# Smart Heart Disease Prediction System with IoT and Fog Computing Sectors Enabled by Cascaded Deep Learning Model

Authors: K. Butchi Raju; Suresh Dara; Ankit Vidyarthi; V. MNSSVKR Gupta; Baseem Khan
Journal: Computational Intelligence and Neuroscience
 (2022)

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## Abstract

Chronic illnesses like chronic respiratory disease, cancer, heart disease, and diabetes are threats to humans around the world. Among them, heart disease with disparate features or symptoms complicates diagnosis. Because of the emergence of smart wearable gadgets, fog computing and “Internet of Things” (IoT) solutions have become necessary for diagnosis. The proposed model integrates Edge-Fog-Cloud computing for the accurate and fast delivery of outcomes. The hardware components collect data from different patients. The heart feature extraction from signals is done to get significant features. Furthermore, the feature extraction of other attributes is also gathered. All these features are gathered and subjected to the diagnostic system using an Optimized Cascaded Convolution Neural Network (CCNN). Here, the hyperparameters of CCNN are optimized by the Galactic Swarm Optimization (GSO). Through the performance analysis, the precision of the suggested GSO-CCNN is 3.7%, 3.7%, 3.6%, 7.6%, 67.9%, 48.4%, 33%, 10.9%, and 7.6% more advanced than PSO-CCNN, GWO-CCNN, WOA-CCNN, DHOA-CCNN, DNN, RNN, LSTM, CNN, and CCNN, respectively. Thus, the comparative analysis of the suggested system ensures its efficiency over the conventional models.


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## Body

## 1. Introduction

Cloud and fog computing paradigms have gained huge attention and served as a backbone for the modern economy, which uses Internet services to provide on-demand service resources to users[1]. These fields have become essential parts of both academia and industry. However, cloud computing is not suitable for real-time applications to get responses due to the high time delay [2]. Recent technologies like Big Data, “fog computing, IoT, and edge computing” have significantly grown because of their ability to offer several response characteristics depending on target applications [3]. These technologies can offer computation, storage, and communication to edge devices for enhancing and facilitating constraints like network bandwidth, low latency, security, privacy, and mobility, and thus, fog computing is more suitable for real-time or latency-sensitive applications [4]. In recent years, cloud computing frameworks have also offered support for new applications by offering reliable and robust infrastructure and services [5]. Moreover, fog computing utilizes gateways, nodes, and routers to offer services with the least energy consumption, network latency, and response time. Recent research studies explore the problems of fog computing in medical applications and recognize that response time and latency are the most difficult and significant for optimizing QoS constraints in practical fog environments [6].Healthcare is the most important application domain for getting precise and also adopting “fog computing” and real-time results for positive developments. The security in healthcare can be increased by introducing fog computing via taking the resources nearer to the users with the aim of attaining the minimum latency [7]. It results in attaining earlier results, enabling necessary and quicker actions to cure critical heart patients. Although it gets faster delivery of results, it suffers from the complex data and also has to obtain highly accurate results [8]. Thus, the high accuracies can be achieved by using deep learning and the varied versions of deep learning in recent studies that are trained on a large dataset. The state-of-the-art approaches have observed that the collection of healthcare data is performed in two ways, especially for heart patients, which is gathered from file input data and also using different devices like IoT sensors [9]. It is observed that healthcare patient data is obtained over the network at higher speeds, like 250 MB per minute or more [10]. Conventional schemes are not sufficient for capturing and providing the outcomes for both data and video, and so there is a necessity to utilize cloud and edge resources for catering to applications with high data volumes. Data is saved and processed on cloud servers or edge nodes after collecting and aggregating the data from “smart devices of IoT networks” [11]. Thus, an integrated “Edge-Fog-Cloud-derived computation model” is suggested for providing competent computer services to heart patients and other users who require practical results to convey latency-sensitive healthcare and other results with low response time, minimum energy consumption, and high accuracy.Deep learning is a new emerging area that has attained significant results in mixed-modality data settings, sequence prediction, and natural language processing tasks that have gained more growth in several applications like speech recognition, computer vision, etc. [12]. In addition, ensemble learning is utilized to get the superior results of several machine learning algorithms. One of the efficient ensemble approaches is the “bag classifier,” which is trained by fitting the estimator on random subgroups of data and, further, their individual identifications are aggregated through averaging or voting to get the final predicted results [13]. These estimators assist in reducing the variance more efficiently than a single estimator through randomizing the data. Advanced deep learning approaches have attained a high accuracy rate for prediction and classification of healthcare data [14].However, healthcare applications often use deep learning, which takes more time for training such complicated neural networks and evaluating data, requires high prediction times, and also requires a huge amount of computational resources for both training and recognition [15, 16]. The existing approaches may suffer from these complexities in healthcare and equivalent IoT applications, where they face complexities in getting the accuracy rate in real-time applications [17]. As edge computing has given the immense benefit of minimizing response time, it gives a novel way of research with integrated edge computing and complex ensemble deep learning models for getting high accuracy results in practical applications. Because of the emergency requiring healthcare applications, there is a need to adopt automatic heart disease diagnosis models using IoT and fog computing technologies, as well as enhanced deep learning applications. Hence, the designed model focuses on implementing this strategy for assisting heart disease patients in a timely manner, which also helps in decision-making processes.The major contribution of the designed smart healthcare model is given here:(i)
Authors presenting a new smart heart disease prediction system with IoT and fog computing with a metaheuristic-based deep learning model(ii)
To gather significant information from standard devices for getting details about other diseases and medical history to process data(iii)
To propose an automatic diagnostic system for heart diseases with optimized CCNN with the optimization of certain parameters using the GSO algorithm to be commended(iv)
To validate the efficiency of the designed smart heart disease prediction model with standard metricsThe remaining sections are given here. Section2 examines related works. Section 3 delves into deep learning-based heart disease prediction in conjunction with IoT and fog computing devices. Section 4 analyzes the feature extraction of signal and data for optimal heart disease prediction. Section 5 analyzes the optimized cascaded CNN for enhanced heart disease prediction. Section 6 evaluates the results. Section 7 concludes this paper.


## 2. Literature Survey

A new framework named HealthFog was introduced by Satyanarayana by deploying edge computing devices through an integrated ensemble deep learning technique for assisting practical applications of heart disease diagnosis automatically. This healthcare service model has served as a fog service by managing the data of heart patients and gathering data using IoT devices. The integrated fog-derived cloud scheme was termed FogBus and was used for deploying and testing the efficiency of the suggested model regarding execution time, accuracy, jitter, latency, network bandwidth, and power consumption. This designed HealthFog was applicable for several operation modes that offered better QoS and high prediction accuracy for several user requirements in many fog computation cases.A new patient monitoring framework was implemented by Sarmah to assist heart patients using “Deep Learning Modified Neural Network (DLMNN)” with IoT devices to diagnose heart diseases. This model uses three steps like “(i) authentication, (ii) encryption, and (iii) classification.” Initially, the heart patient’s particular hospital was authenticated by using the SHA-512 with the substitution cipher. Further, the wearable IoT sensor device was included in a “patient’s body,” where the sensor data was transmitted concurrently to the cloud. The Advanced Encryption Standard (AES) was used for encrypting the data including “patient id, doctor id, and hospital id” and “securely transferred to the cloud.” Then, after decrypting the data, the DLMNN classifier was employed to get the classified results as abnormal and normal classes. The suggested model has focused on diagnosing the heart conditions of patients. The experimental results were compared with other conventional techniques to get high security and also attained less encryption and decryption time.An IoMT scheme was implemented by Khan and Algarni to diagnose the heart disease through “Modified Salp Swarm Optimization (MSSO) and an Adaptive Neuro-Fuzzy Inference System (ANFIS),” which has enhanced the search ability through the Levy flight technique. Initially, the input data was gathered from medical records like blood sugar, cholesterol, chest pain, sex, age, blood pressure (BP), etc. to know about the risk of heart diseases. In ANFIS, gradient-based learning with a regular learning process was used for diagnosis, but it has the risk of being trapped in local minima. The MSSO algorithm was used for optimizing the learning parameters to get superior results for ANFIS. The designed MSSO-ANFIS model has given promising results in terms of precision and accuracy when compared with other methods.An IoT structure for evaluating heart diseases in an accurate manner through “Modified Deep Convolutional Neural Network (MDCNN)” was suggested by Khan. The heart monitoring device and smart watch were fixed to the patient for monitoring the electrocardiogram (ECG) and blood pressure of patients. The classification of gathered sensor data was performed using MDCNN to get the classes as abnormal and normal. The designed model was analyzed with other conventional models like logistic regression and deep learning neural networks. The experimental results have revealed that the designed MDCNN attained superior prediction performance for heart diseases regarding accuracy.The “Enhanced Deep Learning Assisted CNN (EDCNN)” was designed by Pan et al. to assist in improving the prognostics of heart disease patients. This new EDCNN model was designed with regularization learning and several-layer perceptron techniques. Moreover, the efficiency of the system was evaluated with reduced and full features. Thus, the performance of the classification methods has been validated regarding accuracy and processing time. The suggested model was developed on the IoMT framework for “decision support systems” to help doctors with efficient detection of “heart patient’s information in cloud” environments around the world. The designed model has effectively determined the risk level of heart diseases in an efficient manner. The experimental results have shown that the designed model can be optimized through appropriate optimization of EDCNN hyperparameters to get the efficiency in terms of precision and accuracy.An “IoT-based heart disease diagnosis model” was designed by Makhadmeh and Tolba by gathering patient information after and before heart disease. The healthcare center constantly received information from the patients, which was processed through “Higher Order Boltzmann Deep Belief Neural Network (HOBDBNN).” The features were taken from past analysis and have attained performance through efficient computation of complicated data. The efficiency of the designed model was verified by measures like the Receiver Operating Characteristic (ROC) curve, loss function, sensitivity, specificity, and f-measure. The IoT-based analysis and the HOBDBNN technique have effectively identified heart disease in terms of minimum time complexity and high accuracy rate, thereby reducing heart patients’ mortality rates.An identification model was developed by Sood and Mahajan to get the high risk level of coronary heart disease at an earlier stage based on a cloud-based cyber-physical localization system through an “adaptive neuro-fuzzy inference system.” This model took ECG readings into account and monitored the high- or middle-risk level of heart disease. If any abnormalities in ECG readings were observed, then alerts were instantly forwarded to the mobile phones of users and also to the healthcare service providers to take necessary and immediate action in an early manner to track the wellness of patients. The simulation results have shown that the designed model has effectively and efficiently categorized the risk levels in less response time.The “IoT-enabled ECG monitoring system” for analyzing the ECG signal was implemented by Lakshmi and Kalaivani, where the statistical features were extracted and analyzed through the “Pan Tompkins QRS detection” technique to get the dynamic features. The “dynamic and statistical features” were then utilized for the classification stage of predicting the cardiac arrhythmia disease. This model has focused on analyzing the risk levels of cardiac conditions from ECG signals. This model was useful for general practitioners to evaluate heart disease accurately and easily.Heart disease increases the mortality rate around the world. Thus, prediction of heart diseases is necessary, but the identification of heart diseases is challenging and requires both sophisticated and expert understanding. The Internet of Things (IoT) has frequently been implemented in a variety of medical systems to collect sensor readings in order to identify and prognosticate heart diseases. Despite the fact that many researchers have concentrated on heart disease diagnosis, the accuracy of the outcomes is low. Table1 shows the features and challenges of existing IoT healthcare methods for heart diseases. From this study, it is necessary to develop novel methods in IoT healthcare that can predict heart diseases at an earlier stage in a very accurate manner.Table 1
Advantages and problems of traditional methods of IoT healthcare for the heart diseases.
Author [citation]MethodologyFeaturesChallenges[18]Ensemble learning(i) The prediction outcomes are offered in real time.(ii) The high accuracies are attained using very low latencies.(i) It does not permit cost-optimal execution with distinct fog-cloud cost models and QoS characteristics.[19]DLMNN(i) High security is returned in less time.(ii) The HD of the patient is recognized in a much appropriate manner.(i) The performance is not enhanced with various optimization as well as feature selection techniques.[20]MSSO-ANFIS(i) The highest fitness value is attained for the entire iterations.(ii) It is realized by the available products and wearable technologies in the market.(i) It is not performed with various optimization and feature selection approaches for enhancing the predictive classifier efficiency.[21]MDCNN(i) It offers a high level of accuracy.(ii) The prediction and the monitoring systems save the lives through instant intervention.(i) It is not trained and tested using the fully wearable devices.[22]EDCNN(i) It permits the highly reliable and precise heart disease diagnoses.(ii) It minimizes the misdiagnoses count harming the patients.(i) The precision is not enhanced by incorporating the advance artificial intelligence.[23]HOBDBNN(i) It returns high recognition accuracy.(ii) The abnormal heart patterns are recognized in less time.(i) The IoT-oriented medical disease diagnostic process is not enhanced by the optimized approaches.[24]ANFIS(i) The alerts are generated in minimum time.(ii) The utility is also improved by less error rates.(i) It is not made as a user friendly one.[25]SVM(i) It needs less operational and maintenance cost.(i) It does not deploy various intelligent models for enhancing the accuracy.


