Received August 22, 2019, accepted September 12, 2019, date of publication September 17, 2019,

date of current version October 16, 2019.

Digital Object Identifier 10.1109/ACCESS.2019.2941898

Big Data Features, Applications, and Analytics in

Cardiology—A Systematic Literature Review
SHAH NAZIR 1 , MUHAMMAD NAWAZ 2 , AWAIS ADNAN2 ,
SARA SHAHZAD 3 , AND SHAHLA ASADI 4
1 Department of Computer Science, University of Swabi, Swabi 23450, Pakistan
2 Instituteof Management Sciences, Peshawar 25000, Pakistan
3 Department of Computer Science, University of Peshawar, Peshawar 25000, Pakistan
4 Faculty of Computer Science and Information Technology, University Putra Malaysia, Seri Kembangan 43400, Malaysia

Corresponding author: Shah Nazir (snshahnzr@gmail.com)

ABSTRACT In today’s digital world the information surges with the widespread use of the internet
and global communication systems. Healthcare systems are also facing digital transformations with the
enhancement in the utilization of healthcare information systems, electronic records in medical, wearable,
smart devices, handheld devices, and so on. A bulk of data is produced from these digital transformations.
The recent increase in medical big data and the development of computational techniques in the field of
cardiology enables researchers and practitioners to extract and visualize medical big data in a new spectrum.
The role of medical big data in cardiology becomes a challenging task. Early decision making in cardiac
healthcare system has massive potential for dropping the cost of care, refining quality of care, and reducing
waste and error. Therefore, to facilitate this process a detailed report of the existing literature will be feasible
to help the doctors and practitioners in decision making for the purpose of identifying and treating cardiac
diseases. This detailed study will summarize results from the existing literature on big data in the field
cardiac disease. This research uses the systematic literature protocol as presented by Kitchenham et al. The
data was collected from the published materials from 2008 to 2018 as conference or journal publications,
books, magazines and other online sources. 190 papers were included relying on the defined inclusion,
exclusion, and checking the quality criteria. The current study helped to identify medical big data features,
the application of medical big data, and the analytics of the big data in cardiology. The results of the proposed
research shows that several studies exist that are associated to medical big data specifically to cardiology.
This research summarizes and organizes the existing literature based on the defined keywords and research
questions. The analysis will help doctors to make more authentic decisions, which ultimately will help to
use the study as evidence for treating patients with heart related diseases.

INDEX TERMS Big data, big data features, analytics in cardiology, healthcare, systematic literature
review (SLR).

I. INTRODUCTION
Systematic literature review (SLR) is a systematic way of
identifying, organizing, and representing the literature in a
systematic manner [1]. The proposed research work is based
on the protocol of SLR. In today digital and computing
world the information increases rapidly. Devices such as
remote sensor and wearable technologies continuously pro-
duce abundant heterogeneous data. This data is called big
data. The big data is the data whose diversity, scale, and
complexity need new structure, algorithm, technique and
analytics for the management, visualization and to pull-out
The associate editor coordinating the review of this manuscript and
approving it for publication was Vlad Diaconita.
hidden information [2]. Big data has produced key atten-
tion in different of fields, such as in social media, banking
operations, production of healthcare appliance, and satellite
imaging [3]. The data is stored in a vastly organized layout to
visualize contents and information.
Healthcare system is facing the digital transformation with
the enhancement in the utilization of healthcare medical
information system, electronic medical record, wearable,
handheld, and smart devices. A bulk of data is produced
from these digital transformations. Recent prompt increase in
medical big data and development of computation in the field
of cardiology enable researchers and practitioners to extract
and visualise the new insights from healthcare big data.

