2019 IEEE 43rd Annual Computer Software and Applications Conference (COMPSAC)
A Real-time Cardiac Monitoring using a Multisensory Smart IoT System
AKM Jahangir Alam Majumder†, Mohammed ElSaadany ݊, Joshua Aaron Izaguirre†, Donald R. Ucci ݊
†
Division of Mathematics and Computer Science, University of South Carolina, SC, USA
݊
Department of Electrical and Computer Engineering, Miami University, Oxford, OH, USA
majumder@mailbox.sc.edu, izaguirj@uscupstate.edu, {elsaadma, uccidr }@miamiOH.edu
Abstract- The Internet of Things (IoT) with smartphone
technologies contains vast applications in solving the problems
of heart diseases in patients needing care. With wireless sensors
and smart devices, remote monitoring can identify the real-time
physical status of heart patients during normal physical
activities. In this research, we designed and developed an
embedded sensory system with a low power communication
module to discreetly collect electrocardiogram (ECG) and body
accelerations using a smartphone in a common environment. A
wearable sensor is utilized to monitor the ECG patterns and the
smartphone’s built-in sensors; specifically, we use its
accelerometer and GPS sensors to measure the body
acceleration and location information of the user.
Experimentation and verification are conducted on a number
of test subjects with different test scenarios including sitting,
walking, jogging, and running. Using signal classification and
machine learning techniques, we show that it is possible to
design a multisensory system that allows accurate classification
and authentic prediction of heart rate quality.
Keywords- IoT, Cardiac, CPS, Biotechnology, Multisensory.
I. INTRODUCTION
The increase in popularity for wearable technology has
opened the door for an Internet of Things (IoT) specific
solution to healthcare. The advancement of low-power
Cyber-Physical System (CPS) and wireless communications
has brought a dramatic increase in the number of devices we
carry. By capturing heart-rate data, many wearable platforms
provide users' activity and exercise summaries that can be
affectively applied to determine the impact on health
management. By 2050, it is estimated that more than one in
five people will be of age 65 or older [1]. Heart diseases in
the elderly appear to be of very common occurrence, as
opposed to other age demographics. In fact, approximately
one-third to one-half of the elderly population experience
multiple heart attacks or cardiac arrest events on a yearly
basis [2]. Furthermore, series of studies have shown that
ubiquitous heart rate sensing can offer benefits in affective
clinical-grade services [3]. Our research strives to address
this problem by analyzing the ECG and body motion signals
to detect events that will ultimately lead to a cardiac risk
prediction. Since abnormal ECG patterns can lead to a heart
attack, our system identifies abnormality in ECG patterns to
alert the user regarding a potential risk. Heart problems have
huge consequences in an aging society, as they raise
tremendous concerns relating to the deterioration in the
quality of a human being’s life, as well as drastic increases
in the cost of healthcare.
Although there has been a great deal of research on
automatic heart attack detection, the area involving risk of
heart attack prediction is still currently under study. There
978-1-7281-2607-4/19/$31.00 ©2019 IEEE
DOI 10.1109/COMPSAC.2019.10220
exists challenging problems in which the need to identify all
of the possible patterns that can lead to cardiac injury is
pertinent to saving lives.
Historically, seniors living all around the world have
been known to be late adapters to the world of technology
compared to younger generations, but their movement into
digital life is continuing to expand. Recent statistics indicates
that 77% of the elderly have a phone and among that
population, 18% are using smartphone devices [4]. As self-
contained devices, smartphones present a common
commodity and software environment for developing
various cardiac arrest or heart attack detection systems [5].
Ideally, integrated sensors along with ECG monitoring can
automatically detect a risk of injury due to heart variability
[6-7]. In combination with recent studies and advancements
in mobile technology, it is feasible to assume that the elderly
will continue to increase their smartphone use. However, the
existing cardiac monitoring systems can only detect a risk to
a heart injury after it has already occurred. Subsequently, the
system sends an alarm to the caregivers and loving ones. The
ideal way to reduce the number of risks is to alert the users
about their abnormal heart rate and the possibility of an
imminent cardiac injury.
