# Heart Rate

## Description&#x20;

Heart rate (HR) is the number of times the user’s heart beats, expressed as a rate per minute. A bpm of 60-100 is considered healthy/normal.

## Participants&#x20;

Subjects were recruited from Affiliated Hospitals. There were no exclusion criteria when recruiting participants, although most participants were healthy adults above 18 years of age. Table 1 summarizes participant characteristics.

| Participants              | Composition          |
| ------------------------- | -------------------- |
| Average Age               | 41.2 years           |
| Standard deviation of age | 15.2 years           |
| Gender distribution       | 48% Male; 52% Female |

*Table 1: Characteristics of participants for HR and MSI*

## Additional Data Collection Setup

Reference heartbeat information was collected with a 3-lead electrocardiograph (ECG). The data collection setup is depicted in Figure 1.

<figure><img src="/files/wMCQ1LqALxEPtlzOt6qg" alt="" width="375"><figcaption></figcaption></figure>

*Figure 1: HR, Mental Stress Index & Irregular Heartbeat data collection setup*

## Analysis of Accuracy & Reliability&#x20;

Heartbeats were then identified in both ECG signal (reference signal) and BitDoctor signal (test signal).&#x20;

ECG captures heartbeats as characteristic fluctuations in the heart’s electrical signal that occur with each beat (Figure 2). The major peak in this fluctuation (R-wave) was used to identify each heartbeat on the ECG trace. The heart rate is calculated by counting the number of heartbeats on a given trace (Figure 3) and expressing this number as a per minute rate.

<figure><img src="/files/JSWYbvAgFHykWSM2PYFg" alt="" width="353"><figcaption><p><em>Figure 2: Labeled ECG wave.</em></p></figcaption></figure>

<figure><img src="/files/YOxBkKA0YV8POL5vV6of" alt=""><figcaption><p><em>Figure 3: ECG recording used for heart rate computation.</em></p></figcaption></figure>

This signal robustly tracks the activity of the heart in terms of number of beats and inter-beat timing (Figure 4). Like ECG, BitDoctor heart rate was calculated from each participant’s blood flow information.

<figure><img src="/files/oRB2OLr3hu0PihbWTR1a" alt=""><figcaption></figcaption></figure>

*Figure 4. Comparison between ECG heart rate and BitDoctor HR. BitDoctor signal trace (red) is overlaid on an ECG trace (blue) from a healthy adult.*

The accuracy of BitDoctor-based measurements relative to ECG-based measurements was then calculated, considering only measurements with a positive signal-to-noise ratio.

<figure><img src="/files/mkgLyVX8oF079GUnI8ij" alt=""><figcaption><p>Equation 1: Calculation of BitDoctor heart rate accuracy.</p></figcaption></figure>

HR accuracy was calculated as: (1 − 1 𝑁 ∑ | *BITDOCTOR* 𝐻𝑅 − 𝐸𝐶𝐺 𝐻𝑅 𝐸𝐶𝐺 𝐻𝑅 |) × 100%

### Results&#x20;

The accuracy and reliability of BitDoctor-based HR is presented in Table 2. Reliability refers to the test-retest reliability of each item.

| Physiological Measure | Accuracy (%) | Reliability (%) |
| :-------------------: | :----------: | :-------------: |
|           HR          |      99      |       100       |

*Table 2: Accuracy and reliability of BitDoctor HR*

## HR Accuracy Details&#x20;

Table 3 presents additional accuracy metrics pertaining to HR.

|                             | HR Accuracy (bpm) |
| :-------------------------: | :---------------: |
|         Mean ECG HR         |        74.4       |
|      Mean BitDoctor HR      |        75.1       |
|          Mean Error         |        0.63       |
| Standard Deviation of Error |        1.21       |
|    Mean of Absolute Error   |        0.79       |

*Table 3: Additional BitDoctor heart rate accuracy metrics*

Additional analysis was conducted to determine BitDoctor-based HR accuracy with shorter (30-second) measurements. Once again, BitDoctor-based HR tracked reference (ECG) HR very well (Figure 5). The Pearson correlation between ECG and BitDoctor measurements under these conditions was essentially perfect (r=1.0).

<figure><img src="/files/G4ya1IROeuy2I7Koj0Q5" alt="" width="331"><figcaption></figcaption></figure>

*Figure 5: Scatter plot of 30-second HR measurements taken by ECG and BitDoctor Technology.*


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