This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see http://creativecommons.org/licenses/by/4.0/
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S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review
Several big data sources in healthcare are available, such as
biometric data, registration data, health record electronically,
the internet data, imaging, patient reports, biomarker data,
clinical data, and administrative data [4]. Davarzani et al. [5]
did analysis on 499 elderly patients with congestive heart
failure of age ≥ 60 years who had frequently visited clinic
for 19 months to follow-up. Relationship between frequently
measurements of biomarkers and treatment effects of loop
diuretics, β-blockers, spironolactone, and renin-angiotensin
system inhibitors on risk of HF hospitalization was examined
in the generation of hypothesis. The equation of generalized
estimating was used to report the correlation of patient recur-
rences of events. Kinkorová and Topolčan [6] descibed the
key Horizon 2020 of biobanking projects, financing schemes
and the future perspective. The EPMA announced the endur-
ing strategies for the useful endorsement of predictive,
preventive, and personalized (PPP) medicine. Over 45 coun-
tries is contributing toward the implementation and improve-
ment of the promotion of PPP medicine [7]. Golubnitschaja
et al. [8], [9] give an overview of the issues associated with
healthcare services of pandemic scenario in the progres-
sion of frequent non-communicable diseases, poor economy
of health care, lackness of specialised education, overdue
interventional approaches of reactive medicine, challenging
ethical characteristics of some treatments along with insuffi-
cient communications among policymakers and professional
groups. The paper further presents a combined status of the
professionals of PPPM toward the new lifelong instruments
for the progress of technology and science in health related
medical services in the European programme ‘Horizon 2020’.
Medical big data is different from the other discipline big
data due to its distinctive features. The medical big data is
mostly difficult to use and most of the examiners in the
healthcare arena are hesitant to exercise open data science
for the reasons, such as lack of data-sharing incentives and
risk of data exploitation by illegal use [10]. Medical big
data are normally be collected based on some protocol and
are mostly structured [11]. The cost of medical big data is
normally more, as it involves expensive instrumentations,
personnel and discomfort of the patient. Healthcare data are
comparatively less in size to the other disciplines. Medical
big data has several applications in healthcare, such public
health, disease and safety surveillance, predictive modelling
and clinical decision support, and many other research areas.
The role of medical data in cardiology is a challenging task.
Early decision making in cardiology has enormous potential
for refining the care, reduce the cost of care, and reducing
waste and error. Previously some research work has been
done to promote conscious efforts made through the process
and execution of healthcare data, but yet no detailed study
of healthcare big data in cardiology for the purpose of feature
identification, applications, and analytics of medical big data.
A. PROBLEM DEFINITION
The literature reveals several articles published on medical
big data for cardiology. This research investigates potential
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features of big data in cardiology, applications of medical
big data, and techniques used in medical big data which
can ultimately be used for decision making in healthcare.
This research summarises and organises the existing literature
published associated to medical big data in cardiology based
on the defined keywords and research question. This will help
the doctors and practitioners to more close and authentic deci-
sion making of the patient and then ultimately can take help
to use the study as evidence and advice the care accordingly
to the patient.
B. RESEARCH CONTRIBUTIONS
Studies of 190 papers were included according to the defined
inclusion, exclusion, and quality assessment criteria. The
key contributions of proposed research are to counter below
research questions;
• What are the medical big data features in cardiology?
• What research has been done since 2008 in the field of
medical big data in cardiology?
• What techniques are used by the researchers for medical
big data features in cardiology?
• What are the applications of medical big data in
cardiology?
• What are the medical big data analytics in cardiology?
The paper and their sections are ordered as; section 2 elab-
orates the methodology used. Section 3 discusses the pro-
cess of research in the light of guidelines provided by
Kitchenham et al. [1]. The results and discussions are given
briefly in section 4. Some limitations of the proposed research
are given in section 5. The paper concluded in section 6.
II. METHODOLOGY
The healthcare system is facing the digital transformations
with an enhancement in the use of healthcare information
system, electronic medical record, wearable, handheld, and
smart devices. A huge amount of data is produced from
these digital transformations. The current increase and devel-
opment in healthcare big data and its computation in the
field of cardiology enable researchers and practitioners to
extract and visualise the new insights from medical big data
to further provide easy solution for it. The huge amount of
data in healthcare is to be assessed to identify, discover, and
prevent different diseases. The analysis of big data is quite
difficult, as big data contains huge sum of information and
record(s). The analysis of big data can be exploited by differ-
ent algorithms of data mining to mine useful informations and
patterns for further investigation of disease and their preven-
tion [12]. The heart disease is a big issue in health and most
of the time becomes the cause of death. The identification
of heart disease on early time is important in the medical
healthcare and research field [13].
The analytics big data has improved the healthcare
by facilitating personalised medicine based on analytical
prescription. Data sharing model of three layer for big data of
heart is developed which uncover the scope of cardiac remod-
elling [14]. The big data in healthcare can be categorized in
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 S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review
three forms, for example small n and large p, large n and
small p, and large n and large p, (n is the number of samples
while p is the number of parameters) [15]. There are different
categories under which big data features of cardiology can be
placed. For example in cardiology, shortness of breath, typical
chest pain, feet edema, palpitation, syncopy, dyspnea on exer-
tion, unconscious (Rhythm disturbance), hypertension, fever,
skin rash/joint pain, murmurs, and so on. Several studies
are available to identify different techniques to define data
features. A data feature uniquely identifies data and hence
used to detect a specific disease.
A. ROLE OF BIG DATA IN MEDICAL EDUCATION
Big data is a key tool used in medical curriculum by
researchers and teachers to plan, analyze, design, estimate
and deliver teacher activities and enhance healthcare educa-
tion. Big data is mainly used in medical education for the
specific purpose of improvement in the medical field. The
visual analytic has the advantages of combing the analysis
of data and exploitation technique, human cognitive strength
to perceive, information and knowledge representation, and
identify visual patterns [16]. Medical data feature contains all
the essential information of a disease. Features are the static
attributes and information about functional and nonfunctional
qualities that are present in any data system. These data
features are almost interlinked with each other, performing
different operations. An obvious consideration of these fea-
tures of data and their association into logical grouping is
an additional step to further understand the specific disease.
These understandings of a specific disease can ultimately
help in prevent the disease early in medical health care.
The proposed methodology has been conducted and dis-
cussed briefly in the following sections.
III. RESEARCH PROCESS
Several studies have been published in diverse domains by
using SLR [17]. The SLR is an accepted way to analyse and
examine a problem objectively. Medical big data specifically
in the area of cardiology has various features to be analyzed.
Such analysis consists of features mining, classification, clus-
tering, association, and regression. The purpose of SLR is
to systematically see, assess, and deliver all of the available
and published materials related to the research questions
defined to give wide-ranging informations to research com-
munities [17]. Based on protocol adopted for conducting the
SLR [1], the activities are categorized into three major phases
which consists of; design of protocol, conduct the SLR, and
the report evidence.
Details of the protocol followed for conducting the SLR
and process of data collection is given in the following
sub-sections.
A. RESEARCH DEFINITION
The aim of the proposed study is to cover detailed understand-
ings of the existing published research regarding big data
features identification and visualization in the area of cardi-
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ology. Features regarding a particular representation show a
detail description about that phenomenon. The aim of using
the concept of features identification and visualization in
