@Article{info:doi/10.2196/68929,
author="Yang, Li-Tan
and Wu, Chi-Han
and Lee, Jen-Kuang
and Wang, Wei-Jyun
and Chen, Ying-Hsien
and Huang, Ching-Chang
and Hung, Chi-Sheng
and Chiang, Kuang-Chien
and Ho, Yi-Lwun
and Wu, Hui-Wen",
title="Effects of a Cloud-Based Synchronous Telehealth Program on Valvular Regurgitation Regression: Retrospective Study",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="23",
volume="27",
pages="e68929",
keywords="mitral regurgitation",
keywords="tricuspid regurgitation",
keywords="telehealth",
keywords="telemedicine",
keywords="cardiac remodeling",
abstract="Background: Telemedicine has been associated with better cardiovascular outcomes, but its effects on the regression of mitral regurgitation (MR) and tricuspid regurgitation (TR) remain unknown. Objective: This study aimed to evaluate whether telemedicine could facilitate the regression of MR and TR compared to usual care and whether it was associated with better survival. Methods: This retrospective cohort study enrolled consecutive patients with moderate or greater MR or TR from 2010 through 2020, excluding those with concomitant aortic stenosis, aortic regurgitation, or mitral stenosis greater than mild severity. All patients underwent follow-up transthoracic echocardiography (TTE) at least 3 months apart. Patients receiving telehealth services for at least two weeks within 90 days of baseline TTE were categorized as the telehealth group; the remainder constituted the nontelehealth group. Telemedicine participants transmitted daily biometric data---blood pressure, pulse rate, blood glucose, electrocardiogram, and oxygen saturation---to a cloud-based platform for timely monitoring. Experienced case managers regularly contacted patients and initiated immediate action for concerning measurements. The primary endpoint was MR or TR regression from ?moderate to <moderate. The secondary endpoint was all-cause death (ACD). The last follow-up ended in December 2022. Results: The MR cohorts consisted of 264 patients (mean age 67 years), including 97 regressors and 74 telehealth participants. Telehealth participation (hazard ratio 2.20, 95\% CI 1.35-3.58; P=.001) was robustly associated with MR regression; MR regressors were linked to reverse cardiac remodeling, indicated by improved left ventricular ejection fraction (LVEF), and reduced left ventricular (LV) and left atrial (LA) dimensions (all P?.005). Determinants of ACD were age (P<.001), LVEF (P<.001), percutaneous coronary intervention (P<.001), and MR regressors (P=.02). The TR cohort consisted of 245 patients (mean age 68 years), including 87 TR regressors and 61 telehealth participants. Telehealth (P=.05) was one of the univariable determinants of TR regression, while beta-blocker use (P=.048) and baseline TR severity (P=.01) remained strong predictors of TR regression in multivariable analysis. Conclusions: Patients in the telehealth group were 2.2 times more likely to experience MR regression. Moreover, MR regressors had better survival and reverse cardiac remodeling compared to nonregressors. These findings may have important implications for future guidelines. ",
doi="10.2196/68929",
url="https://www.jmir.org/2025/1/e68929"
}


@Article{info:doi/10.2196/62874,
author="Ogunsanmi, Deborah
and Chambers, Jerica
and Mahmood, Asos
and Pakker, Reddy Avinash
and Kompalli, Anusha
and Kabir, Umar
and Surbhi, Satya
and Gatwood, Justin
and Mahmud, Sultan Md
and Bailey, E. James",
title="Technical Requirements, Design, and Automation Process for a Statewide Registry-Based Tailored Text Messaging System: Protocol for a Longitudinal Observational Study",
journal="JMIR Res Protoc",
year="2025",
month="Apr",
day="18",
volume="14",
pages="e62874",
keywords="text messaging",
keywords="clinical informatics",
keywords="chronic disease",
keywords="telehealth",
keywords="telemedicine",
keywords="electronic health records",
abstract="Background: Tailored text messaging is a low-cost mobile health intervention approach shown to effectively improve self-care behaviors and clinical outcomes for patients with chronic cardiometabolic conditions. Given the ubiquitous nature of mobile phones, text messages have the potential to reach a large audience. However, automating and disseminating tailored text messages to large populations at low cost presents major logistical challenges that serve as barriers to implementation. Objective: This study aimed to describe the protocol for a longitudinal observational study designed to assess the feasibility of an innovative approach for automating and disseminating personalized and tailored text messages to large populations at risk of cardiovascular events using a low-cost registry-based tailored text messaging system known as the Heart Health Messages (HHM) program. Further, it describes the technical requirements, architectural design, automation process, and challenges associated with program implementation. Methods: Patients at high risk of cardiovascular diseases are identified using a statewide population health registry known as the Tennessee Population Data Network. Tailored invitation messages and enrollment surveys are sent to eligible patients via Twilio. Upon completion of the receipt of consent and enrollment forms, participants receive tailored text messages from a library of generic messages based on participant-selected frequency of message delivery (daily or every other day). In addition, participants receive monthly text-based check-in survey messages designed to assess intervention adherence and improvement in self-care. Participants are also sent quarterly follow-up surveys to update enrollment information and preferences. All enrolled participants will receive tailored text messages for a 12-month intervention period. Results: Since the start of the program, 18,974 patients from 2 major health systems have met the inclusion criteria and were eligible for the HHM program. A total of 3 phases of HHM 1.0 have been implemented so far, reaching 225 eligible patients in phase 1, a total of 5288 patients in phase 2, and 13,461 patients in phase 3, with an enrollment of approximately 2\% (n=4/225), 3\% (n=137/5228), and 3\% (n=350/13461), respectively. Efforts are underway to implement strategies in collaboration with the health systems to enhance the HHM program rollout and patient participation. Conclusions: The HHM program is a low-cost tailored text messaging intervention set for broader dissemination and potential replication. The program has the capacity to improve outcomes for people with chronic medical conditions. International Registered Report Identifier (IRRID): DERR1-10.2196/62874 ",
doi="10.2196/62874",
url="https://www.researchprotocols.org/2025/1/e62874"
}


@Article{info:doi/10.2196/64438,
author="Graever, Leonardo
and Mafra, Cordeiro Priscila
and Figueira, Klein Vinicius
and Miler, Navega Vanessa
and Sobreiro, Lima J{\'u}lia dos Santos
and Silva, da Gabriel Pesce de Castro
and Issa, Castro Aurora Felice
and Savassi, Monteiro Leonardo Can{\c{c}}ado
and Dias, Borges Mariana
and Melo, Machado Marcelo
and Fonseca, da Viviane Belidio Pinheiro
and N{\'o}brega, da Isabel Cristina Pacheco
and Gomes, K{\'a}tia Maria
and Santos, dos La{\'i}s Pimenta Ribeiro
and Lapa e Silva, Roberto Jos{\'e}
and Froelich, Anne
and Dominguez, Helena",
title="Telehealth Support From Cardiologists to Primary Care Physicians in Heart Failure Treatment: Mixed Methods Feasibility Study of the Brazilian Heart Insufficiency With Telemedicine Trial",
journal="JMIR Cardio",
year="2025",
month="Apr",
day="17",
volume="9",
pages="e64438",
keywords="heart failure",
keywords="telemedicine",
keywords="telehealth",
keywords="intersectoral collaboration",
keywords="primary health care",
keywords="low- and middle-income countries",
keywords="family practice",
abstract="Background: Heart failure is a prevalent condition ideally managed through collaboration between health care sectors. Telehealth between cardiologists and primary care physicians is a strategy to improve the quality of care for patients with heart failure. Still, the effectiveness of this approach on patient-relevant outcomes needs to be determined. Objective: This study aimed to assess the feasibility of telehealth support provided by cardiologists for treating patients with heart failure to primary care physicians from public primary care practices in Rio de Janeiro, Brazil. Methods: We used mixed methods to assess the feasibility of telehealth support. From 2020 to 2022, we tested 2 telehealth approaches: synchronous videoconferences (phase A) and interaction through an asynchronous web platform (phase B). The primary outcome was feasibility. Exploratory outcomes were telehealth acceptability of patients, primary care physicians, and cardiologists; the patients' clinical status; and prescription practices. Qualitative methods comprised content analysis of 3 focus groups and 15 individual interviews with patients, primary care physicians, and cardiologists. Quantitative methods included the baseline assessment of 83 patients; a single-arm, before-and-after assessment of clinical status in 58 patients; and an assessment of guideline-directed medical therapy in 28 patients with reduced ejection fraction measured within 1 year of follow-up. We integrated qualitative and quantitative data using a joint display table and used the A Process for Decision-Making After Pilot and Feasibility Trials framework for feasibility assessment. Results: Telehealth support from cardiologists to primary care physicians was generally well accepted. As barriers, patients expressed concern about reduced direct access to cardiologists, primary care physicians reported work overload and a lack of relative advantage, and cardiologists expressed concern about the sustainability of the intervention. Quantitative analysis revealed an overall poor baseline clinical status of patients with heart failure, with 53\% (44/83) decompensated, as expected. Compliance with guideline-directed medical therapy for the treatment of heart failure with reduced ejection fraction after telehealth showed a modest improvement for $\beta$-blockers (17/20, 85\% to 18/19, 95\%) and renin-angiotensin-aldosterone system inhibitors (14/20, 70\% to 15/19, 79\%) but a drop in the prescription of spironolactone (16/20, 80\% to 15/20, 75\%). Neprilysin and sodium-glucose cotransporter 2 inhibitors were introduced in 4 and 1 patient, respectively. Missing record data precluded a more precise analysis. The feasibility assessment was positive, favoring the asynchronous modality. Potential modifications include more effective patient and professional recruitment strategies and educational activities to raise awareness of collaborative support in primary care. Conclusions: Telehealth was feasible to implement. Considering the stakeholders' views and insights on the process is paramount to attaining engagement. Missing data must be anticipated for future research in this setting. Considering the recommended adaptations, the intervention can be studied in a cluster-randomized trial. ",
doi="10.2196/64438",
url="https://cardio.jmir.org/2025/1/e64438"
}


@Article{info:doi/10.2196/62986,
author="?erban, Bianca Irina
and Fruytier, Lonneke
and Houben, Steven
and Colombo, Sara
and van de Sande, Danny
and Kemps, Hareld
and Brombacher, Aarnout",
title="Design Requirements for Cardiac Telerehabilitation Technologies Supporting Athlete Values: Qualitative Interview Study",
journal="JMIR Rehabil Assist Technol",
year="2025",
month="Apr",
day="17",
volume="12",
pages="e62986",
keywords="athletes with established coronary artery disease",
keywords="cardiac telerehabilitation",
keywords="value-sensitive design",
keywords="sports monitoring",
keywords="card sorting",
keywords="qualitative research",
keywords="artificial intelligence",
keywords="AI",
abstract="Background: Cardiac telerehabilitation (CTR) interventions can provide accessible and affordable remote rehabilitation services. However, as cardiac rehabilitation (CR) primarily targets inactive patients, little is known about the experiences with CR of highly active patients (ie, recreational athletes or, simply, athletes) with established coronary artery disease. Consequently, existing CTR interventions do not address the specific needs of the athletic subpopulation. Understanding the needs and values of athletes is crucial for designing meaningful CTR interventions that enhance user acceptance and engagement, thereby facilitating effective rehabilitation for this patient subgroup. Objective: This study aimed to inform the design of technologies that facilitate CTR for athletes. We intended to identify athletes' values related to CR, including health and sports tracking, as well as high-level requirements for technologies that can facilitate the CTR of athletes according to the identified values. Methods: We used value-sensitive design with a human-centric design approach to elicit design requirements for CTR that can serve athletes with established coronary artery disease. To identify athletes' values, we conducted 25 value-oriented semistructured interviews with 15 athletic patients and 10 health care professionals involved in CR programs. In a second phase, we conducted 6 card-sorting focus group sessions with 13 patients and 7 health care professionals to identify desired CTR features. Finally, we derived high-level CTR technology requirements connected to the athletes' needs and values. Results: We defined 12 athlete values divided into 3 categories: body centric, care centric, and data and technology centric. We clustered findings from the card-sorting activity into CTR technology requirements, such as remotely monitored sport-specific training and training data representations next to clinical limitations, and paired them with corresponding values. Conclusions: Athletes have distinct values and health goals in CR compared to general populations targeted by CTR interventions. Designing patient-centric CTR interventions that address these needs is crucial to support optimal recovery, safe return to sports, and adherence to CTR technologies in the home environment. ",
doi="10.2196/62986",
url="https://rehab.jmir.org/2025/1/e62986",
url="http://www.ncbi.nlm.nih.gov/pubmed/40245391"
}


@Article{info:doi/10.2196/65721,
author="Wiesm{\"u}ller, Fabian
and Prenner, Andreas
and Ziegl, Andreas
and El-Moazen, Gihan
and Modre-Osprian, Robert
and Baumgartner, Martin
and Brodmann, Marianne
and Seinost, Gerald
and Silbernagel, G{\"u}nther
and Schreier, G{\"u}nter
and Hayn, Dieter",
title="Support of Home-Based Structured Walking Training and Prediction of the 6-Minute Walk Test Distance in Patients With Peripheral Arterial Disease Based on Telehealth Data: Prospective Cohort Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="10",
volume="9",
pages="e65721",
keywords="mHealth",
keywords="telehealth",
keywords="peripheral arterial disease",
keywords="home-based structured walking training",
keywords="trend estimation",
keywords="predictive modeling",
keywords="continuous data",
keywords="walking",
keywords="walking training",
keywords="prediction",
keywords="prediction model",
keywords="cardiovascular disease",
keywords="stroke",
keywords="heart failure",
keywords="physical fitness",
keywords="telehealth system",
abstract="Background: Telehealth has been effective in managing cardiovascular diseases like stroke and heart failure and has shown promising results in managing patients with peripheral arterial disease. However, more work is needed to fully understand the effect of telehealth-based predictive modeling on the physical fitness of patients with peripheral arterial disease. Objective: For this work, data from the Keep Pace study were analyzed in depth to gain insights on temporal developments of patients' conditions and to develop models to predict the patients' total walking distance at the study end. This could help to determine patients who are likely to benefit from the telehealth program and to continuously provide estimations to the patients as a motivating factor. Methods: This work analyzes continuous patient-reported telehealth data, in combination with in-clinic data from 19 Fontaine stage II patients with peripheral arterial disease who underwent a 12-week telehealth-based walking program. This analysis granted insights into the increase of the total walking distance of the 6-minute walk tests (6MWT) as a measure for physical fitness, the steady decrease in the patients' pain, and the positive correlation between well-being and the total walking distance measured by the 6MWT. Results: This work analyzed trends of and correlations between continuous patient-generated data. Findings of this study include a significant decrease of the patients' pain sensation over time (P=.006), a low but highly significant correlation between pain sensation and steps taken on the same day (r=?0.11; P<.001) and the walking distance of the independently performed 6MWTs (r=?0.39; P<.001). Despite the reported pain, adherence to the 6MWT measurement protocol was high (85.53\%). Additionally, patients significantly improved their timed-up-and-go test times during the study (P=.002). Predicting the total walking distance at the study end measured by the 6MWT worked well at study baseline (root mean squared error of 30 meters; 7.04\% of the mean total walking distance at the study end of 425 meters) and continuously improved by adding further telehealth data. Future work should validate these findings in a larger cohort and in a prospective setting based on a clinical outcome. Conclusions: We conclude that the prototypical trend estimation has great potential for an integration in the telehealth system to be used in future work to provide tailored patient-specific advice based on these predictions. Continuous data from the telehealth system grant a deeper insight and a better understanding of the patients' status concerning well-being and level of pain as well as their current physical fitness level and the progress toward reaching set goals. Trial Registration: ClinicalTrials.gov Identifier: NCT05619835; https://tinyurl.com/mrxt7y9u ",
doi="10.2196/65721",
url="https://formative.jmir.org/2025/1/e65721"
}


@Article{info:doi/10.2196/66215,
author="Kratka, Allison
and Rotering, L. Thomas
and Munson, Scott
and Raitt, H. Merritt
and Whooley, A. Mary
and S Dhruva, Sanket",
title="Patient and Clinician Perspectives on Alert-Based Remote Monitoring--First Care for Cardiovascular Implantable Electronic Devices: Semistructured Interview Study Within the Veterans Health Administration",
journal="JMIR Cardio",
year="2025",
month="Apr",
day="4",
volume="9",
pages="e66215",
keywords="cardiovascular implantable electronic device",
keywords="CIED",
keywords="remote monitoring",
keywords="RM",
keywords="alert-based monitoring",
keywords="remote monitoring--first care",
keywords="patient perspectives",
keywords="clinician perspectives",
keywords="veteran",
keywords="pacemaker",
keywords="implantable cardioverter-defibrillator",
keywords="mobile phone",
abstract="Background: Patients with cardiovascular implantable electronic devices (CIEDs) typically attend in-person CIED clinic visits at least annually, paired with remote monitoring (RM). As the CIED data available through in-person CIED clinic visits and RM are nearly identical, the 2023 Heart Rhythm Society expert consensus statement introduced ``alert-based RM,'' an RM-first approach where patients with CIEDs that are consistently and continuously connected to RM, in the absence of recent alerts and other cardiac comorbidities, could attend in-person CIED clinic visits every 24 months or ultimately only as clinically prompted by actionable events identified on RM. However, there is no published information about patient and clinician perspectives on barriers and facilitators to such an RM-first care model. Objective: We aimed to understand patient and clinician perspectives about an RM-first care model for CIED care. Methods: We interviewed 40 rural veteran patients who were experienced with RM with CIEDs and 22 CIED clinicians who were experienced in using RM regarding barriers and facilitators to an RM-first care model. We conducted a reflexive thematic analysis of interviews. Two authors familiarized themselves with the dataset and generated separate codebooks based on the interview guides and inductively coded notes. These 2 authors met and reviewed each other's codes, sought additional author input, and resolved differences before 1 author coded the remaining interviews and developed candidate themes. These themes were refined, named, and supported with quotations. Results: Patients expressed interest in an RM-first approach, to reduce the burden of long travel times, sometimes in inclement weather, and to enable clinicians to provide care for other patients. However, many preferred routine in-person visits; reasons included a skepticism of the capabilities of RM, a sense that in-person visits provided superior care, and enjoyment of in-person patient-clinician relationships. Clinicians were interested in RM-first care, especially for stable, RM-adherent patients who were not device-dependent. Clinicians most frequently cited the benefit of reducing patient travel burden as well as optimizing clinic space and time to focus on other care such as reviewing routine RM transmissions, but also noted barriers including lack of in-person assessment, patient-perceived diminution of the patient-clinician relationship, possible loss to follow-up, and technological difficulties. Clinicians felt that an RM-first care model should be evaluated for success based on patient satisfaction and assessment of timely addressing of rhythm issues to prevent adverse outcomes. Most clinicians believed that RM-first care represented the future of CIED care. Conclusions: Both patients and CIED clinicians interviewed who were experienced in using RM were open to an RM-first care model that reduces in-person visits but reported some barriers to solely relying on RM and possible diminution of the patient-clinician relationship. Implementation of new RM recommendations will require attention to these perceptions and prioritization of patient-centered approaches. ",
doi="10.2196/66215",
url="https://cardio.jmir.org/2025/1/e66215"
}


@Article{info:doi/10.2196/68504,
author="Sermsinsaithong, Natsinee
and Yuenyongchaiwat, Kornanong
and Thanawattano, Chusak
and Buekban, Chatchai
and Kulchanarat, Chitima
and Buranapuntalug, Sasipa
and Wattanananont, Khanistha
and Satdhabudha, Opas",
title="Effects of a Home-Based Rehabilitation Exercise Program on Cardiorespiratory Performance in Community-Dwelling Adults Who Underwent Heart Surgery: Randomized Controlled Trial",
journal="JMIR Rehabil Assist Technol",
year="2025",
month="Mar",
day="28",
volume="12",
pages="e68504",
keywords="virtual reality",
keywords="cardiac surgery",
keywords="cardiac rehabilitation",
keywords="cardiopulmonary",
keywords="aerobic exercise",
abstract="Background: Patients undergoing heart surgery demonstrate impaired cardiorespiratory performance. Phase II cardiac rehabilitation (CR) in people undergoing open heart surgery (OHS) aims to reduce the adverse physical effects of cardiovascular diseases. Virtual reality (VR) exercise is now used in CR. Objective: This study aimed to explore the effects of VR exercise on functional capacity, pulmonary function, and respiratory muscle strength in patients who underwent OHS and were in phase II CR. Methods: Forty-nine patients who underwent elective OHS and were in phase II CR were randomized into a VR group (N=24) and a control group (N=25). The VR group completed 8 weeks of a home-based VR exercise program, including chest trunk mobilization and aerobic circuit training for 30 minutes, whereas the control group received an exercise brochure and information regarding the benefits of exercise. Intention-to-treat analysis was conducted, and 2-way mixed ANOVA was performed to compare between- and within-group differences in functional capacity and respiratory performance. Results: After completing the 8-week program, the VR group showed significant improvement in functional capacity compared to the control group (66.29, SD 25.84 m; P=.01). Inspiratory muscle strength increased in both the VR and control groups compared to baseline (9.46, SD 2.85 and 9.64, SD 2.78 cm H2O, respectively). In addition, after the 8-week intervention, significant improvements were found in expiratory muscle strength (15.79, SD 4.65 cm H2O) and forced expiratory volume in 1 second as a percentage of predicted values (2.96\%, SD 1.52\%) in the VR group compared to the baseline session. Conclusions: The home-based VR exercise program significantly improved functional capacity but not respiratory muscle or pulmonary function. Trial Registration: Thai Clinical Trial Registry TCTR20230602001; https://tinyurl.com/3xn44bku ",
doi="10.2196/68504",
url="https://rehab.jmir.org/2025/1/e68504"
}


@Article{info:doi/10.2196/70247,
author="Zhang, Xinyue",
title="Authors' Reply: The SCeiP Model for Remote Rehabilitation in Homebound Patients With Coronary Heart Disease",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="28",
volume="27",
pages="e70247",
keywords="exercise rehabilitation",
keywords="coronary heart disease",
keywords="promotion strategy",
keywords="home rehabilitation",
doi="10.2196/70247",
url="https://www.jmir.org/2025/1/e70247"
}


@Article{info:doi/10.2196/69927,
author="Zhang, Siqi
and Chen, Tielong",
title="The SCeiP Model for Remote Rehabilitation in Homebound Patients With Coronary Heart Disease",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="28",
volume="27",
pages="e69927",
keywords="remote exercise rehabilitation",
keywords="SCeiP model",
keywords="coronary heart disease",
keywords="promotion strategy",
keywords="home rehabilitation",
doi="10.2196/69927",
url="https://www.jmir.org/2025/1/e69927"
}


@Article{info:doi/10.2196/67774,
author="Vanhala, Ville
and Surakka, Outi
and Multisilta, Vilma
and Lundsby Johansen, Mette
and Villinger, Jonas
and Nicolle, Emmanuelle
and Heikkil{\"a}, Johanna
and Korhonen, Pentti",
title="Efficiency Improvement of the Clinical Pathway in Cardiac Monitor Insertion and Follow-Up: Retrospective Analysis",
journal="JMIR Cardio",
year="2025",
month="Mar",
day="21",
volume="9",
pages="e67774",
keywords="insertable cardiac monitor",
keywords="clinical pathway",
keywords="nurse-led service",
keywords="task shifting",
keywords="efficiency improvement",
keywords="remote monitoring",
abstract="Background: The insertable cardiac monitor (ICM) clinical pathway in Tampere Heart Hospital, Finland, did not correspond to the diagnostic needs of the population. There has been growing evidence of delegating the insertion from cardiologists to specially trained nurses and outsourcing the remote follow-up. However, it is unclear if the change in the clinical pathway is safe and improves efficiency. Objective: We aim to describe and assess the efficiency of the change in the ICM clinical pathway. Methods: Pathway improvements included initiating nurse-performed insertions, relocating the procedure from the catheterization laboratory to a procedure room, and outsourcing part of the remote follow-up to manage ICM workload. Data were collected from electronic health records of all patients who received an ICM in the Tampere Heart Hospital in 2018 and 2020. Follow-up time was 36 months after insertion. Results: The number of inserted ICMs doubled from 74 in 2018 to 159 in 2020. In 2018, cardiologists completed all insertions, while in 2020, a total of 70.4\% (n=112) were completed by nurses. The waiting time from referral to procedure was significantly shorter in 2020 (mean 36, SD 27.7 days) compared with 2018 (mean 49, SD 37.3 days; P=.02). The scheduled ICM procedure time decreased from 60 minutes in 2018 to 45 minutes in 2020. Insertions performed in the catheterization laboratory decreased significantly (n=14, 18.9\% in 2018 and n=3, 1.9\% in 2020; P=<.001). Patients receiving an ICM after syncope increased from 71 to 94 patients. Stroke and transient ischemic attack as an indication increased substantially from 2018 to 2020 (2 and 62 patients, respectively). In 2018, nurses analyzed all remote transmissions. In 2020, the external monitoring service escalated only 11.2\% (204/1817) of the transmissions to the clinic for revision. This saved 296 hours of nursing time in 2020. Having nurses insert ICMs in 2020 saved 48 hours of physicians' time and the shorter scheduling for the procedure saved an additional 40 hours of nursing time compared with the process in 2018. Additionally, the catheterization laboratory was released for other procedures (27 h/y). The complication rate did not change significantly (n=2, 2.7\% in 2018 and n=5, 3.1\% in 2020; P=.85). The 36-month diagnostic yield for syncope remained high in 2018 and 2020 (n=32, 45.1\% and n=36, 38.3\%; P=.38). The diagnostic yield for patients who had stroke with a procedure in 2020 was 43.5\% (n=27). Conclusions: The efficiency of the clinical pathway for patients eligible for an ICM insertation can be increased significantly by shifting to nurse-led insertions in procedure rooms and to the use of an external monitoring and triaging service. ",
doi="10.2196/67774",
url="https://cardio.jmir.org/2025/1/e67774"
}


