JMIR Publications

JMIR Cardio

Electronic, mobile, digital health approaches in cardiology and for cardiovascular health.

Official partner journal of the European Congress on eCardiology and eHealth

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Journal Description

JMIR Cardio (inaugural Editor-in-Chief: Nico Bruining) is a sister journal of the Journal of Medical Internet Research (JMIR), the top cited journal in health informatics (Impact Factor 2016: 5.175). It covers electronic / digital health approaches in cardiology and for cardiovascular health, which includes ehealth and mhealth approaches for the prevention and treatment of cardiovascular conditions.

JMIR Cardio is also the official journal of the European Congress on eCardiology and eHealth. Best papers presented at the conference are selected for JMIR Cardio and as official partner organization, JMIR authors receive a discount (Promo Code: JMIRECARDIO17).

 

Recent Articles:

  • Source: The Authors; Copyright: The Authors; URL: https://www.facebook.com/usfhealth/; License: Creative Commons Attribution (CC-BY).

    A Mobile Health Intervention to Improve Self-Care in Patients With Heart Failure: Pilot Randomized Control Trial

    Abstract:

    Background: Heart failure (HF) is a progressive chronic disease affecting 6.5 million Americans and over 15 million individuals globally. Patients with HF are required to engage in complex self-care behaviors. Although the advancements in medicine have enabled people with HF to live longer, they often have poor health-related quality of life and experience severe and frequent symptoms that limit several aspects of their lives. Mobile phone apps have not only created new and interactive ways of communication between patients and health care providers but also provide a platform to enhance adherence to self-care management. Objective: The aim of this pilot study was to test the feasibility of a newly developed mobile app (HeartMapp) in improving self-care behaviors and quality of life of patients with HF and to calculate effect sizes for sample size calculation for a larger study. Methods: This was a pilot feasibility randomized controlled trial. Participants were enrolled in the hospital before discharge and followed at home for 30 days. The intervention group used HeartMapp (n=9), whereas the control group (n=9) received HF education. These apps were downloaded onto their mobile phones for daily use. Results: A total of 72% (13/18) participants completed the study; the mean age of the participants was 53 (SD 4.02) years, 56% (10/18) were females, 61% (11/18) lived alone, 33% (6/18) were African Americans, and 61% (11/18) used mobile phone to get health information. The mean engagement with HeartMapp was 78%. Results were promising with a trend that participants in the HeartMapp group had a significant mean score change on self-care management (8.7 vs 2.3; t3.38=11, P=.01), self-care confidence (6.7 vs 1.8; t2.53=11, P=.28), and HF knowledge (3 vs −0.66; t2.37=11, P=.04. Depression improved among both groups, more so in the control group (−1.14 vs −5.17; t1.97=11, P=.07). Quality of life declined among both groups, more so in the control group (2.14 vs 9.0; t−1.43=11, P=.18). Conclusions: The trends demonstrated in this pilot feasibility study warrant further exploration on the use of HeartMapp to improve HF outcomes. Trial Registration: Pilot study, no funding from National agencies, hence not registered.

  • EpxHypertension (montage). Source: Unsplash / MagicMockups; Copyright: The Authors; URL: http://cardio.jmir.org/2017/2/e2/; License: Creative Commons Attribution (CC-BY).

    Assessing the Utility of a Novel SMS- and Phone-Based System for Blood Pressure Control in Hypertensive Patients: Feasibility Study

    Abstract:

    Background: Although hypertension (HTN) is a major modifiable risk factor for arterial damage, blood pressure (BP) remains poorly controlled in the hypertensive population. Telemedicine is a promising adjunct intervention that may complement traditional therapies and improve adherence rates; however, current approaches have multiple barriers to entry, including the use of relatively expensive Bluetooth devices or the dependence on smart phone utilization, which tend to exclude low-income and more elderly populations. Objective: The aim of this study was to design and implement a new phone call- and short message service text messaging-based intervention, Epharmix’s EpxHypertension, in a quality improvement project that demonstrates the feasibility of this system for BP control in a family medicine setting. Methods: We recruited 174 patients from a community clinic in St Louis from a database of patients diagnosed with HTN. An automated call or text messaging system was used to monitor patient-reported BPs. If determined to be elevated, physicians were notified by an email, text, or electronic medical record alert. Mean systolic BPs (SBPs) and diastolic BPs (DBPs) were compared at the beginning and end of 12 weeks. Results: After 12 weeks on the system, patients with a baseline SBP of 140 mm Hg or higher reduced SBP by 10.8 mm Hg (95% CI −14.5 to −7.2, P<.001) and DBP by 6.6 mm Hg (95% CI −9.9 to −3.4, P=.002), but no significant changes were observed in overall BPs and BPs in the group with baseline SBP less than 140 mm Hg. Conclusions: EpxHypertension provides a viable means to control HTN in patients with high baseline BPs despite previous therapy. This community implementation study demonstrates the feasibility of implementing EpxHypertension across a primary care setting without the need for smartphones or Bluetooth-linked BP cuffs. Future studies should evaluate its effectiveness in a randomized control trial compared with standard of care.