cardiology will eventually help the doctors and practition-
ers to easily identify a disease and then advice treatment
accordingly. The SLR used in this research provides a concise
analysis of the features and their visualization in cardiology
to make it simple the diverse techniques followed in medical
researches and industries. This report specifically explores
the application of medical big data in cardiology.
A formal series of steps of an SLR was performed which
made the process further objectively and repeatable. By fol-
lowing the proper process of SLR, it plays an essential role
in recognition of fundamental nature of the conclusion pre-
sented by the study. Figure 1 shows the steps involved in
conducting the SLR [17].
FIGURE 1. Steps of the SLR.
B. RESEARCH PLAN AND METHOD
The proposed SLR protocol used in this research was fol-
lowed according to the guidelines [1]. Figure 2 shows the
phases of the designed protocol and the steps followed to
carry out the SLR. In figure, the first phase is to define the
research questions (5 questions), the search process consists
of searching the resources based on the defined searching
keywords, the selection process consist of inclusion and
exclusion of articles and their scrutiny, the quality assess-
ment based on the defined criteria and weigh assignment to
the research questions, and finally the analysis of the data
obtained from the included articles. This literature review
follows the following protocol.
FIGURE 2. Protocol designed and followed for conducting of the SLR.
C. RESEARCH QUESTIONS
The proposed literature review addressed the following
research questions (RQ) and is given below:
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S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review
RQ1. What are the medical big data features in
cardiology?
RQ2. What research has been done since 2008 in the
field of medical big data in cardiology?
RQ3. What techniques are used by the researchers for
medical big data features in cardiology?
RQ4. What are the applications of medical big data in
cardiology?
RQ5. What are the medical big data analytics in
cardiology?
D. SEARCH PROCESS
To conduct an SLR, one should plan a proper way to search
relevant materials as it is essential to see each individual
source. A well-structured process of search makes it easy
to systematically study the accessible sources in order to
identify all of the associated literatures meets the pre-defined
search criteria. For conducting the proposed research study,
a proper search process has been performed to identify the
related materials available in the mostly known libraries of
conference proceedings, journals, books, and other material.
In the current study, different keywords associated to the med-
ical big data features identification and analytics in the field
of cardiology according to the research questions (given in
section 2.3) were searched in the mentioned libraries shown
in Figure 4. The steps of search process used for this study
are presented in Figure 3.
FIGURE 3. Steps involved in the process.
Figure 4 shows the libraries that were searched based on the
keywords for the available papers associated to the proposed
research.
The keywords for search were decided by the authors. The
process of defining the keywords was kept very specific.
As we tried search very short words (for example; features
of cardiology or features in cardiology) in the given libraries.
We got very huge bulk of articles such as a total of 2485 links
in IEEE, 6740 in PubMed, 60975 in ScienceDirect, 178548 in
Springer, 14810 in Taylor & Francis Online, and 36257 in
Wiley Online Library. So, the process of inclusion and exclu-
sion, analysis and assessment of these papers were very tricky
task. To overcome this problem and to easily include/exclude,
analyse and assess the papers, the said keywords very kept
very specific.
These keywords include ‘‘medical big data features in
cardiology,’’ ‘‘techniques for medical big data in cardiology,’’
‘‘applications of medical big data in cardiology,’’ and ‘‘med-
ical big data analytics in cardiology.’’
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The process of search was made limited for the years range
2008 to 2018 (above 10 years). The search process showed
a big volume of literatures in the form of journal publica-
tions, books, conference, workshops papers, and many other
available materials. All of the given digital repositories were
searched manually by using the defined keywords. Relevant
citation informations were carefully tackled by using the End-
note [18]. During managing the bibliographic information,
it was determined to keep separate files of Endnote libraries
for each source in initial process of search. After inclusion
and excluding criteria, all of the individual libraries were
then combined into one library. The duplication of papers
was removed manually and only one source of the same
was kept. The bibliographic information included in the End-
note library contain author name(s), title of the article, name
of the journal/conference, publishing year, and total number
of pages of article. The detail of the overall search process
according to the defined keywords in the given libraries is
given in Figure 5.
Separate folders were made for all of the above libraries
and a total of 21230 titles were found. Initially, each folder
of the library was checked manually and all of the articles
were properly name by their titles. The duplicate papers
were then removed by checking title in each folder. The first
process of filtering was done manually for all of the libraries
based on title and 568 articles were achieved. After this,
the articles were filtered by abstract of the paper manually
and a total of 358 articles were achieved. Most of articles
having word cardio or heart were included. In the final stage,
the articles were filtered by content, and total of 190 papers
were included. The exclusion and inclusion process was very
difficult as each of the paper was checked manually. The
details of the selected papers by title, abstract and contents
are given in figure 6.
These 190 papers along with bibliographic information
were managed in the Endnote library. The process of mak-
ing the references was done manually as some time when
downloading a citation from the internet then some of the
information is missing. For example, the information may
be in the form of author name, year, title of the article,
place of publishing, page numbering, and so on. The included
articles were used to answers the questions defined in the
research.
E. STUDY SELECTION
The search process was done to identify the appropriate
papers to the research questions. By performing search pro-
cess, a collection of papers was obtained through the process
of SLR. This collection of papers need to further filter the
papers to make it easy to the criteria of exclusion and inclu-
sion, and to have only relevant material that precisely focused
on topic given in the questions of the research. The following
inclusion criteria were strong-willed by the authors to take
account of the relevant papers:
• The papers evidently talk about the use and applications
of medical big data in cardiology.
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 S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review
FIGURE 4. Libraries for the proposed research.
FIGURE 5. Search process in the given libraries based on keywords.
• The papers provide comprehensible details and context
need to cover and answers the questions defined in the
research.
F. STUDY SELECTION PROCESS
Inclusion of particular article was a very difficult task as
the process of selection consists of a number of steps. The
process needed to be very carefully done. Due to this reason,
two stages process of selection of for studies was performed.
Initially, title of the article was checked manually based on the
defined criteria of exclusion and inclusion, and papers which
were not relevant were excluded. In the next stage, the papers
143746
were filtered by viewing abstracts of articles, and as results
several articles were excluded that were not associated to the
current research. The criteria of inclusion and exclusion were
defined and are shown in table 1.
Table 2 shows a three stags filtering process of papers.
Figure 7 shows the resulted papers after retrieving appro-
priate papers, clearly accepted by using the defined criteria
of exclusion and inclusion [19]. List of the included papers
along with detail is shown in Figure 7.
List of the year-wise papers published is given in Table 3.
According to the above year wise break-up there is an
increase in the research publications after year-wise, marking
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S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review
FIGURE 6. Filtering of papers by title, abstract, and contents.
TABLE 1. Inclusion and exclusion criteria.
TABLE 2. Three stags filtering process of papers.
the obtaining value and applications of medical big data.
Figure 8 represents the raise in number of publication for
medical big data in the selected year range.
G. QUALITY ASSESSMENT
Assessing quality of included papers was done after the
completion process of selecting papers based on inclusion
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criteria. All the articles were checked for quality assessment
of papers to the given research questions. Following is the
defined quality criteria (QR) for questions of the research.
QR1. The papers provide a clear depiction and identifica-
tion of feature of medical big data.
QR2. The papers provide a detail of work done since the
year 2008 till August 2018.
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 S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review

