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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 2017: 4.671). 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:

  • Medly phone with peripheral devices and user manual. Source: Image created by the Authors; Copyright: The Authors; URL: http://cardio.jmir.org/2018/2/e11466/; License: Creative Commons Attribution (CC-BY).

    User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study

    Abstract:

    Background: Telemonitoring interventions for the management of heart failure have seen limited adoption in Canadian health systems, but isolated examples of telemonitoring programs do exist. An example of such a program was launched in a specialty heart failure clinic in Toronto, Canada, and a recent implementation evaluation concluded that reducing the cost of delivering the program is necessary to ensure its sustainability and scalability. Objective: The objectives of this study were to (1) understand which components of the telemonitoring program could be modified to reduce costs and adapted to other contexts while maintaining program fidelity and (2) describe the changes made to the telemonitoring program to enable its sustainability within the initial implementation site and scalability to other health organizations. Methods: Semistructured interviews probed the experiences of patients (n=23) and clinicians (n=8) involved in the telemonitoring program to identify opportunities for cost reduction and resource optimization. Ideas for adapting the program were informed by the interview results and prioritized based on (1) potential impact for sustainability and scalability, (2) feasibility, and (3) perceived risks to negatively impacting the program’s ability to yield desired health outcomes. Results: A total of 5 themes representing opportunities for cost reduction were discussed, including (1) Bring Your Own Device (BYOD), (2) technical support, (3) clinician role, (4) duration of enrollment, and (5) intensity of monitoring. The hardware used for the telemonitoring system and the modalities of providing technical support were found to be highly adaptable, which supported the decision to implement a BYOD model, whereby patients used their own smartphone, weight scale, and blood pressure cuff. Changes also included the development of a website aimed at reducing the burden on a technical support telehealth analyst. In addition, the interviews suggested that although it is important to have a clinician who is part of a patient’s circle of care monitoring telemonitoring alerts, the skill level and experience were moderately adaptable. Thus, a registered nurse was determined to be more cost-effective and was hired to replace the existing nurse practitioners in the frontline management of telemonitoring alerts and take over the technical support role from a telehealth analyst. Conclusions: This study provides a user-centered example of how necessary cost-reduction actions can be taken to ensure the sustainability and scalability of telemonitoring programs. In addition, the findings offer insights into what components of a telemonitoring program can be safely adapted to ensure its integration in various clinical settings.

  • Source: Pixabay; Copyright: stevepb; URL: https://pixabay.com/en/hands-old-typing-laptop-internet-545394/; License: Public Domain (CC0).

    Quality of Medical Advice Provided Between Members of a Web-Based Message Board for Patients With Implantable Defibrillators: Mixed-Methods Study

    Abstract:

    Background: Patients use Web-based medical information to understand medical conditions and treatments. A number of efforts have been made to understand the quality of professionally created content; however, none have described the quality of advice being provided between anonymous members of Web-based message boards. Objective: The objective of this study was to characterize the quality of medical information provided between members of an anonymous internet message board addressing treatment with an implantable cardioverter-defibrillator (ICD). Methods: We quantitatively analyzed 2 years of discussions using a mixed inductive-deductive framework, first, for instances in which members provided medical advice and, then, for the quality of the advice. Results: We identified 82 instances of medical advice within 127 discussions. Advice covered 6 topical areas: (1) Device information, (2) Programming, (3) Cardiovascular disease, (4) Lead management, (5) Activity restriction, and (6) Management of other conditions. Across all advice, 50% (41/82) was deemed generally appropriate, 24% (20/82) inappropriate for most patients, 6% (5/82) controversial, and 20% (16/82) without sufficient context. Proportions of quality categories varied between topical areas. We have included representative examples. Conclusions: The quality of advice shared between anonymous members of a message board regarding ICDs varied considerably according to topical area and the specificity of advice. This report provides a model to describe the quality of the available Web-based patient-generated material.

  • ICD-TEACH initial dashboard at log-in (montage). Source: The Authors; Copyright: The Authors; URL: http://cardio.jmir.org/2018/2/e10499; License: Licensed by JMIR.