## 3. Deep Learning-Based Heart Disease Prediction Connected with IoT and Fog Computing Devices

### 3.1. Proposed Model and Description

As Internet services have emerged in recent years, the IoT and cloud computing play a major role in offering services for several applications. As a result, centralized IoT-based computing platforms are required to address cloud challenges such as the inability to cater to requirements and limited scalability. This new area is required for latency-sensitive frameworks like surveillance systems and health monitoring due to the use of huge amounts of data. Since the medical industry consists of large amounts of data, it adopts new solutions in terms of edge and fog computing frameworks for offering the resources to the user with energy-efficient and low-latency solutions. However, fog computing faces complexities like lower response time and lower accuracy of results. These advanced technologies like fog, IoT, and cloud computing with edge devices provide better communication, computation, and storage solutions for facilitating and enhancing network bandwidth, low latency, security, privacy, and mobility. Thus, real-time or latency-sensitive applications adopt fog computing with cloud services. This paper uses fog computing due to the ability to handle the data of heart patients at edge devices or fog nodes with higher computing capacity to reduce the delay, response time, and latency that occur because of the IoT devices’ proximity to edge devices when compared with cloud data centers. There is also a need to process a large range of heart patients, but the existing systems suffer from high response times, more workloads, high resource usage, and high energy consumption. The designed architecture is illustrated in Figure1.Figure 1
Proposed “smart heart disease prediction system” with IoT-fog computing.The designed “smart heart disease prediction system” gathers the data of heart patients from smart gadgets or IoT devices. These devices are also known as hardware components, like environmental sensors, medical sensors, and activity sensors that are deployed on a patient’s body. The information or data gathered from the body is collected as activity level, blood pressure, EEG, blood oxygen, EMG, respiration rate, ECG, etc. The information gathered is processed by gateway devices, which are further forwarded to the worker or broker nodes for heart disease prediction. The noteworthy features are extracted separately from the signals, like computing peak amplitude, total harmonic distortion, heart rate, zero-crossing rate, entropy, standard deviation, and energy. Further, the feature extraction of other attributes is done by computing the minimum and maximum mean, standard deviation, kurtosis, and skewness. The FogBus then plays an important role in the designed smart heart disease prediction system, which includes modules such as a broker node, a worker node, and a cloud data center. Finally, the extracted features are given to the diagnosis system, where optimized CCNN is used to predict whether the patient has heart disease or not. It is done with the help of the GSO algorithm by optimizing the layers of the cascaded network, hidden neurons, and activation function of CCNN. The major objective of the suggested heart disease diagnosis model is to minimize prediction loss in terms of mean square error (MSE). Thus, it gets the output classes as normal classes and abnormal classes, which helps to ensure the alert and protection of the system.


### 3.2. System Configuration

The designed smart heart disease prediction system is taken as the “lightweight fog service” and effectively manages the information of heart patients from smart gadgets or IoT devices. This proposed model makes use of FogBus to provide services for predicting patients’ heart problems. FogBus is considered as a framework for both the deployment and development of combined Cloud-Fog environments, with platform independence and structured communication of applications. This structure links several IoT sensors, which are also known as “healthcare sensors with gateway devices,” for sending tasks and data to worker nodes of fog. Moreover, task initiation and resource management are performed on the broker nodes of fog. This environment ensures robustness and dependability via a security manager by taking encryption, authentication, and blockchain approaches into account. Moreover, the considered FogBus employs HTTP RESTful APIs for seamless integration and communication with the cloud environment.


#### 3.2.1. IoT

The suggested smart healthcare model combines several hardware instruments with software components and permits seamless and structured “end-to-end integration of Edge-Fog-Cloud” for accurate and faster results. The hardware and software components are explained here. Information can be gathered from three sensors, like “environment sensors, activity sensors, and medical sensors.” Some of the medical sensors are glucose level sensors, respiration rate sensors, temperature sensors, oxygen level sensors, EMG sensors, EEG sensors, and ECG sensors. The gathered data from heart patients is transferred to the connected gateway devices, which consist of tablets, laptops, and mobile phones.


#### 3.2.2. Fog Computing

The IoT devices also serve as fog devices for collecting the sensed data from several sensors and sending this data to worker or broker nodes for processing. FogBus includes nodes like broker nodes, worker nodes, and cloud data centers. The gathered input data or job requests from gateway devices are received by broker nodes. Before transferring the data, the request input module gets “job requests from gateway devices.” Further, secure communication can be offered among several components through a security management module, and then the gathered data is protected from malicious tampering and unauthorized access, thus increasing the data integrity and system credibility. One of the major sections of “resource manager in broker node” is the arbitration module, which considers the input as load statistics of entire worker nodes and then decides the subset of nodes for forwarding the jobs in real-time tasks.Secondly, the worker node is responsible for allocating the tasks through the “resource manager of the broker node.” Here, worker nodes consist of single-board computers and embedded devices, which also include intelligent “deep learning models for processing” and analyzing the input data and obtaining results. Data mining and filtering, data processing, large data storage, and analytics are also components of the worker node. The input data of worker nodes is directly obtained from the gateway devices, which obtain the outcomes and share them with the worker nodes. The third component is the cloud data center, which helps with better data processing and can be used as an efficient storage system. Moreover, the designed model tackles the resources of cloud data centers. While the input data size is higher than average, the services are latency tolerant, and the fog infrastructure becomes overloaded.The software components of the suggested smart healthcare system are feature extraction. The noteworthy features are extracted separately from the signals, like computing peak amplitude, total harmonic distortion, heart rate, zero-crossing rate, entropy, standard deviation, and energy. Further, the feature extraction of other attributes is done by computing the minimum and maximum mean, standard deviation, kurtosis, and skewness. Through considering the extracted features, the decision can be made automatically, which leads to a suitable prescription for medical check-ups and medications through the training of data, which is stored in a database or cloud center for storage. The resource manager has two components, like the arbitration module and the workload manager, where the workload manager is responsible for maintaining the task queues and job requests for processing data. The huge amounts of data can be processed and handled by the workload manager. Further, the scheduling of provisioned cloud and fog resources is performed by the arbitration module to process the queued tasks and is also managed through the workload manager. The “arbitration module” resides inside the “broker node” and decides which fog computing node must be sent the data to get the results: the cloud data center, fog worker node, or the broker itself. Here, the tasks can be divided among several devices for optimal performance and balancing load.


#### 3.2.3. Deep Framework

Thirdly, the deep learning module utilizes the dataset for training a CCNN for classifying the “data points,” which are feature vectors, attained after the feature extraction phase. The prediction is made by considering the task allocated to the resource manager, which has also generated the reduced amount of data attained from the gateway devices. Finally, the results show whether the patient has heart disease or not.


### 3.3. Data Collection

On a manually gathered data set, the proposed model was tested. Information using medical sensors like glucose level sensors, respiration rate sensors, temperature sensors, oxygen level sensors, EMG sensors, EEG sensors, and ECG sensors is gathered from patients:(1)
A glucose level sensor is “used to measure the blood glucose concentration of a patient and is an important part of managing diabetes mellitus.” Type 1 and type 2 diabetes are considered the most general types of diabetes. Glucose level monitoring is essential for predicting heart diseases. High blood glucose from diabetes damages the nerves and blood vessels, which leads to heart disease. Moreover, when compared with people without diabetes, people with diabetes develop heart disease at an early age.(2)
Respiration rate sensor: standard pulse oximeters can be used to monitor respiratory rate. It “measures minute flow rates around the zero point of the respiratory flow and also detects flow rates of several hundred l/min.” Slow breathing was negatively related to heart rate variability (HRV), where differentiations in HRV were considerably lower during slow breathing compared to fast breathing. Thus, evaluation of respiration rate is necessary for heart disease diagnosis.(3)
Temperature sensor: this type of sensor measures the temperature of the patient’s body. When the body temperature increases, the heart beats will be faster and the blood pumps faster, so it is necessary to evaluate.(4)
It is measured by a “pulse oximeter,” which is “a medical device that indirectly monitors the oxygen saturation of a patient’s blood.” Further, a decrease in oxygen saturation results in increased heart rate and pulse rate variability, and thus, there is a need to measure the oxygen level to check the status of heart diseases.(5)
An EMG sensor is “an electrodiagnostic medicine technique for evaluating and recording the electrical activity produced by skeletal muscles,” which is often utilized in biomedical and clinical applications. EMG estimates the health status of the nerve cells and muscles that control them. “EMG signal ranges from 0.1 to 0.5 mV” and is often evaluated in microvolts.(6)
It is a “recording of the electrical activity of the brain from the scalp.” The recorded waveforms reflect the cortical electrical activity. It is employed for assessing the “neurological prognosis in patients who are comatose after cardiac arrest, but its value is limited by varying definitions of pathological patterns and by interrater variability.”(7)
ECG sensors: they are used for assessing the rhythm and heart rate, which is often utilized in detecting abnormal heart rhythms, an enlarged heart, heart attack, and heart disease, which may lead to heart failure.Overall, the gathered data with their unit is given in Table2.Table 2
Comparative analysis of the smart healthcare model with metaheuristic-based algorithms.
DescriptionUnitsGlucose level“Milligrams per decilitre (mg/dL) or millimoles per litre (mmol/L) units”Respiration rateBreaths per minute (BPM)TemperatureFahrenheit (°F) or degrees Celsius (°C)Oxygen levelPercent (%)EMGMicrovolts (mV)EEGmVECGMilliseconds (ms)The gathered data and signals are processed separately by feature extraction process, where the gathered data is termed asXd, d=1,2,…,D, and the total number of gathered data is termed as D. The collected signals are represented as Yn, n=1,2,…,N, and the total number of gathered signals is termed as N.


