gms | German Medical Science

Introduction: Electrocardiography (ECG) is a cost-effective and widely used method for cardiovascular assessment. However, its use in data-driven research is constrained: Firstly, ECGs are often stored in proprietary formats or printed on paper, which hinders their analysis [1]. Secondly, proprietary storage negatively impacts open science, as algorithms and data management systems are often project-specific and not reusable. In response to these challenges, the BMBF-funded ACRIBiS project (Advancing Cardiovascular Risk Identification with Structured Clinical Documentation and Biosignal Derived Phenotypes Synthesis) aims to realize ECG storage and analysis in a Findable, Accessible, Interoperable and Reusable (FAIR) [2] manner. The goal of this literature review is to identify existing approaches towards this goal in clinical conditions.

Methods: A scoping review was conducted, with the following inclusion criteria: articles must contain aspects of at least one principle of FAIR and have to be published after 2014. The search was conducted using the search request “((“accessibility” OR “accessible”) OR (“reusability” OR “reusable”) OR (“findable” OR “findability”) OR (“interoperable” OR “interoperability”)) AND (“ECG” OR “electrocardiogram” OR “electrocardiography”)” in databases PubMed, Web of Science, and IEEExplore. We limit this review to resting 12-lead ECG.

Results: The search revealed 1,026 studies (PubMed: 379 articles, WebOfScience: 357, IEEExplore: 290) which were assessed for eligibility. After removing duplicates and assessing the titles or abstract for adherence to the FAIR principles, 11 articles met the inclusion criteria. These address ECG file standards (6), FAIR clinical decision support and open-source applications (1), ECG data management (2) and innovative technologies (2). Resting ECGs are often stored in files such as proprietary XML formats as well as open standards such as Portable Document Format, Standard communications protocol for computer assisted ECG, Waveform-Database or Digital Imaging and Communications in Medicine. Some centers implemented interoperable systems based on the FHIR standard for ECG mobile alert systems to detect suspected acute coronary syndrome in real-time [3]. Additionally, there have been attempts to store the raw data of resting ECGs in a reusable way [4]; however, open-source applications mostly focus on FAIR data annotation [5]. Another field of research are works exploring options for digitising paper ECGs.

Discussion: Our review reveals a discrepancy between the current practices in hospitals and the accessibility of resting ECGs in interoperable formats. Despite isolated attempts to store the data in accordance with the FAIR principles, open-source solutions tend to prioritize other features (e.g. annotation) over comprehensive user, rights, and patient management. This lack prevents the usage and reusage of resting ECG data in large-scale studies. Complete pipelines from the collection of the resting ECGs to the their analysis and storage of results are lacking.

Conclusion: The accessibility of FAIR-compliant resting ECG data remains severely limited. This reflects a gap between the potential of standardized ECG formats and their actual implementation in clinical practice. In order to mitigate this issue, it is necessary to encourage the adoption of interoperable ECG standards and technologies to enhance patient care, as currently addressed in the ACRIBIS consortium.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.