CarDS-Plus ECG Platform: Development and Feasibility Evaluation of a Multiplatform Artificial Intelligence Toolkit for Portable and Wearable Device Electrocardiograms

Abstract In the rapidly evolving landscape of modern healthcare, the integration of wearable and portable technology provides a unique opportunity for personalized health monitoring in the community. Devices like the Apple Watch, FitBit, and AliveCor KardiaMobile have revolutionized the acquisition and processing of intricate health data streams that were previously accessible only through devices only available to healthcare providers. Amidst the variety of data collected by these gadgets, single-lead electrocardiogram (ECG) recordings have emerged as a crucial source of information for monitoring cardiovascular health. Notably, there has been significant advances in artificial intelligence capable of interpreting these 1-lead ECGs, facilitating clinical diagnosis as well as the detection of rare cardiac disorders. This design study describes the development of an innovative multi-platform system aimed at the rapid deployment of AI-based ECG solutions for clinical investigation and care delivery. The study examines various design considerations, aligning them with specific applications, and develops data flows to maximize efficiency for research and clinical use. This process encompasses the reception of single-lead ECGs from diverse wearable devices, channeling this data into a centralized data lake, and facilitating real-time inference through AI models for ECG interpretation. An evaluation of the platform demonstrates a mean duration from acquisition to reporting of results of 33.0 to 35.7 seconds, after a standard 30 second acquisition, allowing the complete process to be completed in 63.0 to 65.7 seconds. There were no substantial differences in acquisition to reporting across two commercially available devices (Apple Watch and KardiaMobile). These results demonstrate the succcessful translation of design principles into a fully integrated and efficient strategy for leveraging 1-lead ECGs across platforms and interpretation by AI-ECG algorithms. Such a platform is critical to translating AI discoveries for wearable and portable ECG devices to clinical impact through rapid deployment.