    Implantable Cardioverter Defibrillator mHealth App for Physician Referrals and eHealth Education: ICD-TEACH Pilot Study

    Abstract:

    Background: Mobile health (mHealth) decision tools for implantable cardioverter defibrillator may increase physician knowledge and overall patient care. Objective: The goals of the ICD-TEACH pilot study were to design a smartphone app or mHealth technology with a novel physician decision support algorithm, implement a direct referral mechanism for device implantation from the app, and assess its overall usability and feasibility with physicians involved in the care of patients with an implantable cardioverter defibrillator. Methods: The initial design and development of the mHealth or smartphone app included strategic collaboration from an information technology company and key stakeholders including arrhythmia specialists (electrophysiologists), general cardiologists, and key members of the hospital administrative team. A convenience sampling method was used to recruit general internists or cardiologists that refer to our local tertiary care center. Physicians were asked to incorporate the mHealth app in daily clinical practice and avail the decision support algorithm and direct referral feature to the arrhythmia clinic. Feasibility assessment, in the form of a physician survey, was conducted after initial mHealth app use (within 3 months) addressing the physicians’ overall satisfaction with the app, compliance, and reason for noncompliance; usability assessment of the mHealth app was addressed in the physician survey for 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% poststudy survey response rate. Physicians worked in an academic practice, which included both inpatient and ambulatory care. System Usability Scale was applied with an average score of 77 including the 17 participants (>68 points is above average). Regarding the novel physician decision support algorithm for implantable cardioverter defibrillator referral, 11% (1/9) strongly agreed and 78% (7/9) agreed that the algorithm for device eligibility was easy to use. Only 1 patient was referred through the direct referral system via the mHealth app during the pilot study of 3 months. Feasibility assessment showed that 46% (5/11) strongly agreed and 55% (6/11) agreed that the mHealth app would be utilized if integrated into an electronic medical record (EMR) where data are automatically sent to the referring arrhythmia clinic. Conclusions: The ICD-TEACH pilot study revealed high usability features of a physician decision support algorithm; however, we received only 1 direct referral through our app despite supportive feedback. A specific reason from our physician survey included the lack of integration into an EMR. Future studies should continue to systematically evaluate smartphone apps in cardiology to assess usability, feasibility, and strategies to integrate into daily workflow.

  • Source: Shutterstock Inc; Copyright: Rido; URL: https://www.shutterstock.com/image-photo/team-expert-doctors-examining-medical-reports-138847340?irgwc=1&utm_medium=Affiliate&utm_campaign=TinEye&utm_source=77643&utm_term=; License: Licensed by the authors.

    Multidisciplinary Smartphone-Based Interventions to Empower Patients With Acute Coronary Syndromes: Qualitative Study on Health Care Providers’ Perspectives

    Abstract:

    Background: Postdischarge interventions are limited in patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and travel from remote areas. Smartphones have become a viable lifestyle technology to deliver educational and health interventions following discharge from hospital. Objective: The purpose of this study was to identify the requirements for the delivery of a mobile health intervention for the postdischarge management of patients with ACS via a multidisciplinary focus group. Methods: We conducted a focus group among health care professionals (n=10) from a large metropolitan hospital in May 2017. These participants from a multidisciplinary team contributed to a 1-hour discussion by responding to 8 questions relating to the applicability of smartphone-based educational and health interventions. Descriptive statistics of the focus group data were analyzed using SPSS. The qualitative data were analyzed according to relevant themes extracted from the focus group transcription, using a qualitative description software program (NVivo 11) and an ontology-based concept mapping approach. Results: The mean age of the participants was 47 (SD 8) years: 3 cardiologists; 2 nurse practitioners; 2 clinical nurses; 2 research scientists; and 1 physiotherapist. Of these participants, 70% (7/10) had experience using electronic health intervention during their professional practice. A total of 7 major themes and their subthemes emerged from the qualitative analysis. Health care providers indicated that comprehensive education on diet, particularly providing daily meal plans, is critical for patients with ACS. In terms of ACS symptoms, a strong recommendation was to focus on educating patients instead of daily monitoring of chest pain and shortness of breathing due to subjectivity and insufficient information for clinicians. Participants pointed that monitoring health measures such as blood pressure and body weight may result in increased awareness of patient physical health, yet may not be sufficient to support patients with ACS via the smartphone-based intervention. Therefore, monitoring pain and emotional status along with other health measures was recommended. Real-time support via FaceTime or video conferencing was indicated as motivational and supportive for patient engagement and self-monitoring. The general demographics of patients with ACS being older, having a low educational level, and a lack of computer skills were identified as potential barriers for engagement with the smartphone-based intervention. Conclusions: A smartphone-based program that incorporates the identified educational materials and health interventions would motivate patients with ACS to engage in the multidisciplinary intervention and improve their health outcomes following discharge from hospital.