FIGURE 7. Details of selected papers.

QR5. The papers describe medical big data analytics in

FIGURE 8. Trend of medical big data research from 2008 - 2018.
QR3. The papers provide details of different technique
used in medical big data.
QR4. The papers emphasize the applications of medical big
data in the field of cardiology.
cardiology
All the included papers were manually examined and anal-
ysed by the authors. All of the individual papers were given
weights according to each question. Score to each paper was
allotted in below style.
• 0- the paper having no details regarding the question.
• 0.5- question moderately discussed in the paper.
• 1- a question completely discussed in the paper.
To determine the evaluation for more analysis, the total
score of a paper shows the relevancy of individual paper to the
present research. All the assigned values of the five research
questions are added for each paper. Further details are given
in Figure 9 show the assessment of quality of the selected
papers.
H. DATA EXTRACTION
After the assessing the quality of paper, the necessary data
related to the questions of the research defined above were

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S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review

FIGURE 9. Quality evaluation of the selected papers.

FIGURE 10. 5 Vs of big data.

mined. The most significant data extracted is shown in struc- • Table 3 shows the year-wise break-up of included papers
ture of figures and tables, which is briefly given as follows; from year 2008 to 2018.
• Figure 7 shows all of the included papers, with their • Figure 8 provide year-wise number of selected
citation, publishing year, and paper type. publications