@Article{info:doi/10.2196/67228,
author="Nguyen, Thu Hoai Thi
and Tran, Ba Hieu
and Tran, Minh Phuong
and Pham, Manh Hung
and Dao, Xuan Co
and Le, Ngoc Thanh
and Do, Doan Loi
and Nguyen, Quoc Ha
and Vu, Thi Thom
and Kirkpatrick, James
and Reid, Christopher
and Nguyen, Viet Dung",
title="Effect of a Telemedicine Model on Patients With Heart Failure With Reduced Ejection Fraction in a Resource-Limited Setting in Vietnam: Cohort Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="19",
volume="27",
pages="e67228",
keywords="heart failure",
keywords="HFrEF",
keywords="telemedicine",
keywords="telecare",
keywords="remote monitoring",
keywords="remote management",
keywords="heart failure hospitalization",
keywords="all-cause mortality",
keywords="Vietnam",
keywords="telehealth",
keywords="heart",
keywords="cardiology",
keywords="cohort",
keywords="remote",
keywords="monitoring",
keywords="resource-limited",
keywords="cost-effective",
keywords="low-cost",
keywords="cardiovascular disease",
keywords="hospitalization",
keywords="mortality",
abstract="Background: Heart failure (HF) is a complex, life-threatening condition marked by high morbidity, mortality, reduced functional capacity, poor quality of life, and substantial health care costs. HF with reduced ejection fraction (HFrEF) represents the subgroup of HF with the highest risks of mortality and hospitalization, necessitating the prioritization of care and management models to optimize treatment outcomes in these patients. Currently, data on the effectiveness of telemedicine models in resource-limited settings, such as low- and middle-income countries, are scarce. Objective: This study aimed to evaluate the impact of telemedicine on improving prognosis in patients with HFrEF in Vietnam. Methods: In this prospective cohort study, we recruited patients who received either remote monitoring and management (telemedicine) or standard monitoring and management (usual care) in the outpatient department of the Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam. Eligible patients were ?18 years old, had a diagnosis of HFrEF defined as left ventricular ejection fraction (LVEF) ?40\%, had a history of HF hospitalization within the past 12 months, and presented with clinical symptoms classified as New York Heart Association (NYHA) II or III. The primary composite outcome was defined as the time to the first unplanned HF hospitalization or all-cause mortality. The follow-up period for all outcomes extended to 12 months. Results: In total, 426 patients (298/426, 70\% male; 128/426, 30\% female) with a mean age of 61.3 (SD 14.6) years and a mean LVEF of 32.1\% (SD 6.0\%) were included in our study. Of these patients, 121 received telemedicine care, while 305 received usual care. The primary outcome occurred in 23 (23/121, 19\%) patients in the telemedicine group and 82 (82/305, 26.9\%) patients in the usual care group during the follow-up period, indicating a significant reduction in risk (adjusted hazard ratio [aHR] 0.57, 95\% CI 0.35-0.94; P=.03). However, this effect was primarily driven by a significant reduction in unplanned HF hospital admissions (aHR 0.57, 95\% CI 0.33-0.98; P=.04) rather than in all-cause mortality (aHR 0.77, 95\% CI 0.36-1.63; P=.49). Conclusions: This study demonstrates that a simplified telemedicine model, even in resource-limited settings such as Vietnam, can effectively facilitate the remote monitoring and management of patients with HFrEF, resulting in significant reductions in HF-related hospitalizations and all-cause mortality. Trial Registration: National Agency for Science and Technology Information (NASATI), Vietnam CT07/01-2022-3; https://nsti.vista.gov.vn/projects/dth/xay-dung-mo-hinh-theo-doi-va-tu-van-suc-khoe-tim-mach-tu-xa-tai-thanh-pho-ha-noi-109276.html ",
doi="10.2196/67228",
url="https://www.jmir.org/2025/1/e67228"
}


@Article{info:doi/10.2196/59532,
author="Hari, Arnav
and Kumar, Ravishankar
and Kumbhani, Brijesh
and Darshi, Sam
and Agarwal, Satyam
and Sahambi, Singh Jyotindra
and Jain, Suksham
and Chawla, Deepak",
title="Contactless Breathing Monitoring at Home and in the Hospital: Protocol for a Low-Cost Frequency-Modulated Continuous-Wave Radar-Based Device",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="25",
volume="14",
pages="e59532",
keywords="radar",
keywords="contactless vital monitoring",
keywords="breathing rate monitoring",
keywords="vital signs",
keywords="health monitoring",
abstract="Background: Contactless monitoring of vital signs, especially the breathing of children, in the hospital is performed on a priority basis because their organs and immune system are immature. Therefore, continuous monitoring of their vital signs with a sensor that is directly attached to their body is not possible, as it irritates the sensitive newborn skin and causes discomfort. A contactless frequency-modulated continuous-wave (FMCW) radar-based device can wirelessly monitor the breathing rate and pattern of a child in the hospital or at home. Signal-processing capability can be added to this device to process breathing data and analyze the apnea condition arising due to irregular breathing patterns. Objective: This study will develop a contactless FMCW radar-based system to accurately monitor the breathing rate and pattern of neonates and infants in hospitals and at home in order to provide a noninvasive, nonintrusive and contactless alternative to conventional sensor-based methods and address a critical need in neonatal care, potentially improving health outcomes for vulnerable infants. Methods: The radar transmits a signal toward the body, and the time taken by the signal received to travel from the body to the receiving antenna is analyzed. This time is proportional to the distance between the radar and the body, and the breathing pattern is recognized as a slight, periodic variation in this distance. We will use this concept with multiple antenna systems to monitor the breathing of neonates with improved sensitivity. The radar-based device will be installed, in addition to conventional breathing monitors, in the neonatal intensive care unit. The signals received at the radar and the respiration signals from conventional monitors will be recorded in a database. Signal-processing techniques will be applied to extract breathing signals from the signals received at the radar. Results: This study was funded in January 2023 by the Science and Engineering Research Board (SERB) of India. The device was designed by May 2024, and a working proof-of concept was verified in the Indian Institute of Technology (IIT) Ropar laboratory. Implementation of the proposed method for initial study began in December 2024. Results are expected to be published in the first quarter of 2025. Conclusions: The contactless FMCW radar-based system will provide reliable estimation of the breathing rate and pattern, which is close to the conventional reference device values most of the time. Our device will also provide a seamless breathing-monitoring system to be used both in hospitals and at home for newborns and premature babies until they are fully healthy and fit. International Registered Report Identifier (IRRID): PRR1-10.2196/59532 ",
doi="10.2196/59532",
url="https://www.researchprotocols.org/2025/1/e59532"
}


@Article{info:doi/10.2196/53645,
author="Davis-Wilson, Hope
and Hegarty-Craver, Meghan
and Gaur, Pooja
and Boyce, Matthew
and Holt, R. Jonathan
and Preble, Edward
and Eckhoff, Randall
and Li, Lei
and Walls, Howard
and Dausch, David
and Temple, Dorota",
title="Effects of Missing Data on Heart Rate Variability Measured From A Smartwatch: Exploratory Observational Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="24",
volume="9",
pages="e53645",
keywords="plethysmography",
keywords="electrocardiogram",
keywords="missing data",
keywords="smartwatch",
keywords="wearable",
keywords="ECG",
keywords="photoplethysmography",
keywords="PPG",
keywords="mobile phone",
keywords="heart rate",
keywords="pilot study",
keywords="detection",
keywords="sensor",
keywords="monitoring",
keywords="health metric",
keywords="measure",
keywords="real-world settings",
keywords="rest",
keywords="physical activity",
keywords="remote monitoring",
keywords="medical setting",
keywords="youth",
keywords="adolescent",
keywords="teen",
keywords="teenager",
abstract="Background: Measuring heart rate variability (HRV) through wearable photoplethysmography sensors from smartwatches is gaining popularity for monitoring many health conditions. However, missing data caused by insufficient wear compliance or signal quality can degrade the performance of health metrics or algorithm calculations. Research is needed on how to best account for missing data and to assess the accuracy of metrics derived from photoplethysmography sensors. Objective: This study aimed to evaluate the influence of missing data on HRV metrics collected from smartwatches both at rest and during activity in real-world settings and to evaluate HRV agreement and consistency between wearable photoplethysmography and gold-standard wearable electrocardiogram (ECG) sensors in real-world settings. Methods: Healthy participants were outfitted with a smartwatch with a photoplethysmography sensor that collected high-resolution interbeat interval (IBI) data to wear continuously (day and night) for up to 6 months. New datasets were created with various amounts of missing data and then compared with the original (reference) datasets. 5-minute windows of each HRV metric (median IBI, SD of IBI values [STDRR], root-mean-square of the difference in successive IBI values [RMSDRR], low-frequency [LF] power, high-frequency [HF] power, and the ratio of LF to HF power [LF/HF]) were compared between the reference and the missing datasets (10\%, 20\%, 35\%, and 60\% missing data). HRV metrics calculated from the photoplethysmography sensor were compared with HRV metrics calculated from a chest-worn ECG sensor. Results: At rest, median IBI remained stable until at least 60\% of data degradation (P=.24), STDRR remained stable until at least 35\% of data degradation (P=.02), and RMSDRR remained stable until at least 35\% data degradation (P=.001). During the activity, STDRR remained stable until 20\% data degradation (P=.02) while median IBI (P=.01) and RMSDRR P<.001) were unstable at 10\% data degradation. LF (rest: P<.001; activity: P<.001), HF (rest: P<.001, activity: P<.001), and LF/HF (rest: P<.001, activity: P<.001) were unstable at 10\% data degradation during rest and activity. Median IBI values calculated from photoplethysmography sensors had a moderate agreement (intraclass correlation coefficient [ICC]=0.585) and consistency (ICC=0.589) and LF had moderate consistency (ICC=0.545) with ECG sensors. Other HRV metrics demonstrated poor agreement (ICC=0.071-0.472). Conclusions: This study describes a methodology for the extraction of HRV metrics from photoplethysmography sensor data that resulted in stable and valid metrics while using the least amount of available data. While smartwatches containing photoplethysmography sensors are valuable for remote monitoring of patients, future work is needed to identify best practices for using these sensors to evaluate HRV in medical settings. ",
doi="10.2196/53645",
url="https://formative.jmir.org/2025/1/e53645"
}


@Article{info:doi/10.2196/47951,
author="Mastorci, Francesca
and Lazzeri, Lodovica Maria Francesca
and Ait-Ali, Lamia
and Marcheschi, Paolo
and Quadrelli, Paola
and Mariani, Massimiliano
and Margaryan, Rafik
and Penn{\`e}, Wanda
and Savino, Marco
and Prencipe, Giuseppe
and Sirbu, Alina
and Ferragina, Paolo
and Priami, Corrado
and Tommasi, Alessandro
and Zavattari, Cesare
and Festa, Pierluigi
and Dalmiani, Stefano
and Pingitore, Alessandro",
title="Home-Based Intervention Tool for Cardiac Telerehabilitation: Protocol for a Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="22",
volume="14",
pages="e47951",
keywords="cardiac rehabilitation",
keywords="exercise",
keywords="patient education",
keywords="patient-centered approach",
keywords="eHealth",
keywords="artificial intelligence",
abstract="Background: Among cardiovascular diseases, adult patients with congenital heart disease represent a population that has been continuously increasing, which is mainly due to improvement of the pathophysiological framing, including the development of surgical and reanimation techniques. However, approximately 20\% of these patients will require surgery in adulthood and 40\% of these cases will necessitate reintervention for residual defects or sequelae of childhood surgery. In this field, cardiac rehabilitation (CR) in the postsurgical phase has an important impact on the patient by improving psychophysical and clinical recovery in reducing fatigue and dyspnea to ultimately increase survival. In this context, compliance with the rehabilitation program is a key element for the therapeutic benefits of the program. The increase of mobile health care devices and software has greatly extended self-care capabilities across the spectrum of health care activities. Moreover, the possibility of telemonitoring the progress of this self-care provides elements of empowerment and awareness of one's state of health. As a branch of telehealth, CR can be optimized and facilitated using remote telemedicine devices. Objective: The principal goal of the Innovation in Postoperative Rehabilitation Training and Monitoring (IPOTERI) study is to design, realize, and test a composite and integrated system for postsurgical rehabilitation therapies at home specialized for cardiac surgery. The secondary aims are to implement the system in a ``real-life'' context of postcardiac surgical rehabilitation, and to create a data set and a data collection methodology to prototype data analytics algorithms and artificial intelligence techniques for customizing the rehabilitation pathway. Methods: The IPOTERI method consists of a telemonitoring platform that guarantees continuity of postoperative care, an intelligent home station based on an Android app for the patient with a user-friendly interface to record vital signals (electrocardiogram, blood pressure, oxygen saturation, and body weight) and access the planning of rehabilitation activities, and a decision support system that communicates with hospital medical records to transmit alerts and specific support information for the formulation and updating of the treatment and care plan. Results: The pilot test started in June 2023 (protocol number 20406/2021) including 50 patients who will be monitored for 12-14 weeks using the developed platform, as described in the Procedures subsection of the Methods section. Conclusions: The IPOTERI approach, based on the processing of data recorded during the monitoring of telemedicine devices used at home during the postsurgical rehabilitation of a cardiac patient, together with clinical data from the perioperative and postoperative periods could have positive effects on adherence to the rehabilitation program and clinical improvement as well as result in overall improvement of quality of life. International Registered Report Identifier (IRRID): DERR1-10.2196/47951 ",
doi="10.2196/47951",
url="https://www.researchprotocols.org/2025/1/e47951",
url="http://www.ncbi.nlm.nih.gov/pubmed/39841521"
}


@Article{info:doi/10.2196/55586,
author="Kitsiou, Spyros
and Gerber, S. Ben
and Buchholz, W. Susan
and Kansal, M. Mayank
and Sun, Jiehuan
and Pressler, J. Susan",
title="Patient-Centered mHealth Intervention to Improve Self-Care in Patients With Chronic Heart Failure: Phase 1 Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="15",
volume="27",
pages="e55586",
keywords="mHealth",
keywords="app",
keywords="digital health",
keywords="telehealth",
keywords="text messaging",
keywords="smartphone",
keywords="wearable electronic devices",
keywords="heart failure",
keywords="self-care",
keywords="self-management",
keywords="randomized controlled trial",
keywords="cardiology",
keywords="SMS",
abstract="Background: Heart failure (HF) is one of the most common causes of hospital readmission in the United States. These hospitalizations are often driven by insufficient self-care. Commercial mobile health (mHealth) technologies, such as consumer-grade apps and wearable devices, offer opportunities for improving HF self-care, but their efficacy remains largely underexplored. Objective: The objective of this study was to examine the feasibility, acceptability, safety, and preliminary efficacy of a patient-centered mHealth intervention (iCardia4HF) that integrates 3 consumer mHealth apps and devices (Heart Failure Health Storylines, Fitbit, and Withings) with a program of individually tailored SMS text messages to improve HF self-care. Methods: We conducted a phase 1 randomized controlled trial. Eligible patients had stage C HF, were aged ?40 years, and had New York Heart Association (NYHA) class I, II, or III HF. Patients were randomly assigned to either iCardia4HF plus usual care or to usual care only and were observed for 8 weeks. Key feasibility measures were recruitment and retention rates. The primary efficacy outcome was change in HF self-care subscale scores (maintenance, symptom perception, and self-care management) at 8 weeks, assessed with the Self-Care Heart Failure Index (SCHFI; version 7.2). Key secondary outcomes were modifiable behaviors targeted by the intervention (health beliefs, self-efficacy, and HF knowledge), health status, and adherence to daily self-monitoring of 2 core vital signs (body weight and blood pressure). Results: A total of 27 patients were enrolled in the study and randomly assigned to iCardia4HF (n=13, 48\%) or usual care (n=14, 52\%). Of these 27 patients, 11 (41\%) in the intervention group (iCardia4HF) and 14 (52\%) in the usual care group started their assigned care and were included in the full analysis. Patients' mean age was 56 (SD 8.3) years, 44\% (11/25) were female, 92\% (23/25) self-reported race as Black, 76\% (19/25) had NYHA class II or III HF, and 60\% (15/25) had HF with reduced left ventricular ejection fraction. Participant retention, completion of study visits, and adherence to using the mHealth apps and devices for daily self-monitoring were high (>80\%). At 8 weeks, the mean group differences in changes in the SCHFI subscale scores favored the intervention over the control group: maintenance (Cohen d=0.19, 95\% CI --0.65 to 1.02), symptom perception (Cohen d=0.33, 95\% CI --0.51 to 1.17), and self-care management (Cohen d=0.25, 95\% CI --0.55 to 1.04). The greatest improvements in terms of effect size were observed in self-efficacy (Cohen d=0.68) and health beliefs about medication adherence (Cohen d=0.63) and self-monitoring adherence (Cohen d=0.94). There were no adverse events due to the intervention. Conclusions: iCardia4HF was found to be feasible, acceptable, and safe. A larger trial with a longer follow-up duration is warranted to examine its efficacy among patients with HF. Trial Registration: ClinicalTrials.gov NCT03642275; https://clinicaltrials.gov/study/NCT03642275 ",
doi="10.2196/55586",
url="https://www.jmir.org/2025/1/e55586"
}


@Article{info:doi/10.2196/54871,
author="Ceugniez, Maxime
and Devanne, Herv{\'e}
and Hermand, Eric",
title="Reliability and Accuracy of the Fitbit Charge 4 Photoplethysmography Heart Rate Sensor in Ecological Conditions: Validation Study",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Jan",
day="8",
volume="13",
pages="e54871",
keywords="photoplethysmography",
keywords="physical activity",
keywords="ecological conditions",
keywords="accuracy",
keywords="reliability",
keywords="Fitbit Charge 4",
keywords="Fitbit",
keywords="exercise",
keywords="ecological",
keywords="wrist-worn device",
keywords="device",
keywords="sensor",
keywords="wearables",
keywords="usefulness",
keywords="variability",
keywords="sensitivity",
keywords="heart rate",
keywords="heart rate sensor",
abstract="Background: Wrist-worn photoplethysmography (PPG) sensors allow for continuous heart rate (HR) measurement without the inconveniences of wearing a chest belt. Although green light PPG technology reduces HR measurement motion artifacts, only a limited number of studies have investigated the reliability and accuracy of wearables in non--laboratory-controlled conditions with actual specific and various physical activity movements. Objective: The purpose of this study was to (1) assess the reliability and accuracy of the PPG-based HR sensor of the Fitbit Charge 4 (FC4) in ecological conditions and (2) quantify the potential variability caused by the nature of activities. Methods: We collected HR data from participants who performed badminton, tennis, orienteering running, running, cycling, and soccer while simultaneously wearing the FC4 and the Polar H10 chest belt (criterion sensor). Skin tone was assessed with the Fitzpatrick Skin Scale. Once data from the FC4 and criterion data were synchronized, accuracy and reliability analyses were performed, using intraclass correlation coefficients (ICCs), Lin concordance correlation coefficients (CCCs), mean absolute percentage errors (MAPEs), and Bland-Altman tests. A linear univariate model was also used to evaluate the effect of skin tone on bias. All analyses were stratified by activity and pooled activity types (racket sports and running sports). Results: A total of 77.5 hours of HR recordings from 26 participants (age: mean 21.1, SD 5.8 years) were analyzed. The highest reliability was found for running sports, with ICCs and CCCs of 0.90 and 0.99 for running and 0.80 and 0.93 for orienteering running, respectively, whereas the ICCs and CCCs were 0.37 and 0.78, 0.42 and 0.88, 0.65 and 0.97, and 0.49 and 0.81 for badminton, tennis, cycling, and soccer, respectively. We found the highest accuracy for running (bias: 0.1 beats per minute [bpm]; MAPE 1.2\%, SD 4.6\%) and the lowest for badminton (bias: ?16.5 bpm; MAPE 16.2\%, SD 14.4\%) and soccer (bias: ?16.5 bpm; MAPE 17.5\%, SD 20.8\%). Limit of agreement (LOA) width and artifact rate followed the same trend. No effect of skin tone was observed on bias. Conclusions: LOA width, bias, and MAPE results found for racket sports and soccer suggest a high sensitivity to motion artifacts for activities that involve ``sharp'' and random arm movements. In this study, we did not measure arm motion, which limits our results. However, whereas individuals might benefit from using the FC4 for casual training in aerobic sports, we cannot recommend the use of the FC4 for specific purposes requiring high reliability and accuracy, such as research purposes. ",
doi="10.2196/54871",
url="https://mhealth.jmir.org/2025/1/e54871"
}


@Article{info:doi/10.2196/60697,
author="Handra, Julia
and James, Hannah
and Mbilinyi, Ashery
and Moller-Hansen, Ashley
and O'Riley, Callum
and Andrade, Jason
and Deyell, Marc
and Hague, Cameron
and Hawkins, Nathaniel
and Ho, Kendall
and Hu, Ricky
and Leipsic, Jonathon
and Tam, Roger",
title="The Role of Machine Learning in the Detection of Cardiac Fibrosis in Electrocardiograms: Scoping Review",
journal="JMIR Cardio",
year="2024",
month="Dec",
day="30",
volume="8",
pages="e60697",
keywords="machine learning",
keywords="cardiac fibrosis",
keywords="electrocardiogram",
keywords="ECG",
keywords="detection",
keywords="ML",
keywords="cardiovascular disease",
keywords="review",
abstract="Background: Cardiovascular disease remains the leading cause of mortality worldwide. Cardiac fibrosis impacts the underlying pathophysiology of many cardiovascular diseases by altering structural integrity and impairing electrical conduction. Identifying cardiac fibrosis is essential for the prognosis and management of cardiovascular disease; however, current diagnostic methods face challenges due to invasiveness, cost, and inaccessibility. Electrocardiograms (ECGs) are widely available and cost-effective for monitoring cardiac electrical activity. While ECG-based methods for inferring fibrosis exist, they are not commonly used due to accuracy limitations and the need for cardiac expertise. However, the ECG shows promise as a target for machine learning (ML) applications in fibrosis detection. Objective: This study aims to synthesize and critically evaluate the current state of ECG-based ML approaches for cardiac fibrosis detection. Methods: We conducted a scoping review of research in ECG-based ML applications to identify cardiac fibrosis. Comprehensive searches were performed in PubMed, IEEE Xplore, Scopus, Web of Science, and DBLP databases, including publications up to October 2024. Studies were included if they applied ML techniques to detect cardiac fibrosis using ECG or vectorcardiogram data and provided sufficient methodological details and outcome metrics. Two reviewers independently assessed eligibility and extracted data on the ML models used, their performance metrics, study designs, and limitations. Results: We identified 11 studies evaluating ML approaches for detecting cardiac fibrosis using ECG data. These studies used various ML techniques, including classical (8/11, 73\%), ensemble (3/11, 27\%), and deep learning models (4/11, 36\%). Support vector machines were the most used classical model (6/11, 55\%), with the best-performing models of each study achieving accuracies of 77\% to 93\%. Among deep learning approaches, convolutional neural networks showed promising results, with one study reporting an area under the receiver operating characteristic curve (AUC) of 0.89 when combined with clinical features. Notably, a large-scale convolutional neural network study (n=14,052) achieved an AUC of 0.84 for detecting cardiac fibrosis, outperforming cardiologists (AUC 0.63-0.66). However, many studies had limited sample sizes and lacked external validation, potentially impacting the generalizability of the findings. Variability in reporting methods may affect the reproducibility and applicability of these ML-based approaches. Conclusions: ML-augmented ECG analysis shows promise for accessible and cost-effective detection of cardiac fibrosis. However, there are common limitations with respect to study design and insufficient external validation, raising concerns about the generalizability and clinical applicability of the findings. Inconsistencies in methodologies and incomplete reporting further impede cross-study comparisons. Future work may benefit from using prospective study designs, larger and more clinically and demographically diverse datasets, advanced ML models, and rigorous external validation. Addressing these challenges could pave the way for the clinical implementation of ML-based ECG detection of cardiac fibrosis to improve patient outcomes and health care resource allocation. ",
doi="10.2196/60697",
url="https://cardio.jmir.org/2024/1/e60697"
}