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://cardio.jmir.org/2018/2/e10228/; License: Creative Commons Attribution (CC-BY).

    A Mobile Phone–Based Healthy Lifestyle Monitoring Tool for People With Mental Health Problems (MyHealthPA): Development and Pilot Testing

    Abstract:

    Background: People with mental health disorders live, on average, 20 years less than those without, often because of poor physical health including cardiovascular disease (CVD). Evidence-based interventions are required to reduce this lifespan gap. Objective: This study aimed to develop, test, and evaluate a mobile phone–based lifestyle program (MyHealthPA) to help people with mental health problems improve key health risk behaviors and reduce their risk of CVD. Methods: The development of MyHealthPA occurred in 3 stages: (1) scoping of the literature, (2) a survey (n=251) among people with and without the 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 disorders was also conducted. Participants completed a baseline assessment and were given access to the MyHealthPA program for a period of 8 weeks. They were then asked to complete an end-of-treatment assessment and a follow-up assessment 1 month later. Results: In the study, 28 young people aged 19 to 25 years were recruited to the pilot trial. Of these, 12 (12/28, 43%) had been previously diagnosed with a mental illness. Overall, 12 participants (12/28, 43%) completed the end-of-treatment assessment and 6 (6/28, 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 mental health issues. Most participants (history of mental illness: 4/7, 57%; no history of mental illness: 3/5, 60%) reported the program had above average usability; however, only 29% (2/7, no history of mental illness) to 40% (2/5, history of mental illness) 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: This study 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 discussed.

  • Source: Flickr; Copyright: Beryl_snw; URL: https://www.flickr.com/photos/beryl_snw/8143950250/; License: Public Domain (CC0).

    Mobile Technology Utilization Among Patients From Diverse Cultural and Linguistic Backgrounds Attending Cardiac Rehabilitation in Australia: Descriptive,...

    Abstract:

    Background: Barriers to attending cardiac rehabilitation (CR), including cultural and linguistic differences, may be addressed by recent technological developments. However, the feasibility of using these approaches in culturally and linguistically diverse patients is yet to be determined. Objective: This study aims to assess the use of mobile technologies and features, as well as confidence in utilization across patients speaking different languages at home (ie, English, Mandarin Chinese, and a language other than English and Mandarin [other]) and are both eligible and physically suitable for CR. In addition, the study aims to determine the sociodemographic correlates of the mobile technology/feature use, including language spoken at home in the three groups mentioned above. Methods: This is a descriptive, case matched, comparative study. Age and gender-matched patients speaking English, Mandarin and other languages (n=30/group) eligible for CR were surveyed for their mobile technology and mobile feature use. Results: ‘Participants had a mean age of 66.7 years (SD 13, n=90, range 46-95), with 53.3% (48/90) male. The majority (82/90, 91.1%) used at least one technology device, with 87.8% (79/90) using mobile devices, the most common being smartphones (57/90, 63.3%), tablets (28/90, 31.1%), and text/voice-only phones (24/90, 26.7%). More English-speaking participants used computers than Mandarin or “other” language speaking participants (P=.003 and .02) and were more confident in doing so compared to Mandarin-speaking participants (P=.003). More Mandarin-speaking participants used smartphones compared with “other” language speaking participants (P=.03). Most commonly used mobile features were voice calls (77/82, 93.9%), text message (54/82, 65.9%), the internet (39/82, 47.6%), email (36/82, 43.9%), and videoconferencing (Skype or FaceTime [WeChat or QQ] 35/82, 42.7%). Less Mandarin-speaking participants used emails (P=.001) and social media (P=.007) than English-speaking participants. Speaking Mandarin was independently associated with using smartphone, emails, and accessing the web-based medication information (OR 7.238, 95% CI 1.262-41.522; P=.03, OR 0.089, 95% CI 0.016-0.490; P=.006 and OR 0.191, 95% CI 0.037-0.984; P=.05). Conclusions: This study reveals a high usage of mobile technology among CR patients and provides further insights into differences in the technology use across CALD patients in Australia. The findings of this study may inform the design and implementation of future technology-based CR.