The objective of this paper is to present a multisensory
holistic system that can collect heart rates and body
accelerations. We implemented an embedded sensory
system with a Low Power (LP) communication module to
collect Body Area Sensor (BAS) data using a smartphone.
This study introduces the use of signal processing and
machine learning techniques for sensor data analytics for
sudden cardiac arrest prediction. Our proposed system will
be useful not only for the elderly, but has utility in identifying
heart disease among children, physical rehabilitation
patients, and for human behavior analysis research.
A. Major Contributions
This paper presents our unique methods to use smart
devices as the platform for developing an embedded IoT
system to predict heart abnormality; smart devices naturally
combine detection and communication components. Our
major contributions are as follows:
• First, we developed an integrated embedded smart
IoT system for heart abnormality prediction.
• Second, we proposed a real-time health assistance
system with a wearable ECG and smartphone accelerometer
for users as a unique application for predicting cardiac
abnormality.
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 • Third, we designed and developed a low power however, none of them alert the users upon emergencies.
Bluetooth communication network between the ECG sensor “Qardiocore” [14] is a very well-known and high quality
and smartphone for further data processing. heart monitor that tracks a user’s complete heart health and
• Fourth, we analyzed data using a signal displays it on a smartphone [15]. The device yields very
classification and machine learning technique to measure accurate results and is one of the best products on the market
the prediction accuracy. in terms of showing real time graphs of ECG and EKG.
The rest of the paper is organized as follows: in the next However, it only allows users to share data with their doctors
section, we describe the relevant related work. In this section, upon receiving it in an offline manner. Hence, it does not
we will discuss the difference between our system and give them the option of alerting medical personnel in real-
existing ones. Then, we discuss the details and architecture time when the patient’s heart is currently experiencing a
of our IoT system. This section is followed by the evaluation serious abnormal condition and it certainly does not predict
of our smartphone-based prototype system. Finally, we the cardiac injury. Table I represents similar approaches of
conclude the paper with feasible future research directions. risk identification, but none combine the use of an IoT
II. RELATED WORK device, physiological signals, a multisensory system, a
Risk identification using ECG patterns with embedded cyber-physical system, a low cost system, and a high level of
accuracy simultaneously.
sensors has been the subject of much study over the past TABLE I. COMPARISON OF EXISTING WORK BASED ON
decade. Most of the previous approaches regarding heart rate DIFFERENT FEATURES
recognition utilize only ECG sensors attached to the subject Use Use Cyber- High
Multisensory
Approach IoT Physiological Physical Level of
for collecting data. Therefore, they have very limited System
Device Signals System Accuracy
accuracy in predicting cardiac arrest. Peltokangas [5] No Yes No Yes Yes
There has been much work done to which we can relate Vermesan [8] Yes Yes Yes Yes Yes
and build upon. “PatientsLikeMe” launched its first online Pino [16] No No Yes Yes Yes
community in 2006, in which its main objective was to listen Sun [17] Yes Yes Yes No Yes
to patients and identify outcome measures, symptoms, and Sano [18] Yes Yes Yes No No
Agrafioti [19] No Yes No Yes Yes
treatments. It is mainly focused on helping patients answer
Swan [20] Yes No Yes Yes No
the question: “Given my status, what is the best outcome I
Evenson [21] Yes Yes No Yes No
can hope to achieve and how do I get there?” [8]. They
answered patients’ questions in several forms, including Pertrushi [22] No Yes No Yes No
having patients with similar conditions connect to each other Kim [23] No Yes Yes Yes No
and share their experiences. However, this form of E-Health Gao [24] No Yes Yes No No
is based solely on subjective communication rather than Anttonen [25] Yes Yes No Yes Yes
objective data. Calvo [26] No Yes No No No
A smartphone based system was developed by G. Barreto [27] No Yes Yes No No
Wolgast to monitor and detect heart failures in real-time [9]. Bang [28] Yes Yes Yes Yes No
A single lead heart monitor sensor was used with an Savran [29] No Yes Yes No No
ArduinoTM microcontroller, LP Bluetooth device and Our Approach Yes Yes Yes Yes Yes
antenna to send and receive data to and from the AndroidTM As a solution to the drawbacks of the above-mentioned
application created on the smartphone. This research focuses research, we developed an embedded IoT system for heart
on the communications aspects to exchange data in the most abnormality prediction. The most important feature of our
effective way with minimum noise to obtain a clear signal system is the warning that allows the user to prevent an injury
for analysis and display on the application. The authors of before it actually occurs. To the best of our knowledge, our
the application claimed that the system was able to transmit prototype is the first smartphone-based heart assistance
a noise free signal to the smartphone with high accuracy and system that uses an embedded LP IoT system to predict heart
that only further software development is needed for heart related injuries.
