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Electronic, mobile, digital health approaches in cardiology and for cardiovascular health.
Official partner journal of the European Congress on eCardiology and eHealth
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).
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Background: Evidence suggests long term benefit from angiotensin converting enzyme inhibition (ACE-I) or angiotensin receptor blockade (ARB), beta-adrenoceptor antagonism and mineralocorticoid antagon...
Background: Evidence suggests long term benefit from angiotensin converting enzyme inhibition (ACE-I) or angiotensin receptor blockade (ARB), beta-adrenoceptor antagonism and mineralocorticoid antagonism (MRA) in patients with left ventricular dysfunction After myocardial infarction. However, despite clinical evidence and clearly articulated guidelines, several studies suggest low rates of prescription of some medications like MRA in the target group with post- myocardial infarction left ventricular dysfunction (MI LVD), both in Australia and other countries Objective: To identify the real world medication prescription in ST elevation myocardial infarction (STEMI) patients with impaired left ventricular function Methods: We studied prescription trends in 152 consecutive STEMI patients between August 2013 and December 2016 admitted to a single referral centre who also had a pre-discharge echo that demonstrated at least moderate Left ventricular dysfunction Results: The average age was 63 years. Most patients were male (78%) and the average BMI was 28 (±6). 132 patients [87% (80% - 92%)] were prescribed ACE-I/ARBs, 144 patients received beta-adrenoceptor antagonists (95% [90% - 98%]), 147 patients (97%) received DAPT and 146 patients (95%) received statins post-STEMI. 45 eligible patients (30% [23% - 28%]) received an MRA. Younger patients were more likely to be prescribed an MRA (p = 0.008). The MRA prescribed cohort were younger, 59 versus 64 years, had marginally better renal function with average eGFR 108 vs 91 mL/min/1.73m2 and lower rates of stage ≥III CKD 11 vs 22 (p <0.05) Conclusions: Our study shows a substantial treatment gap, in that a majority of patients with impaired LV dysfunction after STEMI with symptoms of heart failure or diabetes are not receiving medications in the MRA class, despite proven benefit. As such, the root causes of this treatment gap require elucidation in a multi-centre context.
Background: Smart phone apps or mhealth technology have demonstrated early success in improving patient and physician outcomes. Objective: The goals of the ICD-TEACH pilot study were to design a smart...
Background: Smart phone apps or mhealth technology have demonstrated early success in improving patient and physician outcomes. Objective: The goals of the ICD-TEACH pilot study were to design a smart phone app/mhealth technology with a novel physician decision support algorithm, implement a direct referral mechanism for ICD implantation from the app, and assess its overall usability and feasibility with physicians involved in the care of these patients. Methods: The initial design and development of the mhealth/smart phone app included strategic collaboration from an information technology company and key stakeholders including arrhythmia specialists (electrophysiologists), general cardiologists, as well as key members of the hospital administrative team. A convenience sampling method was used to recruit general internists/cardiologists that refer to our local tertiary care centre. Physicians were asked to incorporate the mhealth app in daily clinical practice and avail of the decision support algorithm and direct referral feature to the arrhythmia clinic. A physician survey was conducted after initial mhealth app use (within 3 months) about physician’s overall satisfaction with the app, compliance, the reason for non-compliance, technical or hardware problems encountered while using the app, and suggestions on improvement. Results: A total of 17 physicians agreed to participate in the pilot study with 100% post study survey response rate. Physicians worked in an academic practice, which included both inpatient and ambulatory care. System Usability Scale was applied with average score of 77 including the 17 participants (>68 points above average). In regards to the novel physician decision algorithm for ICD referral, 11% strongly agreed and 78% agreed that the algorithm for device eligibility was easy to use. Only one patient was referred through the direct referral system through the mhealth app during the pilot study of 3 months. Feasibility assessment showed 46% strongly agreed and 55% agreed that the mhealth app would be utilized if integrated into an electronic medical record where data is automatically sent to the referring arrhythmia clinic. Conclusions: ICD teach pilot study revealed high usability features of a physician decision algorithm however we received only one direct referral through our app despite supportive feedback. Specific reasons from our physician survey included the lack of integration into an electronic medical record. Future studies should continue to systematically evaluate smart phone apps in cardiology to assess usability, feasibility, and strategies to integrate into daily workflow.
Background: Background: People with mental health disorders live on average 20 years less than those without, often due to poor physical health including cardio-vascular disease (CVD). Evidence-based...
Background: Background: People with mental health disorders live on average 20 years less than those without, often due to poor physical health including cardio-vascular disease (CVD). Evidence-based interventions are required to reduce this lifespan gap. Objective: Objective: This study aimed to develop, trial, and evaluate a mobile-based lifestyle program (MyHealthPA) to help people with mental health problems improve key health risk behaviors and reduce their risk of CVD. Methods: Methods: The development of MyHealthPA occurred in three stages: (1) a review of the literature; (2) a scoping survey (n=251) among people with and without experience of mental health problems; and (3) program development informed by stages (1) and (2). A small pilot trial among young people with and without mental health (MH) disorders was also conducted. Participants completed a baseline assessment and given access to the MyHealthPA program for a period of eight weeks. They were then asked to complete an end-of-treatment assessment and a follow-up assessment one month later. Results: Results: Twenty-eight young people aged 19 to 25 years were recruited to the pilot trial. Of these, 12 (43%) had been previously diagnosed with a MI. Twelve participants (43%) completed the end-of-treatment assessment and six (21%) completed the follow-up assessment. Small improvements in fruit and vegetable consumption, level of physical activity, alcohol use, and mood were found between baseline and end-of-treatment and follow-up, particularly among people with experience of MH issues. Most participants (57-60%) reported the program had above average usability, however only 29-40% of participants reported that they would like to use the program frequently and would recommend it to other young people. Participants also identified a number of ways in which the program could be improved. Conclusions: Conclusions: This article describes the formative research and process of planning that formed the development of MyHealthPA and the evidence base underpinning the approach. The MyHealthPA program represents an innovative approach to CVD risk reduction among people with mental health problems. MyHealthPA appears to be an acceptable, easy to use, and potentially effective mHealth intervention to assist young people with mental illness to monitor risk factors for CVD. However, ways in which the program could be improved for future testing and dissemination were identified and are discussed.