@Article{info:doi/10.2196/56954,
author="Eze, E. Chinwe
and Dorsch, P. Michael
and Coe, B. Antoinette
and Lester, A. Corey
and Buis, R. Lorraine
and Farris, B. Karen",
title="Behavioral Factors Related to Participation in Remote Blood Pressure Monitoring Among Adults With Hypertension: Cross-Sectional Study",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="23",
volume="8",
pages="e56954",
keywords="remote blood pressure monitoring",
keywords="telemonitoring",
keywords="hypertension",
keywords="blood pressure",
keywords="technology",
keywords="health behaviors",
keywords="quantitative",
keywords="cross-sectional study",
keywords="United States",
keywords="lack of awareness",
keywords="health information",
keywords="health provider",
keywords="electronic communication channels",
keywords="adult",
keywords="aging",
keywords="mobile phone",
abstract="Background: Remote blood pressure (BP) monitoring (RBPM) or BP telemonitoring is beneficial in hypertension management. People with hypertension involved in telemonitoring of BP often have better BP control than those in usual care. However, most reports on RBPM are from intervention studies. Objective: This study aimed to assess participant characteristics and technology health behaviors associated with RBPM participation in a wider population with hypertension. This study will help us understand the predictors of RBPM participation and consider how to increase it. Methods: This was a quantitative, cross-sectional survey study of people with hypertension in the United States. The inclusion criteria included people aged ?18 years with a hypertension diagnosis or who self-reported they have hypertension, had a prescription of at least one hypertension medication, understood the English language, and were willing to participate. The survey included demographics, technology health behaviors, and RBPM participation questions. The survey was self-administered on the Qualtrics platform and followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) checklist. The primary dependent variable was participation in RBPM. Results: In total, 507 people with hypertension participated in the survey. The mean age for all respondents was 60 (SD 14.7) years. The respondents were mostly female (306/507, 60.4\%), non-Hispanic (483/507, 95.3\%), and White (429/507, 84.6\%). A little over half of the respondents reported having had hypertension for 5 years or more (287/507, 56.6\%). About one-third of participants were aware of RBPM (165/507, 32.5\%), and 11.8\% (60/507) were enrolled in RBPM. The mean age of those engaging in RBPM and non-RBPM was 46.2 (SD 14.7) and 62 (SD 13.7) years, respectively. The most common reasons for not participating in RBPM were because their health provider did not ask the participant to participate (247/447, 55.3\%) and their lack of awareness of RBPM (190/447, 42.5\%). Most respondents in the RBPM group measure their BP at home (55/60, 91.7\%), and 61.7\% (37/60) engage in daily BP measurement, compared with 62.6\% (280/447) and 25.1\% (112/447), respectively, among the non-RBPM group. A greater number of those in the RBPM group reported tracking their BP measurements with mobile health (mHealth; 37/60, 61.7\%) than those in the non-RBPM group (70/447, 15.6\%). The electronic health records or patient portal was the most common channel of RBPM communication between the respondents and their health care providers. The significant predictors of participation in RBPM were RBPM awareness (adjusted odds ratio [AOR] 34.65, 95\% CI 11.35?150.31; P<.001) and sharing health information electronically with a health provider (AOR 4.90, 95\% CI 1.39?21.64; P=.01) among all participants. However, the significant predictor of participation in RBPM among participants who were aware of RBPM was sharing health information electronically with a health provider (AOR 6.99, 95\% CI 1.62?47.44; P=.007). Conclusions: Participation in RBPM is likely to increase with increased awareness, health providers' recommendations, and tailoring RBPM services to patients' preferred electronic communication channels. ",
doi="10.2196/56954",
url="https://formative.jmir.org/2024/1/e56954"
}


@Article{info:doi/10.2196/60493,
author="Feng, Y. Kent
and Short, A. Sarah
and Saeb, Sohrab
and Carroll, K. Megan
and Olivier, B. Christoph
and Simard, P. Edgar
and Swope, Susan
and Williams, Donna
and Eckstrand, Julie
and Pagidipati, Neha
and Shah, H. Svati
and Hernandez, F. Adrian
and Mahaffey, W. Kenneth",
title="Resting Heart Rate and Associations With Clinical Measures From the Project Baseline Health Study: Observational Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="20",
volume="26",
pages="e60493",
keywords="resting heart rate",
keywords="wearable devices",
keywords="remote monitoring",
keywords="physiology",
keywords="PBHS",
keywords="Project Baseline Health Study",
keywords="Verily Study Watch",
keywords="heart rate",
keywords="observational study",
keywords="cohort study",
keywords="wearables",
keywords="electrocardiogram",
keywords="regression analyses",
keywords="socioeconomic status",
keywords="medical condition",
keywords="vital signs",
keywords="laboratory assessments",
keywords="physical function",
keywords="electronic health",
keywords="eHealth",
abstract="Background: Though widely used, resting heart rate (RHR), as measured by a wearable device, has not been previously evaluated in a large cohort against a variety of important baseline characteristics. Objective: This study aimed to assess the validity of the RHR measured by a wearable device compared against the gold standard of ECG (electrocardiography), and assess the relationships between device-measured RHR and a broad range of clinical characteristics. Methods: The Project Baseline Health Study (PHBS) captured detailed demographic, occupational, social, lifestyle, and clinical data to generate a deeply phenotyped cohort. We selected an analysis cohort within it, which included participants who had RHR determined by both ECG and the Verily Study Watch (VSW). We examined the correlation between these simultaneous RHR measures and assessed the relationship between VSW RHR and a range of baseline characteristics, including demographic, clinical, laboratory, and functional assessments. Results: From the overall PBHS cohort (N=2502), 875 (35\%) participants entered the analysis cohort (mean age 50.9, SD 16.5 years; n=519, 59\% female and n=356, 41\% male). The mean and SD of VSW RHR was 66.6 (SD 11.2) beats per minute (bpm) for female participants and 64.4 (SD 12.3) bpm for male participants. There was excellent reliability between the two measures of RHR (ECG and VSW) with an intraclass correlation coefficient of 0.946. On univariate analyses, female and male participants had similar baseline characteristics that trended with higher VSW RHR: lack of health care insurance (both P<.05), higher BMI (both P<.001), higher C-reactive protein (both P<.001), presence of type 2 diabetes mellitus (both P<.001) and higher World Health Organization Disability Assessment Schedule (WHODAS) 2.0 score (both P<.001) were associated with higher RHR. On regression analyses, within each domain of baseline characteristics (demographics and socioeconomic status, medical conditions, vitals, physical function, laboratory assessments, and patient-reported outcomes), different characteristics were associated with VSW RHR in female and male participants. Conclusions: RHR determined by the VSW had an excellent correlation with that determined by ECG. Participants with higher VSW RHR had similar trends in socioeconomic status, medical conditions, vitals, laboratory assessments, physical function, and patient-reported outcomes irrespective of sex. However, within each domain of baseline characteristics, different characteristics were most associated with VSW RHR in female and male participants. Trial Registration: ClinicalTrials.gov NCT03154346; https://clinicaltrials.gov/study/NCT03154346 ",
doi="10.2196/60493",
url="https://www.jmir.org/2024/1/e60493"
}


@Article{info:doi/10.2196/56763,
author="Zheng, Yaguang
and Adhikari, Samrachana
and Li, Xiyue
and Zhao, Yunan
and Mukhopadhyay, Amrita
and Hamo, E. Carine
and Stokes, Tyrel
and Blecker, Saul",
title="Association Between Video-Based Telemedicine Visits and Medication Adherence Among Patients With Heart Failure: Retrospective Cross-Sectional Study",
journal="JMIR Cardio",
year="2024",
month="Dec",
day="5",
volume="8",
pages="e56763",
keywords="telemedicine",
keywords="medication adherence",
keywords="heart failure",
keywords="systolic dysfunction",
keywords="medical therapy",
keywords="telehealth",
keywords="remote monitoring",
keywords="self-management",
abstract="Background: Despite the exponential growth in telemedicine visits in clinical practice due to the COVID-19 pandemic, it remains unknown if telemedicine visits achieved similar adherence to prescribed medications as in-person office visits for patients with heart failure. Objective: Our study examined the association between telemedicine visits (vs in-person visits) and medication adherence in patients with heart failure. Methods: This was a retrospective cross-sectional study of adult patients with a diagnosis of heart failure or an ejection fraction of ?40\% using data between April 1 and October 1, 2020. This period was used because New York University approved telemedicine visits for both established and new patients by April 1, 2020. The time zero window was between April 1 and October 1, 2020, then each identified patient was monitored for up to 180 days. Medication adherence was measured by the mean proportion of days covered (PDC) within 180 days, and categorized as adherent if the PDC was ?0.8. Patients were included in the telemedicine exposure group or in-person group if all encounters were video visits or in-person office visits, respectively. Poisson regression and logistic regression models were used for the analyses. Results: A total of 9521 individuals were included in this analysis (telemedicine visits only: n=830 in-person office visits only: n=8691). Overall, the mean age was 76.7 (SD 12.4) years. Most of the patients were White (n=6996, 73.5\%), followed by Black (n=1060, 11.1\%) and Asian (n=290, 3\%). Over half of the patients were male (n=5383, 56.5\%) and over half were married or living with partners (n=4914, 51.6\%). Most patients' health insurance was covered by Medicare (n=7163, 75.2\%), followed by commercial insurance (n=1687, 17.7\%) and Medicaid (n=639, 6.7\%). Overall, the average PDC was 0.81 (SD 0.286) and 71.3\% (6793/9521) of patients had a PDC?0.8. There was no significant difference in mean PDC between the telemedicine and in-person office groups (mean 0.794, SD 0.294 vs mean 0.812, SD 0.285) with a rate ratio of 0.99 (95\% CI 0.96-1.02; P=.09). Similarly, there was no significant difference in adherence rates between the telemedicine and in-person office groups (573/830, 69\% vs 6220/8691, 71.6\%), with an odds ratio of 0.94 (95\% CI 0.81-1.11; P=.12). The conclusion remained the same after adjusting for covariates (eg, age, sex, race, marriage, language, and insurance). Conclusions: We found similar rates of medication adherence among patients with heart failure who were being seen via telemedicine or in-person visits. Our findings are important for clinical practice because we provide real-world evidence that telemedicine can be an approach for outpatient visits for patients with heart failure. As telemedicine is more convenient and avoids transportation issues, it may be an alternative way to maintain the same medication adherence as in-person visits for patients with heart failure. ",
doi="10.2196/56763",
url="https://cardio.jmir.org/2024/1/e56763"
}


@Article{info:doi/10.2196/63391,
author="Spethmann, Sebastian
and Hindricks, Gerhard
and Koehler, Kerstin
and Stoerk, Stefan
and Angermann, E. Christiane
and B{\"o}hm, Michael
and Assmus, Birgit
and Winkler, Sebastian
and M{\"o}ckel, Martin
and Mittermaier, Mirja
and Lelgemann, Monika
and Reuter, Daniel
and Bosch, Ralph
and Albrecht, Alexander
and von Haehling, Stephan
and Helms, M. Thomas
and Sack, Stefan
and Bekfani, Tarek
and Gr{\"o}schel, Wolfgang Jan
and Koehler, Magdalena
and Melzer, Christoph
and Wintrich, Jan
and Zippel-Schultz, Bettina
and Ertl, Georg
and Vogelmeier, Claus
and Dagres, Nikolaos
and Zernikow, Jasmin
and Koehler, Friedrich",
title="Telemonitoring for Chronic Heart Failure: Narrative Review of the 20-Year Journey From Concept to Standard Care in Germany",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="4",
volume="26",
pages="e63391",
keywords="telemedicine",
keywords="e-counseling",
keywords="heart decompensation",
keywords="Europe",
keywords="patient care management",
abstract="Background: Chronic heart failure (CHF) is a major cause of morbidity and mortality worldwide, placing a significant burden on health care systems. The concept of telemedicine for CHF was first introduced in the late 1990s, and since 2010, studies have demonstrated its potential to improve patient outcomes and reduce health care costs. Over the following decade, technological advancements and changes in health care policy led to the development of more sophisticated telemedicine solutions for CHF, including remote patient management through invasive or noninvasive telemonitoring devices, mobile apps, and virtual consultations. Years of public funding in Germany have generated evidence that remote patient management improves outcomes for patients with CHF, such as quality of life, and reduces hospital admissions. Based on these data, the Federal Joint Committee (Gemeinsamer Bundesausschuss; G-BA) decided, independently of the current European Society of Cardiology recommendations, to incorporate telemedicine as a standard digital intervention for high-risk patients with reduced left ventricular ejection fraction in Germany in 2020. Objective: This review aims to illustrate the journey from the initial concept through pioneering studies that led to telemedicine's integration into standard care, and to share current experiences that have positioned Germany as a leader in cardiovascular telemedicine. Methods: We review and discuss existing literature and evidence on the development and implementation of telemonitoring for CHF in Germany over the past 20 years. Relevant studies, reports, and guidelines were identified through a comprehensive search of electronic databases, including PubMed, Google Scholar, and specialized journals focused on CHF telemonitoring. Results: Pioneering studies, such as the TIM-HF2 (Telemedical Interventional Management in Heart Failure II) and IN-TIME (Influence of Home Monitoring on Mortality and Morbidity in Heart Failure Patients with Impaired Left Ventricular Function) trials, demonstrated the effectiveness of remote patient management applications for patients with CHF in Germany and their applicability to current practices involving both invasive and noninvasive methods. Collaborations between researchers and technology developers overcame barriers, leading to sustainable improvements in patient care. Ongoing research on artificial intelligence applications for prioritizing and interpreting individual health data will continue to transform digital health care. Conclusions: The establishment of telemedical care for patients with HF across Europe is likely to benefit from experiences in Germany, where significant improvements have been achieved in the care of patients with HF. ",
doi="10.2196/63391",
url="https://www.jmir.org/2024/1/e63391"
}


@Article{info:doi/10.2196/53932,
author="Tisdale, Lauren Rebecca
and Purmal, Colin
and Kalwani, Neil
and Sandhu, Alexander
and Heidenreich, Paul
and Zulman, Donna
and Hussain, Tanvir",
title="Opportunities to Address Specialty Care Deserts and the Digital Divide through the Veterans Health Administration's Telehealth Hub-and-Spoke Cardiology Clinic: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="28",
volume="26",
pages="e53932",
keywords="telehealth",
keywords="specialty care",
keywords="cardiovascular disease",
keywords="telemedicine",
keywords="cardiology",
keywords="veterans",
keywords="low income",
keywords="digital divide",
keywords="access",
keywords="Veterans Health Administration",
keywords="VA",
keywords="VHA",
keywords="rural",
keywords="clinical resource hub",
keywords="CRH",
abstract="Background: To address geographic barriers to specialty care access for services such as cardiology, the Veterans Health Administration (VA) has implemented a novel, regionalized telehealth care hub. The Clinical Resource Hub (CRH) model extends care, including cardiology services, to individuals in low-access communities across the region. Little is known, however, about the reach of such programs. Objective: This study aimed to describe the initial CRH program implementation in terms of growth in users and clinical encounters, as well as the association between user characteristics and the use of CRH cardiology care, in VA's Sierra Pacific region (Northern California, Nevada, and the Pacific Islands). Methods: We compared patients who used CRH cardiology services (CRH users) to those using non-CRH cardiology services (CRH nonusers) in the Sierra Pacific region between July 15, 2021, and March 31, 2023. After characterizing changes in the numbers of CRH users and nonusers and clinical encounters over the study period, we used multivariable logistic regression to estimate the association between patient-level factors and the odds of being a CRH user. Results: There were 804 CRH users over the study period, with 1961 CRH encounters concentrated at 3 main CRH sites. The CRH program comprised a minority of cardiology users and encounters in the region, with 19,583 CRH nonusers with 83,489 encounters. The numbers of CRH patients and encounters both increased at a steady-to-increasing rate over the study period, with increases of 37\% (n=292 vs n=213) in users and 64\% (n=584 vs n=356) in encounters in the first quarter of 2023 compared with the last quarter of 2022. Among CRH users, 8.3\% (67/804) were female and 41.4\% (333/804) were aged ?75 years, compared with 4.3\% (840/19,583) and 49\% (9600/19,583), respectively, among CRH nonusers. The proportions of rural (users: 205/804, 25.5\%; nonusers: 4936/19,583, 25.2\%), highly disabled (users: 387/804, 48.1\%; nonusers: 9246/19,583, 47.2\%), and low-income (users: 165/804, 20.5\%; nonusers: 3941/19,583, 20.1\%) veterans in both groups were similar. In multivariable logistic models, adjusted odds ratios of using CRH were higher for female veterans (1.70, 95\% CI 1.29-2.24) and lower for older veterans (aged ?75 years; 0.33, 95\% CI 0.23-0.47). Rural veterans also had a higher adjusted odds ratio of using CRH (1.19, 95\% CI 1.00-1.42; P=.046). Conclusions: The VA's Sierra Pacific CRH cardiology program grew substantially in its first 2 years of operation, serving disproportionately more female and rural veterans and similar proportions of highly disabled and low-income veterans compared to conventional VA care. This model appears to be effective for overcoming specialty care access barriers for certain individuals, although targeted efforts may be required to reach older veterans. While this study focuses on a single region, specialty, and health care system, lessons from implementing regionalized telehealth hub models may be applicable to other settings. ",
doi="10.2196/53932",
url="https://www.jmir.org/2024/1/e53932"
}


@Article{info:doi/10.2196/49710,
author="Craig, William
and Ohlmann, Suzanne",
title="The Benefits of Using Active Remote Patient Management for Enhanced Heart Failure Outcomes in Rural Cardiology Practice: Single-Site Retrospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="26",
volume="26",
pages="e49710",
keywords="rural",
keywords="remote patient monitoring",
keywords="heart failure",
keywords="heart failure hospitalizations",
keywords="office visits",
keywords="rural health inequalities",
keywords="telehealth",
abstract="Background: Rural populations have a disproportionate burden of heart failure (HF) morbidity and mortality, associated with socioeconomic and racial inequities. Multiple randomized controlled trials of remote patient monitoring (RPM) using both direct patient contact and device-based monitoring have been conducted to assess improvement in HF outcomes, with mixed results. Objective: We aimed to assess whether a novel digital health care platform designed to proactively assess and manage patients with HF improved patient outcomes by preventing HF re-exacerbations, thus reducing emergency room visits and HF hospitalizations. Methods: This was a single-site, retrospective cohort study using electronic medical record (EMR) data gathered from 2 years prior to RPM initiation and 2 years afterward. In January 2017, this single center began enrolling New York Heart Association (NYHA) class II and class III patients with HF prone to HF exacerbation into an RPM program using the Cordella HF system. By July 2022, 93 total patients had been enrolled in RPM. Of these patients, 87\% lived in rural areas. This retrospective review included 40 of the 93 patients enrolled in RPM. These 40 were selected because they had 2 years of established EMR data prior to initiation of RPM and 2 years of post-RPM data; each consented to this Sterling IRB--approved study. Results: We included 40 patients with at least 4 years of follow-up, including 2 years prior to RPM initiation and 2 years after RPM initiation. In the 2 years after RPM initiation, check-up calls increased 519\%, medication change calls increased 519\%, and total calls increased by 519\%. Emergency room visits for HF fell 93\%, heart failure hospitalizations fell 83\%, and all other cardiovascular hospitalizations fell 50\%. Additionally, the total number of office visits declined by 15\% after RPM, and unscheduled or urgent office visits declined by 73\%. Conclusions: Daily monitoring of trends in vital sign data between engaged patients and a collaborative team of clinicians, incorporated into daily clinical workflow, enhanced patient interactions and allowed timely response or intervention when HF decompensation occurred, resulting in a reduction of outpatient and inpatient clinical use over more than 2 years of follow-up. ",
doi="10.2196/49710",
url="https://www.jmir.org/2024/1/e49710",
url="http://www.ncbi.nlm.nih.gov/pubmed/39589775"
}


@Article{info:doi/10.2196/58441,
author="Wettstein, Reto
and Sedaghat-Hamedani, Farbod
and Heinze, Oliver
and Amr, Ali
and Reich, Christoph
and Betz, Theresa
and Kayvanpour, Elham
and Merzweiler, Angela
and B{\"u}sch, Christopher
and Mohr, Isabell
and Friedmann-Bette, Birgit
and Frey, Norbert
and Dugas, Martin
and Meder, Benjamin",
title="A Remote Patient Monitoring System With Feedback Mechanisms Using a Smartwatch: Concept, Implementation, and Evaluation Based on the activeDCM Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Nov",
day="22",
volume="12",
pages="e58441",
keywords="wearable",
keywords="consumer device",
keywords="mobile phone",
keywords="mobile health",
keywords="telemedicine",
keywords="remote patient monitoring",
keywords="usability",
keywords="Health Level 7 Fast Healthcare Interoperability Resources",
keywords="HL7 FHIR",
keywords="cardiology",
keywords="heart failure",
keywords="dilated cardiomyopathy",
abstract="Background: Technological advances allow for recording and sharing health-related data in a patient-centric way using smartphones and wearables. Secure sharing of such patient-generated data with physicians would enable close management of individual health trajectories, monitoring of risk factors, and asynchronous feedback. However, most remote patient monitoring (RPM) systems currently available are not fully integrated into hospital IT systems or lack a patient-centric design. Objective: The objective of this study was to conceptualize and implement a user-friendly, reusable, interoperable, and secure RPM system incorporating asynchronous feedback mechanisms using a broadly available consumer wearable (Apple Watch). In addition, this study sought to evaluate factors influencing patient acceptance of such systems. Methods: The RPM system requirements were established through focus group sessions. Subsequently, a system concept was designed and implemented using an iterative approach ensuring technical feasibility from the beginning. To assess clinical feasibility, the system was used as part of the activeDCM prospective randomized interventional study focusing on dilated cardiomyopathy. Each patient used the system for at least 12 months. The System Usability Scale was used to measure usability from a subjective patient perspective. In addition, an evaluation was conducted on the objective wearable interaction frequency as well as the completeness of transmitted data classified into sensor-based health data (SHD) and patient-reported outcome measures (PROMs). Descriptive statistics using box plots and bootstrapped multiple linear regression with 95\% CIs were used for evaluation analyzing the influence of age, sex, device experience, and intervention group membership. Results: The RPM system comprised 4 interoperable components: patient devices, a data server, a data viewer, and a notification service. The system was evaluated with 95 consecutive patients with dilated cardiomyopathy (28/95, 29\% female; mean age 50, SD 12 y) who completed the activeDCM study protocol. The system's app achieved a mean System Usability Scale score of 78 (SD 17), which was most influenced by device experience. In total, 87\% (83/95) of the patients could integrate the use of the app well or very well into their daily routine, and 71\% (67/95) saw a benefit of the RPM system for management of their health condition. On average, patients interacted with the wearable on 61\% (SD 26\%) of days enrolled in the study. SHD were available on average for 78\% (SD 23\%) of days, and PROM data were available on 64\% (SD 27\%) of weeks enrolled in the study. Wearable interaction frequency, SHD, and PROM completeness were most influenced by intervention group membership. Conclusions: Our results mark a first step toward integrating RPM systems based on a consumer wearable device for primary patient input into standardized clinical workflows. They can serve as a blueprint for creating a user-friendly, reusable, interoperable, and secure RPM system that can be integrated into patients' daily routines. ",
doi="10.2196/58441",
url="https://mhealth.jmir.org/2024/1/e58441"
}


