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This paper presents the Battery-Aware Approximate Wireless Telemetry (BAWT) framework, a co-designed solution that jointly optimizes a Peukert-corrected Li-ion discharge model, a six-state adaptive RF power controller, and a Rayleigh-fading indoor channel model. At the receiver, the proposed Bayesian Adaptive Feature Estimator (BAFE) fuses a Wiener-optimal morphological bandpass prior with a channel-SNR-derived MMSE-Wiener weight, enabling reliable QRS extraction from severely corrupted bit streams without forward error correction hardware. Validated on the MIT-BIH Arrhythmia and PTB-XL clinical databases against the ANSI\/AAMI EC57 standard, BAWT demonstrates substantial performance gains: at the clinically critical 20% SoC operating point, BAFE raises mean QRS sensitivity from 35.1% to 91.9% on MIT-BIH and from 32.9% to 82.8% on PTB-XL, with the majority of individual records satisfying the Se\u2009\u2265\u200995% clinical threshold. The adaptive power controller extends the critical operating window by 355% over fixed full-power operation, and a fully characterized Pareto-optimal frontier enables system designers to navigate the trade-off between battery lifetime extension (up to 144.5%) and clinical QRS detection accuracy across the full SoC range. These results establish a rigorous co-design framework for robust, power-aware wearable cardiac monitoring compliant with ANSI\/AAMI EC57. .<\/jats:p>","DOI":"10.1038\/s41598-026-62387-5","type":"journal-article","created":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T05:44:11Z","timestamp":1784439851000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Battery-aware approximate wireless telemetry framework for resilient wearable ECG monitoring under extreme power constraints"],"prefix":"10.1038","volume":"16","author":[{"given":"Mohamed","family":"Naeem","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"issue":"1","key":"62387_CR1","doi-asserted-by":"publisher","first-page":"e62719","DOI":"10.2196\/62719","volume":"9","author":"S Smith","year":"2025","unstructured":"Smith, S. & Maisrikrod, S. 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