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 S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review
TABLE 3. Year-wise representations of selected papers.
• Figure 9 shows the quality evaluation of the selected
papers
• Table 6 presents the medical big data features in
cardiology
• Table 7 provides the research has been done since
2008 in the field of medical big data in cardiology
• Table 8 provides the techniques that are used by the
researchers for medical big data features in cardiology
• Table 9 provides the applications of medical big data in
cardiology
• Table 10 provides are the medical big data analytics in
cardiology.
IV. RESULTS AND DISCUSSIONS
The EPMA announced the enduring strategies for use-
ful PPP medicine. Over 45 countries are working for the
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implementation and improvement of the promotion of PPP
medicine [7]. The European programme ‘Horizon 2020’ was
presented to combine the status of the professionals of PPPM
toward the new lifelong instruments for the progress of tech-
nology and science in health related medical services.
The following sub-sections give brief discussions of the
derivations of the present review. The discussions are given
in five subsections. Each subsection presents one of the
research question on which this review is based. This dis-
cussion is focused by providing the readers with the essential
detail about medical big data in cardiology. These discussions
include all of 190 papers selected according to the criteria
of search and with the evaluation of quality which is shown
in Figure 9.
A. CONCEPT AND DEFINITION OF MEDICAL BIG DATA
Healthcare has no specific meaning of ‘‘big data.’’ Big data
is commonly categorized into 5 Vs. Figure 10 shows the 5 Vs
of the big data.
Since, the last decade there have been a fast growing digi-
talization in the field of medical and information is increases
rapidly with the wide spread use of internet and global com-
munication. Healthcare system is facing the transformation of
information with the enhancement in healthcare information
system, electronic medical record, wearable, handheld, and
smart devices. As a result, a huge bulk of data is produced
from these digital transformations. This prompt increase in
medical big data and development of computation in the
field healthcare enable researchers and practitioners to extract
and visualise the new insights from this medical big data.
The idea behind big data analytics came into existence by
the help of which we can analyze complex data and derive
valuable facts from it. When these analytics apply to the
medical data, then it has massive potential for refining the
care quality, reduce the care cost, and reducing waste and
error. McKinsey Global Institute [206] presents, if the data
is utilized efficiently, then the US health care can make an
addition than $300 billion every year, of which 2/3 would be
reducing expenses by about 8% in the healthcare. Different
resources of medical big data are available, such as the data
of biometrics, registration, electronic health records, patient
reports, internet, imaging, the data of biomarkers, prospective
cohort studies, clinical, and the data of administration [4]. The
complication of healthcare results from variety of healthcare
associated devices and their co-morbidities, the heterogeneity
of treatments and outcomes, and the subtle intricacies of study
development, investigative method and approach to collect,
process, and interpret healthcare data [6]. Table 4 shows the
volume of big data in the present research.
Table 5 shows the Variety, value, veracity, velocity of big
data in the proposed research.
The following are the journals which have published the
research related to the proposed research.
• The Egyptian Heart Journal
• J Arrhythmia
• Rev Med Chir Soc Med Nat Iasi
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TABLE 4. Volume of big data in the proposed research. TABLE 5. Variety, value, veracity, velocity of big data in the proposed
research.

• Heart Fail Rev

• Journal of Nursing and Care
• Revista Colombiana de Cardiologia
• Annals ofAnatomy
• Heart Asia
• Congenital Heart Disease
• Expert Systems with Applications
• Journal of the American College of Cardiology
• Concurrency Computat.: Pract. Exper
• Baylor University Medical Center Proceedings
• Expert Review of Cardiovascular Therapy • Przegl Epidemiol
• Cardiovascular Ultrasound • J Eval Clin Pract.
• Diabetes Obes Metab • International Journal of Cardiology
• Circulation Journal • Journal of Cardiovascular Magnetic Resonance
• Health and Technology • European Journal of Heart Failure
• Comput. Methods Appl. Mech. Engrg • Health Affairs
• Expert Review of Cardiovascular Therapy • J CARD SURG
• Postgraduate Medicine • Expert Rev Cardiovasc Ther
• European Journal of Heart Failure • Eur J Nucl Med Mol Imaging
• Journal of Management Analytics • British Journal of Pharmacology
• International Journal of Computer Mathematics • Int J Cardiovasc Imaging
• Mechanical Circulatory Support in End-Stage Heart • European Journal of Heart Failure
Failure • Greenhalgh et al. BMC Cardiovascular Disorders
• Decision Support Systems • International Journal of Cardiology
• Circulation • Echocardiography
• Cardiac CT and MR for Adult Congenital Heart Disease • Anat Sci Educ
• Journal of the American College of Cardiology • Trends in Cardiovascular Medicine
• Heart Fail Rev • European Heart Journal
• Int J Clin Pract • The Journal of Physiology
• Curr Cardiol Rep • Journal of Arrhythmia

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TABLE 6. Representation of the work done in the area of big data features.

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TABLE 6. (Continued.) Representation of the work done in the area of big data features.

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TABLE 6. (Continued.) Representation of the work done in the area of big data features.

• Pediatr Cardiol • Cardiac Surgery

• Expert Review of Cardiovascular Therapy • Expert Review of Proteomics
• PLoS ONE • Medical Physics
• European Journal of Heart Failure • Progress in Cardiovascular Diseases
• Gen Thorac Cardiovasc Surg • Production and Operations Management
• Stroke and Vascular Neurology • J Cardiovasc Transl Res.
• Journal of the American College of Cardiology • Trends in Cardiovascular Medicine
• Congenit Heart Dis • computer methods and programs in biomedicine
• Juarez-Orozco et al. European Journal of Hybrid • International Journal of Occupational Safety and
Imaging Ergonomics
• Circ Cardiovasc Qual Outcomes • Heart Failure Clin
• Heart • Expert Review of Cardiovascular Therapy
• International Journal of Cardiology • Expert Review of Cardiovascular Therapy
• Congenital Heart Disease • Echocardiography.
• Journal of the American College of Radiology • Curr Cardiol Rep
• International Journal of Cardiology • Intelligent Automation & Soft Computing
• Journal of the American College of Cardiology • Computer Methods and Programs in Biomedicine
• Acta Cardiologica • International Journal of Medical Informatics
• Pharmacol Res Perspect • Ann Biol Clin (Paris)
• International Journal of Cardiology • JOURNAL OF T H E AMERICAN COL LE GE OF
• Journal of the American College of Cardiology CARD IOLOGY
• IEEE Access • Journal of the American College of Cardiology
• PLoS ONE • Journal of Cardiovascular Magnetic Resonance
• Expert Opinion on Biological Therapy • Curr Cardiovasc Risk Rep
• International Journal of Cardiology • PLoS ONE
• Acta Cardiol Sin • Cardiovascular Research
• Journal of the American Association of Nurse • Baylor University Medical Center Proceedings
Practitioners 28 (2016) • International Journal of Automation and Computing

