Robust fetal ECG extraction and detection from abdominal leads.

The fetal ECG derived from abdominal leads provides an alternative to standard means of fetal monitoring. Furthermore, it permits long-term and ambulant recordings, which expands the range diagnostic possibilities for evaluating the fetal health state. However, due to the temporal and spectral overlap of maternal and fetal signals, the usage of abdominal leads imposes the need for elaborated signal processing routines.In this work a modular combination of processing techniques is presented. Its core consists of two maternal ECG estimation techniques, namely the extended Kalman smoother (EKS) and template adaption (TA) in combination with an innovative detection algorithm. Our detection method employs principles of evolutionary computing to detect fetal peaks by considering the periodicity and morphological characteristics of the fetal signal. In a postprocessing phase, single channel detections are combined by means of kernel density estimation and heart rate correction.The described methodology was presented during the Computing in Cardiology Challenge 2013. The entry was the winner of the closed-source events with average scores for events 4/5 with 15.1/3.32 (TA) and 69.5/4.58 (EKS) on training set-A and 20.4/4.57 (TA) and 219/7.69 (EKS) on test set-B, respectively. Using our own clinical data (24 subjects each 20 min recordings) and statistical measures beyond the Challenge's scoring system, we further validated the proposed method. For our clinical data we obtained an average detection rate of 82.8% (TA) and 83.4% (EKS). The achieved results show that the proposed methods are able produce reliable fetal heart rate estimates from a restricted number of abdominal leads.

Financial and health costs of uncontrolled blood pressure in the United Kingdom.

BACKGROUND: Uncontrolled hypertension is associated with an elevated risk of all cardiovascular disease, especially stroke. However, many patients with hypertension do not achieve agreed targets for blood pressure. OBJECTIVE: To estimate the cost and morbidity consequences of uncontrolled hypertension in the UK. DESIGN: Descriptive epidemiological study. METHODS: The study used a burden-of-disease model combining data on the prevalence of hypertension, the incidence of major cardiovascular (CV) events and the costs of treating these events. The prevalence of uncontrolled hypertension was taken from the 1998 Health Survey for England. The incidences of three CV events, acute myocardial infarction, congestive heart failure and stroke, at different levels of achieved blood pressure, were estimated using results from the Hypertension Optimal Treatment study. Costs were taken from published sources. We estimated the number of major CV events and acute hospital costs that would be avoided if all people with hypertension had blood pressure treated to target levels. RESULTS: The model estimated that in the UK 5.7 million adults (12% of the population aged >16 years) have actual blood pressure above 160/95 mm Hg, and a further 10.3 million (21%) have blood pressure in the range 140/90-160/95 mm Hg. An estimated 58000 major CV events per year occur in these patients that would be avoided if their blood pressure was at target levels. If all patients had blood pressure treated to target, the cost to the NHS of managing major CV events would fall by pound 97.2 million per year at 2000/01 prices (95% CI: pound 56- pound 144 million). CONCLUSION: Failure to achieve blood pressure targets contributes substantially to avoidable NHS costs and to the number of CV events in the UK.