## 3.1. Proposed Model and Description

As Internet services have emerged in recent years, the IoT and cloud computing play a major role in offering services for several applications. As a result, centralized IoT-based computing platforms are required to address cloud challenges such as the inability to cater to requirements and limited scalability. This new area is required for latency-sensitive frameworks like surveillance systems and health monitoring due to the use of huge amounts of data. Since the medical industry consists of large amounts of data, it adopts new solutions in terms of edge and fog computing frameworks for offering the resources to the user with energy-efficient and low-latency solutions. However, fog computing faces complexities like lower response time and lower accuracy of results. These advanced technologies like fog, IoT, and cloud computing with edge devices provide better communication, computation, and storage solutions for facilitating and enhancing network bandwidth, low latency, security, privacy, and mobility. Thus, real-time or latency-sensitive applications adopt fog computing with cloud services. This paper uses fog computing due to the ability to handle the data of heart patients at edge devices or fog nodes with higher computing capacity to reduce the delay, response time, and latency that occur because of the IoT devices’ proximity to edge devices when compared with cloud data centers. There is also a need to process a large range of heart patients, but the existing systems suffer from high response times, more workloads, high resource usage, and high energy consumption. The designed architecture is illustrated in Figure1.Figure 1
Proposed “smart heart disease prediction system” with IoT-fog computing.The designed “smart heart disease prediction system” gathers the data of heart patients from smart gadgets or IoT devices. These devices are also known as hardware components, like environmental sensors, medical sensors, and activity sensors that are deployed on a patient’s body. The information or data gathered from the body is collected as activity level, blood pressure, EEG, blood oxygen, EMG, respiration rate, ECG, etc. The information gathered is processed by gateway devices, which are further forwarded to the worker or broker nodes for heart disease prediction. The noteworthy features are extracted separately from the signals, like computing peak amplitude, total harmonic distortion, heart rate, zero-crossing rate, entropy, standard deviation, and energy. Further, the feature extraction of other attributes is done by computing the minimum and maximum mean, standard deviation, kurtosis, and skewness. The FogBus then plays an important role in the designed smart heart disease prediction system, which includes modules such as a broker node, a worker node, and a cloud data center. Finally, the extracted features are given to the diagnosis system, where optimized CCNN is used to predict whether the patient has heart disease or not. It is done with the help of the GSO algorithm by optimizing the layers of the cascaded network, hidden neurons, and activation function of CCNN. The major objective of the suggested heart disease diagnosis model is to minimize prediction loss in terms of mean square error (MSE). Thus, it gets the output classes as normal classes and abnormal classes, which helps to ensure the alert and protection of the system.


## 3.2. System Configuration

The designed smart heart disease prediction system is taken as the “lightweight fog service” and effectively manages the information of heart patients from smart gadgets or IoT devices. This proposed model makes use of FogBus to provide services for predicting patients’ heart problems. FogBus is considered as a framework for both the deployment and development of combined Cloud-Fog environments, with platform independence and structured communication of applications. This structure links several IoT sensors, which are also known as “healthcare sensors with gateway devices,” for sending tasks and data to worker nodes of fog. Moreover, task initiation and resource management are performed on the broker nodes of fog. This environment ensures robustness and dependability via a security manager by taking encryption, authentication, and blockchain approaches into account. Moreover, the considered FogBus employs HTTP RESTful APIs for seamless integration and communication with the cloud environment.


### 3.2.1. IoT

The suggested smart healthcare model combines several hardware instruments with software components and permits seamless and structured “end-to-end integration of Edge-Fog-Cloud” for accurate and faster results. The hardware and software components are explained here. Information can be gathered from three sensors, like “environment sensors, activity sensors, and medical sensors.” Some of the medical sensors are glucose level sensors, respiration rate sensors, temperature sensors, oxygen level sensors, EMG sensors, EEG sensors, and ECG sensors. The gathered data from heart patients is transferred to the connected gateway devices, which consist of tablets, laptops, and mobile phones.


### 3.2.2. Fog Computing

The IoT devices also serve as fog devices for collecting the sensed data from several sensors and sending this data to worker or broker nodes for processing. FogBus includes nodes like broker nodes, worker nodes, and cloud data centers. The gathered input data or job requests from gateway devices are received by broker nodes. Before transferring the data, the request input module gets “job requests from gateway devices.” Further, secure communication can be offered among several components through a security management module, and then the gathered data is protected from malicious tampering and unauthorized access, thus increasing the data integrity and system credibility. One of the major sections of “resource manager in broker node” is the arbitration module, which considers the input as load statistics of entire worker nodes and then decides the subset of nodes for forwarding the jobs in real-time tasks.Secondly, the worker node is responsible for allocating the tasks through the “resource manager of the broker node.” Here, worker nodes consist of single-board computers and embedded devices, which also include intelligent “deep learning models for processing” and analyzing the input data and obtaining results. Data mining and filtering, data processing, large data storage, and analytics are also components of the worker node. The input data of worker nodes is directly obtained from the gateway devices, which obtain the outcomes and share them with the worker nodes. The third component is the cloud data center, which helps with better data processing and can be used as an efficient storage system. Moreover, the designed model tackles the resources of cloud data centers. While the input data size is higher than average, the services are latency tolerant, and the fog infrastructure becomes overloaded.The software components of the suggested smart healthcare system are feature extraction. The noteworthy features are extracted separately from the signals, like computing peak amplitude, total harmonic distortion, heart rate, zero-crossing rate, entropy, standard deviation, and energy. Further, the feature extraction of other attributes is done by computing the minimum and maximum mean, standard deviation, kurtosis, and skewness. Through considering the extracted features, the decision can be made automatically, which leads to a suitable prescription for medical check-ups and medications through the training of data, which is stored in a database or cloud center for storage. The resource manager has two components, like the arbitration module and the workload manager, where the workload manager is responsible for maintaining the task queues and job requests for processing data. The huge amounts of data can be processed and handled by the workload manager. Further, the scheduling of provisioned cloud and fog resources is performed by the arbitration module to process the queued tasks and is also managed through the workload manager. The “arbitration module” resides inside the “broker node” and decides which fog computing node must be sent the data to get the results: the cloud data center, fog worker node, or the broker itself. Here, the tasks can be divided among several devices for optimal performance and balancing load.


### 3.2.3. Deep Framework

Thirdly, the deep learning module utilizes the dataset for training a CCNN for classifying the “data points,” which are feature vectors, attained after the feature extraction phase. The prediction is made by considering the task allocated to the resource manager, which has also generated the reduced amount of data attained from the gateway devices. Finally, the results show whether the patient has heart disease or not.


## 3.2.1. IoT

The suggested smart healthcare model combines several hardware instruments with software components and permits seamless and structured “end-to-end integration of Edge-Fog-Cloud” for accurate and faster results. The hardware and software components are explained here. Information can be gathered from three sensors, like “environment sensors, activity sensors, and medical sensors.” Some of the medical sensors are glucose level sensors, respiration rate sensors, temperature sensors, oxygen level sensors, EMG sensors, EEG sensors, and ECG sensors. The gathered data from heart patients is transferred to the connected gateway devices, which consist of tablets, laptops, and mobile phones.


## 3.2.2. Fog Computing

The IoT devices also serve as fog devices for collecting the sensed data from several sensors and sending this data to worker or broker nodes for processing. FogBus includes nodes like broker nodes, worker nodes, and cloud data centers. The gathered input data or job requests from gateway devices are received by broker nodes. Before transferring the data, the request input module gets “job requests from gateway devices.” Further, secure communication can be offered among several components through a security management module, and then the gathered data is protected from malicious tampering and unauthorized access, thus increasing the data integrity and system credibility. One of the major sections of “resource manager in broker node” is the arbitration module, which considers the input as load statistics of entire worker nodes and then decides the subset of nodes for forwarding the jobs in real-time tasks.Secondly, the worker node is responsible for allocating the tasks through the “resource manager of the broker node.” Here, worker nodes consist of single-board computers and embedded devices, which also include intelligent “deep learning models for processing” and analyzing the input data and obtaining results. Data mining and filtering, data processing, large data storage, and analytics are also components of the worker node. The input data of worker nodes is directly obtained from the gateway devices, which obtain the outcomes and share them with the worker nodes. The third component is the cloud data center, which helps with better data processing and can be used as an efficient storage system. Moreover, the designed model tackles the resources of cloud data centers. While the input data size is higher than average, the services are latency tolerant, and the fog infrastructure becomes overloaded.The software components of the suggested smart healthcare system are feature extraction. The noteworthy features are extracted separately from the signals, like computing peak amplitude, total harmonic distortion, heart rate, zero-crossing rate, entropy, standard deviation, and energy. Further, the feature extraction of other attributes is done by computing the minimum and maximum mean, standard deviation, kurtosis, and skewness. Through considering the extracted features, the decision can be made automatically, which leads to a suitable prescription for medical check-ups and medications through the training of data, which is stored in a database or cloud center for storage. The resource manager has two components, like the arbitration module and the workload manager, where the workload manager is responsible for maintaining the task queues and job requests for processing data. The huge amounts of data can be processed and handled by the workload manager. Further, the scheduling of provisioned cloud and fog resources is performed by the arbitration module to process the queued tasks and is also managed through the workload manager. The “arbitration module” resides inside the “broker node” and decides which fog computing node must be sent the data to get the results: the cloud data center, fog worker node, or the broker itself. Here, the tasks can be divided among several devices for optimal performance and balancing load.


## 3.2.3. Deep Framework

Thirdly, the deep learning module utilizes the dataset for training a CCNN for classifying the “data points,” which are feature vectors, attained after the feature extraction phase. The prediction is made by considering the task allocated to the resource manager, which has also generated the reduced amount of data attained from the gateway devices. Finally, the results show whether the patient has heart disease or not.