@Article{info:doi/10.2196/54746,
author="Saraya, Norah
and McBride, Jonathon
and Singh, Karandeep
and Sohail, Omar
and Das, Jeet Porag",
title="Comparison of Auscultation Quality Using Contemporary Digital Stethoscopes",
journal="JMIR Cardio",
year="2024",
month="Nov",
day="8",
volume="8",
pages="e54746",
keywords="auscultation",
keywords="digital stethoscopes",
keywords="valvular heart disease",
doi="10.2196/54746",
url="https://cardio.jmir.org/2024/1/e54746"
}


@Article{info:doi/10.2196/53444,
author="Marier-T{\'e}trault, Emmanuel
and Bebawi, Emmanuel
and B{\'e}chard, St{\'e}phanie
and Brouillard, Philippe
and Zuchinali, Priccila
and Remillard, Emilie
and Carrier, Zo{\'e}
and Jean-Charles, Loyda
and Nguyen, Kha John Nam
and Lehoux, Pascale
and Pomey, Marie-Pascale
and Ribeiro, B. Paula A.
and Tournoux, Fran{\c{c}}ois",
title="Remote Patient Monitoring and Digital Therapeutics Enhancing the Continuum of Care in Heart Failure: Nonrandomized Pilot Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="6",
volume="8",
pages="e53444",
keywords="heart failure",
keywords="remote patient management",
keywords="telemonitoring",
keywords="digital therapeutics",
keywords="digital health",
keywords="heart",
keywords="therapeutics",
keywords="pilot study",
keywords="patient care",
keywords="medical therapy",
keywords="vitals",
keywords="weight",
keywords="symptoms",
keywords="quality of life",
keywords="medication optimization",
keywords="mobile phone",
abstract="Background: Heart failure (HF) is the primary cause of hospitalization among Canadian patients aged ?65 years. Care for HF requires regular clinical follow-ups to prevent readmissions and facilitate medical therapy optimization. Multiple barriers lead to therapeutic medical inertia including limited human resources and regional inequities. Remote patient monitoring (RPM) and digital therapeutics (DTx) solutions have been developed to improve HF management, but their adoption remains limited and underexplored. The Continuum project emerged as a collaborative initiative involving a health care center, a software start-up, and an industrial partner. Objective: We aimed to develop and test the feasibility of the Continuum intervention that seamlessly combined an RPM system with a DTx solution for HF within the same software. Methods: A 3-month pre-post pilot study was conducted from October 2020 to June 2021. Patients with HF who owned a smartphone or tablet (having remote patient monitoring [RPM+]), had (1) access to a self-care app where they could enter their vital signs, weight, and HF symptoms and view educational content; (2) daily monitoring of their data by a nurse; and (3) a DTx module with automated HF medication suggestions based on national guidelines, made available to their treating medical team. Bluetooth devices were offered to facilitate data recording. Nurses on RPM monitoring could call patients and arrange appointments with their medical team. Patients without a mobile device or unable to use the app were followed in another group (without remote patient monitoring [RPM--]). Results: In total, 52 patients were enrolled in this study (32 RPM+ and 20 RPM--). Among patients owning a mobile device, only 14\% (5/37) could not use the app. In the RPM+ group, 47\% (15/32) of the patients used the app for more than 80\% (67 days) of the 12-week study period. The use of our digital solution was integrated into the regular nursing workday and only 34 calls had to be made by the nurse during the study period. Only 6\% (2/32) of the patients in the RPM+ group experienced at least 1 all-cause hospitalization versus 35\% (7/20) of the RPM-- ones during the follow-up (6\%, 2/32 vs 25\%, 5/20 for HF hospitalization) and patients were more likely to have their HF therapy optimized if the DTx solution was available. Quality of life improved in patients compliant with the use of the mobile app (mean score variation +10.6, SD 14.7). Conclusions: This pilot study demonstrated the feasibility of implementing our digital solution, within the specific context of HF. The seamless integration of Continuum into nursing workflow, mobile app accessibility, and adoption by patients, were the 3 main key learning points of this study. Further investigation is required to assess the potential impacts on hospitalizations, drug optimization, and quality of life. Trial Registration: ClinicalTrials.gov NCT05377190; https://clinicaltrials.gov/study/NCT05377190 (pilot study \#21.403) ",
doi="10.2196/53444",
url="https://formative.jmir.org/2024/1/e53444"
}


@Article{info:doi/10.2196/56552,
author="Xu, Dandan
and Xu, Dongmei
and Wei, Lan
and Bao, Zhipeng
and Liao, Shengen
and Zhang, Xinyue",
title="The Effectiveness of Remote Exercise Rehabilitation Based on the ``SCeiP'' Model in Homebound Patients With Coronary Heart Disease: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="5",
volume="26",
pages="e56552",
keywords="coronary heart disease",
keywords="exercise rehabilitation",
keywords="promotion strategy",
keywords="home rehabilitation",
abstract="Background: While exercise rehabilitation is recognized as safe and effective, medium- to long-term compliance among patients with coronary heart disease (CHD) remains low. Therefore, promoting long-term adherence to exercise rehabilitation for these patients warrants significant attention. Objective: This study aims to investigate the impact of remote exercise rehabilitation on time investment and related cognitive levels in homebound patients with CHD. This study utilizes the SCeiP (Self-Evaluation/Condition of Exercise-Effect Perception-Internal Drive-Persistence Behavior) model, alongside WeChat and exercise bracelets. Methods: A total of 147 patients who underwent percutaneous coronary intervention in the cardiovascular department of a grade III hospital in Jiangsu Province from June 2022 to March 2023 were selected as study participants through convenience sampling. The patients were randomly divided into an experimental group and a control group. The experimental group received an exercise rehabilitation promotion strategy based on the ``SCeiP'' model through WeChat and exercise bracelets, while the control group followed rehabilitation training according to a standard exercise rehabilitation guide. The days and duration of exercise, levels of cardiac rehabilitation cognition, exercise planning, and exercise input were analyzed before the intervention and at 1 month and 3 months after the intervention. Results: A total of 81 men (55.1\%) and 66 women (44.9\%) were recruited for the study. The completion rate of exercise days was significantly higher in the experimental group compared with the control group at both 1 month (t145=5.429, P<.001) and 3 months (t145=9.113, P<.001) after the intervention. Similarly, the completion rate of exercise duration was significantly greater in the experimental group (t145=3.471, P=.001) than in the control group (t145=5.574, P<.001). The levels of autonomy, exercise planning, and exercise input in the experimental group were significantly higher than those in the control group at both 1 month and 3 months after the intervention (P<.001). Additionally, the experimental group exhibited a significant reduction in both process anxiety and outcome anxiety scores (P<.001). Repeated measures ANOVA revealed significant differences in the trends of cognitive function related to cardiac rehabilitation between the 2 patient groups over time: autonomy, F1,145(time{\texttimes}group)=9.055 (P<.001); process anxiety, F1,145(time{\texttimes}group)=30.790 (P<.001); and outcome anxiety, F1,145(time{\texttimes}group)=28.186 (P<.001). As expected, the scores for exercise planning (t145=2.490, P=.01 and t145=3.379, P<.001, respectively) and exercise input (t145=2.255, P=.03 and t145=3.817, P<.001, respectively) consistently demonstrated superiority in the experimental group compared with the control group at both 1 and 3 months after the intervention. Interestingly, we observed that the levels of exercise planning and exercise input in both groups initially increased and then slightly decreased over time, although both remained higher than the preintervention levels (P<.001). Conclusions: The remote health intervention based on the ``SCeiP'' model effectively enhances exercise compliance, exercise planning, exercise input, and cognitive levels during cardiac rehabilitation in patients with CHD. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300069463; https://www.chictr.org.cn/showproj.html?proj=192461 ",
doi="10.2196/56552",
url="https://www.jmir.org/2024/1/e56552"
}


@Article{info:doi/10.2196/57115,
author="Jin, Xiaorong
and Zhang, Yimei
and Zhou, Min
and Zhang, Xiong
and Mei, Qian
and Bai, Yangjuan
and Wei, Wei
and Ma, Fang",
title="Experiences With mHealth Use Among Patient-Caregiver Dyads With Chronic Heart Failure: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="31",
volume="26",
pages="e57115",
keywords="chronic heart failure",
keywords="informal caregiver",
keywords="mHealth",
keywords="experience",
keywords="dyad",
abstract="Background: Chronic heart failure has become a serious threat to the health of the global population, and self-management is key to treating chronic heart failure. The emergence of mobile health (mHealth) provides new ideas for the self-management of chronic heart failure in which the informal caregiver plays an important role. Current research has mainly studied the experiences with using mHealth among patients with chronic heart failure from the perspective of individual patients, and there is a lack of research from the dichotomous perspective. Objective: The aim of this study was to explore the experiences with mHealth use among patients with chronic heart failure and their informal caregivers from a dichotomous perspective. Methods: This descriptive phenomenological study from a post-positivist perspective used a dyadic interview method, and face-to-face semistructured interviews were conducted with patients with chronic heart failure and their informal caregivers. Data were collected and managed using NVivo 12 software, and data analysis used thematic analysis to identify and interpret participants' experiences and perspectives. The thematic analysis included familiarizing ourselves with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. Results: A total of 14 dyads of patients with chronic heart failure and their informal caregivers (13 men and 15 women) participated in this study, including 3 couples and 11 parent-child pairs. We constructed 4 key themes and their subthemes related to the experiences with mHealth use: (1) opposing experiences with mHealth as human interaction or trauma (great experience with mHealth use; trauma), (2) supplement instead of replacement (it is useful but better as a reference; offline is unavoidable sometimes), (3) both agreement and disagreement over who should be the adopter of mHealth (achieving consensus regarding who should adopt mHealth; conflict occurs when considering patients as the adopter of mHealth), (4) for better mHealth (applying mHealth with caution; suggestions for improved mHealth). Conclusions: This study reported that the experiences with mHealth use among patients with chronic heart failure and their informal caregivers were mixed, and it highlighted the human touch of mHealth and the importance of network security. These results featured mHealth as a complement to offline hospitals rather than a replacement. In the context of modern or changing Chinese culture, we encourage patients to use mHealth by themselves and their informal caregivers to provide help when necessary. In addition, we need to use mHealth carefully, and future mHealth designs should focus more on ease of use and be oriented more toward older adults. ",
doi="10.2196/57115",
url="https://www.jmir.org/2024/1/e57115"
}


@Article{info:doi/10.2196/63707,
author="Gibson, Irene
and Neubeck, Lis
and Corcoran, Marissa
and Morland, Chris
and Donovan, Steve
and Jones, Jennifer
and Costello, Caroline
and Hynes, Lisa
and Harris, Aisling
and Harrahill, Mary
and Lillis, Mary
and Atrey, Alison
and Ski, F. Chantal
and Savickas, Vilius
and Byrne, Molly
and Murphy, W. Andrew
and McEvoy, William John
and Wood, David
and Jennings, Catriona",
title="Development of a Digital Health Intervention for the Secondary Prevention of Cardiovascular Disease (INTERCEPT): Co-Design and Usability Testing Study",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="23",
volume="11",
pages="e63707",
keywords="cardiovascular disease",
keywords="secondary prevention",
keywords="digital health",
keywords="intervention development",
keywords="co-design",
keywords="usability testing",
keywords="mobile health",
keywords="usability",
keywords="design",
keywords="conline workshop",
keywords="social support",
keywords="behavioral change",
keywords="self-monitoring",
abstract="Background: Secondary prevention is an important strategy to reduce the burden of cardiovascular disease (CVD), a leading cause of death worldwide. Despite the growing evidence for the effectiveness of digital health interventions (DHIs) for the secondary prevention of CVD, the majority are designed with minimal input from target end users, resulting in poor uptake and usage. Objective: This study aimed to optimize the acceptance and effectiveness of a DHI for the secondary prevention of CVD through co-design, integrating end users' perspectives throughout. Methods: A theory-driven, person-based approach using co-design was adopted for the development of the DHI, known as INTERCEPT. This involved a 4-phase iterative process using online workshops. In phase 1, a stakeholder team of health care professionals, software developers, and public and patient involvement members was established. Phase 2 involved identification of the guiding principles, content, and design features of the DHI. In phase 3, DHI prototypes were reviewed for clarity of language, ease of navigation, and functionality. To anticipate and interpret DHI usage, phase 4 involved usability testing with participants who had a recent cardiac event (<2 years). To assess the potential impact of usability testing, the System Usability Scale was administered before and after testing. The GUIDED (Guidance for Reporting Intervention Development Studies in Health Research) checklist was used to report the development process. Results: Five key design principles were identified: simplicity and ease of use, behavioral change through goal setting and self-monitoring, personalization, system credibility, and social support. Usability testing resulted in 64 recommendations for the app, of which 51 were implemented. Improvements in System Usability Scale scores were observed when comparing the results before and after implementing the recommendations (61 vs 83; P=.02). Conclusions: Combining behavior change theory with a person-based, co-design approach facilitated the development of a DHI for the secondary prevention of CVD that optimized responsiveness to end users' needs and preferences, thereby potentially improving future engagement. ",
doi="10.2196/63707",
url="https://humanfactors.jmir.org/2024/1/e63707",
url="http://www.ncbi.nlm.nih.gov/pubmed/39441626"
}


@Article{info:doi/10.2196/54598,
author="McCullough, May Julie Elizabeth
and Sinclair, Marlene
and Gillender, Jonathan
and McCrossan, Brian
and Slater, F. Paul
and Browne, Rosie
and Casey, Frank",
title="Touching Technology---Parents' Experiences of Remote Consultations for Children With Severe Congenital Cardiac Conditions: Quasi-Experimental Cohort Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Oct",
day="22",
volume="7",
pages="e54598",
keywords="congenital heart disease",
keywords="pediatric cardiology",
keywords="pediatric cardiologist",
keywords="pediatric",
keywords="parent",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="telemedicine",
keywords="telehealth",
keywords="virtual care",
keywords="virtual health",
keywords="virtual medicine",
keywords="remote consultation",
keywords="telephone consultation",
keywords="video consultation",
keywords="remote patient monitoring",
keywords="technology acceptance",
keywords="videoconferencing consultations",
abstract="Background: Remote consultations (RCs) using videoconferencing was recommended by the General Medical Council as the method for clinicians to provide patient consultations during the COVID-19 pandemic. Facilitating this while providing high-quality care depends on the usability and acceptability of the technology. Objective: This project aimed to investigate parents' experiences of using videoconferencing technology for real-time RCs with children who had congenital heart defects during the COVID-19 pandemic lockdown. Methods: This study's design was quasi-experimental and was underpinned by the Unified Theory of Acceptance and Use of Technology model that seeks to explain and predict an individual's intention to use a technology. Parents were informed of this study by the medical team, posters were made available in the wards and clinics, and leaflets were left for browsing. Clinician screening of potential participants led to the identification of 33 children and parents who were enrolled on this study. The intervention was a web-based RC by medical staff using a secure, interactive videoconferencing platform (Pexip). Each child and their mother or father received 8 RCs with the same specialist doctor or nurse. Measurements were taken using web-based questionnaires pre and post consultation at the first, middle, and last events; questions were focused on the acceptability, usability, and clinical applicability of RCs. Parents' experiences were explored using recorded interviews and analyzed thematically. Results: In total, 29 children aged 4?1052 (mean 95, SD 191.14) days completed the project, receiving a total of 189 RCs as part of their routine care. Parents' prior experience of consultation via videoconference was low; however, as time progressed, their use and acceptance of the technology increased. The intervention was warmly received by all parents who found the face-to-face component particularly useful for discussion with their child's medical team. Furthermore, parents noted the savings on time, money, and childcare. Conclusions: While in-person consultations are considered the gold standard of patient care, increasing pressures on health services and staff reduce availability. Given the ease of access and additional benefits experienced by parents and their children, it is proposed that hybrid models of consultation and care provision are equal, if not superior, to in-person consultations in the management of children with severe congenital heart defects while reducing costs and pressure on the health service and parents. ",
doi="10.2196/54598",
url="https://pediatrics.jmir.org/2024/1/e54598"
}


@Article{info:doi/10.2196/54978,
author="Zhou, You
and Li, Si-Jia
and Huang, Ren-Qian
and Ma, Hao-Ming
and Wang, Ao-Qi
and Tang, Xing-Yi
and Pei, Run-Yuan
and Piao, Mei-Hua",
title="Behavior Change Techniques Used in Self-Management Interventions Based on mHealth Apps for Adults With Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="22",
volume="26",
pages="e54978",
keywords="hypertension",
keywords="mHealth",
keywords="app",
keywords="behavior change technique",
keywords="systematic review",
keywords="meta-analysis",
keywords="mobile phone",
abstract="Background: Hypertension has become an important global public health challenge. Mobile health (mHealth) intervention is a viable strategy to improve outcomes for patients with hypertension. However, evidence on the effect of mHealth app interventions on self-management in patients with hypertension is yet to be updated, and the active ingredients promoting behavior change in interventions remain unclear. Objective: We aimed to evaluate the effect of mHealth app self-management interventions on blood pressure (BP) management and investigate the use of behavior change techniques (BCTs) in mHealth app interventions. Methods: We conducted a literature search in 6 electronic databases from January 2009 to October 2023 for studies reporting the application of mHealth apps in self-management interventions. The Cochrane Risk of Bias (version 2) tool for randomized controlled trials was used to assess the quality of the studies. BCTs were coded according to the Taxonomy of BCTs (version 1). The extracted data were analyzed using RevMan5.4 software (Cochrane Collaboration). Results: We reviewed 20 studies, of which 16 were included in the meta-analysis. In total, 21 different BCTs (mean 8.7, SD 3.8 BCTs) from 12 BCT categories were reported in mHealth app interventions. The most common BCTs were self-monitoring of outcomes of behavior, feedback on outcomes of behavior, instruction on how to perform the behavior, and pharmacological support. The mHealth app interventions resulted in a --5.78 mm Hg (95\% CI --7.97 mm Hg to --3.59 mm Hg; P<.001) reduction in systolic BP and a --3.28 mm Hg (95\% CI --4.39 mm Hg to --2.17 mm Hg; P<.001) reduction in diastolic BP. The effect of interventions on BP reduction was associated with risk factors, such as hypertension, that were addressed by the mHealth app intervention (multiple risk factors vs a single risk factor: --6.50 mm Hg, 95\% CI --9.00 mm Hg to --3.99 mm Hg vs --1.54 mm Hg, 95\% CI --4.15 mm Hg to 1.06 mm Hg; P=.007); the presence of a theoretical foundation (with vs without behavior change theory: --10.06 mm Hg, 95\% CI --16.42 mm Hg to --3.70 mm Hg vs --4.13 mm Hg, 95\% CI --5.50 to --2.75 mm Hg; P=.07); intervention duration (3 vs ?6 months: --8.87 mm Hg, 95\% CI --10.90 mm Hg to --6.83 mm Hg vs --5.76 mm Hg, 95\% CI --8.74 mm Hg to --2.77 mm Hg; P=.09); and the number of BCTs (?11 vs <11 BCTs: --9.68 mm Hg, 95\% CI --13.49 mm Hg to --5.87 mm Hg vs --2.88 mm Hg, 95\% CI --3.90 mm Hg to --1.86 mm Hg; P<.001). Conclusions: The self-management interventions based on mHealth apps were effective strategies for lowering BP in patients with hypertension. The effect of interventions was influenced by factors related to the study's intervention design and BCT. ",
doi="10.2196/54978",
url="https://www.jmir.org/2024/1/e54978"
}


@Article{info:doi/10.2196/53455,
author="Po, Hui-Wen
and Chu, Ying-Chien
and Tsai, Hui-Chen
and Lin, Chen-Liang
and Chen, Chung-Yu
and Ma, Huei-Ming Matthew",
title="Efficacy of Remote Health Monitoring in Reducing Hospital Readmissions Among High-Risk Postdischarge Patients: Prospective Cohort Study",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="13",
volume="8",
pages="e53455",
keywords="telemonitoring",
keywords="discharge planning",
keywords="case manager",
keywords="hospital readmission",
keywords="telehealth",
keywords="remote healthcare",
keywords="high-risk",
keywords="post-discharge",
keywords="respiratory disease",
keywords="respiratory diseases",
keywords="cardiovascular disease",
keywords="cardiovascular diseases",
keywords="case management",
keywords="patient education",
keywords="readmission",
keywords="health status tracking",
keywords="care guidance",
keywords="medical advice",
keywords="male",
keywords="men",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="home monitoring",
keywords="physiological signal",
keywords="physiological signals",
keywords="mobile phone",
abstract="Background: Patients with respiratory or cardiovascular diseases often experience higher rates of hospital readmission due to compromised heart-lung function and significant clinical symptoms. Effective measures such as discharge planning, case management, home telemonitoring follow-up, and patient education can significantly mitigate hospital readmissions. Objective: This study aimed to determine the efficacy of home telemonitoring follow-up in reducing hospital readmissions, emergency department (ED) visits, and total hospital days for high-risk postdischarge patients. Methods: This prospective cohort study was conducted between July and October 2021. High-risk patients were screened for eligibility and enrolled in the study. The intervention involved implementing home digital monitoring to track patient health metrics after discharge, with the aim of reducing hospital readmissions and ED visits. High-risk patients or their primary caregivers received education on using communication measurement tools and recording and uploading data. Before discharge, patients were familiarized with these tools, which they continued to use for 4 weeks after discharge. A project manager monitored the daily uploaded health data, while a weekly video appointment with the program coordinator monitored the heart and breathing sounds of the patients, tracked health status changes, and gathered relevant data. Care guidance and medical advice were provided based on symptoms and physiological signals. The primary outcomes of this study were the number of hospital readmissions and ED visits within 3 and 6 months after intervention. The secondary outcomes included the total number of hospital days and patient adherence to the home monitoring protocol. Results: Among 41 eligible patients, 93\% (n=38) were male, and 46\% (n=19) were aged 41-60 years, while 46\% (n=19) were aged 60 years or older. The study revealed that home digital monitoring significantly reduced hospitalizations, ED visits, and total hospital stay days at 3 and 6 months after intervention. At 3 months after intervention, average hospitalizations decreased from 0.45 (SD 0.09) to 0.19 (SD 0.09; P=.03), and average ED visits decreased from 0.48 (SD 0.09) to 0.06 (SD 0.04; P<.001). Average hospital days decreased from 6.61 (SD 2.25) to 1.94 (SD 1.15; P=.08). At 6 months after intervention, average hospitalizations decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.01), and average ED visits decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.02). Average hospital days decreased from 7.48 (SD 2.32) to 6.03 (SD 3.12; P=.73). Conclusions: By integrating home telemonitoring with regular follow-up, our research demonstrates a viable approach to reducing hospital readmissions and ED visits, ultimately improving patient outcomes and reducing health care costs. The practical application of telemonitoring in a real-world setting showcases its potential as a scalable solution for chronic disease management. ",
doi="10.2196/53455",
url="https://formative.jmir.org/2024/1/e53455"
}


