Frequently Asked Questions
Q1: What are Congenital Heart Defects (CHDs)? Why is early detection necessary?
There are at least 18 different types of common heart defects that can be present since birth (known as congenital heart defects or CHDs, which is sometimes also referred to under congenital heart disease). These heart defects are the heart not performing as it should due to problems with the structure or rhythm of the heart. These CHDs cause problems with blood flow, which can prevent the body from receiving the proper amount of oxygen, which allows your organs to function at their optimum level. Essentially, you are not getting enough oxygen because blood carries oxygen throughout your body.Valves are essential to the heart; they prevent blood from flowing backward by opening and closing, like a door, as the heart pumps blood. A heart murmur is detected when blood passes across these valves when they fail to close properly, so blood can flow backward when we only want it to move forward. A physician listening to your heart for abnormal sounds such as a heart murmur, can detect these heart defects.
Visible signs of a heart defect may not appear until they become more severe, making early detection of these heart defects vital. Signs/ symptoms of a heart defect can vary but commonly are:
• Cyanosis- blue lips, fingers, or toes (due to lack of oxygen from problems with blood flow-because blood carries oxygen),
• Shortness of breath, and
• Activity intolerance (getting tired very quickly when performing an activity).
When a congenital heart defect is suspected, the infant or child is referred to a pediatric cardiologist to determine the best course of treatment, which can include surgery. Unfortunately, underserved areas worldwide do not have access to physicians or routine health services. Source: (American Heart Association [AHA], 2018).
Q2: Why are CHDs such a threat to pediatric health in under-resourced communities?
CHDs are the most common congenital disability worldwide, with at least 8 in 1,000 babies being born with CHD (American Academy of Pediatrics, 2016). Identification and treatment of CHD remain challenging in these low-resourced settings due to an overall shortage of medical technology and trained medical professionals. It was found that newborns and infants in socially and economically deprived communities had a 48% higher risk of CHDs than those born in higher-resourced communities (AHA, 2019). Consequences for undiagnosed and untreated CHD in newborns result in a 40% increase in special healthcare needs, such as medication management, physical and speech therapy, and services for developmental and behavioral conditions (CDC, 2022).Q3: What is One Heart Health’s mission? What strategies are being utilized by the organization to accomplish this mission?
The mission of One Heart Health is to develop cost-effective medical technologies to enable early diagnosis of CHD in children who live in low-resource areas of the world, thereby improving health outcomes.One Heart Health utilizes and focuses on a machine learning algorithm to detect CHD automatically because the lack of access to experienced cardiologists is a primary barrier to timely diagnosis and treatment in low- and middle-income countries (LMICs) we want to serve. We can embed the machine learning algorithm in mobile phones or web applications, which are widely available in most parts of LMICs.
One Heart Health can improve overall CHD awareness and capacity of care by delivering the algorithm-based CHD screening tools to the local community and its partners. This screening tool reduces the burden of intense training required to master auscultation skills to detect abnormal murmurs.
Until all communities provide universal and equitable access to pediatric heart screenings, CHDs will be missed, and children will fail to thrive. One Heart Health aims to give under-resourced communities worldwide an inexpensive and easy way to identify CHDs in newborns, infants, and children. In doing so, provide every child with a heart defect the chance to live a healthy life.
Q4: One Heart Health uses heart sounds to determine if a child has a heart defect, but CHD diagnosis typically uses echocardiograms or ultrasounds, not stethoscopes. Why focus on heart sounds and this approach to detecting CHDs?
One Heart Health did not start with the assumption that auscultation, the technique of listening to heart sounds via a stethoscope, would necessarily be our method for detecting pediatric heart disease in low-resourced environments, but our field research proved otherwise. We have spent significant time consulting local medical providers in rural and remote areas and have concluded that remote locations are not requesting DIAGNOSIS capabilities but rather the ability to SCREEN for CHD.At most clinics, primary health workers in China do not have the resources, equipment, or time to treat heart defects. These resources are the value of secondary and tertiary care options at China’s regional hospitals. Community needs, as described by front-line health workers, were responsive expert cardiac consults and the confidence to know whether a cardiac referral to a non-primary clinic was warranted. In short, under-resourced communities want to know if a cardiac defect is present and if further interventions and medical escalation are necessary. The One Heart Health telemedicine is the desired solution. A 2017 published medical report on the One Heart App showed 91% accuracy in detecting heart defects with our remote consultation system, which relied on cardiologists to listen to hundreds of recorded heart sounds to detect and diagnose CHD in a child. The 2022 PhysioNet Challenge, which aimed to demonstrate real-time CHD results- instead of relying on the cardiologist to sift through hundreds of recorded heart sounds- showed a sensitivity of 76% and specificity of 85% to detect abnormal murmurs (Araujo et al., 2022). For comparison, during CHD screening in rural Yunnan, China, we found that a cardiologist had a sensitivity of 79% and specificity of 93% with detecting pathological murmurs from digital heart sounds (Araujo et al., 2022). The Chao Heart Alert is getting close to matching cardiologists when identifying abnormal murmurs to detect CHD.