## 3.3. Data Collection

On a manually gathered data set, the proposed model was tested. Information using medical sensors like glucose level sensors, respiration rate sensors, temperature sensors, oxygen level sensors, EMG sensors, EEG sensors, and ECG sensors is gathered from patients:(1)
A glucose level sensor is “used to measure the blood glucose concentration of a patient and is an important part of managing diabetes mellitus.” Type 1 and type 2 diabetes are considered the most general types of diabetes. Glucose level monitoring is essential for predicting heart diseases. High blood glucose from diabetes damages the nerves and blood vessels, which leads to heart disease. Moreover, when compared with people without diabetes, people with diabetes develop heart disease at an early age.(2)
Respiration rate sensor: standard pulse oximeters can be used to monitor respiratory rate. It “measures minute flow rates around the zero point of the respiratory flow and also detects flow rates of several hundred l/min.” Slow breathing was negatively related to heart rate variability (HRV), where differentiations in HRV were considerably lower during slow breathing compared to fast breathing. Thus, evaluation of respiration rate is necessary for heart disease diagnosis.(3)
Temperature sensor: this type of sensor measures the temperature of the patient’s body. When the body temperature increases, the heart beats will be faster and the blood pumps faster, so it is necessary to evaluate.(4)
It is measured by a “pulse oximeter,” which is “a medical device that indirectly monitors the oxygen saturation of a patient’s blood.” Further, a decrease in oxygen saturation results in increased heart rate and pulse rate variability, and thus, there is a need to measure the oxygen level to check the status of heart diseases.(5)
An EMG sensor is “an electrodiagnostic medicine technique for evaluating and recording the electrical activity produced by skeletal muscles,” which is often utilized in biomedical and clinical applications. EMG estimates the health status of the nerve cells and muscles that control them. “EMG signal ranges from 0.1 to 0.5 mV” and is often evaluated in microvolts.(6)
It is a “recording of the electrical activity of the brain from the scalp.” The recorded waveforms reflect the cortical electrical activity. It is employed for assessing the “neurological prognosis in patients who are comatose after cardiac arrest, but its value is limited by varying definitions of pathological patterns and by interrater variability.”(7)
ECG sensors: they are used for assessing the rhythm and heart rate, which is often utilized in detecting abnormal heart rhythms, an enlarged heart, heart attack, and heart disease, which may lead to heart failure.Overall, the gathered data with their unit is given in Table2.Table 2
Comparative analysis of the smart healthcare model with metaheuristic-based algorithms.
DescriptionUnitsGlucose level“Milligrams per decilitre (mg/dL) or millimoles per litre (mmol/L) units”Respiration rateBreaths per minute (BPM)TemperatureFahrenheit (°F) or degrees Celsius (°C)Oxygen levelPercent (%)EMGMicrovolts (mV)EEGmVECGMilliseconds (ms)The gathered data and signals are processed separately by feature extraction process, where the gathered data is termed asXd, d=1,2,…,D, and the total number of gathered data is termed as D. The collected signals are represented as Yn, n=1,2,…,N, and the total number of gathered signals is termed as N.


## 4. Feature Extraction of Signal and Data for Optimal Heart Disease Prediction

### 4.1. Feature Extraction from Signals

The collected signalsYs are given to the feature extraction, which is carried out through computing peak amplitude, total harmonic distortion, heart rate, zero-crossing rate, entropy, “standard deviation,” and energy. It is used for reducing the amount of redundant data from the dataset. It reduces the computational complexity and increases the generalization steps in the prediction process and enhances the speed of learning. The new features are the summarized information of the original set of features.


#### 4.1.1. Peak Amplitude

The “peak amplitude of a sinusoidal waveform is the maximum positive or negative deviation of a waveform from its zero-reference level.”


#### 4.1.2. Total Harmonic Distortion

It is “a measurement of the harmonic distortion present in a signal or defined as the ratio of the sum of the powers of all harmonic components to the power of the fundamental frequency,” which is formulated in(1)THD=∑v=2N/2hv2h1.Here, the maximum harmonic order is termed asN/2, the harmonic order vth amplitude is derived as hv, and the amount of samples per period is denoted as N and the harmonic order is denoted as h.


#### 4.1.3. Heart Rate

The “heart rate can be derived through the interval among two successive QRS complexes (Q wave, R wave, and S wave, the “QRS complex”) when the cardiac rhythm is regular.” The heart rate is computed by dividing the “number of large boxes (5 mm or 0.2 seconds) between two successive QRS complexes into 300.”


#### 4.1.4. Zero-Crossing Rate

It is “the rate at which a signal changes from positive to zero to negative or from negative to zero to positive,” which is also defined as a “measure of number of times in a given time interval/frame that the amplitude of the speech signals passes through a value of zero,” which is derived in(2)Zcn=∑u=−∞∞sgnyu−sgnyu−1wsn−u,wsn=12N,for0≤n≤N−1,0,for or,sgnyu=1,yu≥0,−1,yu<0.Here, the sign function is termed assgn⋅.


#### 4.1.5. The Entropy Function

It is formulated as shown in(3)Ent=−prjlogprj.Here, the probability of features is mentioned asprj in Jth feature set.


#### 4.1.6. Standard Deviation

It is “a measure of how far the signal fluctuates from the mean. The variance represents the power of this fluctuation” as measured in(4)σ2=1N∑j=0N−1yj−μ2.All the signals are listed inyj and the number of samples is termed as N, and the mean and standard deviation of samples are denoted as μ and σ, respectively.


#### 4.1.7. Energy

The energy of signalyu is the integral of squared signal magnitude and is determined in(5)Eng=∫−∞∞yu2du.Finally, the overall determined features from signals are termed asSff, f=1,2,…,F, and the total number of gathered features is termed as F.


### 4.2. Feature Extraction from Data

Some of the gathered data from the patients are given to the feature extraction stage, where the minimum and “maximum mean, standard deviation, kurtosis, and skewness” are utilized as feature extraction approaches. The gathered dataXd is forwarded here for minimizing the “number of resources required for processing without losing relevant or important information.” It also minimizes the count of redundant data for a specific analysis. It solves the overfitting problem.


#### 4.2.1. Minimum and Maximum Mean

The mean is determined for a dataset by “adding the data values and dividing by the number of data values.”(6)μ=∑ydd.Here, all the values in the dataset are denoted asyd and the total values in the dataset are mentioned as d. Here, the mean of minimum and maximum values is referred to as the smallest value in the dataset and the largest value in the dataset, respectively.


#### 4.2.2. Standard Deviation

It is “the square root of variance by determining each data point’s deviation relative to the mean.” The formula for standard deviation is computed in equation (4).


#### 4.2.3. Kurtosis

It is “a measure of whether the data are heavy-tailed or light-tailed relative to a normal distribution” as equated in(7)ku=1D∑d=1DYd−Y¯σ4.


#### 4.2.4. Skewness

It “refers to a distortion or asymmetry that deviates from the symmetrical bell curve, or normal distribution, in a set of data” as formulated in(8)ku=1D∑d=1DYd−Y¯σ3.Finally, the overall extracted features from data are represented asDffs, fs=1,2,…,Fs, and the total number of gathered features is termed as Fs.


## 4.1. Feature Extraction from Signals

The collected signalsYs are given to the feature extraction, which is carried out through computing peak amplitude, total harmonic distortion, heart rate, zero-crossing rate, entropy, “standard deviation,” and energy. It is used for reducing the amount of redundant data from the dataset. It reduces the computational complexity and increases the generalization steps in the prediction process and enhances the speed of learning. The new features are the summarized information of the original set of features.


### 4.1.1. Peak Amplitude

The “peak amplitude of a sinusoidal waveform is the maximum positive or negative deviation of a waveform from its zero-reference level.”


### 4.1.2. Total Harmonic Distortion

It is “a measurement of the harmonic distortion present in a signal or defined as the ratio of the sum of the powers of all harmonic components to the power of the fundamental frequency,” which is formulated in(1)THD=∑v=2N/2hv2h1.Here, the maximum harmonic order is termed asN/2, the harmonic order vth amplitude is derived as hv, and the amount of samples per period is denoted as N and the harmonic order is denoted as h.


### 4.1.3. Heart Rate

The “heart rate can be derived through the interval among two successive QRS complexes (Q wave, R wave, and S wave, the “QRS complex”) when the cardiac rhythm is regular.” The heart rate is computed by dividing the “number of large boxes (5 mm or 0.2 seconds) between two successive QRS complexes into 300.”


### 4.1.4. Zero-Crossing Rate

It is “the rate at which a signal changes from positive to zero to negative or from negative to zero to positive,” which is also defined as a “measure of number of times in a given time interval/frame that the amplitude of the speech signals passes through a value of zero,” which is derived in(2)Zcn=∑u=−∞∞sgnyu−sgnyu−1wsn−u,wsn=12N,for0≤n≤N−1,0,for or,sgnyu=1,yu≥0,−1,yu<0.Here, the sign function is termed assgn⋅.


### 4.1.5. The Entropy Function

It is formulated as shown in(3)Ent=−prjlogprj.Here, the probability of features is mentioned asprj in Jth feature set.


### 4.1.6. Standard Deviation

It is “a measure of how far the signal fluctuates from the mean. The variance represents the power of this fluctuation” as measured in(4)σ2=1N∑j=0N−1yj−μ2.All the signals are listed inyj and the number of samples is termed as N, and the mean and standard deviation of samples are denoted as μ and σ, respectively.


### 4.1.7. Energy

The energy of signalyu is the integral of squared signal magnitude and is determined in(5)Eng=∫−∞∞yu2du.Finally, the overall determined features from signals are termed asSff, f=1,2,…,F, and the total number of gathered features is termed as F.


## 4.1.1. Peak Amplitude

The “peak amplitude of a sinusoidal waveform is the maximum positive or negative deviation of a waveform from its zero-reference level.”


## 4.1.2. Total Harmonic Distortion

It is “a measurement of the harmonic distortion present in a signal or defined as the ratio of the sum of the powers of all harmonic components to the power of the fundamental frequency,” which is formulated in(1)THD=∑v=2N/2hv2h1.Here, the maximum harmonic order is termed asN/2, the harmonic order vth amplitude is derived as hv, and the amount of samples per period is denoted as N and the harmonic order is denoted as h.


## 4.1.3. Heart Rate

The “heart rate can be derived through the interval among two successive QRS complexes (Q wave, R wave, and S wave, the “QRS complex”) when the cardiac rhythm is regular.” The heart rate is computed by dividing the “number of large boxes (5 mm or 0.2 seconds) between two successive QRS complexes into 300.”


## 4.1.4. Zero-Crossing Rate

It is “the rate at which a signal changes from positive to zero to negative or from negative to zero to positive,” which is also defined as a “measure of number of times in a given time interval/frame that the amplitude of the speech signals passes through a value of zero,” which is derived in(2)Zcn=∑u=−∞∞sgnyu−sgnyu−1wsn−u,wsn=12N,for0≤n≤N−1,0,for or,sgnyu=1,yu≥0,−1,yu<0.Here, the sign function is termed assgn⋅.


## 4.1.5. The Entropy Function

It is formulated as shown in(3)Ent=−prjlogprj.Here, the probability of features is mentioned asprj in Jth feature set.


## 4.1.6. Standard Deviation

It is “a measure of how far the signal fluctuates from the mean. The variance represents the power of this fluctuation” as measured in(4)σ2=1N∑j=0N−1yj−μ2.All the signals are listed inyj and the number of samples is termed as N, and the mean and standard deviation of samples are denoted as μ and σ, respectively.