  • Source: Flickr; Copyright: Jody Morris; URL: https://www.flickr.com/photos/jodydigger/5761881001; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Exploring Health Information-Seeking Preferences of Older Adults With Hypertension: Quasi-Experimental Design

    Abstract:

    Background: Patients’ engagement in health care decision making is constituted by at least two behaviors: health information seeking and active involvement in medical decisions. Previous research reported that older adults desire a lot of information, but want to participate in decision making to a lesser degree. However, there is only limited evidence on the effect of desire for health information on seniors’ perceived confidence in making an informed choice (ie, decision self-efficacy). Objective: The goal of this study was to investigate the role desire for health information has for older patients. More specifically, it tested whether decision self-efficacy increases as a function of an assisted computer-based information search. Additionally, the study allowed insights into the sources seniors with hypertension prefer to consult. Methods: A sample of 101 senior citizens (aged ≥60 years) with high blood pressure in the Italian-speaking part of Switzerland answered a questionnaire before and after an informational intervention was applied. The intervention consisted of offering additional information on hypertension from five different sources and of providing the information the participant desired. Preference for receiving this information was the major independent variable. The main outcome measure was decision self-efficacy (assessed at baseline and posttest). Analyses of covariance were conducted to detect differences between and within who desired additional hypertension-related content (intervention group) and “information avoiders” (control group). Results: Health care professionals firmly remain the preferred and most trusted source of health information for senior patients. The second most consulted source was the internet (intervention group only). However, among the total sample, the internet obtained the lowest credibility score. A significant increase in decision self-efficacy occurred in seniors consulting additional information compared to information avoiders (F1,93=28.25, P<.001). Conclusions: Consulting health information on a computer screen, and assistance by a computer-savvy person, may be a helpful activity to increase perceived confidence in making treatment decisions in seniors with hypertension.

  • Cardiio app. Source: Cardiio / Smartmockups; Copyright: JMIR Publications; URL: http://cardio.jmir.org/2018/1/e10057/; License: Creative Commons Attribution (CC-BY).

    Mobile Phone Apps to Support Heart Failure Self-Care Management: Integrative Review

    Abstract:

    Background: With an explosive growth in mobile health, an estimated 500 million patients are potentially using mHealth apps for supporting health and self-care of chronic diseases. Therefore, this review focused on mHealth apps for use among patients with heart failure. Objective: The aim of this integrative review was to identify and assess the functionalities of mHealth apps that provided usability and efficacy data and apps that are commercially available without supporting data, all of which are to support heart failure self-care management and thus impact heart failure outcomes. Methods: A search of published, peer-reviewed literature was conducted for studies of technology-based interventions that used mHealth apps specific for heart failure. The initial database search yielded 8597 citations. After filters for English language and heart failure, the final 487 abstracts was reviewed. After removing duplicates, a total of 18 articles that tested usability and efficacy of mobile apps for heart failure self-management were included for review. Google Play and Apple App Store were searched with specified criteria to identify mHealth apps for heart failure. A total of 26 commercially available apps specific for heart failure were identified and rated using the validated Mobile Application Rating Scale. Results: The review included studies with low-quality design and sample sizes ranging from 7 to 165 with a total sample size of 847 participants from all 18 studies. Nine studies assessed usability of the newly developed mobile health system. Six of the studies included are randomized controlled trials, and 4 studies are pilot randomized controlled trials with sample sizes of fewer than 40. There were inconsistencies in the self-care components tested, increasing bias. Thus, risk of bias was assessed using the Cochrane Collaboration’s tool for risk of selection, performance, detection, attrition, and reporting biases. Most studies included in this review are underpowered and had high risk of bias across all categories. Three studies failed to provide enough information to allow for a complete assessment of bias, and thus had unknown or unclear risk of bias. This review on the commercially available apps demonstrated many incomplete apps, many apps with bugs, and several apps with low quality. Conclusions: The heterogeneity of study design, sample size, intervention components, and outcomes measured precluded the performance of a systematic review or meta-analysis, thus introducing bias of this review. Although the heart failure–related outcomes reported in this review vary, they demonstrated trends toward making an impact and offer a potentially cost-effective solution with 24/7 access to symptom monitoring as a point of care solution, promoting patient engagement in their own home care.