failures predictions by looking at the ST-segment. Therefore, III. ARCHITECTURE OF THE SYSTEM
this research lacks methods for prediction and is utilized only A strength of our proposed architecture is that it relies on
for cardiac arrest recognition. existing wireless communications systems to provide a LP
Everyday, IoT systems produce content relating to health with maximum freedom of movement to users in their
and wellness [10-13]. Even though a large number of physical activities. In addition, we have used small, light-
companies provide health services, none of them have the weight devices that are user friendly. In this section, we will
feature of providing hardware devices that can be used by discuss the methods by which users can employ our system.
patients to monitor their daily activities and alert them when First, the user powers the device using the battery cable; then
needed. There are many heart monitors available that provide the user will wrap the straps around his or her arm, attaching
users with their ECG signals to track their condition, the red lead to the right part of the stomach, the black lead to

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the right part of the chest, and the blue lead to the left part of
the chest. Figure 1 shows the basic connections of the system
architecture.
Figure 1. Proposed wearable IoT system connected to the user’s body
To integrate the embedded sensors, we perform an
extensive set of experiments for evaluating normal and
abnormal heart-rate patterns. Subjects wear the embedded
sensors and carry their smartphone on their person or hold it
in their hands. The embedded ECG and smartphone sensors
will constantly collect the heart parameters during daily
activities. After receiving the data through LP
communications, the smartphone processes the data to
classify whether the user’s condition is normal or abnormal.
A quantitative heart-rate analysis is then performed on an
Android™ platform that provides the user with the option of
viewing their real-time plots of ECG signal and body
accelerations.
To determine abnormal heart patterns, we first establish
a criterion for a normal heart-rate. Quantitative analysis of
heart rate stability and pulse symmetry yields a series of
parameters, such as the R-R interval, QRS peak, and heart-
rate. An early warning system monitors these parameters for
a subject’s signs of heart abnormality during an activity.
Though the system continuously monitors ECG patterns, a
warning triggers only if the ECG patterns and body
accelerations of the user reaches a certain point wherein the
user might face a potential heart attack. The IoT sensors
constantly collect data from the users and sends this
information to the smartphone via Bluetooth. The user has
the option to view their real-time plots which provides the
user with a basic idea of the health status. Finally, when the
application senses an abnormality, it will either alert the user
or send an alert to the caregiver in the case of an emergency.
IV. HARDWARE
The IoT system consists of an AD8232 Heart Monitor,
an Arduino, and a LP communications system as listed in
Figure 2. A smartphone is used to collect and process the
sensors’ data. The Arduino is used as an analog to digital
converter (ADC). The Arduino is programmed to read an
analog signal from the ECG sensors and convert it into a
digital form. Subsequently, it sends multisensory data to the
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phone as a response to a data-send request. It will also
manage the Bluetooth communication by coordinating with
the LP Bluetooth chip that [30], essentially, equips the
Arduino with the ability to connect to the smartphone
application. The system reads the smartphone sensor value
through the smartphone heart collector interface.
To avoid reading inaccurate values from the Arduino,
we use a delay between each reading and read from the same
analog pin twice and send the second reading. We send
different symbols before the sensor readings to be able to
parse the data at the receiving end (android application).