## 4.1.7. Energy

The energy of signalyu is the integral of squared signal magnitude and is determined in(5)Eng=∫−∞∞yu2du.Finally, the overall determined features from signals are termed asSff, f=1,2,…,F, and the total number of gathered features is termed as F.


## 4.2. Feature Extraction from Data

Some of the gathered data from the patients are given to the feature extraction stage, where the minimum and “maximum mean, standard deviation, kurtosis, and skewness” are utilized as feature extraction approaches. The gathered dataXd is forwarded here for minimizing the “number of resources required for processing without losing relevant or important information.” It also minimizes the count of redundant data for a specific analysis. It solves the overfitting problem.


### 4.2.1. Minimum and Maximum Mean

The mean is determined for a dataset by “adding the data values and dividing by the number of data values.”(6)μ=∑ydd.Here, all the values in the dataset are denoted asyd and the total values in the dataset are mentioned as d. Here, the mean of minimum and maximum values is referred to as the smallest value in the dataset and the largest value in the dataset, respectively.


### 4.2.2. Standard Deviation

It is “the square root of variance by determining each data point’s deviation relative to the mean.” The formula for standard deviation is computed in equation (4).


### 4.2.3. Kurtosis

It is “a measure of whether the data are heavy-tailed or light-tailed relative to a normal distribution” as equated in(7)ku=1D∑d=1DYd−Y¯σ4.


### 4.2.4. Skewness

It “refers to a distortion or asymmetry that deviates from the symmetrical bell curve, or normal distribution, in a set of data” as formulated in(8)ku=1D∑d=1DYd−Y¯σ3.Finally, the overall extracted features from data are represented asDffs, fs=1,2,…,Fs, and the total number of gathered features is termed as Fs.


## 4.2.1. Minimum and Maximum Mean

The mean is determined for a dataset by “adding the data values and dividing by the number of data values.”(6)μ=∑ydd.Here, all the values in the dataset are denoted asyd and the total values in the dataset are mentioned as d. Here, the mean of minimum and maximum values is referred to as the smallest value in the dataset and the largest value in the dataset, respectively.


## 4.2.2. Standard Deviation

It is “the square root of variance by determining each data point’s deviation relative to the mean.” The formula for standard deviation is computed in equation (4).


## 4.2.3. Kurtosis

It is “a measure of whether the data are heavy-tailed or light-tailed relative to a normal distribution” as equated in(7)ku=1D∑d=1DYd−Y¯σ4.


## 4.2.4. Skewness

It “refers to a distortion or asymmetry that deviates from the symmetrical bell curve, or normal distribution, in a set of data” as formulated in(8)ku=1D∑d=1DYd−Y¯σ3.Finally, the overall extracted features from data are represented asDffs, fs=1,2,…,Fs, and the total number of gathered features is termed as Fs.


## 5. Optimized Cascaded CNN for Enhanced Heart Disease Prediction

### 5.1. Optimized Cascaded CNN

The proposed model utilizes the CCNN [26] for predicting the heart diseases. It processes the features of both signal and data attributes. As a new innovation to the original CCNN, layers of cascaded network, hidden neurons, and activation function of CCNN are optimized by GSO algorithm. This results in better identification of heart diseases with the aim of maximizing the prediction rate with less error rates.CCNN is basically several layers of CNNs. CNNs are feedforward neural networks, which include convolutional, pooling, and fully connected layers. CNN expresses the unique structure with characteristics like pooling, weight sharing, and local perception. Here, a feature map is acquired by involving local perception with a convolution kernal performing in a local rectangular region in the input data. For each features map, weight sharing is involved in the distribution of biases and weights in a convolution kernel. In the feature map, a descending sampling operation or pooling is aimed at summarizing and reducing the attained feature map. Moreover, the maximum pooling and average pooling get maximum or average of smaller regions in the feature map. Then, the size of these data is minimized without influencing the extracted features.The output from these layers is given into a one-dimensional vector during supervised learning, after crossing multiple convolutional and max-pooling layers for a given input into the fully connected network. For classification, one or more fully connected layers are involved. The existing studies show that the CNNs with small convolution kernels get better recognition accuracy. For reducing the number of parameters and dimensionality, a cross-channel aggregation has acted as the convolution kernel with a size of 1 × 1. But it affects the accuracy of recognition. Moreover, it has to solve the overfitting problem and vanishing gradients.The cascaded CNN model is modeled based on finding the entropy loss, where the number of layers in cascaded network is assigned with threshold value. Initially, the input data like features of both data and signals are given to convolution layer of CNN, which is further forwarded to the pooling layer. The entropy loss is computed in fully connected layer, in which if it is attained as 0.4, then the CCNN has only one network or else if it gets less than threshold value the output of the pooling layer is given to the input layer of next network. Finally, the classified outcomes are attained from the fully connected layers. Here, the threshold value is assigned as0.3∗10−3. Thus, the number of networks is assigned in training based on threshold value and entropy loss. Moreover, the optimized CCNN is proposed by layers of cascaded network, hidden neurons, and activation function. Thus, the superior recognition rate is observed by GSO algorithm. The architecture of optimized CCNN with GSO is given in Figure 2.Figure 2
Optimized CCNN architecture for smart heart disease diagnosis.The parameters of the CCNN are hidden neurons (HNe), for which activation function (AF) can be selected for each layer. The range of hidden neurons is assigned among 5 to 255. The selection of activation functionsAF of CNN is done among Rectified Linear Unit (ReLU), Leaky ReLU function, Tanh function, and sigmoid function and thus, the limit of AF is given as [18, 21], which is especially used as the last component of the convolutional layer for increasing the nonlinearity in the output. ReLU has better features when compared with others, which does not activate entire neurons at the equivalent time. It converges six times faster than sigmoid and tanh activation functions. Leaky ReLu is used when the gradient is equivalent to zero. The sigmoid activation “function takes any real value as input and outputs values in the range 0 to 1. The tanh function takes any real value as input and outputs values in the range −1 to 1.” The solution encoding of the designed model for CCNN is given in Figure 3.Figure 3
Parameter optimization of cascaded convolutional neural network with GSO algorithm.The major objective of the suggested smart healthcare model through GSO technique is the minimization of Mean Square Error (MSE) among predicted and actual outcomes, which is given in(9)Obj=argminMSEAF,HNe.It is used for “measuring the average of the squares of the errors that is the average squared difference between the predicted outcomesPrq and the actual outcomes Acq” as given in(10)MSE=1Q∑q=iQAcq−Prq2.Here, the total number of features is termed asQ. Thus, the minimization of error results in better prediction rate for the suggested smart healthcare model with IoT-assisted fog computing.


### 5.2. GSO

This proposed smart healthcare model with IoT-assisted fog computing uses the GSO [27] algorithm for enhancing the prediction rate of heart diseases. It is used for optimizing the hidden layers of the cascaded network, hidden neurons in the cascaded network, and activation function. This optimization helps in maximizing the accuracy rate and minimizing the error rate. The GSO algorithm is selected here due to its plenty of benefits, like getting local optimal solutions, faster convergence rate, finding local solutions for getting the global optimum, and proper balancing between the exploitation and exploration phases. Moreover, this algorithm reports lower computational time and higher accuracy in recent studies. It is one of the nature-inspired metaheuristic optimization algorithms.This algorithm is motivated by considering the movement of “heavenly bodies” such as galaxies and stars under the influence of gravity forces. Here, the entire galaxy is assumed as a “point mass” that is fascinating to other galaxies because it minimizes their probable energy. The population is separated into subpopulations based on their population, where each individual is attracted to better solutions. This algorithm permits various cycles of exploitation for identifying the probable local optima solutions. Furthermore, during the exploration phase, the issue of convergence to a local minima is overcome, giving a faster convergence rate than other existing algorithms. Several stars are present in the small galaxies, which are also known as subswarms. To reduce the energy of galaxies, the “small galaxies are interrelated among themselves and try to update the positions.” In addition, the best star in each small galaxy tries to interact with the best “star of other small galaxies.”Here, the best position of the stars is represented asp1,p2,p3,p4 and their velocities of four small galaxies are noted as ϑ1,ϑ2,ϑ3,ϑ4. The superswam is considered by considering the cluster or set of the small galaxies. In the superswam galaxy, the best star and velocity are denoted as P and V, respectively. For reducing the energy of complete system, this superswam galaxy updates their velocity and position, which results in stabilization of the system.It is assumed as the subswarm has a cluster ofG of k tuples including the elements as gi,j∈ℜk, which consists of B partitions with each of size K. From the input data, the random initialization of elements of G is done here, where the framework of complete swarm is formulated.(11)Yi⊂G;∀i1,B,gj⊂Yi;∀j1,K,Yi∩Yj=ϕ;ifi≠j,∪i=1BYi=G.This GSO has two levels of experimentation like “subswarm level and independent execution of PSO.” GSO is considered for running equivalent toB subswarms. The subswarm Gi consists of a global best correlated with them, where j include smaller function value than pi and pi is updated with any of their personal bests ℓi. It is given as Fvℓi,j<Fvpi. Therefore, galaxies in every subswarm are included to the better solutions, which is pi of that specific subswarm. Every subswarm explores all the search space at independent manner. Initial iterations, the position, and velocity are determined for every galaxy in the swarm. The formulations for position and velocity updates are given in equations (12) and (13), respectively.(12)gi,j=ϑi,j+gi,j,(13)ϑi,j=ϖi×ϑi,j+cn1×rn1×ℓi,j−gi,j+cn2×rn2×pi,j−gi,j.Here, the random parameters are given asrn1 and rn2 and the inertia weight is given as ϖi, which are updated in (14) and (15), respectively.(14)rni=∪0,1,(15)ϖi=1−enenmax+1.Here, a random number lies among 0 and 1 and the current epoch number is termed asen, which is varied among 1,enmax. The construction of superwarms or superclusters is performed, while best subwarms assist in the next phase of clustering. Hence, the superswarm includes every subswarm. The position vectors and velocity of superswarm are updated as given in “equations (16) and (17),” respectively.(16)pi,j=Vi,j+pi,j.(17)Vi=ϖi×Vi+cn1×rn1×ℓi−gi+cn2×rn2×P−pi.Here, the global best galaxy is denoted asP, which is updated only if the best galaxy is attained compared to the earlier one. Thus, the superswarm concept improves exploitation process as it comprises global best galaxies.The flowchart of the GSO algorithm is given in Figure4.Figure 4
Flowchart of GSO algorithm.The pseudocode of the proposed GSO is shown in Algorithm 1.Algorithm 1: GSO algorithm.
Initialize the populationInitialization of two levelsForl = 1 to lmaxStart level 1Forj←1toKFori←0toBSubswarmIfFvgi,j<Fvℓi,jℓi,j←gi,jIfFvℓi,j<Fvpipi←ℓi,jIfFvpi<FvPP←piEnd ifEnd ifEnd ifUpdate the velocity of GSO byϑi,j=ϖi×ϑi,j+cn1×rn1×ℓi,j−gi,j+cn2×rn2×pi,j−gi,jmod2dUpdate the position of bygi,j=ϑi,j+gi,jmod2dSuperswarmSwarm initializationFori←0toBForj←1toKIfFvgi<Fvℓiℓi←giEnd ifIfFvℓi<FvPP←ℓiEnd ifEnd ifUpdate the velocity of GSO byϑi,j=ϖi×ϑi,j+cn1×rn1×ℓi,j−gi,j+cn2×rn2×pi,j−gi,jmod2dUpdate the position of bygi,j=ϑi,j+gi,jmod2dEnd forIfFvP<Fvℜℜ←PEnd ifEnd forEnd forEnd forReturn best solutionsStop