  • Source: Image created by the authors; Copyright: AIT Austrian Institute of Technology GmbH; URL: http://cardio.jmir.org/2018/1/e11/; License: Licensed by JMIR.

    HerzMobil, an Integrated and Collaborative Telemonitoring-Based Disease Management Program for Patients With Heart Failure: A Feasibility Study Paving the...

    Abstract:

    Background: Heart failure is a major health problem associated with frequent hospital admissions. HerzMobil Tirol is a multidisciplinary postdischarge disease management program for heart failure patients to improve quality of life, prevent readmission, and reduce mortality and health care costs. It uses a telemonitoring system that is incorporated into a network of specialized heart failure nurses, physicians, and hospitals. Patients are equipped with a mobile phone, a weighing scale, and a blood pressure and heart rate monitor for daily acquisition and transmission of data on blood pressure, heart rate, weight, well-being, and drug intake. These data are transmitted daily and regularly reviewed by the network team. In addition, patients are scheduled for 3 visits with the network physician and 2 visits with the heart failure nurse within 3 months after hospitalization for acute heart failure. Objective: The objectives of this study were to evaluate the feasibility of HerzMobil Tirol by analyzing changes in health status as well as patients’ self-care behavior and satisfaction and to derive recommendations for implementing a telemonitoring-based interdisciplinary disease management program for heart failure in everyday clinical practice. Methods: In this prospective, pilot, single-arm study including 35 elderly patients, the feasibility of HerzMobil Tirol was assessed by analyzing changes in health status (via Kansas City Cardiomyopathy Questionnaire, KCCQ), patients’ self-care behavior (via European Heart Failure Self-Care Behavior Scale, revised into a 9-item scale, EHFScB-9), and user satisfaction (via Delone and McLean System Success Model). Results: A total of 43 patients joined the HerzMobil Tirol program, and of these, 35 patients completed it. The mean age of participants was 67 years (range: 43-86 years). Health status (KCCQ, range: 0-100) improved from 46.2 to 69.8 after 3 months. Self-care behavior (EHFScB-9, possible range: 9-22) after 3 months was 13.2. Patient satisfaction in all dimensions was 86% or higher. Lessons learned for the rollout of HerzMobil Tirol comprise a definite time schedule for interventions, solid network structures with clear process definition, a network coordinator, and specially trained heart failure nurses. Conclusions: On the basis of the positive evaluation results, HerzMobil Tirol has been officially introduced in the province of Tyrol in July 2017. It is, therefore, the first regular financed telehealth care program in Austria.

  • Source: Pixabay; Copyright: BootstrapGiver; URL: https://pixabay.com/en/donut-baked-goods-sweet-1801316/; License: Public Domain (CC0).

    Food Addiction Support: Website Content Analysis

    Abstract:

    Background: Food addiction has a long history; however, there has been a substantial increase in published literature and public media focus in the past decade. Food addiction has previously demonstrated an overlap with overweight and obesity, a risk for cardiovascular disease. This increased focus has led to the establishment of numerous support options for addictive eating behaviors, yet evidence-based support options are lacking. Objective: This study aimed to evaluate the availability and content of support options, accessible online, for food addiction. Methods: A standardized Web search was conducted using 4 search engines to identify current support availability for food addiction. Through use of a comprehensive data extraction sheet, 2 reviewers independently extracted data related to the program or intervention characteristics, and support fidelity including fundamentals, support modality, social support offered, program or intervention origins, member numbers, and program or intervention evaluation. Results: Of the 800 records retrieved, 13 (1.6%, 13/800) websites met the inclusion criteria. All 13 websites reported originating in the United States, and 1 website reported member numbers. The use of credentialed health professionals was reported by only 3 websites, and 5 websites charged a fee-for-service. The use of the 12 steps or traditions was evident in 11 websites, and 9 websites described the use of food plans. In total, 6 websites stated obligatory peer support, and 11 websites featured spirituality as a main theme of delivery. Moreover, 12 websites described phone meetings as the main program delivery modality, with 7 websites stating face-to-face delivery and 4 opting for online meetings. Newsletters (n=5), closed social media groups (n=5), and retreat programs (n=5) were the most popular forms of social support. Conclusions: This is the first review to analyze online support options for food addiction. Very few online support options include health professionals, and a strengthening argument is forming for an increase in support options for food addiction. This review forms part of this argument by showing a lack of evidence-based options. By reviewing current support availability, it can provide a guide toward the future development of evidence-based support for food addiction.

