Automated assessment of cardiovascular disease associated with diabetes in rural and remote health care practice

Damage to the autonomic nervous system results in changes in the heart rhythm and rate. Diabetes associated cardiovascular changes related to autonomic nervous system damage may be present anytime prior to manifestation of diabetes. Testing for changes to heart rhythm may provide a means of early identification of cardiovascular disease and allow timely intervention. Identification of cardiac autonomic neuropathy (CAN) in people with diabetes has progressed from simple reflex tests to mathematical analysis associated with heart rate variability. Barriers such as lack of specialists, travel requirements of patients to metropolitan clinics and funding of equipment has restricted the utilisation of cardiovascular screening in diabetes care. We conducted a 3-lead ECG screening trial using 20-minute recordings and analysing the beat-tobeat variation (heart rate variability—HRV) using a computer based analysis, detrended fluctuation analysis (DFA). The method is robust against noise and ectopic beats. 24 traces of controls and 24 of people with diabetes were analysed. The average age of the participants was similar in both the diabetes and control groups. The ratio of females to males was also similar between groups. A significant difference between people with diabetes 1.00 ± 0.22 and controls 1.12 ± 0.18 was observed. There was no significant difference between people with diabetes with and without CAN using DFA. However a trend for people with CAN to have lower mean values (0.91 ± 0.24) than people without CAN (1.05 ± 0.18) or the controls (1.12 ± 0.18) for DFA was found. These advances in ECG interpretation provide an additional option for community health workers in rural and remote areas to assess autonomic neuropathy associated with diabetes before clinical signs are present.