Bluefruit LE Shield Arduino uno
ECG Sensor Heart-rate Monitor
Figure 2. IoT hardware components
V. EVALUATION OF THE SYSTEM
To evaluate our system, we developed a prototype
application and investigated its performance. We evaluated
the prototype with extensive experimentation. In this section,
we first introduce our data collection method. Then we
present the means by which data is analyzed and
performance is measured.
A. Experimental Setup
To test the effectiveness of our proposed model, we
collected data from an ECG and accelerometer using a
smartphone. We used multiple subjects and collected data for
different events regarding user daily activity. The
smartphone placed was either in the subject’s hand or a
pocket.
B. Data Collection
For data collection, we implement an application for
heart rate monitoring on the smartphone. First, the system
reads the analog signal from electrodes that are attached to
the body, then passes it to the ECG acquisition device
through a built-in amplifier and filter. The signal is sent to
the smartphone application using a LP Bluetooth device and
then graphed and analyzed on the smartphone. The
screenshots of the prototype application are shown in Figure
3. In Figure 3 (a), the multisensory data collection interface
is shown while walking. This is used to collect the user’s
ECG pattern and body accelerations for a fixed period of real people to verify the detection accuracy of the proposed
time. The system can also monitor variations of the body system. The IoT device for data collection is shown in Figure 5.
accelerations and ECG patterns with graphical representation
on a smartphone which is shown is Fig. 3(b). We used our
prototype application for data collection and for evaluating
our system.

Figure 5. Early prototype of IoT components used for data collection

C. Result Analysis
In this section, we discuss the performance of the
smartphone-based embedded IoT system. In signal
processing, noise is a general term for unwanted alterations
(a) Multisensory data collection (b) Real-time ECG and body that a signal may suffer during collecting, storing,
interface accelerations monitoring on a transmitting, or processing [31]. In our system, we collected
smartphone data from analog sensors and transmitted them via an LP
Figure 3. Smartphone Screenshots of the system prototype
communication channel. The readings can be affected
TABLE II. STATISTICS ABOUT SUBJECTS PARTICIPATING IN through the process of the transmission. Therefore, we
OUR DATA COLLECTION. employed data enhancement techniques before analyzing the
Height [cm]
150-159: 6 data.
Gender Age [yrs.] 160-169: 4 Body Acceleration
F: 6 20-24: 6 170-179: 4 We collected body accelerations using the smartphone
M: 10 25-30: 4 180-200: 2 sensor for a period of one-minute tests while the subject
30-34: 6
performed different activities. A sample of body acceleration
We collected data for 16 test subjects, as shown in Table events during sitting, running, jogging, and exercising
II, in different environments, at a rate of 80 samples per activities for a 25 second time frame with sampling rate of
second. Each segment is 20 seconds long. The collected 10 points per second are shown in Figure 6.
sample data is shown in Figure 4. We noted that average acceleration is different for each
activity. For example, the average acceleration is near zero
while sitting.

Figure 4. Heart-rate variations of a test subject while sitting,

walking, jogging, and exercising
We collected sensor data for sitting, walking, jogging,
and exercising. We started by using these datasets as training Figure 6. Body Accelerations for sitting, running, jogging and
for our system. Later, we introduced the trained system with exercising

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ECG Signals
High-Frequency Component Removal
For dynamic features, we perform the following
operations on the signal: differencing, filtering, frequency
domain conversion, and peak detection, as shown in Figure
7. First, we use differencing to flatten out parts of the signal
that do not vary greatly in magnitude. The result will then
contain peaks that are significantly higher in magnitude than
the portions of the signal, which typically leave the QRS
peaks more visible. A smoothing operation is then performed
on the absolute value of the differenced signal with a window
of 20 points. To measure the heart-rate, we take the Fourier
transform of the processed signal. Then, we find the location
of the maximum peak, which is the frequency of occurrence
for that peak, indicating the QRS.
Figure 7. Noise reduction from ECG signal using smoothing
To get the QRS and T-wave voltages, we start by
observing all the peaks in the signal window available, then
sort them. Using the number of beats, N, calculated earlier,
we take the largest N numbers as the QRS values and the
second N numbers as the T wave values. The Length
Transform is then used to get the QRS duration.
