A research team from Nanyang Technological University, Singapore (NTU Singapore) and Tan Tock Seng Hospital (TTSH) have invented a smart handheld medical device that could enable early intervention for patients with congestive heart failure.

The portable innovation, which resembles a stethoscope, is made up of an acoustic sensor connected to a smartphone. It enables early intervention by allowing patients to check for excess fluid in the lungs at home. Fluid accumulation in the lungs, which causes breathlessness, is a common symptom of congestive heart failure.

One in five people worldwide run the risk of developing congestive heart failure, and this prevalence increases with age. As there is no cure for the ailment, patients can only monitor their health closely with lifestyle changes or medication to prevent their heart function from deteriorating irreversibly.

Currently, patients can only check for fluid accumulation in the lungs by going for a clinical examination, which can be considerably subjective, or through imaging modalities and serum biomarker tests, which are costly and take a longer time.

The non-invasive device built by a team led by NTU Associate Professor Ser Wee and TTSH Associate Professor David Foo circumvents these problems with its portability, ease of use and quick results. Currently a prototype, the device is able to detect any excess fluid in the lungs in 10 seconds once placed on the patient?s chest or back.

In a pilot study using lung sounds recorded from TTSH?s congestive heart failure patients, Assoc Prof Ser and his team found the device to have over 92 per cent accuracy in identifying patients with the condition ? comparable to existing ?gold standard? diagnosis methods such as X-rays and CT scans. The findings were first presented at the 2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

Associate Professor Foo, Head of Cardiology at TTSH, said, ?Patients can monitor their condition at home and use the device whenever they feel slightly breathless at home. It is potentially a game-changer in the management of ambulatory heart failure patients. It can also provide a rapid and accurate acute diagnosis of heart failure in situations of undifferentiated shortness of breath symptoms.?

Associate Professor Ser from NTU?s School of Electrical and Electronic Engineering added, ?Currently, such diagnosis can only be conducted through clinical examination, which cannot be made frequently. Our smart medical device can be used by anyone, anywhere and any number of times, which will enable the possibility of early intervention of congestive heart failure.

?The next wave of MedTech (medical technology) start-ups will see the massive proliferation of smart medical devices that rely on artificial intelligence (AI) and sensing technologies, such as the one we invented, and that will enable personalised self-assessment and screening of cardiopulmonary and other diseases, and revolutionise the way healthcare is managed in future.?

In congestive heart failure, the diseased or overworked heart ventricle is unable to pump out enough of the blood it receives from the lungs. This causes pressure to build up first in the heart, then in the veins and capillaries in the lungs. The pressure then pushes fluid back through the capillary walls and into the air sacs of the lungs.

As a result, when air passes through these fluid-filled air sacs, crackles can be heard from the lungs. Depending on the intensity, a crackle may sound like salt added to a hot pan, or Velcro being torn apart. Based on this principle, Prof Ser and his team found a unique set of features that can be used to identify characteristics of sounds unique to patients with fluid accumulation in the lungs. They then developed a proprietary AI algorithm capable of identifying and processing these signals to determine if there is fluid accumulation in the lungs.

The smart medical device developed by NTU and TTSH first picks up breathing sounds through a sound sensor. Through a mobile app, the sound signals are then sent to a server located in the cloud. The NTU-developed algorithm stored in the cloud then processes these sound signals, and the results are shown on the mobile app. This whole process takes about 10 seconds to complete.

Following two rounds of tests with samples collected from 86 patients, the team is now running a third round of tests on the device to further validate its sensitivity and specificity.

A major pharmaceutical company, a healthcare MNC and a local healthcare company have approached the team to explore the possibility of collaborations.

The research team has filed a patent for the invention, and is now refining the product. A MedTech start-up from NTU to commercialise the device is in the pipeline. The team will seek clinical and regulatory validation for the product before mass producing it.

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Foo Jie Ying

Manager

Corporate Communications Office

Nanyang Technological University

Tel: 6790 6681

Email: jieying@ntu.edu.sg

Praveen Nayago

Assistant Manager

Corporate Communications

Tan Tock Seng Hospital

Tel: 6357 8434

Email: praveen_nayago@ttsh.com.sg

A research-intensive public university, Nanyang Technological University, Singapore (NTU Singapore) has 33,000 undergraduate and postgraduate students in the Engineering, Business, Science, Humanities, Arts, & Social Sciences, and Graduate colleges. It also has a medical school, the Lee Kong Chian School of Medicine, set up jointly with Imperial College London.

NTU is also home to world-class autonomous institutes ? the National Institute of Education, S Rajaratnam School of International Studies, Earth Observatory of Singapore, and Singapore Centre for Environmental Life Sciences Engineering ? and various leading research centres such as the Nanyang Environment & Water Research Institute (NEWRI) and Energy Research Institute @ NTU (ERI@N).

Ranked 12th in the world, NTU has been placed the world?s top young university for the past five years. The University?s main campus is frequently listed among the Top 15 most beautiful university campuses in the world and it has 57 Green Mark-certified (equivalent to LEED-certified) building projects comprising more than 230 buildings, of which 95% are certified Green Mark Platinum. Apart from its main campus, NTU also has a campus in Singapore?s healthcare district.

For more information, visit www.ntu.edu.sg.

TTSH is one of Singapore?s largest multi-disciplinary hospitals with more than 174 years of pioneering medical care and development. The hospital has 45 clinical and allied health departments, 16 specialist centres. It also has three institutes that are spearheading care, research and innovations in geriatric medicine, infectious diseases and ophthalmology. Powered by more than 8,000 healthcare staff, TTSH sees over 2,500 patients at its specialist clinics and some 460 patients at its emergency department every day. TTSH is part of the National Healthcare Group, providing holistic and integrated patient care.? With a strong quality culture steeped in patient safety, TTSH constantly challenges itself to provide faster, better, cheaper and safer care for patients. To achieve this, the hospital keeps abreast and believes in investing in its staff, facilities, medical technology and system improvements.

More information is available at www.ttsh.com.sg.