@Article{info:doi/10.2196/55506,
author="Mir, Hassan
and Cullen, J. Katelyn
and Mosleh, Karen
and Setrak, Rafi
and Jolly, Sanjit
and Tsang, Michael
and Rutledge, Gregory
and Ibrahim, Quazi
and Welsford, Michelle
and Mercuri, Mathew
and Schwalm, JD
and Natarajan, K. Madhu",
title="Smartphone App for Prehospital ECG Transmission in ST-Elevation Myocardial Infarction Activation: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="6",
volume="13",
pages="e55506",
keywords="ST-elevation myocardial infarction",
keywords="m-health",
keywords="cardiac systems of care",
keywords="knowledge mobilization",
keywords="digital health",
keywords="smartphone technology",
keywords="technology",
keywords="STEMI",
keywords="Canada",
keywords="implementation",
keywords="mobile phone",
abstract="Background: Timely diagnosis and treatment for ST-elevation myocardial infarction (STEMI) requires a coordinated response from multiple providers. Rapid intervention is key to reducing mortality and morbidity. Activation of the cardiac catheterization laboratory may occur through verbal communication and may also involve the secure sharing of electrocardiographic images between frontline health care providers and interventional cardiologists. To improve this response, we developed a quick, easy-to-use, privacy-compliant smartphone app, that is SMART AMI-ACS (Strategic Management of Acute Reperfusion and Therapies in Acute Myocardial Infarction Acute Coronary Syndromes), for real-time verbal communication and sharing of electrocardiographic images among health care providers in Ontario, Canada. The app further provides information about diagnosis, management, and risk calculators for patients presenting with acute coronary syndrome. Objective: This study aims to integrate the app into workflow processes to improve communication for STEMI activation, resulting in decreased treatment times, improved patient outcomes, and reduced unnecessary catheterization laboratory activation and transfer. Methods: Implementation of the app will be guided by the Reach, Effectiveness, Acceptability, Implementation, and Maintenance (RE-AIM) framework to measure impact. The study will use quantitative registry data already being collected through the SMART AMI project (STEMI registry), the use of the SMART AMI app, and quantitative and qualitative survey data from physicians. Survey questions will be based on the Consolidated Framework for Implementation Research. Descriptive quantitative analysis and thematic qualitative analysis of survey results will be conducted. Continuous variables will be described using either mean and SD or median and IQR values at pre- and postintervention periods by the study sites. Categorical variables, such as false activation, will be described as frequencies (percentages). For each outcome, an interrupted time series regression model will be fitted to evaluate the impact of the app. Results: The primary outcomes of this study include the usability, acceptability, and functionality of the app for physicians. This will be measured using electronic surveys to identify barriers and facilitators to app use. Other key outcomes will measure the implementation of the app by reviewing the timing-of-care intervals, false ``avoidable'' catheterization laboratory activation rates, and uptake and use of the app by physicians. Prospective evaluation will be conducted between April 1, 2022, and March 31, 2023. However, for the timing- and accuracy-of-care outcomes, registry data will be compared from January 1, 2019, to March 31, 2023. Data analysis is expected to be completed in Fall 2024, with the completion of a paper for publication anticipated by the end of 2024. Conclusions: Smartphone technology is well integrated into clinical practice and widely accessible. The proposed solution being tested is secure and leverages the accessibility of smartphones. Emergency medicine physicians can use this app to quickly, securely, and accurately transmit information ensuring faster and more appropriate decision-making for STEMI activation. Trial Registration: ClinicalTrials.gov NCT05290389; https://clinicaltrials.gov/study/NCT05290389 International Registered Report Identifier (IRRID): DERR1-10.2196/55506 ",
doi="10.2196/55506",
url="https://www.researchprotocols.org/2024/1/e55506",
url="http://www.ncbi.nlm.nih.gov/pubmed/39240681"
}


@Article{info:doi/10.2196/55852,
author="Pohl, Petra
and Klerfors, Karoline
and Kj{\"o}rk, K. Emma",
title="Evaluation of a Digital Previsit Tool for Identifying Stroke-Related Health Problems Before a Follow-Up Visit (Part 1): Survey Study",
journal="JMIR Hum Factors",
year="2024",
month="Sep",
day="3",
volume="11",
pages="e55852",
keywords="e-health",
keywords="stroke",
keywords="Strokeh{\"a}lsa",
keywords="follow-up",
keywords="previsit",
keywords="person-centred care",
keywords="health literacy",
keywords="digital tool",
keywords="shared decision-making",
keywords="survey",
keywords="mobile phone",
abstract="Background: Stroke may lead to various disabilities, and a structured follow-up visit is strongly recommended within a few months after an event. To facilitate this visit, the digital previsit tool ``Strokehealth'' was developed for patients to fill out in advance. The concept Strokeh{\"a}lsa (or Strokehealth) was initially developed in-house as a Windows application, later incorporated in 1177.se. Objective: The study's primary objective was to use a patient satisfaction survey to evaluate the digital previsit tool Strokehealth when used before a follow-up visit, with a focus on feasibility and relevance from the perspective of people with stroke. Our secondary objective was to explore the extent to which the previsit tool identified stroke-related health problems. Methods: Between November 2020 and June 2021, a web-based survey was sent to patients who were scheduled for a follow-up visit after discharge from a stroke unit and had recently filled in the previsit tool. The survey covered demographic characteristics, internet habits, and satisfaction rated using 5 response options. Descriptive statistics were used to present data from both the previsit tool and the survey. We also compared the characteristics of those who completed the previsit tool and those who did not, using nonparametric statistics. Free-text responses were thematically analyzed. Results: All patients filling out the previsit tool (80/171; age: median 67, range 32-91 years) were community-dwelling. Most had experienced a mild stroke and reported a median of 2 stroke-related health problems (range 0-8), and they were significantly younger than nonresponders (P<.001). The survey evaluating the previsit tool was completed by 73\% (58/80; 39 men). The majority (48/58, 83\%) reported using the internet daily. Most respondents (56/58, 97\%) were either satisfied (n=15) or very satisfied (n=41) with how well the previsit tool captured their health problems. The highest level of dissatisfaction was related to the response options in Strokehealth (n=5). Based on the free-text answers to the survey, we developed 4 themes. First, Strokehealth was perceived to provide a structure that ensured that issues would be emphasized and considered. Second, user-friendliness and accessibility were viewed as acceptable, although respondents suggested improvements. Third, participants raised awareness about being approached digitally for communication and highlighted the importance of how to be approached. Fourth, their experiences with Strokehealth were influenced by their perceptions of the explanatory texts, the response options, and the possibility of elaborating on their answers in free text. Conclusions: People with stroke considered the freely available previsit tool Strokehealth feasible for preparing in advance for a follow-up visit. Despite high satisfaction with how well the tool captured their health problems, participants indicated that additional free-text responses and revised information could enhance usability. Improvements need to be considered in parallel with qualitative data to ensure that the tool meets patient needs. Trial Registration: Researchweb 275135; https://www.researchweb.org/is/vgr/project/275135 ",
doi="10.2196/55852",
url="https://humanfactors.jmir.org/2024/1/e55852"
}


@Article{info:doi/10.2196/56921,
author="Klassen, A. Stephen
and Jabbar, Jesica
and Osborne, Jenna
and Iannarelli, J. Nathaniel
and Kirby, S. Emerson
and O'Leary, D. Deborah
and Locke, Sean",
title="Examining the Light Heart Mobile Device App for Assessing Human Pulse Interval and Heart Rate Variability: Validation Study",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="20",
volume="8",
pages="e56921",
keywords="pulse interval",
keywords="mobile app",
keywords="validation",
keywords="mHealth",
keywords="mHealth app",
keywords="app mobile device",
keywords="mobile device app",
keywords="pulse",
keywords="heart",
keywords="heart rate",
keywords="validation study",
keywords="biomarker",
keywords="psychological",
keywords="physiological",
keywords="pulse rate",
keywords="young adults",
keywords="youth",
keywords="linear correlation",
keywords="heart rate variability",
keywords="examining",
keywords="examine",
keywords="validity",
keywords="psychological health",
keywords="physiological health",
keywords="interval data",
keywords="mobile phone",
abstract="Background: Pulse interval is a biomarker of psychological and physiological health. Pulse interval can now be assessed using mobile phone apps, which expands researchers' ability to assess pulse interval in the real world. Prior to implementation, measurement accuracy should be established. Objective: This investigation evaluated the validity of the Light Heart mobile app to measure pulse interval and pulse rate variability in healthy young adults. Methods: Validity was assessed by comparing the pulse interval and SD of normal pulse intervals obtained by Light Heart to the gold standard, electrocardiogram (ECG), in 14 young healthy individuals (mean age 24, SD 5 years; n=9, 64\% female) in a seated posture. Results: Mean pulse interval (Light Heart: 859, SD 113 ms; ECG: 857, SD 112 ms) demonstrated a strong positive linear correlation (r=0.99; P<.001) and strong agreement (intraclass correlation coefficient=1.00, 95\% CI 0.99-1.00) between techniques. The Bland-Altman plot demonstrated good agreement for the mean pulse interval measured with Light Heart and ECG with evidence of fixed bias (--1.56, SD 1.86; 95\% CI --5.2 to 2.1 ms), suggesting that Light Heart overestimates pulse interval by a small margin. When Bland-Altman plots were constructed for each participant's beat-by-beat pulse interval data, all participants demonstrated strong agreement between Light Heart and ECG with no evidence of fixed bias between measures. Heart rate variability, assessed by SD of normal pulse intervals, demonstrated strong agreement between techniques (Light Heart: mean 73, SD 23 ms; ECG: mean 73, SD 22 ms; r=0.99; P<.001; intraclass correlation coefficient=0.99, 95\% CI 0.97-1.00). Conclusions: This study provides evidence to suggest that the Light Heart mobile app provides valid measures of pulse interval and heart rate variability in healthy young adults. ",
doi="10.2196/56921",
url="https://formative.jmir.org/2024/1/e56921"
}


@Article{info:doi/10.2196/52648,
author="Urien, Marie Jean
and Berthelot, Emmanuelle
and Raphael, Pierre
and Moine, Thomas
and Lopes, Emilie Marie
and Assayag, Patrick
and Jourdain, Patrick",
title="Evaluation of a New Telemedicine System for Early Detection of Cardiac Instability in Patients With Chronic Heart Failure: Real-Life Out-of-Hospital Study",
journal="JMIR Cardio",
year="2024",
month="Aug",
day="13",
volume="8",
pages="e52648",
keywords="telemedicine system",
keywords="follow-up",
keywords="detection",
keywords="heart failure",
keywords="chronic heart failure",
keywords="CHF",
keywords="heart disease",
keywords="ambulatory patient",
keywords="ambulatory patients",
keywords="home-based",
keywords="TwoCan Pulse",
keywords="telecardiology",
keywords="cardiology",
keywords="e-device",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="effectiveness",
keywords="real-life setting",
keywords="remote monitoring",
keywords="virtual monitoring",
keywords="France",
keywords="men",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older man",
keywords="ageing",
keywords="aging",
abstract="Background: For a decade, despite results from many studies, telemedicine systems have suffered from a lack of recommendations for chronic heart failure (CHF) care because of variable study results. Another limitation is the hospital-based architecture of most telemedicine systems. Some systems use an algorithm based on daily weight, transcutaneous oxygen measurement, and heart rate to detect and treat acute heart failure (AHF) in patients with CHF as early on as possible. Objective: The aim of this study is to determine the efficacy of a telemonitoring system in detecting clinical destabilization in real-life settings (out-of-hospital management) without generating too many false positive alerts. Methods: All patients self-monitoring at home using the system after a congestive AHF event treated at a cardiology clinic in France between March 2020 and March 2021 with at least 75\% compliance on daily measurements were included retrospectively. New-onset AHF was defined by the presence of at least 1 of the following criteria: transcutaneous oxygen saturation loss, defined as a transcutaneous oxygen measurement under 90\%; rise of cardiac frequency above 110 beats per minute; weight gain of at least 2 kg; and symptoms of congestive AHF, described over the phone. An AHF alert was generated when the criteria reached our definition of new-onset acute congestive heart failure (HF). Results: A total of 111 consecutive patients (n=70 men) with a median age of 76.60 (IQR 69.5-83.4) years receiving the telemonitoring system were included. Thirty-nine patients (35.1\%) reached the HF warning level, and 28 patients (25\%) had confirmed HF destabilization during follow-up. No patient had AHF without being detected by the telemonitoring system. Among incorrect AHF alerts (n=11), 5 patients (45\%) had taken inaccurate measurements, 3 patients (27\%) had supraventricular arrhythmia, 1 patient (9\%) had a pulmonary bacterial infection, and 1 patient (9\%) contracted COVID-19. A weight gain of at least 2 kg within 4 days was significantly associated with a correct AHF alert (P=.004), and a heart rate of more than 110 beats per minute was more significantly associated with an incorrect AHF alert (P=.007). Conclusions: This single-center study highlighted the efficacy of the telemedicine system in detecting and quickly treating cardiac instability complicating the course of CHF by detecting new-onset AHF as well as supraventricular arrhythmia, thus helping cardiologists provide better follow-up to ambulatory patients. ",
doi="10.2196/52648",
url="https://cardio.jmir.org/2024/1/e52648",
url="http://www.ncbi.nlm.nih.gov/pubmed/39137030"
}


@Article{info:doi/10.2196/59948,
author="Carter, Carter Jocelyn A.
and Swack, Natalia
and Isselbacher, Eric
and Donelan, Karen
and Thorndike, Anne",
title="Feasibility, Acceptability, and Preliminary Effectiveness of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Pilot Randomized Controlled Trial",
journal="JMIR Cardio",
year="2024",
month="Aug",
day="8",
volume="8",
pages="e59948",
keywords="heart failure",
keywords="heart",
keywords="cardiology",
keywords="failure",
keywords="clinical pilot trial",
keywords="digital platform",
keywords="home",
keywords="digital health",
keywords="remote monitoring",
keywords="monitoring",
keywords="home-based care",
keywords="community health workers",
keywords="social needs care",
keywords="randomized controlled trial",
keywords="controlled trials",
keywords="feasibility",
keywords="usability",
keywords="acceptability",
keywords="social needs",
abstract="Background: Heart failure (HF) is a burdensome condition and a leading cause of 30-day hospital readmissions in the United States. Clinical and social factors are key drivers of hospitalization. These 2 strategies, digital platforms and home-based social needs care, have shown preliminary effectiveness in improving adherence to clinical care plans and reducing acute care use in HF. Few studies, if any, have tested combining these 2 strategies in a single intervention. Objective: This study aims to perform a pilot randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of a 30-day digitally-enabled community health worker (CHW) intervention in HF. Methods: Adults hospitalized with a diagnosis of HF at an academic hospital were randomly assigned to receive digitally-enabled CHW care (intervention; digital platform +CHW) or CHW-enhanced usual care (control; CHW only) for 30 days after hospital discharge. Primary outcomes were feasibility (use of the platform) and acceptability (willingness to use the platform in the future). Secondary outcomes assessed preliminary effectiveness (30-day readmissions, emergency department visits, and missed clinic appointments). Results: A total of 56 participants were randomized (control: n=31; intervention: n=25) and 47 participants (control: n=28; intervention: n=19) completed all trial activities. Intervention participants who completed trial activities wore the digital sensor on 78\% of study days with mean use of 11.4 (SD 4.6) hours/day, completed symptom questionnaires on 75\% of study days, used the blood pressure monitor 1.1 (SD 0.19) times/day, and used the digital weight scale 1 (SD 0.13) time/day. Of intervention participants, 100\% responded very or somewhat true to the statement ``If I have access to the [platform] moving forward, I will use it.'' Some (n=9, 47\%) intervention participants indicated they required support to use the digital platform. A total of 19 (100\%) intervention participants and 25 (89\%) control participants had ?5 CHW interactions during the 30-day study period. All intervention (n=19, 100\%) and control (n=26, 93\%) participants who completed trial activities indicated their CHW interactions were ``very satisfying.'' In the full sample (N=56), fewer participants in the intervention group were readmitted 30 days after hospital discharge compared to the control group (n=3, 12\% vs n=8, 26\%; P=.12). Both arms had similar rates of missed clinic appointments and emergency department visits. Conclusions: This pilot trial of a digitally-enabled CHW intervention for HF demonstrated feasibility, acceptability, and a clinically relevant reduction in 30-day readmissions among participants who received the intervention. Additional investigation is needed in a larger trial to determine the effect of this intervention on HF home management and clinical outcomes. Trial Registration: Clinicaltrials.gov NCT05130008; https://clinicaltrials.gov/study/NCT05130008 International Registered Report Identifier (IRRID): RR2-10.2196/55687 ",
doi="10.2196/59948",
url="https://cardio.jmir.org/2024/1/e59948",
url="http://www.ncbi.nlm.nih.gov/pubmed/38959294"
}


@Article{info:doi/10.2196/53977,
author="Gaur, Pooja
and Temple, S. Dorota
and Hegarty-Craver, Meghan
and Boyce, D. Matthew
and Holt, R. Jonathan
and Wenger, F. Michael
and Preble, A. Edward
and Eckhoff, P. Randall
and McCombs, S. Michelle
and Davis-Wilson, C. Hope
and Walls, J. Howard
and Dausch, E. David",
title="Continuous Monitoring of Heart Rate Variability in Free-Living Conditions Using Wearable Sensors: Exploratory Observational Study",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="7",
volume="8",
pages="e53977",
keywords="heart rate variability",
keywords="physiological monitoring",
keywords="wearable sensors",
keywords="smartwatch",
keywords="PPG",
keywords="photoplethysmography",
keywords="monitoring",
keywords="physiological",
keywords="heart rate",
keywords="wearable",
keywords="wearables",
keywords="sensor",
keywords="sensors",
keywords="observation study",
keywords="wearable devices",
keywords="devices",
keywords="remote monitoring",
keywords="community",
keywords="data platform",
keywords="data collection",
keywords="health risk",
abstract="Background: Wearable physiological monitoring devices are promising tools for remote monitoring and early detection of potential health changes of interest. The widespread adoption of such an approach across communities and over long periods of time will require an automated data platform for collecting, processing, and analyzing relevant health information. Objective: In this study, we explore prospective monitoring of individual health through an automated data collection, metrics extraction, and health anomaly analysis pipeline in free-living conditions over a continuous monitoring period of several months with a focus on viral respiratory infections, such as influenza or COVID-19. Methods: A total of 59 participants provided smartwatch data and health symptom and illness reports daily over an 8-month window. Physiological and activity data from photoplethysmography sensors, including high-resolution interbeat interval (IBI) and step counts, were uploaded directly from Garmin Fenix 6 smartwatches and processed automatically in the cloud using a stand-alone, open-source analytical engine. Health risk scores were computed based on a deviation in heart rate and heart rate variability metrics from each individual's activity-matched baseline values, and scores exceeding a predefined threshold were checked for corresponding symptoms or illness reports. Conversely, reports of viral respiratory illnesses in health survey responses were also checked for corresponding changes in health risk scores to qualitatively assess the risk score as an indicator of acute respiratory health anomalies. Results: The median average percentage of sensor data provided per day indicating smartwatch wear compliance was 70\%, and survey responses indicating health reporting compliance was 46\%. A total of 29 elevated health risk scores were detected, of which 12 (41\%) had concurrent survey data and indicated a health symptom or illness. A total of 21 influenza or COVID-19 illnesses were reported by study participants; 9 (43\%) of these reports had concurrent smartwatch data, of which 6 (67\%) had an increase in health risk score. Conclusions: We demonstrate a protocol for data collection, extraction of heart rate and heart rate variability metrics, and prospective analysis that is compatible with near real-time health assessment using wearable sensors for continuous monitoring. The modular platform for data collection and analysis allows for a choice of different wearable sensors and algorithms. Here, we demonstrate its implementation in the collection of high-fidelity IBI data from Garmin Fenix 6 smartwatches worn by individuals in free-living conditions, and the prospective, near real-time analysis of the data, culminating in the calculation of health risk scores. To our knowledge, this study demonstrates for the first time the feasibility of measuring high-resolution heart IBI and step count using smartwatches in near real time for respiratory illness detection over a long-term monitoring period in free-living conditions. ",
doi="10.2196/53977",
url="https://formative.jmir.org/2024/1/e53977"
}


@Article{info:doi/10.2196/46319,
author="Chen, Wenfei
and Chen, Jiana
and Jiang, Shaojun
and Wang, Chunhua
and Zhang, Jinhua",
title="Web-Based Warfarin Management (Alfalfa App) Versus Traditional Warfarin Management: Multicenter Prospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="29",
volume="26",
pages="e46319",
keywords="warfarin",
keywords="telemedicine",
keywords="smart phone application",
keywords="anti-coagulation management",
keywords="management",
keywords="cohort study",
keywords="application",
keywords="chronic disease",
keywords="support",
keywords="effectiveness",
keywords="online model",
keywords="patient management",
abstract="Background: Poor anticoagulation management of warfarin may lead to patient admission, prolonged hospital stays, and even death due to anticoagulation-related adverse events. Traditional non--web-based outpatient clinics struggle to provide ideal anticoagulation management services for patients, and there is a need to explore a safer, more effective, and more convenient mode of warfarin management. Objective: This study aimed to compare differences in the quality of anticoagulation management and clinical adverse events between a web-based management model (via a smartphone app) and the conventional non--web-based outpatient management model. Methods: This study is a prospective cohort research that includes multiple national centers. Patients meeting the nadir criteria were split into a web-based management group using the Alfalfa app or a non--web-based management group with traditional outpatient management, and they were then monitored for a 6-month follow-up period to collect coagulation test results and clinical events. The effectiveness and safety of the 2 management models were assessed by the following indicators: time in therapeutic range (TTR), bleeding events, thromboembolic events, all-cause mortality events, cumulative event rates, and the distribution of the international normalized ratio (INR). Results: This national multicenter cohort study enrolled 522 patients between June 2019 and May 2021, with 519 (99\%) patients reaching the follow-up end point, including 260 (50\%) in the non--web-based management group and 259 (50\%) in the web-based management group. There were no observable differences in baseline characteristics between the 2 patient groups. The web-based management group had a significantly higher TTR than the non--web-based management group (82.4\% vs 71.6\%, P<.001), and a higher proportion of patients received effective anticoagulation management (81.2\% vs 63.5\%, P<.001). The incidence of minor bleeding events in the non--web-based management group was significantly higher than that in the web-based management group (12.1\% vs 6.6\%, P=.048). Between the 2 groups, there was no statistically significant difference in the incidence of severe bleeding and thromboembolic and all-cause death events. In addition, compared with the non--web-based management group, the web-based management group had a lower proportion of INR in the extreme subtreatment range (17.6\% vs 21.3\%) and severe supertreatment range (0\% vs 0.8\%) and a higher proportion in the treatment range (50.4\% vs 43.1\%), with statistical significance. Conclusions: Compared with traditional non--web-based outpatient management, web-based management via the Alfalfa app may be more beneficial because it can enhance patient anticoagulation management quality, lower the frequency of small bleeding events, and improve INR distribution. ",
doi="10.2196/46319",
url="https://www.jmir.org/2024/1/e46319",
url="http://www.ncbi.nlm.nih.gov/pubmed/39073869"
}


@Article{info:doi/10.2196/56345,
author="Razjouyan, Javad
and Orkaby, R. Ariela
and Horstman, J. Molly
and Goyal, Parag
and Intrator, Orna
and Naik, D. Aanand",
title="The Frailty Trajectory's Additional Edge Over the Frailty Index: Retrospective Cohort Study of Veterans With Heart Failure",
journal="JMIR Aging",
year="2024",
month="Jun",
day="27",
volume="7",
pages="e56345",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="aging",
keywords="frailty",
keywords="frailty index",
keywords="frailty trajectory",
keywords="frail",
keywords="weak",
keywords="weakness",
keywords="heart failure",
keywords="HF",
keywords="cardiovascular disease",
keywords="CVD",
keywords="congestive heart failure",
keywords="CHF",
keywords="myocardial infarction",
keywords="MI",
keywords="unstable angina",
keywords="angina",
keywords="cardiac arrest",
keywords="atherosclerosis",
keywords="cardiology",
keywords="cardiac",
keywords="cardiologist",
keywords="cardiologists",
doi="10.2196/56345",
url="https://aging.jmir.org/2024/1/e56345"
}