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TABLE 7. Representation of the work done in the area of healthcare big data from 2008 to 2018.

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TABLE 7. (Continued.) Representation of the work done in the area of healthcare big data from 2008 to 2018.

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TABLE 7. (Continued.) Representation of the work done in the area of healthcare big data from 2008 to 2018.

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 S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review

TABLE 7. (Continued.) Representation of the work done in the area of healthcare big data from 2008 to 2018.

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S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review

TABLE 7. (Continued.) Representation of the work done in the area of healthcare big data from 2008 to 2018.

• Journal of Family Social Work • Acta Chirurgica Belgica

• The Annals of Thoracic Surgery • Journal of Clinical Nursing
• European Heart Journal - Quality of Care and Clinical • Journal of the American College of Cardiology
Outcomes • J Clin Nurs
• Machine Learning Paradigms • Wiley Periodicals, Inc.
• Journal of Medical Engineering & Technology • Journal compilation
• Nat Rev Cardio • Expert Rev Med Devices
• Parallel Distrib. Comput. • Int J Cardiovasc Imaging
• Heart Vessels • Acta Cardiologica
• Heart & Lung • Curr Treat Options Cardio Med
• Expert Opinion on Biological Therapy • Expert Review of Cardiovascular Therapy
• Circ Res • Curr Treat Options Cardio Med
• Med Sci Monit • European Journal of Heart Failure
• Journal of European CME • Expert Review of Cardiovascular Therapy
• Ann Noninvasive Electrocardiol • Future Generation Computer Systems
• The Journal of Heart and Lung Transplantation • Int J Biometeorol
• Curr Probl Cardiol • International Conference on Big Data Technologies and
• Expert Review of Cardiovascular Therapy Applications

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 S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review

TABLE 8. Research work done in medical big data features in cardiology.

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S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review

TABLE 8. (Continued.) Research work done in medical big data features in cardiology.

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 S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review

TABLE 9. Representation of the applications of medical big data in cardiology.

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S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review

TABLE 9. (Continued.) Representation of the applications of medical big data in cardiology.

• BMC Cardiovascular Disorders study is an attempt to cover this gap and presented the work
• Big Data for the Greater Good done in the healthcare big data in the heart related issues.
• Expert Review of Molecular Diagnostics Table 7 shows the representation of the work done in the
• Journal of Medical Systems area of medical big data in heart related issues since January
2008 to August 2018. The details of the papers [13], [14],
B. RQ1. WHAT ARE THE MEDICAL BIG DATA [22], [23], [26]–[28], [32], [35], [36], [40], [42], [45]–[47],
FEATURES IN CARDIOLOGY? [50], [55], [57], [58], [60], [62], [63], [68], [69], [72]–[74],
Big data specifically in the area of cardiology has various [84], [92], [100], [109], [110], [114], [119], [120], [122],
features to be analyzed. Such analysis consists of features [125], [126], [129], [131], [138], [145], [155], [179], [181],
mining, classification, clustering, association, and regression. [185] are already given in table 6, while the rest of the papers
Table 6 summarizes the research work done for research are discussed in table 7.
question 1.
D. RQ3. WHAT TECHNIQUES ARE USED BY THE
C. RQ2. WHAT RESEARCH HAS BEEN DONE SINCE RESEARCHERS FOR MEDICAL BIG DATA
2008 IN THE FIELD OF MEDICAL BIG FEATURES IN CARDIOLOGY?
DATA IN CARDIOLOGY? Details of the papers [13], [14], [22], [26], [28], [32], [35],
Till now, researchers and practitioners try to come across a [40], [45], [50], [57], [62], [74], [84], [92], [100], [110],
complete study of the healthcare big data in the area of car- [119], [125], [126], [129], [138], [164] are already given
diology and related disease. Several studies in the literature in Table 6 while Table 8 show the representation of rest
exist about the heart disease, but yet, there is lack of detailed of the papers in the field of medical big data features in
study to present the prominent heart issues. The proposed cardiology.