## 5.1. Optimized Cascaded CNN

The proposed model utilizes the CCNN [26] for predicting the heart diseases. It processes the features of both signal and data attributes. As a new innovation to the original CCNN, layers of cascaded network, hidden neurons, and activation function of CCNN are optimized by GSO algorithm. This results in better identification of heart diseases with the aim of maximizing the prediction rate with less error rates.CCNN is basically several layers of CNNs. CNNs are feedforward neural networks, which include convolutional, pooling, and fully connected layers. CNN expresses the unique structure with characteristics like pooling, weight sharing, and local perception. Here, a feature map is acquired by involving local perception with a convolution kernal performing in a local rectangular region in the input data. For each features map, weight sharing is involved in the distribution of biases and weights in a convolution kernel. In the feature map, a descending sampling operation or pooling is aimed at summarizing and reducing the attained feature map. Moreover, the maximum pooling and average pooling get maximum or average of smaller regions in the feature map. Then, the size of these data is minimized without influencing the extracted features.The output from these layers is given into a one-dimensional vector during supervised learning, after crossing multiple convolutional and max-pooling layers for a given input into the fully connected network. For classification, one or more fully connected layers are involved. The existing studies show that the CNNs with small convolution kernels get better recognition accuracy. For reducing the number of parameters and dimensionality, a cross-channel aggregation has acted as the convolution kernel with a size of 1 × 1. But it affects the accuracy of recognition. Moreover, it has to solve the overfitting problem and vanishing gradients.The cascaded CNN model is modeled based on finding the entropy loss, where the number of layers in cascaded network is assigned with threshold value. Initially, the input data like features of both data and signals are given to convolution layer of CNN, which is further forwarded to the pooling layer. The entropy loss is computed in fully connected layer, in which if it is attained as 0.4, then the CCNN has only one network or else if it gets less than threshold value the output of the pooling layer is given to the input layer of next network. Finally, the classified outcomes are attained from the fully connected layers. Here, the threshold value is assigned as0.3∗10−3. Thus, the number of networks is assigned in training based on threshold value and entropy loss. Moreover, the optimized CCNN is proposed by layers of cascaded network, hidden neurons, and activation function. Thus, the superior recognition rate is observed by GSO algorithm. The architecture of optimized CCNN with GSO is given in Figure 2.Figure 2
Optimized CCNN architecture for smart heart disease diagnosis.The parameters of the CCNN are hidden neurons (HNe), for which activation function (AF) can be selected for each layer. The range of hidden neurons is assigned among 5 to 255. The selection of activation functionsAF of CNN is done among Rectified Linear Unit (ReLU), Leaky ReLU function, Tanh function, and sigmoid function and thus, the limit of AF is given as [18, 21], which is especially used as the last component of the convolutional layer for increasing the nonlinearity in the output. ReLU has better features when compared with others, which does not activate entire neurons at the equivalent time. It converges six times faster than sigmoid and tanh activation functions. Leaky ReLu is used when the gradient is equivalent to zero. The sigmoid activation “function takes any real value as input and outputs values in the range 0 to 1. The tanh function takes any real value as input and outputs values in the range −1 to 1.” The solution encoding of the designed model for CCNN is given in Figure 3.Figure 3
Parameter optimization of cascaded convolutional neural network with GSO algorithm.The major objective of the suggested smart healthcare model through GSO technique is the minimization of Mean Square Error (MSE) among predicted and actual outcomes, which is given in(9)Obj=argminMSEAF,HNe.It is used for “measuring the average of the squares of the errors that is the average squared difference between the predicted outcomesPrq and the actual outcomes Acq” as given in(10)MSE=1Q∑q=iQAcq−Prq2.Here, the total number of features is termed asQ. Thus, the minimization of error results in better prediction rate for the suggested smart healthcare model with IoT-assisted fog computing.


## 5.2. GSO

This proposed smart healthcare model with IoT-assisted fog computing uses the GSO [27] algorithm for enhancing the prediction rate of heart diseases. It is used for optimizing the hidden layers of the cascaded network, hidden neurons in the cascaded network, and activation function. This optimization helps in maximizing the accuracy rate and minimizing the error rate. The GSO algorithm is selected here due to its plenty of benefits, like getting local optimal solutions, faster convergence rate, finding local solutions for getting the global optimum, and proper balancing between the exploitation and exploration phases. Moreover, this algorithm reports lower computational time and higher accuracy in recent studies. It is one of the nature-inspired metaheuristic optimization algorithms.This algorithm is motivated by considering the movement of “heavenly bodies” such as galaxies and stars under the influence of gravity forces. Here, the entire galaxy is assumed as a “point mass” that is fascinating to other galaxies because it minimizes their probable energy. The population is separated into subpopulations based on their population, where each individual is attracted to better solutions. This algorithm permits various cycles of exploitation for identifying the probable local optima solutions. Furthermore, during the exploration phase, the issue of convergence to a local minima is overcome, giving a faster convergence rate than other existing algorithms. Several stars are present in the small galaxies, which are also known as subswarms. To reduce the energy of galaxies, the “small galaxies are interrelated among themselves and try to update the positions.” In addition, the best star in each small galaxy tries to interact with the best “star of other small galaxies.”Here, the best position of the stars is represented asp1,p2,p3,p4 and their velocities of four small galaxies are noted as ϑ1,ϑ2,ϑ3,ϑ4. The superswam is considered by considering the cluster or set of the small galaxies. In the superswam galaxy, the best star and velocity are denoted as P and V, respectively. For reducing the energy of complete system, this superswam galaxy updates their velocity and position, which results in stabilization of the system.It is assumed as the subswarm has a cluster ofG of k tuples including the elements as gi,j∈ℜk, which consists of B partitions with each of size K. From the input data, the random initialization of elements of G is done here, where the framework of complete swarm is formulated.(11)Yi⊂G;∀i1,B,gj⊂Yi;∀j1,K,Yi∩Yj=ϕ;ifi≠j,∪i=1BYi=G.This GSO has two levels of experimentation like “subswarm level and independent execution of PSO.” GSO is considered for running equivalent toB subswarms. The subswarm Gi consists of a global best correlated with them, where j include smaller function value than pi and pi is updated with any of their personal bests ℓi. It is given as Fvℓi,j<Fvpi. Therefore, galaxies in every subswarm are included to the better solutions, which is pi of that specific subswarm. Every subswarm explores all the search space at independent manner. Initial iterations, the position, and velocity are determined for every galaxy in the swarm. The formulations for position and velocity updates are given in equations (12) and (13), respectively.(12)gi,j=ϑi,j+gi,j,(13)ϑi,j=ϖi×ϑi,j+cn1×rn1×ℓi,j−gi,j+cn2×rn2×pi,j−gi,j.Here, the random parameters are given asrn1 and rn2 and the inertia weight is given as ϖi, which are updated in (14) and (15), respectively.(14)rni=∪0,1,(15)ϖi=1−enenmax+1.Here, a random number lies among 0 and 1 and the current epoch number is termed asen, which is varied among 1,enmax. The construction of superwarms or superclusters is performed, while best subwarms assist in the next phase of clustering. Hence, the superswarm includes every subswarm. The position vectors and velocity of superswarm are updated as given in “equations (16) and (17),” respectively.(16)pi,j=Vi,j+pi,j.(17)Vi=ϖi×Vi+cn1×rn1×ℓi−gi+cn2×rn2×P−pi.Here, the global best galaxy is denoted asP, which is updated only if the best galaxy is attained compared to the earlier one. Thus, the superswarm concept improves exploitation process as it comprises global best galaxies.The flowchart of the GSO algorithm is given in Figure4.Figure 4
Flowchart of GSO algorithm.The pseudocode of the proposed GSO is shown in Algorithm 1.Algorithm 1: GSO algorithm.
Initialize the populationInitialization of two levelsForl = 1 to lmaxStart level 1Forj←1toKFori←0toBSubswarmIfFvgi,j<Fvℓi,jℓi,j←gi,jIfFvℓi,j<Fvpipi←ℓi,jIfFvpi<FvPP←piEnd ifEnd ifEnd ifUpdate the velocity of GSO byϑi,j=ϖi×ϑi,j+cn1×rn1×ℓi,j−gi,j+cn2×rn2×pi,j−gi,jmod2dUpdate the position of bygi,j=ϑi,j+gi,jmod2dSuperswarmSwarm initializationFori←0toBForj←1toKIfFvgi<Fvℓiℓi←giEnd ifIfFvℓi<FvPP←ℓiEnd ifEnd ifUpdate the velocity of GSO byϑi,j=ϖi×ϑi,j+cn1×rn1×ℓi,j−gi,j+cn2×rn2×pi,j−gi,jmod2dUpdate the position of bygi,j=ϑi,j+gi,jmod2dEnd forIfFvP<Fvℜℜ←PEnd ifEnd forEnd forEnd forReturn best solutionsStop


## 6. Results and Discussion

### 6.1. Experimental Setup

The proposed heart disease diagnosis model was executed in MATLAB 2020a. The effectiveness of the designed system was compared over the conventional models in terms of standard performance measures. The designed model was analyzed with different optimization algorithms like Particle Swarm Optimization (PSO) [28], Grey Wolf Optimization (GWO) [29], Whale Optimization Algorithm (WOA) [30], and Deer Hunting Optimization Algorithm (DHOA) [31] with the GSO-based CCNN and some classifiers like deep neural networks (DNN) [32], Recurrent Neural Networks (RNN) [33], Long Short-Term Memory (LSTM) [34], CNN [35], and CCNN [26]. The system configuration has been added in here. The experimentation was performed on Intel core i3 processor, RAM size 4 GB, and system type 64-bit OS, x64-based processor, and windows 10 edition, and 21H1 version.