@Article{info:doi/10.2196/57111,
author="Huecker, Martin
and Schutzman, Craig
and French, Joshua
and El-Kersh, Karim
and Ghafghazi, Shahab
and Desai, Ravi
and Frick, Daniel
and Thomas, Jeremy Jarred",
title="Accurate Modeling of Ejection Fraction and Stroke Volume With Mobile Phone Auscultation: Prospective Case-Control Study",
journal="JMIR Cardio",
year="2024",
month="Jun",
day="26",
volume="8",
pages="e57111",
keywords="ejection fraction",
keywords="stroke volume",
keywords="auscultation",
keywords="digital health",
keywords="telehealth",
keywords="acoustic recording",
keywords="acoustic recordings",
keywords="acoustic",
keywords="mHealth",
keywords="mobile health",
keywords="mobile phone",
keywords="mobile phones",
keywords="heart failure",
keywords="heart",
keywords="cardiac",
keywords="cardiology",
keywords="health care costs",
keywords="audio",
keywords="echocardiographic",
keywords="echocardiogram",
keywords="ultrasonography",
keywords="echocardiography",
keywords="accuracy",
keywords="monitoring",
keywords="telemonitoring",
keywords="recording",
keywords="recordings",
keywords="ejection",
keywords="machine learning",
keywords="algorithm",
keywords="algorithms",
abstract="Background: Heart failure (HF) contributes greatly to morbidity, mortality, and health care costs worldwide. Hospital readmission rates are tracked closely and determine federal reimbursement dollars. No current modality or technology allows for accurate measurement of relevant HF parameters in ambulatory, rural, or underserved settings. This limits the use of telehealth to diagnose or monitor HF in ambulatory patients. Objective: This study describes a novel HF diagnostic technology using audio recordings from a standard mobile phone. Methods: This prospective study of acoustic microphone recordings enrolled convenience samples of patients from 2 different clinical sites in 2 separate areas of the United States. Recordings were obtained at the aortic (second intercostal) site with the patient sitting upright. The team used recordings to create predictive algorithms using physics-based (not neural networks) models. The analysis matched mobile phone acoustic data to ejection fraction (EF) and stroke volume (SV) as evaluated by echocardiograms. Using the physics-based approach to determine features eliminates the need for neural networks and overfitting strategies entirely, potentially offering advantages in data efficiency, model stability, regulatory visibility, and physical insightfulness. Results: Recordings were obtained from 113 participants. No recordings were excluded due to background noise or for any other reason. Participants had diverse racial backgrounds and body surface areas. Reliable echocardiogram data were available for EF from 113 patients and for SV from 65 patients. The mean age of the EF cohort was 66.3 (SD 13.3) years, with female patients comprising 38.3\% (43/113) of the group. Using an EF cutoff of ?40\% versus >40\%, the model (using 4 features) had an area under the receiver operating curve (AUROC) of 0.955, sensitivity of 0.952, specificity of 0.958, and accuracy of 0.956. The mean age of the SV cohort was 65.5 (SD 12.7) years, with female patients comprising 34\% (38/65) of the group. Using a clinically relevant SV cutoff of <50 mL versus >50 mL, the model (using 3 features) had an AUROC of 0.922, sensitivity of 1.000, specificity of 0.844, and accuracy of 0.923. Acoustics frequencies associated with SV were observed to be higher than those associated with EF and, therefore, were less likely to pass through the tissue without distortion. Conclusions: This work describes the use of mobile phone auscultation recordings obtained with unaltered cellular microphones. The analysis reproduced the estimates of EF and SV with impressive accuracy. This technology will be further developed into a mobile app that could bring screening and monitoring of HF to several clinical settings, such as home or telehealth, rural, remote, and underserved areas across the globe. This would bring high-quality diagnostic methods to patients with HF using equipment they already own and in situations where no other diagnostic and monitoring options exist. ",
doi="10.2196/57111",
url="https://cardio.jmir.org/2024/1/e57111"
}


@Article{info:doi/10.2196/55953,
author="V{\"o}geli, Benjamin
and Arenja, Nisha
and Sch{\"u}tz, Narayan
and Nef, Tobias
and Buluschek, Philipp
and Saner, Hugo",
title="Evaluation of Ambient Sensor Systems for the Early Detection of Heart Failure Decompensation in Older Patients Living at Home Alone: Protocol for a Prospective Cohort Study",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="31",
volume="13",
pages="e55953",
keywords="heart failure",
keywords="home telemonitoring",
keywords="digital health",
keywords="biomarker",
keywords="ambient sensor system",
abstract="Background: The results of telemedicine intervention studies in patients with heart failure (HF) to reduce rehospitalization rate and mortality by early detection of HF decompensation are encouraging. However, the benefits are lower than expected. A possible reason for this could be the fact that vital signs, including blood pressure, heart rate, heart rhythm, and weight changes, may not be ideal indicators of the early stages of HF decompensation but are more sensitive for acute events triggered by ischemic episodes or rhythm disturbances. Preliminary results indicate a potential role of ambient sensor--derived digital biomarkers in this setting. Objective: The aim of this study is to identify changes in ambient sensor system--derived digital biomarkers with a high potential for early detection of HF decompensation. Methods: This is a prospective interventional cohort study. A total of 24 consecutive patients with HF aged 70 years and older, living alone, and hospitalized for HF decompensation will be included. Physical activity in the apartment and toilet visits are quantified using a commercially available, passive, infrared motion sensing system (DomoHealth SA). Heart rate, respiration rate, and toss-and-turns in bed are recorded by using a commercially available Emfit QS device (Emfit Ltd), which is a contact-free piezoelectric sensor placed under the participant's mattress. Sensor data are visualized on a dedicated dashboard for easy monitoring by health professionals. Digital biomarkers are evaluated for predefined signs of HF decompensation, including particularly decreased physical activity; time spent in bed; increasing numbers of toilet visits at night; and increasing heart rate, respiration rate, and motion in bed at night. When predefined changes in digital biomarkers occur, patients will be called in for clinical evaluation, and N-terminal pro b-type natriuretic peptide measurement (an increase of >30\% considered as significant) will be performed. The sensitivity and specificity of the different biomarkers and their combinations for the detection of HF decompensation will be calculated. Results: The study is in the data collection phase. Study recruitment started in February 2024. Data analysis is scheduled to start after all data are collected. As of manuscript submission, 5 patients have been recruited. Results are expected to be published by the end of 2025. Conclusions: The results of this study will add to the current knowledge about opportunities for telemedicine to monitor older patients with HF living at home alone by evaluating the potential of ambient sensor systems for this purpose. Timely recognition of HF decompensation could enable proactive management, potentially reducing health care costs associated with preventable emergency presentations or hospitalizations. Trial Registration: ClinicalTrials.gov NCT06126848; https://clinicaltrials.gov/study/NCT06126848 International Registered Report Identifier (IRRID): PRR1-10.2196/55953 ",
doi="10.2196/55953",
url="https://www.researchprotocols.org/2024/1/e55953",
url="http://www.ncbi.nlm.nih.gov/pubmed/38820577"
}


@Article{info:doi/10.2196/52647,
author="Mittal, Ajay
and Elkaldi, Yasmine
and Shih, Susana
and Nathu, Riken
and Segal, Mark",
title="Mobile Electrocardiograms in the Detection of Subclinical Atrial Fibrillation in High-Risk Outpatient Populations: Protocol for an Observational Study",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="27",
volume="13",
pages="e52647",
keywords="mobile ECG",
keywords="digital health",
keywords="cardiology",
keywords="ECG",
keywords="electrocardiogram",
keywords="atrial fibrillation",
keywords="outpatient",
keywords="randomized",
keywords="controlled trial",
keywords="controlled trials",
keywords="smartphone",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="feasibility",
keywords="effectiveness",
keywords="KardiaMobile single-lead ECGs",
keywords="mobile phone",
abstract="Background: Single-lead, smartphone-based mobile electrocardiograms (ECGs) have the potential to provide a noninvasive, rapid, and cost-effective means of screening for atrial fibrillation (AFib) in outpatient settings. AFib has been associated with various comorbid diseases that prompt further investigation and screening methodologies for at-risk populations. A simple 30-second sinus rhythm strip from the KardiaMobile ECG (AliveCor) can provide an effective screen for cardiac rhythm abnormalities. Objective: The aim of this study is to demonstrate the feasibility of performing Kardia-enabled ECG recordings routinely in outpatient settings in high-risk populations and its potential use in uncovering previous undiagnosed cases of AFib. Specific aim 1 is to determine the feasibility and accuracy of performing routine cardiac rhythm sampling in patients deemed at high risk for AFib. Specific aim 2 is to determine whether routine rhythm sampling in outpatient clinics with high-risk patients can be used cost-effectively in an outpatient clinic without increasing the time it takes for the patient to be seen by a physician. Methods: Participants were recruited across 6 clinic sites across the University of Florida Health Network: University of Florida Health Nephrology, Sleep Center, Ophthalmology, Urology, Neurology, and Pre-Surgical. Participants, aged 18-99 years, who agreed to partake in the study were given a consent form and completed a questionnaire regarding their past medical history and risk factors for cardiovascular disease. Single-lead, 30-second ECGs were taken by the KardiaMobile ECG device. If patients are found to have newly diagnosed AFib, the attending physician is notified, and a 12-lead ECG or standard ECG equivalent will be ordered. Results: As of March 1, 2024, a total of 2339 participants have been enrolled. Of the data collected thus far, the KardiaMobile rhythm strip reported 381 abnormal readings, which are pending analysis from a cardiologist. A total of 78 readings were labeled as possible AFib, 159 readings were labeled unclassified, and 49 were unreadable. Of note, the average age of participants was 61 (SD 10.25) years, and the average self-reported weight was 194 (SD 14.26) pounds. Additionally, 1572 (67.25\%) participants report not regularly seeing a cardiologist. Regarding feasibility, the average length of enrolling a patient into the study was 3:30 (SD 0.5) minutes after informed consent was completed, and medical staff across clinic sites (n=25) reported 9 of 10 level of satisfaction with the impact of the screening on clinic flow. Conclusions: Preliminary data show promise regarding the feasibility of using KardiaMobile ECGs for the screening of AFib and prevention of cardiological disease in vulnerable outpatient populations. The use of a single-lead mobile ECG strip can serve as a low-cost, effective AFib screen for implementation across free clinics attempting to provide increased health care accessibility. International Registered Report Identifier (IRRID): DERR1-10.2196/52647 ",
doi="10.2196/52647",
url="https://www.researchprotocols.org/2024/1/e52647",
url="http://www.ncbi.nlm.nih.gov/pubmed/38801762"
}


@Article{info:doi/10.2196/53500,
author="Zakiyah, Neily
and Marulin, Dita
and Alfaqeeh, Mohammed
and Puspitasari, Melyani Irma
and Lestari, Keri
and Lim, Keat Ka
and Fox-Rushby, Julia",
title="Economic Evaluations of Digital Health Interventions for Patients With Heart Failure: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="30",
volume="26",
pages="e53500",
keywords="digital health",
keywords="telemonitoring",
keywords="telehealth",
keywords="heart failure",
keywords="cost-effectiveness",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Digital health interventions (DHIs) have shown promising results in enhancing the management of heart failure (HF). Although health care interventions are increasingly being delivered digitally, with growing evidence on the potential cost-effectiveness of adopting them, there has been little effort to collate and synthesize the findings. Objective: This study's objective was to systematically review the economic evaluations that assess the adoption of DHIs in the management and treatment of HF. Methods: A systematic review was conducted using 3 electronic databases: PubMed, EBSCOhost, and Scopus. Articles reporting full economic evaluations of DHIs for patients with HF published up to July 2023 were eligible for inclusion. Study characteristics, design (both trial based and model based), input parameters, and main results were extracted from full-text articles. Data synthesis was conducted based on the technologies used for delivering DHIs in the management of patients with HF, and the findings were analyzed narratively. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. The reporting quality of the included studies was evaluated using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Results: Overall, 27 economic evaluations were included in the review. The economic evaluations were based on models (13/27, 48\%), trials (13/27, 48\%), or a combination approach (1/27, 4\%). The devices evaluated included noninvasive remote monitoring devices (eg, home telemonitoring using digital tablets or specific medical devices that enable transmission of physiological data), telephone support, mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems. Most of the studies (24/27, 89\%) used cost-utility analysis. The majority of the studies (25/27, 93\%) were conducted in high-income countries, particularly European countries (16/27, 59\%) such as the United Kingdom and the Netherlands. Mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems yielded cost-effective results or even emerged as dominant strategies. However, conflicting results were observed, particularly in noninvasive remote monitoring devices and telephone support. In 15\% (4/27) of the studies, these DHIs were found to be less costly and more effective than the comparators (ie, dominant), while 33\% (9/27) reported them to be more costly but more effective with incremental cost-effectiveness ratios below the respective willingness-to-pay thresholds (ie, cost-effective). Furthermore, in 11\% (3/27) of the studies, noninvasive remote monitoring devices and telephone support were either above the willingness-to-pay thresholds or more costly than, yet as effective as, the comparators (ie, not cost-effective). In terms of reporting quality, the studies were classified as good (20/27, 74\%), moderate (6/27, 22\%), or excellent (1/27, 4\%). Conclusions: Despite the conflicting results, the main findings indicated that, overall, DHIs were more cost-effective than non-DHI alternatives. Trial Registration: PROSPERO CRD42023388241; https://tinyurl.com/2p9axpmc ",
doi="10.2196/53500",
url="https://www.jmir.org/2024/1/e53500",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687991"
}


@Article{info:doi/10.2196/47616,
author="Raes, Sarah
and Prezzi, Andrea
and Willems, Rik
and Heidbuchel, Hein
and Annemans, Lieven",
title="Investigating the Cost-Effectiveness of Telemonitoring Patients With Cardiac Implantable Electronic Devices: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="19",
volume="26",
pages="e47616",
keywords="systematic review",
keywords="cost-effectiveness",
keywords="telemonitoring",
keywords="cardiac device",
keywords="implantable cardioverter-defibrillator",
keywords="ICD",
keywords="pacemaker",
keywords="monitoring",
keywords="patient management",
keywords="effectiveness",
keywords="cost",
keywords="quality of life",
keywords="cardiac implantable electronic device",
keywords="cardiac",
abstract="Background: Telemonitoring patients with cardiac implantable electronic devices (CIEDs) can improve their care management. However, the results of cost-effectiveness studies are heterogeneous. Therefore, it is still a matter of debate whether telemonitoring is worth the investment. Objective: This systematic review aims to investigate the cost-effectiveness of telemonitoring patients with CIEDs, focusing on its key drivers, and the impact of the varying perspectives. Methods: A systematic review was performed in PubMed, Web of Science, Embase, and EconLit. The search was completed on July 7, 2022. Studies were included if they fulfilled the following criteria: patients had a CIED, comparison with standard care, and inclusion of health economic evaluations (eg, cost-effectiveness analyses and cost-utility analyses). Only complete and peer-reviewed studies were included, and no year limits were applied. The exclusion criteria included studies with partial economic evaluations, systematic reviews or reports, and studies without standard care as a control group. Besides general study characteristics, the following outcome measures were extracted: impact on total cost or income, cost or income drivers, cost or income drivers per patient, cost or income drivers as a percentage of the total cost impact, incremental cost-effectiveness ratios, or cost-utility ratios. Quality was assessed using the Consensus Health Economic Criteria checklist. Results: Overall, 15 cost-effectiveness analyses were included. All studies were performed in Western countries, mainly Europe, and had primarily a male participant population. Of the 15 studies, 3 (20\%) calculated the incremental cost-effectiveness ratio, 1 (7\%) the cost-utility ratio, and 11 (73\%) the health and cost impact of telemonitoring. In total, 73\% (11/15) of the studies indicated that telemonitoring of patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy ICDs was cost-effective and cost-saving, both from a health care and patient perspective. Cost-effectiveness results for telemonitoring of patients with pacemakers were inconclusive. The key drivers for cost reduction from a health care perspective were hospitalizations and scheduled in-office visits. Hospitalization costs were reduced by up to US \$912 per patient per year. Scheduled in-office visits included up to 61\% of the total cost reduction. Key drivers for cost reduction from a patient perspective were loss of income, cost for scheduled in-office visits and transport. Finally, of the 15 studies, 8 (52\%) reported improved quality of life, with statistically significance in only 1 (13\%) study (P=.03). Conclusions: From a health care and patient perspective, telemonitoring of patients with an ICD or a cardiac resynchronization therapy ICD is a cost-effective and cost-saving alternative to standard care. Inconclusive results were found for patients with pacemakers. However, telemonitoring can lead to a decrease in providers' income, mainly due to a lack of reimbursement. Introducing appropriate reimbursement could make telemonitoring sustainable for providers while still being cost-effective from a health care payer perspective. Trial Registration: PROSPERO CRD42022322334; https://tinyurl.com/puunapdr ",
doi="10.2196/47616",
url="https://www.jmir.org/2024/1/e47616",
url="http://www.ncbi.nlm.nih.gov/pubmed/38640471"
}


@Article{info:doi/10.2196/42402,
author="Han, Yunmin
and Sung, Hoyong
and Kim, Geonhui
and Ryu, Yeun
and Yoon, Jiyeon
and Kim, Soo Yeon",
title="Effects of a Web-based Weight Management Education Program on Various Factors for Overweight and Obese Women: Randomized Controlled Trial",
journal="JMIR Cardio",
year="2024",
month="Apr",
day="18",
volume="8",
pages="e42402",
keywords="weight loss",
keywords="obesity",
keywords="health education",
keywords="self-management",
keywords="health promotion",
keywords="tailored feedback",
keywords="web-based intervention",
keywords="behavior change",
abstract="Background: Mediated diet and exercise methods yield effective short-term weight loss but are costly and hard to manage. However, web-based programs can serve many participants, offering ease of access and cost-efficiency. Objective: This study aimed to compare the effectiveness of a web-based weight management program through web-based education alone (MINE) or combined with tailored video feedback (MINE Plus) with a control (CO) group. Methods: This intervention included 60 Korean women with overweight and obesity (BMI?23 kg/m2) aged 19 years to 39 years old. We randomly allocated 60 participants to each of 3 groups: (1) MINE group (web-based education video and self-monitoring app), (2) MINE Plus group (web-based education video, self-monitoring app, and 1:1 tailored video feedback), and (3) CO group (only self-monitoring app). Web-based education included nutrition, physical activity, psychological factors, medical knowledge for weight loss, goal setting, and cognitive and behavioral strategies. Tailored feedback aimed to motivate and provide solutions via weekly 10-minute real-time video sessions. The intervention lasted 6 weeks, followed by a 6-week observation period to assess the education's lasting effects, with evaluations at baseline, 6 weeks, and 12 weeks. A generalized linear mixed model was used to evaluate time and group interactions. Results: In the intention-to-treat analysis including all 60 participants, there were significant differences in weight change at 6 weeks in the MINE and MINE Plus groups, with mean weight changes of --0.74 (SD 1.96) kg (P=.03) and --1.87 (SD 1.8) kg (P<.001), respectively, while no significant change was observed in the CO group, who had a mean weight increase of 0.03 (SD 1.68) kg (P=.91). After 12 weeks, changes in body weight were --1.65 (SD 2.64) kg in the MINE group, --1.59 (SD 2.79) kg in the MINE Plus group, and 0.43 (SD 1.42) kg in the CO group. There was a significant difference between the MINE and MINE Plus groups (P<.001). Significant group {\texttimes} time effects were found for body weight in the MINE and CO groups (P<.001) and in the MINE Plus and CO groups (P<.001), comparing baseline and 12 weeks. Regarding physical activity and psychological factors, only body shape satisfaction and health self-efficacy were associated with improvements in the MINE and MINE Plus groups (P<.001). Conclusions: This study found that the group receiving education and tailored feedback showed significant weight loss and improvements in several psychological factors, though there were differences in the sustainability of the effects. Trial Registration: Korea Disease Control and Prevention Agency (KDCA) KCT0007780: https://cris.nih.go.kr/cris/search/detailSearch.do/22861 ",
doi="10.2196/42402",
url="https://cardio.jmir.org/2024/1/e42402",
url="http://www.ncbi.nlm.nih.gov/pubmed/38635975"
}


@Article{info:doi/10.2196/54801,
author="Wang, Xuzhi
and Zhang, Yuankai
and Pathiravasan, H. Chathurangi
and Ukonu, C. Nene
and Rong, Jian
and Benjamin, J. Emelia
and McManus, D. David
and Larson, G. Martin
and Vasan, S. Ramachandran
and Hamburg, M. Naomi
and Murabito, M. Joanne
and Liu, Chunyu
and Mitchell, F. Gary",
title="Association of Arterial Stiffness With Mid- to Long-Term Home Blood Pressure Variability in the Electronic Framingham Heart Study: Cohort Study",
journal="JMIR Cardio",
year="2024",
month="Apr",
day="8",
volume="8",
pages="e54801",
keywords="arterial stiffness",
keywords="mobile health",
keywords="mHealth",
keywords="blood pressure",
keywords="blood pressure variability",
keywords="risk factors",
abstract="Background: Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies have examined associations between arterial stiffness and digital home BPV over a mid- to long-term time span, irrespective of underlying hypertension. Objective: This study aims to investigate if arterial stiffness traits were associated with subsequent mid- to long-term home BPV in the electronic Framingham Heart Study (eFHS). We hypothesized that higher arterial stiffness was associated with higher home BPV over up to 1-year follow-up. Methods: At a Framingham Heart Study research examination (2016-2019), participants underwent arterial tonometry to acquire measures of arterial stiffness (carotid-femoral pulse wave velocity [CFPWV]; forward pressure wave amplitude [FWA]) and wave reflection (reflection coefficient [RC]). Participants who agreed to enroll in eFHS were provided with a digital blood pressure (BP) cuff to measure home BP weekly over up to 1-year follow-up. Participants with less than 3 weeks of BP readings were excluded. Linear regression models were used to examine associations of arterial measures with average real variability (ARV) of week-to-week home systolic (SBP) and diastolic (DBP) BP adjusting for important covariates. We obtained ARV as an average of the absolute differences of consecutive home BP measurements. ARV considers not only the dispersion of the BP readings around the mean but also the order of BP readings. In addition, ARV is more sensitive to measurement-to-measurement BPV compared with traditional BPV measures. Results: Among 857 eFHS participants (mean age 54, SD 9 years; 508/857, 59\% women; mean SBP/DBP 119/76 mm Hg; 405/857, 47\% hypertension), 1 SD increment in FWA was associated with 0.16 (95\% CI 0.09-0.23) SD increments in ARV of home SBP and 0.08 (95\% CI 0.01-0.15) SD increments in ARV of home DBP; 1 SD increment in RC was associated with 0.14 (95\% CI 0.07-0.22) SD increments in ARV of home SBP and 0.11 (95\% CI 0.04-0.19) SD increments in ARV of home DBP. After adjusting for important covariates, there was no significant association between CFPWV and ARV of home SBP, and similarly, no significant association existed between CFPWV and ARV of home DBP (P>.05). Conclusions: In eFHS, higher FWA and RC were associated with higher mid- to long-term ARV of week-to-week home SBP and DBP over 1-year follow-up in individuals across the BP spectrum. Our findings suggest that higher aortic stiffness and wave reflection are associated with higher week-to-week variation of BP in a home-based setting over a mid- to long-term time span. ",
doi="10.2196/54801",
url="https://cardio.jmir.org/2024/1/e54801",
url="http://www.ncbi.nlm.nih.gov/pubmed/38587880"
}


@Article{info:doi/10.2196/46098,
author="Ahn, Hyo-Jeong
and Choi, Eue-Keun
and Lee, So-Ryoung
and Kwon, Soonil
and Song, Hee-Seok
and Lee, Young-Shin
and Oh, Seil",
title="Three-Day Monitoring of Adhesive Single-Lead Electrocardiogram Patch for Premature Ventricular Complex: Prospective Study for Diagnosis Validation and Evaluation of Burden Fluctuation",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="21",
volume="26",
pages="e46098",
keywords="premature ventricular complex",
keywords="single-lead electrocardiogram",
keywords="wearable device",
keywords="extended monitor",
keywords="electrocardiogram",
keywords="EKG",
keywords="ECG",
keywords="wearable",
keywords="heart",
keywords="cardiology",
keywords="cardiovascular",
abstract="Background: Wearable electrocardiogram (ECG) monitoring devices are used worldwide. However, data on the diagnostic yield of an adhesive single-lead ECG patch (SEP) to detect premature ventricular complex (PVC) and the optimal duration of wearing an SEP for PVC burden assessment are limited. Objective: We aimed to validate the diagnostic yield of an SEP (mobiCARE MC-100, Seers Technology) for PVC detection and evaluate the PVC burden variation recorded by the SEP over a 3-day monitoring period. Methods: This is a prospective study of patients with documented PVC on a 12-lead ECG. Patients underwent simultaneous ECG monitoring with the 24-hour Holter monitor and SEP on the first day. On the subsequent second and third days, ECG monitoring was continued using only SEP, and a 3-day extended monitoring was completed. The diagnostic yield of SEP for PVC detection was evaluated by comparison with the results obtained on the first day of Holter monitoring. The PVC burden monitored by SEP for 3 days was used to assess the daily and 6-hour PVC burden variations. The number of patients additionally identified to reach PVC thresholds of 10\%, 15\%, and 20\% during the 3-day extended monitoring by SEP and the clinical factors associated with the higher PVC burden variations were explored. Results: The recruited data of 134 monitored patients (mean age, 54.6 years; males, 45/134, 33.6\%) were analyzed. The median daily PVC burden of these patients was 2.4\% (IQR 0.2\%-10.9\%), as measured by the Holter monitor, and 3.3\% (IQR 0.3\%-11.7\%), as measured in the 3-day monitoring by SEP. The daily PVC burden detected on the first day of SEP was in agreement with that of the Holter monitor: the mean difference was --0.07\%, with 95\% limits of agreement of --1.44\% to 1.30\%. A higher PVC burden on the first day was correlated with a higher daily (R2=0.34) and 6-hour burden variation (R2=0.48). Three-day monitoring by SEP identified 29\% (12/42), 18\% (10/56), and 7\% (4/60) more patients reaching 10\%, 15\%, and 20\% of daily PVC burden, respectively. Younger age was additionally associated with the identification of clinically significant PVC burden during the extended monitoring period (P=.02). Conclusions: We found that the mobiCARE MC-100 SEP accurately detects PVC with comparable diagnostic yield to the 24-hour Holter monitor. Performing 3-day PVC monitoring with SEP, especially among younger patients, may offer a pragmatic alternative for identifying more individuals exceeding the clinically significant PVC burden threshold. ",
doi="10.2196/46098",
url="https://www.jmir.org/2024/1/e46098",
url="http://www.ncbi.nlm.nih.gov/pubmed/38512332"
}


