Rationale and design of the AutoHealth study: prospective clinical validation of continuous multimodal in-vehicle health monitoring in real-world mobility.

Aims: Continuous physiological monitoring outside clinical environments remains limited by usability, reproducibility, and user adherence. Vehicles offer a semi-controlled setting enabling unobtrusive multimodal sensing during everyday mobility. The Automotive Health Proof of Concept Trial (AutoHealth) investigates the real-world feasibility and accuracy of continuous in-vehicle cardiovascular monitoring using integrated optical, electrical, and acoustic sensors benchmarked against medical-grade reference standards. Methods and results: AutoHealth is a prospective, observational cohort study at Charité - Universitätsmedizin Berlin enrolling adults across five predefined cohorts: healthy individuals, patients with an elevated cardiometabolic risk, HFpEF, HFrEF, and persistent atrial fibrillation. Participants undergo comprehensive baseline phenotyping followed by a structured in-vehicle session comprising static and dynamic driving segments and predefined physical and cognitive stress tasks. Synchronized biosignals including rPPG, steering-wheel ECG, phonocardiography, and voice-derived features are compared with clinical reference measurements. The primary endpoint is the median absolute percentage error (MAPE) of in-vehicle vital sign estimates vs. reference measurements, with successful performance defined Discussion: AutoHealth is designed to provide a prospective clinical validation of continuous multimodal cardiovascular monitoring inside a modified production vehicle under real-world driving conditions and reproducible closed-course testing. Study findings will characterize feasibility, performance, and translational potential of Automotive Health as a scalable prevention and remote physiological monitoring paradigm.