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://cardio.jmir.org/2018/1/e8/; License: Creative Commons Attribution (CC-BY).

    A Novel Intelligent Two-Way Communication System for Remote Heart Failure Medication Uptitration (the CardioCoach Study): Randomized Controlled Feasibility...

    Abstract:

    Background: European Society of Cardiology guidelines for the treatment of heart failure (HF) prescribe uptitration of angiotensin-converting enzyme inhibitors (ACE-I) and β-blockers to the maximum-tolerated, evidence-based dose. Although HF prognosis can drastically improve when correctly implementing these guidelines, studies have shown that they are insufficiently implemented in clinical practice. Objective: The aim of this study was to verify whether supplementing the usual care with the CardioCoach follow-up tool is feasible and safe, and whether the tool is more efficient in implementing the guideline recommendations for β-blocker and ACE-I. Methods: A total of 25 HF patients were randomly assigned to either the usual care control group (n=10) or CardioCoach intervention group (n=15), and observed for 6 months. The CardioCoach follow-up tool is a two-way communication platform with decision support algorithms for semiautomatic remote medication uptitration. Remote monitoring sensors automatically transmit patient’s blood pressure, heart rate, and weight on a daily basis. Results: Patients’ satisfaction and adherence for medication intake (10,018/10,825, 92.55%) and vital sign measurements (4504/4758, 94.66%) were excellent. However, the number of technical issues that arose was large, with 831 phone contacts (median 41, IQR 32-65) in total. The semiautomatic remote uptitration was safe, as there were no adverse events and no false positive uptitration proposals. Although no significant differences were found between both groups, a higher number of patients were on guideline-recommended medication dose in both groups compared with previous reports. Conclusions: The CardioCoach follow-up tool for remote uptitration is feasible and safe and was found to be efficient in facilitating information exchange between care providers, with high patient satisfaction and adherence. Trial Registration: ClinicalTrials.gov NCT03294811; https://clinicaltrials.gov/ct2/show/NCT03294811 (Archived by WebCite at http://www.webcitation.org/6xLiWVsgM)

  • How postprocedural telemonitoring can help patients undergoing transcatheter aortic valve replacement. Source: Pixabay; Copyright: Engin Akyurt; URL: https://pixabay.com/en/surgery-hospital-doctor-operation-3034133/; License: Public Domain (CC0).

    Remote Monitoring of Patients Undergoing Transcatheter Aortic Valve Replacement: A Framework for Postprocedural Telemonitoring

    Abstract:

    Background: The postprocedural trajectory of patients undergoing transcatheter aortic valve replacement (TAVR) involves in-hospital monitoring of potential cardiac rhythm or conduction disorders and other complications. Recent advances in telemonitoring technologies create opportunities to monitor electrocardiogram (ECG) and vital signs remotely, facilitating redesign of follow-up trajectories. Objective: This study aimed to outline a potential set-up of telemonitoring after TAVR. Methods: A multidisciplinary team systematically framed the envisioned telemonitoring scenario according to the intentions, People, Activities, Context, Technology (iPACT) and Functionality, Interaction, Content, Services (FICS) methods and identified corresponding technical requirements. Results: In this scenario, a wearable sensor system is used to continuously transmit ECG and contextual data to a central monitoring unit, allowing remote follow-up of ECG abnormalities and physical deteriorations. Telemonitoring is suggested as an alternative or supplement to current in-hospital monitoring after TAVR, enabling early hospital dismissal in eligible patients and accessible follow-up prolongation. Together, this approach aims to improve rehabilitation, enhance patient comfort, optimize hospital capacity usage, and reduce overall costs. Required technical components include continuous data acquisition, real-time data transfer, privacy-ensured storage, automatic event detection, and user-friendly interfaces. Conclusions: The suggested telemonitoring set-up involves a new approach to patient follow-up that could bring durable solutions for the growing scarcities in health care and for improving health care quality. To further explore the potential and feasibility of post-TAVR telemonitoring, we recommend evaluation of the overall impact on patient outcomes and of the safety, social, ethical, legal, organizational, and financial factors.