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 S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review
TABLE 10. Representation of the work done in healthcare big data analytics in cardiology.
E. RQ4. WHAT ARE THE APPLICATIONS OF
MEDICAL BIG DATA IN CARDIOLOGY?
The paper [13], [14], [22], [28], [32], [45], [50], [73], [84],
[92], [100], [109], [110], [126], [131], [145], [164] are
already discussed in table 6, while the table 9 shows the
representation of rest of the paper for the applications of
healthcare big data in cardiology.
F. RQ5. WHAT ARE THE MEDICAL BIG DATA
ANALYTICS IN CARDIOLOGY?
Analytical goal of big data in healthcare is the modelling, pre-
diction, and inference, clustering, classification, and regres-
sion are general approaches exploited [15]. The classification
of medical big data is a kind of supervised learning and is
brought as analytical modelling. The analytics of big data
can help and support in the early on accurate prediction
of heart disease, and discovery of variation from healthy
state. Rumsfeld et al. [4] categorized eight areas of big data
143764
analytics for the improvement of healthcare. These areas
are; 1) analytical modelling for risk and usage of resources;
2) disease and treatment heterogeneity; 3) surveillance of
drug and device safety in healthcare; 4) management of pop-
ulation; 5) measurement of performance and quality care;
6) clinical decision support and precision medicine; 7) public
health; and 8) application of research.
Analytics of big data and applications of ML is used in
cardiology for many reasons, such as for clinical decision
support, detection of risk factor for cardiovascular disease,
and for precision medicine using genomic information [50].
Table 10 shows the representation of the research work iden-
tified by this study big data analytics in healthcare especially
in cardiology.
V. LIMITATIONS OF THE RESEARCH
The following are some of the limitations of the proposed
research work
VOLUME 7, 2019
S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review
• There are a number of libraries exists, but the proposed
research was limited only to six of the most extensively
referenced libraries. This decision was taken to only
focus on high quality peer reviewed articles.
• Google Scholar was skipped; the reason was that it
provides access to most of the articles, and to save time
from difficulty of reproduction of entries.
• An article might have been skipped which talks about
the idea associated to healthcare big data in cardiology
but not uses the term at all.
VI. CONCLUSION
Big data role in healthcare especially in cardiology becomes a
challenging task. On-time decision making in cardiac health-
care system has massive potential for refining the care quality,
minimize the cost of care, and decrease error and waste.
Therefore, it is ideal to have a detailed study and report of
the existing literature with the help of which the doctors and
practitioners can take better decisions early healthcare. The
detailed study will eventually summarise the results of the
available literature published related to big data in cardiology.
The current research is an endeavour toward comprehen-
sive report on big data in cardiology. The proposed study uses
systematic literature protocol and guidelines as presented by
Kitchenham et al. [1]. Data was collected from the work pub-
lished during the year 2008 to 2018 in the form of conference,
journals, books, magazines and other online sources.
This research summarises literature published associated
to medical big data in cardiology based on the defined key-
words and research questions. A total of 190 primary studies
were included according to pre-defined inclusion, exclusion,
and quality assessment criteria. The proposed research has
analysed a total of 47 research articles in the area of medical
big data features in cardiology, total of 139 articles in area
and work done in the medical big data in cardiology since
January 2008 to August 2018, total of 59 articles are analysed
for the work done in the area of medical big data features in
cardiology. The paper analysed total of 47 articles related to
the applications of medical big data in cardiology and total
of 10 articles associated to the medical big data analytics in
cardiology.
The proposed study identifies all the selected articles,
along with their details of mentioning the title, citation, paper
type, and publishing year of the paper. The paper presented a
year-wise distribution of included papers from 2008 to 2018.
The paper presents the medical big data features in cardiol-
ogy, provides the research been done since 2008 in the field
of medical big data in cardiology, the techniques that are used
by the researchers for medical big data features in cardiology,
the applications of medical big data in cardiology, and the
medical big data analytics in cardiology. The results of the
proposed research show that there is increase in research
related to cardiology. The study highlights the summaries
will help the doctors and practitioners to more close and
authentic decision making of the patient and then ultimately
VOLUME 7, 2019
can take help to use the study as evidence and advice the care
accordingly to the patient.
CONFLICT OF INTEREST
The authors declared that there are no potential conflicts of
interests regarding the article.
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SHAH NAZIR received the Ph.D. degree in
Boolean functions minimization method,’’ Expert Syst. Appl., vol. 38,
pp. 14037–14043, Oct. 2011.
computer science with a specialization in soft-
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ware engineering. He was with the University of
betes and cardiovascular disease in polycystic ovary syndrome: What are Peshawar. He is currently an Assistant Professor
the risks and can they be reduced?’’ J. Compilation, vol. 27, pp. 498–515, and the Head of Department with the University
May 2010. of Swabi. He has several research publications