  • Sentinel Vest. Image Source: Copyright Philips Research.

    Bioimpedance-Based Heart Failure Deterioration Prediction Using a Prototype Fluid Accumulation Vest-Mobile Phone Dyad: An Observational Study

    Abstract:

    Background: Recurrent heart failure (HF) events are common in patients discharged after acute decompensated heart failure (ADHF). New patient-centered technologies are needed to aid in detecting HF decompensation. Transthoracic bioimpedance noninvasively measures pulmonary fluid retention. Objective: The objectives of our study were to (1) determine whether transthoracic bioimpedance can be measured daily with a novel, noninvasive, wearable fluid accumulation vest (FAV) and transmitted using a mobile phone and (2) establish whether an automated algorithm analyzing daily thoracic bioimpedance values would predict recurrent HF events. Methods: We prospectively enrolled patients admitted for ADHF. Participants were trained to use a FAV–mobile phone dyad and asked to transmit bioimpedance measurements for 45 consecutive days. We examined the performance of an algorithm analyzing changes in transthoracic bioimpedance as a predictor of HF events (HF readmission, diuretic uptitration) over a 75-day follow-up. Results: We observed 64 HF events (18 HF readmissions and 46 diuretic uptitrations) in the 106 participants (67 years; 63.2%, 67/106, male; 48.1%, 51/106, with prior HF) who completed follow-up. History of HF was the only clinical or laboratory factor related to recurrent HF events (P=.04). Among study participants with sufficient FAV data (n=57), an algorithm analyzing thoracic bioimpedance showed 87% sensitivity (95% CI 82-92), 70% specificity (95% CI 68-72), and 72% accuracy (95% CI 70-74) for identifying recurrent HF events. Conclusions: Patients discharged after ADHF can measure and transmit daily transthoracic bioimpedance using a FAV–mobile phone dyad. Algorithms analyzing thoracic bioimpedance may help identify patients at risk for recurrent HF events after hospital discharge.

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Latest Submissions Open for Peer-Review:

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  • Validity and reliability of the Apple Watch for measuring moderate-intensity exercise

    Date Submitted: Jul 27, 2017

    Open Peer Review Period: Jul 27, 2017 - Sep 21, 2017

    Background: Moderate fitness levels and habitual exercise have a protective effect for cardiovascular disease, stroke, type 2 diabetes, and all-cause mortality. The Apple Watch displays exercise compl...

    Background: Moderate fitness levels and habitual exercise have a protective effect for cardiovascular disease, stroke, type 2 diabetes, and all-cause mortality. The Apple Watch displays exercise completed at an intensity of a brisk walk or above using a green ‘exercise’ ring. However, it is unknown if the exercise ring accurately represents an exercise intensity comparable to that defined as moderate-intensity. In order for health professionals to prescribe exercise intensity with confidence, consumer sensor-derived wearables need to accurately reflect that measured within the laboratory if they are to be used as part of a personalized medicine approach to disease management. Objective: The aim of this study was to examine the validity and reliability of the Apple Watch for measuring moderate-intensity exercise, as defined as 40-59% oxygen consumption reserve (VO2R). Methods: Twenty recreationally active participants completed VO2rest and VO2max tests prior to a series of 5-min bouts of treadmill walking while wearing an Apple Watch on both wrists and with oxygen consumption measured continuously. Exercise continued until the Apple Watch advanced the green ‘exercise’ ring by 5 min (inflection speed). Results: The mean (SD) %VO2R at the treadmill inflection speed was 30 (7) % for both Apple Watches. There was a large underestimation of moderate-intensity exercise (left: mean difference -10% [95%CI: -14 to -7], d = -1.4; right: -10% [95%CI: -13 to -7], d = -1.5) when compared to the criterion of 40% VO2R. Conclusions: The Apple Watch under-estimated moderate-intensity exercise which would lead to an over-estimation of moderate-intensity exercise completed throughout the day.

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