Vocal biomarker is associated with hospitalization and mortality among heart failure patients

Abstract

BACKGROUND: The purpose of this article is to evaluate the association of voice signal analysis with adverse outcome among patients with congestive heart failure (CHF). METHODS AND RESULTS: The study cohort included 10 583 patients who were registered to a call center of patients who had chronic conditions including CHF in Israel between 2013 and 2018. A total of 223 acoustic features were extracted from 20 s of speech for each patient. A biomarker was developed based on a training cohort of non-CHF patients (N=8316). The biomarker was tested on a mutually exclusive CHF study cohort (N=2267) and was evaluated as a continuous and ordinal (4 quartiles) variable. Median age of the CHF study population was 77 (interquartile range 68–83) and 63% were men. During a median follow-up of 20 months (interquartile range 9–34), 824 (36%) patients died. Kaplan–Meier survival analysis showed higher cumulative probability of death with increasing quartiles (23%, 29%, 38%, and 54%; P<0.001). Survival analysis with adjustment to known predictors of poor survival demonstrated that each SD increase in the biomarker was associated with a significant 32% increased risk of death during follow-up (95% CI, 1.24–1.41, P<0.001) and that compared with the lowest quartile, patients in the highest quartile were 96% more likely to die (95% CI, 1.59–2.42, P<0.001). The model consistently demonstrated an independent association of the biomarker with hospitalizations during follow-up (P<0.001). CONCLUSIONS: Noninvasive vocal biomarker is associated with adverse outcome among CHF patients, suggesting a possible role for voice analysis in telemedicine and CHF patient care.