One Heart Health technology is reliable. Whether one-on-one in a clinic exam room or on a school playground listening to hundreds of children’s hearts in one afternoon, community medical workers, with simple training, can easily upload the heart sounds captured by the One Heart App to the Cloud without fear that the data will buffer due to their remote location. If the generator at the clinic breaks down, smartphones have their own battery power supply. If the equipment breaks down, even in the most rural sections of China, most can go to a local cellphone shop for repairs. This same reliance and accessibility with a portable ultrasound are not likely in these under- resourced areas. One Heart Health believes our technology is the most effective, economical, and reliable technology for the job, and we look forward to implementing and proving this belief.
Q5: What is One Heart Health doing to overcome the barrier of funding development from industry and venture capitalists for the Chao Heart Alert?
Historically, medical technology targeted for addressing health problems in underserved areas of the world has tended to deter funding from industry and venture capitalists due to the lack of financial return from these interventions in those locations, as is the case with funding the Chao Heart Alert in under-resourced areas of the world.To overcome this funding barrier, One Heart Health has established partnerships across the globe to increase awareness of the organization’s efforts in the hopes of connecting the people worldwide to the importance of this health issue and obtaining donations, as well as applying for multiple grants for more sustainable funding sources for program initiatives.
Q6: Why is One Heart Health pursuing an open-access database for its heart sounds? Isn’t that contrary to patient privacy?
At One Heart Health, we prefer open-access databases. To ensure patient privacy, we de- personalize information to ensure no identifiable information can connect an individual patient. When we collect data, we ensure we have permission for research. Also, as a practice, One Heart Health has developed its Cloud infrastructure and mobile applications following HIPPA and HITRUST guidelines to ensure that patient data is secure.Open-access medical information is an exciting method for encouraging scientific discovery on a global scale. Open-access databases increase international scientific collaboration on algorithm development and encourage others to contribute their CHD data. These efforts will make One Heart Health’s heart sound database the largest open-access database of its kind in the world, while protecting patient privacy.
One exciting premise we are pursuing is creating a crowd-sourced challenge like Kaggle.com. We have followed other health-related challenges like the Heritage Health Prize with great interest and hope to encourage a similar enthusiasm for the One Heart Health Auscultation Challenge to collect and analyze more CHD heart sounds!
Q7: Who does One Heart Health partner with? Why?
Our partnership with other organizations (such as Cleveland Clinic Foundation and CHL), and faculty from academic institutions, such as West Virginia University and Notre Dame University, focuses on developing local partners in underserved parts of the world that can assist with the improvement and distribution of One Heart Health services and bring CHD screening and treatment to children in need. So far, our leading partner is Children’s Heart Link (CHL).CHL, one of the Chao Foundation’s preferred partners, is One Heart Health’s “sister program.” One Heart Health is working with CHL to identify two to three programs from their partners in China and India to develop CHD screening programs in the future. One Heart Health has deep connections with CHL in that both are located in the Twin Cities of Minnesota; our Executive Director and Medical Director have been volunteers for CHL in China for 14 years; and CHL’s Vice President of Global Advocacy serves on the board of directors for One Heart Health. The funding from the Chao Foundation for the Chao Heart Alert will improve our ability to scale our field cardiac screening programs to serve more Children HeartLink partner hospitals and surrounding communities in China and India in 2023.
Additionally, we aim to build partnerships with other for-profit organizations, such as Medtronic, Boston Scientific, Edwards Science, and ThinkLabs. These partners manufacture products in CHD diagnosis and surgeries widely used in developed markets and can support our mission in underserved parts of emerging markets.
Q8: What are One Heart Health’s short-term and long-term goals? How will these goals be achieved?
Our short-term goal is to develop a scalable technological solution for CHD screening and distribute this tool in pilot programs in under-resourced areas across China and India. Our long- term goal is to make CHD screening widely accessible, reliable, and efficient worldwide so that newborns, infants, and children can be screened for CHDs before any health or life-threatening consequences are developed.These goals will be achieved through the continued and expanded efforts of One Heart Health and its partners from:
1. Continued partnership with like-minded organizations.
2. Additional collaboration with organizations with similar missions, visions, and objectives.
3. Continued focus on technological development until the best outcomes are achieved.
4. Identification of under-resourced communities across the globe in need of CHD screening technology.
5. Sustainable funding through partnerships and routine grant applications.
Q9: Do you collaborate with NGO partners like Children’s HeartLink to leverage efforts?
Yes, in fact we are close “sister programs” with Children’s HeartLink (CHL). Right now, One Heart Health is working with CHL to identify two to three programs from their partners in China and Vietnam to develop CHD screening programs in the future. Our plan is to launch these programs in 2022 when CHL resumes cardiac surgery training visits. One Heart Health has a deep connection with CHL. Both are located in the Twin Cities of Minnesota. Our Executive Director and Medical Director have been volunteers for CHL in China for 14 years. Our Development Director is a former program manager for CHL in China. CHL’s Vice President of Global Advocacy serves on the board of directors for One Heart Health.
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