Figure 8: Length Transform to find QRS duration
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First, we use differencing, then we apply a smoothing
with a window size of 5. Next, we sort all the peaks in the
processed signal and take the largest N numbers where N is
the number of beats in that window, then average those N
peaks. We create an array of zeros and add ones in the places
where the value in the processed signal is higher than the
calculated average value of the peaks. To get the QRS
duration for a certain beat, we count the consecutive ones and
divide by the sampling frequency. Figure 8 shows the
original signal at the top, the processed signal at the bottom,
and both bounded by the array of zeros and ones created to
highlight the QRS duration.
We can observe all the patterns that an ECG signal can
have and see under what conditions some of the
characteristics would be missing or changing. Table III
shows the different ECG features and the average values
calculated from the data collected using our device.
TABLE III. AVERAGE FEATURES FROM ECG SIGNALS.
Sitting Walking Jogging Running
Avg. Heart rate 70.624 79.270 91.027 121.945
(b/min)
Avg. R-R Interval 0.880 0.775 0.663 0.496
(sec)
Avg. QRS Peak 0.982 0.943 0.852 0.820
(volts)
Avg. T-wave Peak 0.801 0.799 0.789 0.734
(volts)
Avg. QRS Duration 0.082 0.071 0.085 0.070
(sec)
One major feature that we extracted from the recorded
ECG signals is a person’s heart-rate or beats per minute. This
can be calculated using several techniques including taking
the number of QRS peaks in a given time, using an
autocorrelation technique, or using the Fourier transform.
We can determine the heart-rate from the autocorrelation of
an ECG signal by a series of simple steps.
Prediction Algorithm
After extracting all features from the sensors, we
combined the analyzed results and apply a prediction
algorithm. Our prediction process includes collecting the
ECG as well as accelerometer data and then extracting the
features from both sensors. These features are then provided
as an input to our algorithm that is trained by previously
stored datasets. In our data analysis, we used Naive Bayes
classification technique to classify normal and abnormal
ECG patterns, as it produces highly accurate results and is
easy to implement [32-34].
The probability of a heart risk in relation to ECG
signals represents the posterior probability in this equation.
The posterior probability is what the equation will equal to
and how we will determine a prediction of heart risk to the
user. The probability of heart risk alone is the class prior
probability and will be multiplied with the product of the
likelihood. The likelihood, which is the probability of every
ECG signal in relation to the heart rate, will utilize each
measurement that the ECG signals detect to give us an
accurate heart risk prediction. The algorithm provided proof
of a high accuracy in prediction as shown in Figure 9.

Figure 9. The heart-rate variations for sitting, walking, jogging,
and running class using Naïve Bayes classifier
The use of both the heart rate and the horizontal
energy from body accelerations clearly separates the four
different classes with minimum overlap. Based upon the
output of the algorithm, we make one of two decisions. If the
probability of an imminent heart attack is high and an
abnormality is detected, then we alert the user as well as the
caregiver; if the data looks normal, then the system keeps
reading data from both sensors in real-time.
VI. CONCLUSIONS
The IoT sensors along with their wide-distribution have
revealed the possibilities of actualizing ubiquitous healthcare
applications. Given the recent interest in wearable devices
from the clinical research community, we foresee that, in the
near future, there will be an even more diverse set of
healthcare sensors integrated into wearable IoT devices. In
this paper, we have developed an embedded IoT system to
monitor heart abnormality and body accelerations using a
smartphone. We use an ECG sensor system to detect the
abnormality in users’ ECG patterns. The results from
multisensory data showed that our approach provides a high
rate of classification accuracy in distinguishing between
normal and abnormal ECG patterns.
To test the permanence and long-term feasibility of our
approach in the future, we plan to test our system with data
from the people who suffer from chronic heart problems.
Additionally, the system can be used in smart home
monitoring systems for future wireless technologies.
ACKNOWLEDGMENT
We would like to thank the Electrical and Computer
Engineering department at Miami University for funding the
project. This especially includes Ms. Tina Carico and Mr.
Jeff Peterson. This paper is based on the MS thesis work by
the author, Mohamed ElSaadany [35].
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