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  • Correlation of Limb Bioimpedance to Echocardiographic Indicators of Congestion in Patients with NYHA Class II/III Heart Failure

    Date Submitted: Nov 28, 2018

    Open Peer Review Period: Dec 4, 2018 - Jan 29, 2019

    Background: The treatment of heart failure (HF) in the United States is estimated to exceed $30 billion each year and is anticipated to increase to a staggering $70 billion by the year 2030. This mak...

    Background: The treatment of heart failure (HF) in the United States is estimated to exceed $30 billion each year and is anticipated to increase to a staggering $70 billion by the year 2030. This makes the management of HF one of the leading challenges Medicare will face in the years to come. Traditional methods to detect impending congestion such as body weight and physical examination findings are often non-specific and lack sensitivity making them inadequate to recognize fluid overload and prevent decompensation. It has been suggested that bioimpedance spectroscopy (BIS) can be used as a surrogate marker for detecting fluid overload and therefore, serve as an adjunct to clinical exam findings. Objective: This study examines the relationship between a BIS device and echocardiographic parameters associated with volume overload with same day measurements in the first 8 patients with NYHA Class II/III HF on an IRB approved protocol. Methods: Each patient was followed 3 times a week for 4 weeks within the hospital outpatient setting. At each visit BIS measures were recorded for whole body as well as arms and legs. Additionally, signs and symptoms, weight and echocardiograph findings were all recorded. Results: Correlations of BIS measurements with echo parameters were performed. The leg impedance measurement correlated strongly with echo findings; inferior vena cava (IVC) size (p=0.001), right atrial pressure (RAP) (p<0.001), and pulmonary artery systolic pressure (PAS) measurements (p<0.001). Conclusions: Preliminary findings demonstrated excellent correlations with BIS measurements and IVC size, right atrial pressure and pulmonary artery systolic pressure measurements which suggest a possible alternative method to detect fluid overload despite the small sample size. Trending a patient's impedance using the SOZO device at home or the practitioner's office may assist clinicians in providing more accurate, individualized HF care.  Clinical Trial: . IRB approval was obtained for this study (Scripps IRB #IRB-16-6852).

  • Remote monitoring and early detection of sub-clinical atrial fibrillation in implantable cardioverter defibrillator recipients: incidence, risk factors and prognostic significance

    Date Submitted: Nov 2, 2018

    Open Peer Review Period: Nov 3, 2018 - Dec 29, 2018

    Background: Atrial high rate episodes (AHREs) detected by cardiac electronic implantable devices are common. They are significantly associated with mortality and morbidity due to systemic embolism and...

    Background: Atrial high rate episodes (AHREs) detected by cardiac electronic implantable devices are common. They are significantly associated with mortality and morbidity due to systemic embolism and ischemic stroke. Much earlier detection of AHREs might allow the timely introduction of therapies to protect the patient. Objective: The aim of this study was to determine the incidence and risk factors of AHREs in patients with implantable defibrillator in the era of remote monitoring (RM), and to analyze the choice of anticoagulant treatment strategies and its potential complications. Methods: 1226 patients with implantable cardioverter defibrillator remotely followed-up were prospectively included from January 2009 to December 2016 at Lille University Hospital. The first phase of the study focuses primarily on the incidence and risk factors of AHREs and the second analysis was confined to patients presenting at least one AHRE. Survey analysis was determined using the Kaplan-Meier method and compared between groups with the Logrank test. Results: Among the 1226 patients, 63 presented at least one AHRE detected by RM which corresponds to an incidence of 5.14%. In ¾ of cases, the AHRE was completely asymptomatic. In the remaining quarter, the most common symptom was dyspnea. The main precipitating factor was infection. AHRE risk factors were thyroid dysfunction (p = 0.0047) and left atrial enlargement (p = 0.0317). None of these factors were associated with atrial fibrillation duration. The mean CHA2DS2-VASc score was 2.64 ± 1.38. Oral anticoagulation therapy was introduced in 47 patients (88.7%). The incidence of thromboembolic events was 1.6% and that of anticoagulation-related hemorrhagic complications was 8.5% (n = 4) with ¾ major. Conclusions: AHRE is a common disease. Risk factors are thyroid dysfunction and left atrial enlargement. Its thromboembolism risk seems to be low. The introduction of anticoagulation therapy is based on the evaluation of clinical risk scores for systemic embolism and its indication must be regularly assessed because hemorrhagic complications are common.

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