Mining telemonitored physiological data and patient-reported outcomes of congestive heart failure patients

PLoS One. 2018 Mar 1;13(3):e0190323. doi: 10.1371/journal.pone.0190323. eCollection 2018.


This paper addresses patient-reported outcomes (PROs) and telemonitoring in congestive heart failure (CHF), both increasingly important topics. The interest in CHF trials is shifting from hard end-points such as hospitalization and mortality, to softer end-points such health-related quality of life. However, the relation of these softer end-points to objective parameters is not well studied. Telemonitoring is suitable for collecting both patient-reported outcomes and objective parameters. Most telemonitoring studies, however, do not take full advantage of the available sensor technology and intelligent data analysis. The Chiron clinical observational study was performed among 24 CHF patients (17 men and 7 women, age 62.9 ± 9.4 years, 15 NYHA class II and 9 class III, 10 of ishaemic, aetiology, 6 dilated, 2 valvular, and 6 of multiple aetiologies or cardiomyopathy) in Italy and UK. A large number of physiological and ambient parameters were collected by wearable and other devices, together with PROs describing how well the patients felt, over 1,086 days of observation. The resulting data were mined for relations between the objective parameters and the PROs. The objective parameters (humidity, ambient temperature, blood pressure, SpO2, and sweeting intensity) could predict the PROs with accuracies up to 86% and AUC up to 0.83, making this the first report providing evidence for ambient and physiological parameters to be objectively related to PROs in CHF patients. We also analyzed the relations in the predictive models, gaining some insights into what affects the feeling of health, which was also generally not attempted in previous investigations. The paper strongly points to the possibility of using PROs as primary end-points in future trials.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accelerometry
  • Algorithms
  • Area Under Curve
  • Blood Protein Disorders
  • Body Temperature
  • Data Mining* / methods
  • Decision Trees
  • Electrocardiography
  • Female
  • Heart Failure / diagnosis*
  • Heart Failure / physiopathology*
  • Humans
  • Humidity
  • Male
  • Middle Aged
  • Models, Biological
  • Monitoring, Ambulatory*
  • Patient Reported Outcome Measures*
  • ROC Curve
  • Telemedicine
  • Telemetry*
  • Wearable Electronic Devices

Grant support

This research described in this paper partially was carried out in the Chiron project (, which was co-funded by the ARTEMIS Joint Undertaking (grant agreement # 2009-1-100228) and by national authorities, and partially in the HeartMan project (, which received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 689660. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.