### 6.2. Performance Metrics

Various performance metrics are estimated for evaluating the performance, where termsteng, tepos, fepos, and feng refer to the “true negatives, true positives, false positives, and false negatives,” respectively:(a)
F1-score: “harmonic mean between precision and recall. It is used as a statistical measure to rate performance.”(18)F1‐score=2tepos2tepos+fepos+feng.(b)
MCC: “correlation coefficient computed by four values.”(19)MCC=tepos×teng−fepos×fenegtepos+fepostepos+fenegteng+feposteng+feng.(c)
NPV: “probability that subjects with a negative screening test truly do not have the disease.”(20)NPV=tengfeng+teng.(d)
FDR: “the number of false positives in all of the rejected hypotheses.”(21)FDR=feposfepos+tepos.(e)
FPR: “the ratio of count of false positive predictions to the entire count of negative predictions.”(22)FPR=feposfepos+teng.(f)
FNR: “the proportion of positives which yield negative test outcomes with the test.”(23)FNR=fengteng+tepos.(g)
Sensitivity: “the number of true positives, which are recognized exactly.”(24)Se=tepostepos+feng.(h)
Specificity: “the number of true negatives, which are determined precisely.”(25)Sp=tengteng+fepos.(i)
“Precision: it is the ratio of positive observations that are predicted exactly to the total number of observations that are positively predicted.”(26)Pr=tepostepos+fepos.(j)
“Accuracy: it is a ratio of the observation of exactly predicted to the whole observations.”(27)Ac=tepos+tengtepos+trng+fepos+feng.The performance is also analyzed with k-fold validation, which is a “procedure used to estimate the skill of the model on new data.”


### 6.3. Performance Analysis Based on Heuristic Techniques

The performance of the designed smart heart disease prediction system is analyzed with existing metaheuristic-based algorithms as given in Figure5. A newly developed GSO-CCNN is evaluated with some standard performance measures to show the effectiveness of the heart disease diagnosis by varying the learning percentages from 35% to 85%. The accuracy of the suggested GSO-CCNN is considerably higher than other algorithms due to its effectiveness. However, at the initial learning percentages, the accuracy is maintained like others. But, while increasing the learning percentages, the better performance is observed by GSO-CCNN by evaluating the performance measures. The accuracy of GSO-CCNN is 2% superior to PSO-CCNN, GWO-CCNN, and DHOA-CCNN, respectively, and 4.2% superior to WOA-CCNN at 85%. While taking the FNR measure, the designed GSO-CCNN gets higher error rate at initial percentages and further, the lesser error is observed by 85%. Similarly, better performance is attained by GSO-CCNN while analyzing with other performance measures, which demonstrate the higher prediction rate with fog assisted IoT technology.Figure 5
Analysis on designed smart “heart disease prediction” model with different heuristic-based algorithms in terms of “accuracy, sensitivity, specificity, precision, FPR, FNR, NPV, FDR,F1-score, and MCC.”
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)


### 6.4. Performance Analysis on Classifiers

Figure6 presents the analysis on designed smart “heart disease prediction model” with different classifiers in terms of accuracy, sensitivity, specificity, and precision, FPR, FNR, NPV, FDR, F1-score, and MCC. The efficiency of the suggested smart heart disease prediction model is analyzed with existing classifiers to show the efficiency by changing the “learning percentages.” While analyzing the performance, the suggested GSO-CCNN gets higher prediction rate and lesser error rate for all the performance measures. While taking the precision measure, the GSO-CCNN is 67.7%, 52%, 32%, 10%, and 6.45% more enhanced than DNN, RNN, LSTM, CNN, and CCNN, respectively, at 35%. When evaluating the error measures, the FPR attains lesser error rates through GSO-CCNN, where GSO-CCNN attains 91.3%, 87.5%, 86.4%, 72%, and 44% more progress than DNN, RNN, LSTM, CNN, and CCNN, respectively, at 65%. Likewise, the maximum performance is observed by GSO-CCNN for all the performance measures compared to other classifiers, and so, the promising performance is demonstrated by the suggested smart heart disease prediction model.Figure 6
Analysis on designed smart “heart disease prediction model” with different classifiers in terms of “accuracy, sensitivity, specificity, precision, FPR, FNR, NPV, FDR,F1-score, and MCC.”
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)


### 6.5. Performance Analysis on k-Fold Validation

The efficiency of the smart healthcare prediction model is analyzed by varying the different k-folds, which is given by comparing with metaheuristic algorithms and classifiers as depicted in Figures7 and 8, respectively. The superior performance is observed by the designed smart healthcare prediction model using GSO-CCNN by evaluating with various performance metrics. While considering the k-fold as 2, the MCC of the designed GSO-CCNN is 9%, 10.4%, 11.7%, and 7.9% more progressed than PSO-CCNN, GWO-CCNN, WOA-CCNN, and DHOA-CCNN, respectively, by considering the k-fold as 3. Moreover, the GSO-CCNN gets 82.6%, 82.9%, 63.6%, 50%, and 52.9% lesser FDR than DNN, RNN, LSTM, CNN, and CCNN, respectively, at f-fold as 5. Hence, the better performance is observed by the designed smart heart disease diagnosis model in terms of k-fold validation.Figure 7
Analysis on designed smart “heart disease prediction” model with several metaheuristic techniques on k-fold validations in terms of “accuracy, sensitivity, specificity, precision, FPR, FNR, NPV, FDR,F1-score, and MCC.”
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)Figure 8
Analysis on designed smart heart disease prediction model with different classifiers on k-fold validations regarding “accuracy, sensitivity, specificity, precision, FPR, FNR, NPV, FDR,F1-score, and MCC.”
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)


### 6.6. Comparative Analysis

The overall efficiency of the suggested smart healthcare model with IoT-assisted fog computing is reviewed in Tables3 and 4 for diverse metaheuristic-based algorithms and classifiers, respectively. The accuracy of the proposed GSO-CCNN is 40%, 25.6%, 17.3%, 4.5%, 40.3%, 25.6%, 17.3%, 4.5%, and 3.7% better than PSO-CCNN, GWO-CCNN, WOA-CCNN, and DHOA-CCNN, DNN, RNN, LSTM, CNN, and CCNN, respectively. Similarly, the superior performance is observed by the designed smart healthcare model and attained promising results while comparing with conventional methods.Table 3
Comparative analysis of the smart healthcare model with metaheuristic-based algorithms.
MeasuresPSO-CCNN [28]GWO-CCNN [29]WOA-CCNN [30]DHOA-CCNN [31]GSO-CCNN“Accuracy”0.94080.93660.93440.94810.9499“Sensitivity”0.93620.92640.92080.99260.93483“Specificity”0.94540.94680.9480.90360.9725“Precision”0.944890.945690.946550.911480.98077“FPR”0.05460.05320.0520.09640.0275“FNR”0.06380.07360.07920.00740.065167“NPV”0.94540.94680.9480.90360.9725“FDR”0.0551070.0543080.0534540.0885220.019234“F1-score”0.940530.935950.93350.950310.95725“MCC”0.881640.873380.869120.899770.89834Table 4
Comparative analysis of the designed smart healthcare model with existing classifiers.
MeasuresDNN [32]RNN [33]LSTM [34]CNN [35]CCNN [26]GSO-CCNN“Accuracy”0.67670.75580.80980.90850.91580.9499“Sensitivity”0.978890.889070.986540.946210.9050.93483“Specificity”0.429450.655260.618330.868450.9250.9725“Precision”0.583990.66050.736860.884230.911340.98077“FPR”0.570550.344740.381670.131550.0750.0275“FNR”0.0211110.110930.0134620.0537860.0950.065167“NPV”0.429450.655260.618330.868450.9250.9725“FDR”0.416010.33950.263140.115770.088660.019234“F1-score”0.731550.757930.843610.914170.908160.95725“MCC”0.471890.545790.657090.818590.830450.89834


### 6.7. K-Fold Validation

The comparative analysis of the suggested smart healthcare model with IoT-assisted fog computing is depicted in terms of k-fold validation as shown in Tables5 and 6 for diverse metaheuristic-based algorithms and classifiers, respectively, by taking the k-fold as 5. Cross-validation is a resampling procedure used to evaluate machine learning models on a limited data sample. The accuracy of the proposed GSO-CCNN is 2.2%, 3%, 2.5%, 3.3%, 16%, 12%, 8.3%, 8.3%, and 5.4% more progressed than PSO-CCNN, GWO-CCNN, WOA-CCNN, and DHOA-CCNN, DNN, RNN, LSTM, CNN, and CCNN, respectively. Thus, it is observed that the designed smart healthcare model gets promising results while comparing with conventional methods.Table 5
Comparative analysis of the smart healthcare model with metaheuristic-based algorithms by taking the k-fold validation as 5.
MeasuresPSO-CCNN [28]GWO-CCNN [29]WOA-CCNN [30]DHOA-CCNN [31]GSO-CCNN“Accuracy”0.95080.94330.94830.94050.9721“Sensitivity”0.9510.940.94820.93140.97667“Specificity”0.95060.94660.94840.94960.96525“Precision”0.950620.946250.948390.948670.97683“FPR”0.04940.05340.05160.05040.03475“FNR”0.0490.060.05180.06860.023333“NPV”0.95060.94660.94840.94960.96525“FDR”0.049380.0537550.051610.0513340.023171“F1-score”0.950810.943110.948290.939950.97675“MCC”0.90160.886620.89660.881150.94188Table 6
Comparative analysis of the designed smart healthcare model with existing classifiers by taking the k-fold validation as 5.
MeasuresDNN [32]RNN [33]LSTM [34]CNN [35]CCNN [26]GSO-CCNN“Accuracy”0.83780.86710.8970.89650.92180.9721“Sensitivity”0.918440.998370.896540.879610.935220.97667“Specificity”0.771820.768070.89750.914430.910370.96525“Precision”0.767070.764560.904540.916080.898870.97683“FPR”0.228180.231930.10250.0855670.089630.03475“FNR”0.0815560.0016280.103460.120390.0647830.023333“NPV”0.771820.768070.89750.914430.910370.96525“FDR”0.232930.235440.095460.0839230.101130.023171“F1-score”0.835960.865960.900520.897470.916680.97675“MCC”0.688880.76470.793780.793740.843650.94188


## 6.1. Experimental Setup

The proposed heart disease diagnosis model was executed in MATLAB 2020a. The effectiveness of the designed system was compared over the conventional models in terms of standard performance measures. The designed model was analyzed with different optimization algorithms like Particle Swarm Optimization (PSO) [28], Grey Wolf Optimization (GWO) [29], Whale Optimization Algorithm (WOA) [30], and Deer Hunting Optimization Algorithm (DHOA) [31] with the GSO-based CCNN and some classifiers like deep neural networks (DNN) [32], Recurrent Neural Networks (RNN) [33], Long Short-Term Memory (LSTM) [34], CNN [35], and CCNN [26]. The system configuration has been added in here. The experimentation was performed on Intel core i3 processor, RAM size 4 GB, and system type 64-bit OS, x64-based processor, and windows 10 edition, and 21H1 version.


