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Published on: August 30, 2016
A Closed-Loop Cardiovascular Model of the Supine-To-Stand Manoeuvre: Implications for Falls
Joeri A van de Sande1, Valeria Krzhizhanovskaya1, Lex M van Loon2,3
1Computational Science Lab, Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, the Netherlands.
Summary
Older adults at risk of falling can be better assessed using a new cardiovascular model. This model analyzes continuous blood pressure and heart rate data to identify differences linked to fall history.
Area of Science:
- Cardiovascular physiology
- Geriatric medicine
- Biomedical modeling
Background:
- Falls are a significant risk in aging populations, often linked to orthostatic hypotension (OH).
- Current OH diagnostics using intermittent measurements may not fully capture dynamic cardiovascular responses to standing.
- A need exists for advanced methods to assess orthostatic haemodynamics in older adults.
Purpose of the Study:
- To develop and validate a closed-loop cardiovascular lumped-parameter model for evaluating orthostatic haemodynamic responses.
- To enable model-based assessment of beat-to-beat blood pressure and heart rate during orthostatic stress in older adults.
- To identify cardiovascular model parameter differences between older adults with and without a history of falls.
Main Methods:
- A 23-compartment cardiovascular lumped-parameter model incorporating baroreflex and cardiopulmonary regulation was developed.
- The model was calibrated using continuous Finapres data from older adults undergoing a supine-to-stand manoeuvre.
- A stochastic ranking evolutionary strategy was used to fit 31 parameters to cohort data, distinguishing between fallers and non-fallers.
Main Results:
- The model accurately reproduced population-level systolic/diastolic blood pressure and heart rate responses during orthostatic stress.
- Model performance showed low normalised root mean squared errors (10.6% for fallers, 9.6% for non-fallers).
- Significant differences in four parameters were found between fallers and non-fallers: baroreflex reference heart rate, a baroreflex transfer function parameter, transient external muscle pressure, and total blood volume.
Conclusions:
- A physiologically structured cardiovascular model can effectively simulate orthostatic haemodynamics in older adults.
- Model-based analysis reveals distinct cardiovascular parameter profiles associated with fall history in the elderly.
- This approach offers a promising tool for enhanced assessment of fall risk in aging populations.