@Article{info:doi/10.2196/53835,
author="Hofner, Michael
and Hurnaus, Patrick
and DiStefano, Dan
and Philip, Shaji
and Kim, Sarah
and Shaw, Julie
and Waring, Chander Avantika",
title="Outcomes of an Asynchronous Care Model for Chronic Conditions in a Diverse Population: 12-Month Retrospective Chart Review Study",
journal="JMIR Diabetes",
year="2024",
month="Mar",
day="13",
volume="9",
pages="e53835",
keywords="asynchronous",
keywords="blood pressure",
keywords="cardiology",
keywords="chronic disease",
keywords="cohort",
keywords="diabetes mellitus therapy",
keywords="diabetes",
keywords="diabetics",
keywords="eHealth",
keywords="e-health",
keywords="HbA1c",
keywords="health disparities",
keywords="heart",
keywords="hemoglobin A1c",
keywords="hypertension therapy",
keywords="hypertension",
keywords="hypertensive",
keywords="remote care",
keywords="retrospective",
keywords="telehealth",
keywords="telemedicine",
keywords="virtual care",
abstract="Background: Diabetes and hypertension are some of the most prevalent and costly chronic conditions in the United States. However, outcomes continue to lag behind targets, creating further risk of long-term complications, morbidity, and mortality for people living with these conditions. Furthermore, racial and ethnic disparities in glycemic and hypertension control persist. Flexible telehealth programs leveraging asynchronous care allow for increased provider access and more convenient follow-up, ultimately improving critical health outcomes across demographic groups. Objective: We aim to evaluate the 12-month clinical outcomes of participants in the 9amHealth web-based clinic for diabetes and hypertension. We hypothesized that participation in the 9amHealth program would be associated with significant improvements in glycemic and blood pressure (BP) control across a diverse group of individuals. Methods: We enrolled 95 patients in a completely web-based care clinic for diabetes and hypertension who received nutrition counseling, health coaching, and asynchronous physician consultations for medication prescribing. Patients received standard or cellular-connected glucose meters and BP cuffs in order to share data. Laboratory tests were completed either with at-home phlebotomy draws or a self-administered test kit. Patients' first and last hemoglobin A1c (HbA1c) and BP results over the 12-month period were compared, and analyses were repeated across race and ethnicity groups. Results: Among all 95 patients, the average HbA1c decreased by --1.0 (from 8.2\% to 7.2\%; P<.001) over 12 months of program participation. In those with a baseline HbA1c >8\%, the average HbA1c decreased by --2.1 (from 10.2\% to 8.1\%; P<.001), and in those with a baseline HbA1c >9\%, the average HbA1c decreased by --2.8 (from 11\% to 8.2\%; P<.001). Among participants who identified as a race or ethnicity other than White, the HbA1c decreased by --1.2 (from 8.6\% to 7.4\%, P=.001). Further examination of subgroups confirmed HbA1c lowering within each race or ethnicity group. In the overall population, the average systolic BP decreased by 17.7 mm Hg (P=.006) and the average diastolic BP decreased by 14.3 mm Hg (P=.002). Among participants self-identifying as a race or ethnicity other than White, the results similarly showed a decrease in BP (average reduction in systolic BP of 10 mm Hg and in diastolic BP of 9 mm Hg). Conclusions: A fully web-based model leveraging all-asynchronous physician review and prescribing, combined with synchronous and asynchronous coaching and nutrition support, was associated with clinically meaningful improvement in HbA1c and BP control over a 12-month period among a diverse group of individuals. Further studies should prospectively evaluate the effectiveness of such models among larger populations, assess the longer-term sustainability of these outcomes, and explore financial models to make these types of programs broadly accessible. ",
doi="10.2196/53835",
url="https://diabetes.jmir.org/2024/1/e53835",
url="http://www.ncbi.nlm.nih.gov/pubmed/38363585"
}


@Article{info:doi/10.2196/52442,
author="Keogh, Alison
and Brennan, Carol
and Johnston, William
and Dickson, Jane
and Leslie, J. Stephen
and Burke, David
and Megyesi, Peter
and Caulfield, Brian",
title="Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="1",
volume="8",
pages="e52442",
keywords="digital health",
keywords="heart failure",
keywords="cardiology",
keywords="self-care",
keywords="behavior change",
keywords="eHealth",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="mobile phone",
keywords="elderly",
keywords="self-management",
keywords="digital tools",
keywords="digital tool",
keywords="human-centered design",
keywords="app",
keywords="apps",
keywords="applications",
keywords="wearables",
keywords="wearable",
keywords="Fitbit",
keywords="usability",
keywords="adherence",
keywords="feasibility",
keywords="congestive heart failure",
keywords="cardiac failure",
keywords="myocardial failure",
keywords="heart decompensation",
abstract="Background: Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centered design development of a digital tool to support self-care of HF, the next step was to pilot the tool over a period of time to establish people's acceptance of it in practice. Objective: This study aims to conduct an observational pilot study to examine the usability, adherence, and feasibility of a digital health tool for HF within the Irish health care system. Methods: A total of 19 participants with HF were provided with a digital tool comprising a mobile app and the Fitbit Charge 4 and Aria Air smart scales for a period of 6 months. Changes to their self-care were assessed before and after the study with the 9-item European HF Self-care Behavior Scale (EHFScBS) and the Minnesota Living with HF Questionnaire (MLwHFQ) using a Wilcoxon signed rank test. After the study, 3 usability questionnaires were implemented and descriptively analyzed: the System Usability Scale (SUS), Wearable Technology Motivation Scale (WTMS), and Comfort Rating Scale (CRS). Participants also undertook a semistructured interview regarding their experiences with the digital tool. Interviews were analyzed deductively using the Theoretical Domains Framework. Results: Participants wore their devices for an average of 86.2\% of the days in the 6-month testing period ranging from 40.6\% to 98\%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (P=.10 and P=.70, respectively, where P>.03, after a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (IQR 55.0-60.0; range 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (median 6.0, IQR 5.0-7.0; range 1.0-7.0), whereas the Fitbit was considered very comfortable as demonstrated by the low CRS results (median 0.0, IQR 0.0-0.0; range 0.0-2.0). According to participant interviews, the digital tool supported self-management through increased knowledge, improved awareness, decision-making, and confidence in their own data, and improving their social support through a feeling of comfort in being watched. Conclusions: The digital health tool demonstrated high levels of adherence and acceptance among participants. Although the SUS results suggest low usability, this may be explained by participants uncertainty that they were using it fully, rather than it being unusable, especially given the experiences documented in their interviews. The digital tool targeted key self-management behaviors and feelings of social support. However, a number of changes to the tool, and the health service, are required before it can be implemented at scale. A full-scale feasibility trial conducted at a wider level is required to fully determine its potential effectiveness and wider implementation needs. ",
doi="10.2196/52442",
url="https://formative.jmir.org/2024/1/e52442",
url="http://www.ncbi.nlm.nih.gov/pubmed/38427410"
}


@Article{info:doi/10.2196/51248,
author="Tegegne, Kassaw Teketo
and Tran, Ly-Duyen
and Nourse, Rebecca
and Gurrin, Cathal
and Maddison, Ralph",
title="Daily Activity Lifelogs of People With Heart Failure: Observational Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="21",
volume="8",
pages="e51248",
keywords="heart failure",
keywords="self-management",
keywords="lifelogs",
keywords="daily activity",
keywords="wearable camera",
keywords="E-Mysc{\'e}al",
keywords="activities of daily living",
keywords="ADL",
keywords="intervention",
keywords="self-report method",
keywords="wearable",
keywords="chronic condition",
abstract="Background: Globally, heart failure (HF) affects more than 64 million people, and attempts to reduce its social and economic burden are a public health priority. Interventions to support people with HF to self-manage have been shown to reduce hospitalizations, improve quality of life, and reduce mortality rates. Understanding how people self-manage is imperative to improve future interventions; however, most approaches to date, have used self-report methods to achieve this. Wearable cameras provide a unique tool to understand the lived experiences of people with HF and the daily activities they undertake, which could lead to more effective interventions. However, their potential for understanding chronic conditions such as HF is unclear. Objective: This study aimed to determine the potential utility of wearable cameras to better understand the activities of daily living in people living with HF. Methods: The ``Seeing is Believing (SIB)'' study involved 30 patients with HF who wore wearable cameras for a maximum of 30 days. We used the E-Mysc{\'e}al web-based lifelog retrieval system to process and analyze the wearable camera image data set. Search terms for 7 daily activities (physical activity, gardening, shopping, screen time, drinking, eating, and medication intake) were developed and used for image retrieval. Sensitivity analysis was conducted to compare the number of images retrieved using different search terms. Temporal patterns in daily activities were examined, and differences before and after hospitalization were assessed. Results: E-Mysc{\'e}al exhibited sensitivity to specific search terms, leading to significant variations in the number of images retrieved for each activity. The highest number of images returned were related to eating and drinking, with fewer images for physical activity, screen time, and taking medication. The majority of captured activities occurred before midday. Notably, temporal differences in daily activity patterns were observed for participants hospitalized during this study. The number of medication images increased after hospital discharge, while screen time images decreased. Conclusions: Wearable cameras offer valuable insights into daily activities and self-management in people living with HF. E-Mysc{\'e}al efficiently retrieves relevant images, but search term sensitivity underscores the need for careful selection. ",
doi="10.2196/51248",
url="https://formative.jmir.org/2024/1/e51248",
url="http://www.ncbi.nlm.nih.gov/pubmed/38381484"
}


@Article{info:doi/10.2196/49526,
author="Muehlensiepen, Felix
and Hoffmann, Josephine Marie
and N{\"u}bel, Jonathan
and Ignatyev, Yury
and Heinze, Martin
and Butter, Christian
and Haase-Fielitz, Anja",
title="Acceptance of Telemedicine by Specialists and General Practitioners in Cardiology Care: Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="20",
volume="8",
pages="e49526",
keywords="acceptance",
keywords="adoption",
keywords="cardiac",
keywords="cardiology",
keywords="cross sectional",
keywords="health services research",
keywords="heart",
keywords="preference",
keywords="survey",
keywords="telecardiology",
keywords="telehealth",
keywords="telemedicine",
abstract="Background: In the coming years, telemedicine will play a key role in health care. Especially in rural areas with weak infrastructure, telemedicine could be crucial to providing adequate and personalized medical care. Objective: We investigated the acceptance and preferences of telemedicine among cardiologists, internists, and general practitioners. In addition, we aimed to identify knowledge, explore factors that influence the decision to adopt or reject this technology, and create starting points for demand-oriented further research. Methods: We conducted a web-based survey between May 2021 and February 2022. The 34-item questionnaire covered a wide range of questions regarding knowledge, acceptance, and use of telemedicine in cardiology care. Participants (cardiologists, internists, and general practitioners) were contacted through their professional email addresses, through a QR code published in a regional health journal, and through X (formerly known as Twitter). After exclusion of questionnaires with missed values, multidimensional scaling and k-means clustering were performed. Participants were divided into 3 clusters (C1, C2, and C3) based on their attitudes toward telecardiology. C1 uses telemedicine for personal health and clinical practice; C2 shows reluctance; C3 uses telemedicine mainly clinically. Results: We contacted 929 physicians. Of those 12.1\% (112/929) completed the questionnaires. Participants were 56\% male (54/97), 29\% female (28/97), and 2\% (2/97) diverse (median age 50 years). About 16\% (18/112) of the respondents currently use telemedicine daily, 14.3\% (16/112) 3-4 times a week, and 43\% (48/112) did not use telemedicine at all. Overall, 35.1\% (34/97) rated their knowledge of telemedicine as very good or good. Most of the respondents replied that telemedicine could support cardiology care in monitoring of blood pressure and electrocardiograms (57/97, 58.8\%, both), consultation (57/97, 58.8\%), and extending follow-up time (59/97, 60.8\%). Reported barriers to implementation were mostly administration (26/97, 26.8\%), inadequate reimbursement (25/97, 25.8\%), and the purchase of technology equipment (23/97, 23.7\%). Attitudes toward telemedicine in clinical practice were closely related to the number of patients being treated per annual quarter: C3 (median 1350, IQR 1000-1500) versus C1 (median 750, IQR 300-1200) and C2 (median 500, IQR 105-825). The differences between clinical caseloads of C1-C3 members were significant: C1 versus C2 (P=.03), C1 versus C3 (P=.02), and C2 versus C3 (P<.001). Most participants (87/112, 77.7\%) would like to expand telemedicine approaches in the future. In the field of cardiology, the participants reported a high suitability of telemedicine. The willingness to train in telemedicine is high to very high for > 50\% of the participants. Conclusions: Our results indicate generally moderate use but positive attitudes toward telemedicine among participating physicians with a higher clinical caseload. The lack of a structural framework seems to be a barrier to the effective implementation of telecardiology. ",
doi="10.2196/49526",
url="https://formative.jmir.org/2024/1/e49526",
url="http://www.ncbi.nlm.nih.gov/pubmed/38376898"
}


@Article{info:doi/10.2196/51439,
author="Meng, Guangxia
and McAiney, Carrie
and McKillop, Ian
and Perlman, M. Christopher
and Tsao, Shu-Feng
and Chen, Helen",
title="Factors That Influence Patient Satisfaction With the Service Quality of Home-Based Teleconsultation During the COVID-19 Pandemic: Cross-Sectional Survey Study",
journal="JMIR Cardio",
year="2024",
month="Feb",
day="16",
volume="8",
pages="e51439",
keywords="teleconsultation",
keywords="secondary stroke prevention",
keywords="telemedicine",
keywords="service quality",
keywords="patient satisfaction",
abstract="Background: Ontario stroke prevention clinics primarily held in-person visits before the COVID-19 pandemic and then had to shift to a home-based teleconsultation delivery model using telephone or video to provide services during the pandemic. This change may have affected service quality and patient experiences. Objective: This study seeks to understand patient satisfaction with Ontario stroke prevention clinics' rapid shift to a home-based teleconsultation delivery model used during the COVID-19 pandemic. The research question explores explanatory factors affecting patient satisfaction. Methods: Using a cross-sectional service performance model, we surveyed patients who received telephone or video consultations at 2 Ontario stroke prevention clinics in 2021. This survey included closed- and open-ended questions. We used logistic regression and qualitative content analysis to understand factors affecting patient satisfaction with the quality of home-based teleconsultation services. Results: The overall response rate to the web survey was 37.2\% (128/344). The quantitative analysis was based on 110 responses, whereas the qualitative analysis included 97 responses. Logistic regression results revealed that responsiveness (adjusted odds ratio [AOR] 0.034, 95\% CI 0.006-0.188; P<.001) and empathy (AOR 0.116, 95\% CI 0.017-0.800; P=.03) were significant factors negatively associated with low satisfaction (scores of 1, 2, or 3 out of 5). The only characteristic positively associated with low satisfaction was when survey consent was provided by the substitute decision maker (AOR 6.592, 95\% CI 1.452-29.927; P=.02). In the qualitative content analysis, patients with both low and high global satisfaction scores shared the same factors of service dissatisfaction (assurance, reliability, and empathy). The main subcategories associated with dissatisfaction were missing clinical activities, inadequate communication, administrative process issues, and absence of personal connection. Conversely, the high-satisfaction group offered more positive feedback on assurance, reliability, and empathy, as well as on having a competent clinician, appropriate patient selection, and excellent communication and empathy skills. Conclusions: The insights gained from this study can be considered when designing home-based teleconsultation services to enhance patient experiences in stroke prevention care. ",
doi="10.2196/51439",
url="https://cardio.jmir.org/2024/1/e51439",
url="http://www.ncbi.nlm.nih.gov/pubmed/38363590"
}


@Article{info:doi/10.2196/48971,
author="Chai, R. Peter
and Kaithamattam, J. Jenson
and Chung, Michelle
and Tom, J. Jeremiah
and Goodman, R. Georgia
and Hasdianda, Adrian Mohammad
and Carnes, Christopher Tony
and Vaduganathan, Muthiah
and Scirica, M. Benjamin
and Schnipper, L. Jeffrey",
title="Formative Perceptions of a Digital Pill System to Measure Adherence to Heart Failure Pharmacotherapy: Mixed Methods Study",
journal="JMIR Cardio",
year="2024",
month="Feb",
day="15",
volume="8",
pages="e48971",
keywords="behavioral interventions",
keywords="cardiac treatment",
keywords="digital pill system",
keywords="heart failure medication",
keywords="heart failure",
keywords="ingestible sensors",
keywords="medication adherence",
abstract="Background: Heart failure (HF) affects 6.2 million Americans and is a leading cause of hospitalization. The mainstay of the management of HF is adherence to pharmacotherapy. Despite the effectiveness of HF pharmacotherapy, effectiveness is closely linked to adherence. Measuring adherence to HF pharmacotherapy is difficult; most clinical measures use indirect strategies such as calculating pharmacy refill data or using self-report. While helpful in guiding treatment adjustments, indirect measures of adherence may miss the detection of suboptimal adherence and co-occurring structural barriers associated with nonadherence. Digital pill systems (DPSs), which use an ingestible radiofrequency emitter to directly measure medication ingestions in real-time, represent a strategy for measuring and responding to nonadherence in the context of HF pharmacotherapy. Previous work has demonstrated the feasibility of using DPSs to measure adherence in other chronic diseases, but this strategy has yet to be leveraged for individuals with HF. Objective: We aim to explore through qualitative interviews the facilitators and barriers to using DPS technology to monitor pharmacotherapy adherence among patients with HF. Methods: We conducted individual, semistructured qualitative interviews and quantitative assessments between April and August 2022. A total of 20 patients with HF who were admitted to the general medical or cardiology service at an urban quaternary care hospital participated in this study. Participants completed a qualitative interview exploring the overall acceptability of and willingness to use DPS technology for adherence monitoring and perceived barriers to DPS use. Quantitative assessments evaluated HF history, existing medication adherence strategies, and attitudes toward technology. We analyzed qualitative data using applied thematic analysis and NVivo software (QSR International). Results: Most participants (12/20, 60\%) in qualitative interviews reported a willingness to use the DPS to measure HF medication adherence. Overall, the DPS was viewed as useful for increasing accountability and reinforcing adherence behaviors. Perceived barriers included technological issues, a lack of need, additional costs, and privacy concerns. Most were open to sharing adherence data with providers to bolster clinical care and decision-making. Reminder messages following detected nonadherence were perceived as a key feature, and customization was desired. Suggested improvements are primarily related to the design and usability of the Reader (a wearable device). Conclusions: Overall, individuals with HF perceived the DPS to be an acceptable and useful tool for measuring medication adherence. Accurate, real-time ingestion data can guide adherence counseling to optimize adherence management and inform tailored behavioral interventions to support adherence among patients with HF. ",
doi="10.2196/48971",
url="https://cardio.jmir.org/2024/1/e48971",
url="http://www.ncbi.nlm.nih.gov/pubmed/38358783"
}


@Article{info:doi/10.2196/52076,
author="Gerhardy, Benjamin
and Sivapathan, Shanthosh
and Orde, Sam
and Morgan, Lucy",
title="Simultaneous Cardiopulmonary Exercise Testing and Echocardiography for Investigation of Cardiopulmonary Dysfunction in Outpatients: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Feb",
day="12",
volume="13",
pages="e52076",
keywords="cardiopulmonary",
keywords="echocardiography",
keywords="exercise",
keywords="cardiopulmonary exercise test",
abstract="Background: Cardiopulmonary dysfunction is a complex process with a broad range of etiologies. Investigations performed either at rest or those that only assess the function of a single organ (heart or lungs) are often insufficient. A simultaneous cardiopulmonary exercise test with stress echocardiography is a new approach to assessing cardiopulmonary dysfunction as it provides anatomical and functional imaging simultaneously while under increasing stress. To date, the application of cardiopulmonary exercise test-stress echocardiography (CPET-SE) has been broad and without structure, and its effect on patient outcomes is unclear. Objective: The objective of this scoping review is to explore and analyze the evidence regarding the role of simultaneous CPET-SE in investigating cardiopulmonary dysfunction in outpatients. It will include any published study in which adult (older than or equal to 18 years of age) patients have completed a CPET-SE for the investigation of cardiopulmonary dysfunction. Methods: This review will follow the Arksey and O'Malley framework, supported by the Joanna Briggs Institute methodology for scoping reviews. It will use the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Data sources will include MEDLINE, Scopus, Embase, and Cochrane (including reviews, trials, and protocols) electronic databases, with no date range defined. The search will be limited to the English language with no restrictions regarding pathology. Secondary references of the included sources will also be assessed by a hand search for suitability. A 2-person title-abstract screen and data charting process will be used. Independent experts will be used for consultation including an academic librarian and clinicians. The Covidence software will be used for article screening. Results: This scoping review will provide a unified and detailed description of the applications of CPET-SE in investigating cardiopulmonary dysfunction. This will provide a platform for future research harnessing this investigatory method. The results will be presented in both tabular and graphical formats to ensure clarity. The results of this scoping review will be submitted to a relevant peer-reviewed academic journal for publication. Conclusions: The CPET-SE is a powerful tool for investigating cardiopulmonary dysfunction but remains in its infancy with a patchwork approach to indications, data reporting, and interpretation. This scoping review will unify the literature and provide a platform for future researchers and the development of a comprehensive application guideline. Trial Registration: Open Science Framework; https://osf.io/98r3e International Registered Report Identifier (IRRID): PRR1-10.2196/52076 ",
doi="10.2196/52076",
url="https://www.researchprotocols.org/2024/1/e52076",
url="http://www.ncbi.nlm.nih.gov/pubmed/38345834"
}