## 6.2. Performance Metrics

Various performance metrics are estimated for evaluating the performance, where termsteng, tepos, fepos, and feng refer to the “true negatives, true positives, false positives, and false negatives,” respectively:(a)
F1-score: “harmonic mean between precision and recall. It is used as a statistical measure to rate performance.”(18)F1‐score=2tepos2tepos+fepos+feng.(b)
MCC: “correlation coefficient computed by four values.”(19)MCC=tepos×teng−fepos×fenegtepos+fepostepos+fenegteng+feposteng+feng.(c)
NPV: “probability that subjects with a negative screening test truly do not have the disease.”(20)NPV=tengfeng+teng.(d)
FDR: “the number of false positives in all of the rejected hypotheses.”(21)FDR=feposfepos+tepos.(e)
FPR: “the ratio of count of false positive predictions to the entire count of negative predictions.”(22)FPR=feposfepos+teng.(f)
FNR: “the proportion of positives which yield negative test outcomes with the test.”(23)FNR=fengteng+tepos.(g)
Sensitivity: “the number of true positives, which are recognized exactly.”(24)Se=tepostepos+feng.(h)
Specificity: “the number of true negatives, which are determined precisely.”(25)Sp=tengteng+fepos.(i)
“Precision: it is the ratio of positive observations that are predicted exactly to the total number of observations that are positively predicted.”(26)Pr=tepostepos+fepos.(j)
“Accuracy: it is a ratio of the observation of exactly predicted to the whole observations.”(27)Ac=tepos+tengtepos+trng+fepos+feng.The performance is also analyzed with k-fold validation, which is a “procedure used to estimate the skill of the model on new data.”


## 6.3. Performance Analysis Based on Heuristic Techniques

The performance of the designed smart heart disease prediction system is analyzed with existing metaheuristic-based algorithms as given in Figure5. A newly developed GSO-CCNN is evaluated with some standard performance measures to show the effectiveness of the heart disease diagnosis by varying the learning percentages from 35% to 85%. The accuracy of the suggested GSO-CCNN is considerably higher than other algorithms due to its effectiveness. However, at the initial learning percentages, the accuracy is maintained like others. But, while increasing the learning percentages, the better performance is observed by GSO-CCNN by evaluating the performance measures. The accuracy of GSO-CCNN is 2% superior to PSO-CCNN, GWO-CCNN, and DHOA-CCNN, respectively, and 4.2% superior to WOA-CCNN at 85%. While taking the FNR measure, the designed GSO-CCNN gets higher error rate at initial percentages and further, the lesser error is observed by 85%. Similarly, better performance is attained by GSO-CCNN while analyzing with other performance measures, which demonstrate the higher prediction rate with fog assisted IoT technology.Figure 5
Analysis on designed smart “heart disease prediction” model with different heuristic-based algorithms in terms of “accuracy, sensitivity, specificity, precision, FPR, FNR, NPV, FDR,F1-score, and MCC.”
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)


## 6.4. Performance Analysis on Classifiers

Figure6 presents the analysis on designed smart “heart disease prediction model” with different classifiers in terms of accuracy, sensitivity, specificity, and precision, FPR, FNR, NPV, FDR, F1-score, and MCC. The efficiency of the suggested smart heart disease prediction model is analyzed with existing classifiers to show the efficiency by changing the “learning percentages.” While analyzing the performance, the suggested GSO-CCNN gets higher prediction rate and lesser error rate for all the performance measures. While taking the precision measure, the GSO-CCNN is 67.7%, 52%, 32%, 10%, and 6.45% more enhanced than DNN, RNN, LSTM, CNN, and CCNN, respectively, at 35%. When evaluating the error measures, the FPR attains lesser error rates through GSO-CCNN, where GSO-CCNN attains 91.3%, 87.5%, 86.4%, 72%, and 44% more progress than DNN, RNN, LSTM, CNN, and CCNN, respectively, at 65%. Likewise, the maximum performance is observed by GSO-CCNN for all the performance measures compared to other classifiers, and so, the promising performance is demonstrated by the suggested smart heart disease prediction model.Figure 6
Analysis on designed smart “heart disease prediction model” with different classifiers in terms of “accuracy, sensitivity, specificity, precision, FPR, FNR, NPV, FDR,F1-score, and MCC.”
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)


## 6.5. Performance Analysis on k-Fold Validation

The efficiency of the smart healthcare prediction model is analyzed by varying the different k-folds, which is given by comparing with metaheuristic algorithms and classifiers as depicted in Figures7 and 8, respectively. The superior performance is observed by the designed smart healthcare prediction model using GSO-CCNN by evaluating with various performance metrics. While considering the k-fold as 2, the MCC of the designed GSO-CCNN is 9%, 10.4%, 11.7%, and 7.9% more progressed than PSO-CCNN, GWO-CCNN, WOA-CCNN, and DHOA-CCNN, respectively, by considering the k-fold as 3. Moreover, the GSO-CCNN gets 82.6%, 82.9%, 63.6%, 50%, and 52.9% lesser FDR than DNN, RNN, LSTM, CNN, and CCNN, respectively, at f-fold as 5. Hence, the better performance is observed by the designed smart heart disease diagnosis model in terms of k-fold validation.Figure 7
Analysis on designed smart “heart disease prediction” model with several metaheuristic techniques on k-fold validations in terms of “accuracy, sensitivity, specificity, precision, FPR, FNR, NPV, FDR,F1-score, and MCC.”
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)Figure 8
Analysis on designed smart heart disease prediction model with different classifiers on k-fold validations regarding “accuracy, sensitivity, specificity, precision, FPR, FNR, NPV, FDR,F1-score, and MCC.”
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)


## 6.6. Comparative Analysis

The overall efficiency of the suggested smart healthcare model with IoT-assisted fog computing is reviewed in Tables3 and 4 for diverse metaheuristic-based algorithms and classifiers, respectively. The accuracy of the proposed GSO-CCNN is 40%, 25.6%, 17.3%, 4.5%, 40.3%, 25.6%, 17.3%, 4.5%, and 3.7% better than PSO-CCNN, GWO-CCNN, WOA-CCNN, and DHOA-CCNN, DNN, RNN, LSTM, CNN, and CCNN, respectively. Similarly, the superior performance is observed by the designed smart healthcare model and attained promising results while comparing with conventional methods.Table 3
Comparative analysis of the smart healthcare model with metaheuristic-based algorithms.
MeasuresPSO-CCNN [28]GWO-CCNN [29]WOA-CCNN [30]DHOA-CCNN [31]GSO-CCNN“Accuracy”0.94080.93660.93440.94810.9499“Sensitivity”0.93620.92640.92080.99260.93483“Specificity”0.94540.94680.9480.90360.9725“Precision”0.944890.945690.946550.911480.98077“FPR”0.05460.05320.0520.09640.0275“FNR”0.06380.07360.07920.00740.065167“NPV”0.94540.94680.9480.90360.9725“FDR”0.0551070.0543080.0534540.0885220.019234“F1-score”0.940530.935950.93350.950310.95725“MCC”0.881640.873380.869120.899770.89834Table 4
Comparative analysis of the designed smart healthcare model with existing classifiers.
MeasuresDNN [32]RNN [33]LSTM [34]CNN [35]CCNN [26]GSO-CCNN“Accuracy”0.67670.75580.80980.90850.91580.9499“Sensitivity”0.978890.889070.986540.946210.9050.93483“Specificity”0.429450.655260.618330.868450.9250.9725“Precision”0.583990.66050.736860.884230.911340.98077“FPR”0.570550.344740.381670.131550.0750.0275“FNR”0.0211110.110930.0134620.0537860.0950.065167“NPV”0.429450.655260.618330.868450.9250.9725“FDR”0.416010.33950.263140.115770.088660.019234“F1-score”0.731550.757930.843610.914170.908160.95725“MCC”0.471890.545790.657090.818590.830450.89834


## 6.7. K-Fold Validation

The comparative analysis of the suggested smart healthcare model with IoT-assisted fog computing is depicted in terms of k-fold validation as shown in Tables5 and 6 for diverse metaheuristic-based algorithms and classifiers, respectively, by taking the k-fold as 5. Cross-validation is a resampling procedure used to evaluate machine learning models on a limited data sample. The accuracy of the proposed GSO-CCNN is 2.2%, 3%, 2.5%, 3.3%, 16%, 12%, 8.3%, 8.3%, and 5.4% more progressed than PSO-CCNN, GWO-CCNN, WOA-CCNN, and DHOA-CCNN, DNN, RNN, LSTM, CNN, and CCNN, respectively. Thus, it is observed that the designed smart healthcare model gets promising results while comparing with conventional methods.Table 5
Comparative analysis of the smart healthcare model with metaheuristic-based algorithms by taking the k-fold validation as 5.
MeasuresPSO-CCNN [28]GWO-CCNN [29]WOA-CCNN [30]DHOA-CCNN [31]GSO-CCNN“Accuracy”0.95080.94330.94830.94050.9721“Sensitivity”0.9510.940.94820.93140.97667“Specificity”0.95060.94660.94840.94960.96525“Precision”0.950620.946250.948390.948670.97683“FPR”0.04940.05340.05160.05040.03475“FNR”0.0490.060.05180.06860.023333“NPV”0.95060.94660.94840.94960.96525“FDR”0.049380.0537550.051610.0513340.023171“F1-score”0.950810.943110.948290.939950.97675“MCC”0.90160.886620.89660.881150.94188Table 6
Comparative analysis of the designed smart healthcare model with existing classifiers by taking the k-fold validation as 5.
MeasuresDNN [32]RNN [33]LSTM [34]CNN [35]CCNN [26]GSO-CCNN“Accuracy”0.83780.86710.8970.89650.92180.9721“Sensitivity”0.918440.998370.896540.879610.935220.97667“Specificity”0.771820.768070.89750.914430.910370.96525“Precision”0.767070.764560.904540.916080.898870.97683“FPR”0.228180.231930.10250.0855670.089630.03475“FNR”0.0815560.0016280.103460.120390.0647830.023333“NPV”0.771820.768070.89750.914430.910370.96525“FDR”0.232930.235440.095460.0839230.101130.023171“F1-score”0.835960.865960.900520.897470.916680.97675“MCC”0.688880.76470.793780.793740.843650.94188


## 7. Conclusion

This paper has attempted to propose a novel smart healthcare model with the help of Edge-Fog-Cloud computing. The proposed model has gathered information from diverse hardware instruments. Here, the heart feature extraction from signals was done through computing peak amplitude, total harmonic distortion, heart rate, zero-crossing rate, entropy, standard deviation, and energy. Similarly, the features of other attributes were extracted by computing their “minimum and maximum mean, standard deviation, kurtosis, and skewness.” All these features were given to the diagnostic system by utilizing the CCNN with GSO algorithm for optimizing certain parameters of CNN. Here, the layers of the cascaded network, hidden neurons, and activation function of CCNN were optimized by GSO. Through the performance analysis, the precision of the suggested GSO-CCNN was 3.7%, 3.7%, 3.6%, 7.6%, 67.9%, 48.4%, 33%, 10.9%, and 7.6% better than PSO-CCNN, GWO-CCNN, WOA-CCNN, and DHOA-CCNN, DNN, RNN, LSTM, CNN, and CCNN, respectively. Thus, the smart healthcare model with IoT-assisted fog computing has attained promising performance. In the future, the suggested model could be extended by using more advanced feature selection algorithms, optimization techniques, and classification algorithms to improve the efficiency of the predictive system for the diagnosis of heart disease. This model can also be deployed in real-time applications.



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*Source: 1070697-2022-01-10.xml*