[191] S. Rud and J.-S. Yang, ‘‘A support vector machine (SVM) classification in well-reputed international journals and confer-
approach to heart murmur detection,’’ in Proc. Int. Symp. Neural Netw., ence proceedings. His research interests include
2010, pp. 52–59. component-based software engineering, software
[192] V. Rocha, P. Borza, J. Correia, G. GonÃğalves, A. Puscas, R. Seromenho, birthmark, systematic literature review (SLR), and
A. Mascioletti, A. Picano, S. Cocorada, and M. Carp, ‘‘Wearable com- decision making. He is also a Reviewer for several journals and conferences.
puting for patients with coronary diseases: Gathering efforts by compar-
ing methods,’’ presented at the IEEE Int. Conf. Automat., Qual. Test.,
Robot. (AQTR), 2010.
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perspective,’’ Baylor Univ. Med. Center Proc., vol. 23, no. 3, pp. 266–269,
2010.
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‘‘Interoperability solution for an EMR system applied in a cardiology MUHAMMAD NAWAZ received the Ph.D.
department supported by mobile communication,’’ presented at the Int. degree from the School of Engineering and
Joint Conf. Comput. Cybern. Tech. Inform., 2010.
Design, Brunel University London, U.K., in 2013.
[195] H. Suradi, S. Byers, D. Green-Hess, I. Gradus-Pizlo, S. Sawada, and
He has been in the teaching profession for the last
H. Feigenbaum, ‘‘Feasibility of using real time ‘live 3D’ echocardiog-
17 years. He has rich experience in research and
raphy to visualize the stenotic aortic valve,’’ Echocardiography, vol. 27,
no. 8, pp. 1011–1020, 2010.
education and has been involved in teaching at
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undergraduate and postgraduate programs at dif-
adults with congenital heart disease,’’ Int. J. Clinical Practic, pp. 13–24, ferent prestigious universities as well as extensive
Jan. 2010. knowledge in projects. He is currently an Assistant
[197] L. T. D’Angelo, E. Tarita, T. K. Zywietz, and T. C. Lueth, ‘‘A system Professor with the Centre for Excellence in Infor-
for intelligent home care ECG upload and priorisation,’’ presented at the mation Technology, Institute of Management Sciences, Peshawar. He has a
32nd Annu. Int. Conf. IEEE EMBS, Buenos Aires, Argentina, 2010. great aptitude for research and has numerous publications in journals of high
[198] T. Bombardini, D. Cini, G. Arpesella, and E. Picano, ‘‘WEB download- repute. He has also presented research in international-level conferences in
able software for training in cardiovascular hemodynamics in the (3-D) Germany and South Korea. He was a member of numerous societies/bodies
stress echo lab,’’ Cardiovascular Ultrasound, vol. 8, p. 48, Nov. 2010. of Brunel University London. He is also a member of various academic
[199] J. Aguado-Sierra, R. C. P. Kerckhoffs, F. Lionetti, D. Hunt, C. Villongco, bodies, including the Board of Advance Studies, the Academic Committee,
M. Gonzales, S. G. Campbell, and A. D. McCulloch, ‘‘A computa- the Ph.D. Committee, the Office of Research, Innovation and Commercial-
tional framework for patient-specific multi-scale cardiac modeling,’’ in ization (ORIC) at IMSciences, and various public sector universities.
Patient-Specific Modeling of the Cardiovascular System. Springer, 2010,
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A. Tasdemir, and H. Ceyran, Surgical Approach to the Management
of Cardiovascular Echinococcosis. Hoboken, NJ, USA: Wiley, 2009, AWAIS ADNAN has been an Assistant Profes-
pp. 281–284.
sor with the Institute of Management Sciences,
[202] J. Tagney, ‘‘A literature review comparing the experiences and emer-
Peshawar, since 2000. He has been teaching differ-
gent needs of adult patients with permanent pacemakers (PPMs) and
ent programs at graduate and postgraduate levels
implantable cardioverter defibrillators (ICDs),’’ J. Clinical Nursing,
vol. 19, pp. 2081–2089, Aug. 2009. and supervising students at M.S. in IT, M.S. in CS,
[203] K. Sakakura, N. Kubo, J. Ako, N. Ikeda, H. Funayama, T. Hirahara, and B.Sc. levels. He is currently working on the
H. Wada, Y. Sugawara, T. Yasu, M. Kawakami, and S. I. Momomura, Urdu OCR and CBIR systems with his M.S. stu-
‘‘Clinical features of early recurrent myocardial infarction,’’ Heart Ves- dents. He is also a Trainer in HRDC—IMS, where
sels, vol. 24, no. 5, pp. 347–351, 2009. he has been giving training on computer packages
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vectors machine-based identification of heart valve diseases using heart from different government other public sector organizations. His research
sounds,’’ Comput. Methods Programs Biomed., vol. 95, no. 1, pp. 47–61, interests include multimedia, digital image processing, and network on
2009. chip (NOC).

143770 VOLUME 7, 2019

S. Nazir et al.: Big Data Features, Applications, and Analytics in Cardiology—A Systematic Literature Review
SARA SHAHZAD received the Ph.D. degree in
computer science with a specialization in agile
software development. She has almost 20 years
of experience of teaching at graduate and post-
graduate levels and leads the Software Engineering
Research Group, Department of Computer Sci-
ence. Her group is actively working in different
areas, such as software quality, program compre-
hension and software complexity, software cloning
and theft detection, and agile software develop-
ment. She is currently an Associate Professor with the Department of Com-
puter Science, University of Peshawar. She has a special interest in using
agile methods for software engineering education and for the professional
grooming of students.
VOLUME 7, 2019
SHAHLA ASADI received the master’s degree
in information technology management from
the Faculty of Computing, Universiti Teknologi
Malaysia, in 2013. She is the author of two books.
Her research interests include green information
technology, green information systems, big data,
wireless sensor networks, and cloud computing.
Her journal and conference research articles have
been published in the ISI- and Scopus-indexed
Information Systems.
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