed to this subject total, solely those that have contributed to the central community of analysis (see Supplementary Desk 1 for particulars of every cluster). There are ten clusters with ten or extra authors.
Clusters 1, 2, 3, 6, and 10 are teams of students researching cardiac electrophysiology. Nevertheless, there are some minor variations in analysis subject, for instance, clusters 3 and 6 is concentrated on cardiac resynchronisation remedy, while clusters 2 and 6 are taking a look at lead extraction and administration, and cluster 10 is related to analysis in infections related CIEDs. Cluster 1 may be very homogenous and based mostly in Western Europe, with few exceptions. Equally, Cluster 6 is predicated in North America, with a number of authors affiliated with Cleveland Clinic. Cluster 5, one other group researching thromboembolic illnesses and telecardiology, is unique to Italian affiliations. Except for subjects associated to CIEDs, 4 of the opposite main collaborative teams are researching cardiopulmonary resuscitation (cluster #4), telemonitoring in HF and stroke prevention (cluster #7), mHealth and telemonitoring in HF (cluster #8) and secondary prevention of coronary coronary heart illness (CHD) (cluster #9).
The strongest hyperlinks inside this central creator community are between Ewa Piotrowicz and Ryszard Piotrowicz (cluster 7, hyperlink power = 23.73), Friedrich Koehler and Kerstin Koehler (cluster 18, 13.50), and Clara Chow and Julie Redfern (cluster 9, 13.78). Virtually all of the strongest hyperlinks are between authors in the identical cluster, aside from frequent collaboration between Julie Redfern and Lis Neubeck (cluster 9 and 15 respectively, hyperlink power = 7.33), which hyperlinks two teams of multidisciplinary clinician researchers who’re focussed on secondary prevention of CHD and CR.
Influential references of digital know-how and cardiovascular science literature
Influential articles related to the particular subject, ranked by native quotation depend, are listed in Supplementary Desk 3. This metric considers the reference lists of paperwork within the total dataset and what number of citations the references obtain. Primarily based on this metric, ‘Telemonitoring in Sufferers with Coronary heart Failure’16 is probably the most influential research on this discipline. The research indicated that the applying of telemonitoring for sufferers just lately hospitalized for HF didn’t enhance outcomes. The opposite two most influential papers inside this subject are ‘2016 ESC Tips for the prognosis and therapy of acute and power coronary heart failure’17 and ‘Replace on Cardiovascular Implantable Digital Gadget Infections and Their Administration: A Scientific Assertion From the American Coronary heart Affiliation’18. The final of which gives an essential replace on suggestions for the care of sufferers with infections attributable to CIEDs, in addition to highlighting the analysis gaps. Research, evaluations, and tips focussed on HF, telemonitoring and CIEDs dominate the listing of high ten regionally cited articles.
Moreover, we are able to observe the articles which have had the strongest burst of citations since publication (see Supplementary Desk 4). The topics of all of articles with the strongest bursts are associated to telemonitoring or distant monitoring. The highest two are ‘Noninvasive house telemonitoring for sufferers with coronary heart failure at excessive threat of recurrent admission and dying: the Trans-European Community-Dwelling-Care Administration System (TEN-HMS) research’ (power = 36.55)19 and ‘Structured phone assist or telemonitoring programmes for sufferers with power coronary heart failure’ (power = 31.81)20.
Temporal evolution of digital well being applied sciences in cardiovascular analysis
The expansion and temporal evolution of this subject was visualized utilizing doc co-citation methodology. Determine 5 reveals a birds-eye view of the twenty main divisions – or analysis streams – through which digital applied sciences have been utilized in cardiovascular analysis (Supplementary Fig. 2 reveals the analysis streams in a timeline format).
Determine 6 gives a visible illustration of the extent of analysis exercise inside every stream of digital well being purposes inside cardiovascular medication (1990-2021) (see Supplementary Fig. 3 for deeper perception into the twenty analysis streams). It’s evident that inside the main streams, blood strain reactivity, bypass surgical procedure, cardiac reactivity to gaming and gamification are not energetic analysis areas in digital well being purposes. We are able to clearly see that there are rising and heightened analysis actions within the areas of cardiac rehabilitation and out-of-hospital cardiac arrest. Analysis in distant monitoring, Digital Actuality, HF, transvenous lead extraction, distant monitoring, and arrythmias emerged between 2000-2010 and have maintained a excessive degree of scholarly curiosity since. Analysis into the applying of wearables (smartwatches, physique sensors and so on.) and exercise monitoring for cardiovascular care, and eMRs, appeared to peak between 2015-2020 however at the moment are exhibiting indicators of slowing down. The oldest clusters, as decided by the imply 12 months of article publication are Cardiac reactivity (1981), and equally Blood strain reactivity (1984), and Software program evaluation of cardiac output (1989). The common 12 months the citing articles are 1991, 1993 and 2007 respectively, exhibiting that there’s little or no fashionable analysis being carried out in these areas. Contrastingly, taking a look at analysis exercise we are able to see that probably the most fashionable subjects are Cardiac rehabilitation (imply citing 12 months 2018), Exercise monitoring (2018), Radiology in sufferers with CIEDs, (2018), Arrythmias (2019) and Out-of-hospital cardiac arrest (2020).
Cardiac rehabilitation is an attention-grabbing cluster in that it has a few of oldest articles, courting from 1954, nevertheless it nonetheless a modern-day analysis space. The sooner papers from mid-1970’s-1980’s have a deal with behavioural change and self-efficacy21,22.
A paper by Chow, Redfern23, titled ‘Impact of Way of life-Centered Textual content Messaging on Threat Issue Modification in Sufferers With Coronary Coronary heart Illness A Randomized Medical Trial’ has obtained probably the most native citations (n = 131, and globally n = 554) in addition to having the strongest burst of quotation (13.05) between 2017-2021. Chow, Redfern23, whose focus is secondary prevention of CHD, reveals that utilizing a text-message intervention could enhance cardiovascular threat components resembling blood lipids, bodily exercise, blood strain, BMI and tobacco consumption; a transparent instance of a easy digital well being software for bettering cardiovascular care outcomes. Lastly, analysis associated to HF, CIEDs and distant monitoring make an look in additional than half of the analysis.