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Updated: Nov 7, 2025

A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
A Vital Signs Telemonitoring Programme Improves the Dynamic Prediction of Readmission Risk in Patients with Heart
Fatemeh Fahimi1, Yang Guo1, Shao Chuen Tong2
1Institute for Infocomm Research, Agency for Science Technology & Research, Singapore.
Abstract:
Heart failure (HF) is a leading cause of hospital readmissions. There is great interest in approaches to efficiently predict emerging HF-readmissions in the community setting. We investigate the possibility of leveraging streaming telemonitored vital signs data alongside readily accessible patient profile information for predicting evolving 30-day HF-related readmission risk. We acquired data within a non-randomized controlled study that enrolled 150 HF patients over a 1-year post-discharge telemonitoring and telesupport programme. Using the sequential data and associated ground truth readmission outcomes, we developed a recurrent neural network model for dynamic risk prediction. The model detects emerging readmissions with sensitivity > 71%, specificity > 75%, AUROC ~80%. We characterize model performance in relation to telesupport based nurse assessments, and demonstrate strong sensitivity improvements. Our approach enables early stratification of high-risk patients and could enable adaptive targeting of care resources for managing patients with the most urgent needs at any given time.
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