@Article{info:doi/10.2196/51841,
author="Kokkonen, Jorma
and Mustonen, Pirjo
and Heikkil{\"a}, Eija
and Leskel{\"a}, Riikka-Leena
and Pennanen, Paula
and Kr{\"u}hn, Kati
and Jalkanen, Arto
and Laakso, Jussi-Pekka
and Kempers, Jari
and V{\"a}is{\"a}nen, Sami
and Torkki, Paulus",
title="Effectiveness of Telemonitoring in Reducing Hospitalization and Associated Costs for Patients With Heart Failure in Finland: Nonrandomized Pre-Post Telemonitoring Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Feb",
day="7",
volume="12",
pages="e51841",
keywords="cost",
keywords="Finland",
keywords="heart failure",
keywords="hospital",
keywords="resource use",
keywords="telemonitoring",
abstract="Background: Many patients with chronic heart failure (HF) experience a reduced health status, leading to readmission after hospitalization despite receiving conventional care. Telemonitoring approaches aim to improve the early detection of HF decompensations and prevent readmissions. However, knowledge about the impact of telemonitoring on preventing readmissions and related costs remains scarce. Objective: This study assessed the effectiveness of adding a telemonitoring solution to the standard of care (SOC) for the prevention of hospitalization and related costs in patients with HF in Finland. Methods: We performed a nonrandomized pre-post telemonitoring study to estimate health care costs and resource use during 6 months on SOC followed by 6 months on SOC with a novel telemonitoring solution. The telemonitoring solution consisted of a digital platform for patient-reported symptoms and daily weight and blood pressure measurements, automatically generated alerts triggering phone calls with secondary care nurses, and rapid response to alerts by treating physicians. Telemonitoring solution data were linked to patient register data on primary care, secondary care, and hospitalization. The patient register of the Southern Savonia Social and Health Care Authority (Essote) was used. Eligible patients had at least 1 hospital admission within the last 12 months and self-reported New York Heart Association class II-IV from the central hospital in the Southern Savonia region. Results: Out of 50 recruited patients with HF, 43 completed the study and were included in the analysis. The hospitalization-related cost decreased (49\%; P=.03) from {\texteuro}2189 (95\% CI {\texteuro}1384-{\texteuro}2994; a currency exchange rate of EUR {\texteuro}1=US \$1.10589 is applicable) during SOC to {\texteuro}1114 (95\% CI {\texteuro}425-{\texteuro}1803) during telemonitoring. The number of patients with at least 1 hospitalization due to HF was reduced by 70\% (P=.002) from 20 (47\%) out of 43patients during SOC to 6 (14\%) out of 43 patients in telemonitoring. The estimated mean total health care cost per patient was {\texteuro}3124 (95\% CI {\texteuro}2212-{\texteuro}4036) during SOC and {\texteuro}2104 (95\% CI {\texteuro}1313-{\texteuro}2895) during telemonitoring, resulting in a 33\% reduction (P=.07) in costs with telemonitoring. Conclusions: The results suggest that the telemonitoring solution can reduce hospital-related costs for patients with HF with a recent hospital admission. ",
doi="10.2196/51841",
url="https://mhealth.jmir.org/2024/1/e51841",
url="http://www.ncbi.nlm.nih.gov/pubmed/38324366"
}


@Article{info:doi/10.2196/55687,
author="Carter, Jocelyn
and Swack, Natalia
and Isselbacher, Eric
and Donelan, Karen
and Thorndike, Anne",
title="Feasibility, Acceptability, and Preliminary Effectiveness of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Feb",
day="6",
volume="13",
pages="e55687",
keywords="heart failure",
keywords="digital platform",
keywords="remote monitoring",
keywords="home-based care",
keywords="health worker",
keywords="social needs care",
keywords="community health worker",
abstract="Background: Interventions focused on remote monitoring and social needs care have shown promise in improving clinical outcomes for patients with heart failure (HF). However, patient willingness to use technology as well as concerns about access in underresourced settings have limited digital platform implementation and adoption. There is little research in HF populations examining the effect of a combined digital and social needs care intervention that could enhance patient engagement in digital platform use while closing gaps in care related to social determinants of health. Here, we describe the protocol for a clinical trial of a digitally enabled community health worker intervention designed for patients with HF. Objective: This study aims to describe the protocol for a randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of an intervention that combines remote monitoring with a digital platform and community health worker (CHW) social needs care for patients with HF who are transitioning from hospital to home. Given the elevated morbidity and mortality, identifying comprehensive and patient-centered interventions at the time of hospital care transitions that can improve clinical outcomes, impact cost, and augment the quality of care for this cohort is a priority. Methods: This trial randomized adult inpatient participants (n=50) with a diagnosis of HF receiving care at a single academic health care institution to the 30-day intervention (digital platform+CHW pairing+usual care) or the 30-day control (CHW pairing+usual care) arms. All study participants completed baseline questionnaires and 30-day exit interviews and questionnaires. The primary outcomes will be acceptability, feasibility, and preliminary effectiveness. Results: This clinical trial opened for enrollment in September 2022 and was completed in June 2023. Initial results are expected to be published in the spring of 2024, and analysis is currently underway. Feasibility outcome measures will include the use rates of the biometric sensor (average hours per day), the digital blood pressure monitor (average times per day), the weight scale (average times per day), and the completion of the symptoms questionnaire (average times per day). The acceptability outcome will be measured by the patients' response to the truthfulness of the statement that they would be willing to use the digital platform in the future (response options: very true, somewhat true, or not true). Preliminary effectiveness will be measured by tracking 30-day clinical outcomes (hospital readmissions, emergency room visits, and missed primary care and cardiology appointments). Conclusions: The results of this investigation are expected to contribute to our understanding of the use of digital interventions and the implementation of supportive home-based social needs care to enhance engagement and the potential effectiveness of clinically focused digital platforms. These results may inform the construction of a future multi-institutional trial designed to test the true effectiveness of this intervention in HF. Trial Registration: ClinicalTrials.gov NCT05130008; https://clinicaltrials.gov/study/NCT05130008 International Registered Report Identifier (IRRID): DERR1-10.2196/55687 ",
doi="10.2196/55687",
url="https://www.researchprotocols.org/2024/1/e55687",
url="http://www.ncbi.nlm.nih.gov/pubmed/38216543"
}


@Article{info:doi/10.2196/50973,
author="Dhruva, S. Sanket
and Raitt, H. Merritt
and Munson, Scott
and Moore, J. Hans
and Steele, Pamela
and Rosman, Lindsey
and Whooley, A. Mary",
title="Barriers and Facilitators Associated With Remote Monitoring Adherence Among Veterans With Pacemakers and Implantable Cardioverter-Defibrillators: Qualitative Cross-Sectional Study",
journal="JMIR Cardio",
year="2023",
month="Nov",
day="21",
volume="7",
pages="e50973",
keywords="cardiac implantable electronic device",
keywords="electrophysiology",
keywords="pacemaker",
keywords="remote monitoring",
keywords="veterans",
keywords="adherence",
abstract="Background: The Heart Rhythm Society strongly recommends remote monitoring (RM) of cardiovascular implantable electronic devices (CIEDs) because of the clinical outcome benefits to patients. However, many patients do not adhere to RM and, thus, do not achieve these benefits. There has been limited study of patient-level barriers and facilitators to RM adherence; understanding patient perspectives is essential to developing solutions to improve adherence. Objective: We sought to identify barriers and facilitators associated with adherence to RM among veterans with CIEDs followed by the Veterans Health Administration. Methods: We interviewed 40 veterans with CIEDs regarding their experiences with RM. Veterans were stratified into 3 groups based on their adherence to scheduled RM transmissions over the past 2 years: 6 fully adherent (?95\%), 25 partially adherent (?65\% but <95\%), and 9 nonadherent (<65\%). As the focus was to understand challenges with RM adherence, partially adherent and nonadherent veterans were preferentially weighted for selection. Veterans were mailed a letter stating they would be called to understand their experiences and perspectives of RM and possible barriers, and then contacted beginning 1 week after the letter was mailed. Interviews were structured (some questions allowing for open-ended responses to dive deeper into themes) and focused on 4 predetermined domains: knowledge of RM, satisfaction with RM, reasons for nonadherence, and preferences for health care engagement. Results: Of the 44 veterans contacted, 40 (91\%) agreed to participate. The mean veteran age was 75.3 (SD 7.6) years, and 98\% (39/40) were men. Veterans had been implanted with their current CIED for an average of 4.4 (SD 2.8) years. A total of 58\% (23/40) of veterans recalled a discussion of home monitoring, and 45\% (18/40) reported a good understanding of RM; however, when asked to describe RM, their understanding was sometimes incomplete or not correct. Among the 31 fully or partially adherent veterans, nearly all were satisfied with RM. Approximately one-third recalled ever being told the results of a remote transmission. Among partially or nonadherent veterans, only one-fourth reported being contacted by a Department of Veterans Affairs health care professional regarding not having sent a remote transmission; among those who had troubleshooted to ensure they could send remote transmissions, they often relied on the CIED manufacturer for help (this experience was nearly always positive). Most nonadherent veterans felt more comfortable engaging in RM if they received more information or education. Most veterans were interested in being notified of a successful remote transmission and learning the results of their remote transmissions. Conclusions: Veterans with CIEDs often had limited knowledge about RM and did not recall being contacted about nonadherence. When they were contacted and troubleshooted, the experience was positive. These findings provide opportunities to optimize strategies for educating and engaging patients in RM. ",
doi="10.2196/50973",
url="https://cardio.jmir.org/2023/1/e50973",
url="http://www.ncbi.nlm.nih.gov/pubmed/37988153"
}


@Article{info:doi/10.2196/46296,
author="Nicmanis, Mitchell
and Chur-Hansen, Anna
and Linehan, Karen",
title="The Information Needs and Experiences of People Living With Cardiac Implantable Electronic Devices: Qualitative Content Analysis of Reddit Posts",
journal="JMIR Cardio",
year="2023",
month="Nov",
day="1",
volume="7",
pages="e46296",
keywords="implantable cardioverter defibrillator",
keywords="pacemaker",
keywords="cardiac resynchronization therapy",
keywords="social media",
keywords="patients",
keywords="peer support",
keywords="content analysis",
keywords="experiences",
abstract="Background: Cardiac implantable electronic devices (CIEDs) are used to treat a range of cardiovascular diseases and can lead to substantial clinical improvements. However, studies evaluating patients' experiences of living with these devices are sparse and have focused mainly on implantable cardioverter defibrillators. In addition, there has been limited evaluation of how people living with a CIED use social media to gain insight into their condition. Objective: This study aims to analyze posts from web-based communities called subreddits on the website Reddit, intended for people living with a CIED, to characterize the informational needs and experiences of patients. Methods: Reddit was systematically searched for appropriate subreddits, and we found 1 subreddit that could be included in the analysis. A Python-based web scraping script using the Reddit application programming interface was used to extract posts from this subreddit. Each post was individually screened for relevancy, and a register of participants' demographic information was created. Conventional qualitative content analysis was used to inductively classify the qualitative data collected into codes, subcategories, and overarching categories. Results: Of the 484 posts collected using the script, 186 were excluded, resulting in 298 posts from 196 participants being included in the analysis. The median age of the participants who reported this was 33 (IQR 22.0-39.5; range 17-72) years, and the majority had a permanent pacemaker. The content analysis yielded 5 overarching categories: use of the subreddit by participants, questions and experiences related to the daily challenges of living with a CIED, physical sequelae of CIED implantation, psychological experiences of living with a CIED, and questions and experiences related to health care while living with a CIED. These categories provided insight into the diverse experiences and informational needs of participants living with a CIED. The data predominantly represented the experiences of younger and more physically active participants. Conclusions: Social media provides a platform through which people living with a CIED can share information and provide support to their peers. Participants generally sought information about the experiences of others living with a CIED. This was often done to help overcome a range of challenges faced by participants, including the need to adapt to living with a CIED, difficulties with navigating health care, psychological difficulties, and various aversive physical sequelae. These challenges may be particularly difficult for younger and physically active people. Health care professionals may leverage peer support and other aid to help people overcome the challenges they face while living with a CIED. ",
doi="10.2196/46296",
url="https://cardio.jmir.org/2023/1/e46296",
url="http://www.ncbi.nlm.nih.gov/pubmed/37766632"
}


@Article{info:doi/10.2196/43038,
author="Auener, L. Stefan
and van Dulmen, A. Simone
and Atsma, Femke
and van der Gali{\"e}n, Onno
and Bellersen, Louise
and van Kimmenade, Roland
and Westert, P. Gert
and Jeurissen, T. Patrick P.",
title="Characteristics Associated With Telemonitoring Use Among Patients With Chronic Heart Failure: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="18",
volume="25",
pages="e43038",
keywords="heart failure",
keywords="telemonitoring",
keywords="remote monitoring",
keywords="eHealth",
keywords="chronic heart failure",
keywords="heart",
keywords="disease",
keywords="patient",
keywords="self-management",
keywords="prevention",
keywords="utilization",
keywords="Netherlands",
keywords="hospital",
keywords="treatment",
abstract="Background: Chronic heart failure (HF) is a chronic disease affecting more than 64 million people worldwide, with an increasing prevalence and a high burden on individual patients and society. Telemonitoring may be able to mitigate some of this burden by increasing self-management and preventing use of the health care system. However, it is unknown to what degree telemonitoring has been adopted by hospitals and if the use of telemonitoring is associated with certain patient characteristics. Insight into the dissemination of this technology among hospitals and patients may inform strategies for further adoption. Objective: We aimed to explore the use of telemonitoring among hospitals in the Netherlands and to identify patient characteristics associated with the use of telemonitoring for HF. Methods: We performed a retrospective cohort study based on routinely collected health care claim data in the Netherlands. Descriptive analyses were used to gain insight in the adoption of telemonitoring for HF among hospitals in 2019. We used logistic multiple regression analyses to explore the associations between patient characteristics and telemonitoring use. Results: Less than half (31/84, 37\%) of all included hospitals had claims for telemonitoring, and 20\% (17/84) of hospitals had more than 10 patients with telemonitoring claims. Within these 17 hospitals, a total of 7040 patients were treated for HF in 2019, of whom 5.8\% (409/7040) incurred a telemonitoring claim. Odds ratios (ORs) for using telemonitoring were higher for male patients (adjusted OR 1.90, 95\% CI 1.50-2.41) and patients with previous hospital treatment for HF (adjusted OR 1.76, 95\% CI 1.39-2.24). ORs were lower for higher age categories and were lowest for the highest age category, that is, patients older than 80 years (OR 0.30, 95\% CI 0.21-0.44) compared to the reference age category (18-59 years). Socioeconomic status, degree of multimorbidity, and excessive polypharmacy were not associated with the use of telemonitoring. Conclusions: The use of reimbursed telemonitoring for HF was limited up to 2019, and our results suggest that large variation exists among hospitals. A lack of adoption is therefore not only due to a lack of diffusion among hospitals but also due to a lack of scaling up within hospitals that already deploy telemonitoring. Future studies should therefore focus on both kinds of adoption and how to facilitate these processes. Older patients, female patients, and patients with no previous hospital treatment for HF were less likely to use telemonitoring for HF. This shows that some patient groups are not served as much by telemonitoring as other patient groups. The underlying mechanism of the reported associations should be identified in order to gain a deeper understanding of telemonitoring use among different patient groups. ",
doi="10.2196/43038",
url="https://www.jmir.org/2023/1/e43038",
url="http://www.ncbi.nlm.nih.gov/pubmed/37851505"
}


@Article{info:doi/10.2196/48454,
author="Nakrys, Marius
and Valinskas, Sarunas
and Aleknavicius, Kasparas
and Jonusas, Justinas",
title="Pilot Investigation of Blood Pressure Control Using a Mobile App (Cardi.Health): Retrospective Chart Review Study",
journal="JMIR Cardio",
year="2023",
month="Oct",
day="17",
volume="7",
pages="e48454",
keywords="mobile app",
keywords="Cardi.Health",
keywords="blood pressure",
keywords="engagement",
keywords="app",
keywords="pilot study",
keywords="hypertension",
keywords="effective",
keywords="blood pressure control",
keywords="self-monitoring",
keywords="medication",
keywords="management",
keywords="users",
keywords="use",
abstract="Background: The high prevalence of hypertension necessitates effective, scalable interventions for blood pressure (BP) control. Self-monitoring has shown improved adherence to medication and better BP management. Mobile apps offer a promising approach with their increasing popularity and potential for large-scale implementation. Studies have demonstrated associations between mobile app interventions and lowered BP, yet real-world data on app effectiveness and engagement remain limited. Objective: In this study, we analyzed real-world user data from the Cardi.Health mobile app, which is aimed at helping its users monitor and control their BP. Our goal was to find out whether there is an association between the use of the mobile app and a decrease in BP. Additionally, the study explored how engagement with the app may influence this outcome. Methods: This was a retrospective chart review study. The initial study population comprised 4407 Cardi.Health users who began using the app between January 2022 and April 2022. After applying inclusion criteria, the final study cohort comprised 339 users with elevated BP at the baseline. The sample consisted of 108 (31.9\%) men and 231 (68.1\%) women (P=.04). This retrospective chart review study obtained permission from the Biomedical Research Alliance of New York Institutional Review Board (June 2022, registration ID 22-08-503-939). Results: The study's main findings were that there is a possible relationship between use of the Cardi.Health mobile app and a decrease in systolic BP. Additionally, there was a significant association between active use of the app and systolic BP decrease ($\chi$21=5.311; P=.02). Finally, active users had an almost 2 times greater chance of reducing systolic BP by 5 mm Hg or more over 4 weeks (odds ratio 1.932, 95\% CI 1.074-3.528; P=.03). Conclusions: This study shows a possible relationship between Cardi.Health mobile app use and decreased BP. Additionally, engagement with the app may be related to better results---active use was associated with an almost 2-fold increase in the odds of reducing BP by 5 or more mm Hg. ",
doi="10.2196/48454",
url="https://cardio.jmir.org/2023/1/e48454",
url="http://www.ncbi.nlm.nih.gov/pubmed/37847544"
}


@Article{info:doi/10.2196/47947,
author="Yang, Li-Tan
and Lee, Jen-Kuang
and Tsai, Chieh-Mei
and Chen, Ying-Hsien
and Huang, Ching-Chang
and Wu, Hui-Wen
and Su, Chin-Hua
and Lee, Chien-Chang
and Hung, Chi-Sheng
and Ho, Yi-Lwun",
title="Effect of Telehealth Services on Mitral and Tricuspid Regurgitation Progression: Retrospective Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="26",
volume="25",
pages="e47947",
keywords="mitral regurgitation",
keywords="tricuspid regurgitation",
keywords="telehealth",
keywords="telemedicine",
keywords="point-of-care ultrasound",
keywords="cardiovascular health",
keywords="heart disease",
keywords="cardiac",
keywords="cardiology",
keywords="patience care",
keywords="patient-reported outcome",
keywords="remote monitoring",
keywords="health management",
abstract="Background: Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common cardiac conditions with high mortality risks, which can be improved through early intervention. Telehealth services, which allow for remote monitoring of patient conditions, have been proven to improve the health management of chronic diseases, but the effects on MR and TR progression are unknown. Objective: This study aimed to explore whether patients receiving telehealth services have less MR and TR progression compared with a control group. We also aimed to identify the determinants of MR and TR progression. Methods: This single-center retrospective study conducted at the National Taiwan University Hospital compared MR and TR progression (defined as either progression to moderate or greater MR and TR or MR and TR progression by ?2 grades during the study period) between the telehealth and control groups. Patients had a minimum of 2 transthoracic echocardiograms at least 6 months apart; baseline mild-moderate MR and TR or lower; and no prior surgeries on the mitral or tricuspid valve. Telehealth patients were defined as those who received telehealth services for at least 28 days within 3 months of baseline. Basic demographics, baseline blood pressure measurements, prescribed medication, and Charlson Comorbidity Index components were obtained for all patients. Results: A total of 1081 patients (n=226 in the telehealth group and n=855 in the control group) were included in the study analyses. The telehealth group showed significantly lower baseline systolic blood pressure (P<.001), higher Charlson Comorbidity Index (P=.02), higher prevalence of prior myocardial infarction (P=.01) and heart failure (P<.001), higher beta-blocker (P=.03) and diuretic (P=.04) use, and lower nitrate use (P=.04). Both groups showed similar cardiac remodeling conditions at baseline. Telehealth was found to be neutral for both MR (hazard ratio 1.10, 95\% CI 0.80-1.52; P=.52) and TR (hazard ratio 1.27, 95\% CI 0.92-1.74; P=.14) progression. Determinants for moderate or greater MR progression included older age, female sex, diuretic use, larger left atrial dimension, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, and lower left ventricular ejection fraction. Determinants of moderate or greater TR progression included older age, female sex, diuretic use, presence of atrial fibrillation, LA dimension, left ventricular end-systolic dimension, and lower left ventricular ejection fraction; statin use was found to be protective. Conclusions: This is the first study to assess the association between telehealth services and the progression of MR and TR. Telehealth patients, who had more comorbidities, displayed similar MR and TR progression versus control patients, indicating that telehealth may slow MR and TR progression. Determinants of MR and TR progression included easy-to-measure traditional echo parameters of cardiac function, older age, female sex, and atrial fibrillation, which can be incorporated into a telehealth platform and advanced alert system, improving patient outcomes through personalized care. ",
doi="10.2196/47947",
url="https://www.jmir.org/2023/1/e47947",
url="http://www.ncbi.nlm.nih.gov/pubmed/37751276"
}


@Article{info:doi/10.2196/45760,
author="Kwun, Ju-Seung
and Lee, Hoon Jang
and Park, Eun Bo
and Park, Sung Jong
and Kim, Jeong Hyeon
and Kim, Sun-Hwa
and Jeon, Ki-Hyun
and Cho, Hyoung-won
and Kang, Si-Hyuck
and Lee, Wonjae
and Youn, Tae-Jin
and Chae, In-Ho
and Yoon, Chang-Hwan",
title="Diagnostic Value of a Wearable Continuous Electrocardiogram Monitoring Device (AT-Patch) for New-Onset Atrial Fibrillation in High-Risk Patients: Prospective Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="18",
volume="25",
pages="e45760",
keywords="arrhythmias",
keywords="atrial fibrillation",
keywords="wearable electronic device",
keywords="patch electrocardiogram monitor",
keywords="electrocardiogram",
keywords="adult",
keywords="AT-Patch",
keywords="heart failure",
keywords="mobile phone",
abstract="Background: While conventional electrocardiogram monitoring devices are useful for detecting atrial fibrillation, they have considerable drawbacks, including a short monitoring duration and invasive device implantation. The use of patch-type devices circumvents these drawbacks and has shown comparable diagnostic capability for the early detection of atrial fibrillation. Objective: We aimed to determine whether a patch-type device (AT-Patch) applied to patients with a high risk of new-onset atrial fibrillation defined by the congestive heart failure, hypertension, age ?75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex scale (CHA2DS2-VASc) score had increased detection rates. Methods: In this nonrandomized multicenter prospective cohort study, we enrolled 320 adults aged ?19 years who had never experienced atrial fibrillation and whose CHA2DS2-VASc score was ?2. The AT-Patch was attached to each individual for 11 days, and the data were analyzed for arrhythmic events by 2 independent cardiologists. Results: Atrial fibrillation was detected by the AT-Patch in 3.4\% (11/320) of patients, as diagnosed by both cardiologists. Interestingly, when participants with or without atrial fibrillation were compared, a previous history of heart failure was significantly more common in the atrial fibrillation group (n=4/11, 36.4\% vs n=16/309, 5.2\%, respectively; P=.003). When a CHA2DS2-VASc score ?4 was combined with previous heart failure, the detection rate was significantly increased to 24.4\%. Comparison of the recorded electrocardiogram data revealed that supraventricular and ventricular ectopic rhythms were significantly more frequent in the new-onset atrial fibrillation group compared with nonatrial fibrillation group (3.4\% vs 0.4\%; P=.001 and 5.2\% vs 1.2\%; P<.001), respectively. Conclusions: This study detected a moderate number of new-onset atrial fibrillations in high-risk patients using the AT-Patch device. Further studies will aim to investigate the value of early detection of atrial fibrillation, particularly in patients with heart failure as a means of reducing adverse clinical outcomes of atrial fibrillation. Trial Registration: ClinicalTrials.gov NCT04857268; https://classic.clinicaltrials.gov/ct2/show/NCT04857268 ",
doi="10.2196/45760",
url="https://www.jmir.org/2023/1/e45760",
url="http://www.ncbi.nlm.nih.gov/pubmed/37721791"
}


@Article{info:doi/10.2196/46351,
author="Estrella, Tony
and Alfonso, Carla
and Ramos-Castro, Juan
and Alsina, Aitor
and Capdevila, Lluis",
title="A Serious Game to Self-Regulate Heart Rate Variability as a Technique to Manage Arousal Level Through Cardiorespiratory Biofeedback: Development and Pilot Evaluation Study",
journal="JMIR Serious Games",
year="2023",
month="Aug",
day="24",
volume="11",
pages="e46351",
keywords="serious game",
keywords="heart rate variability",
keywords="biofeedback",
keywords="mobile health",
keywords="mHealth",
keywords="app",
keywords="mobile phone",
abstract="Background: Heart rate variability biofeedback (HRVB) is an established intervention for increasing heart rate variability (HRV) in the clinical context. Using this technique, participants become aware of their HRV through real-time feedback and can self-regulate it. Objective: The aim of this study was 2-fold: first, to develop a serious game that applies the HRVB technique to teach participants to self-regulate HRV and, second, to test the app with participants in a pilot study. Methods: An HRVB app called the FitLab Game was developed for this study. To play the game, users must move the main character up and down the screen, avoiding collisions with obstacles. The wavelength that users must follow to avoid these obstacles is based on the user's basal heart rate and changes in instantaneous heart rate. To test the FitLab Game, a total of 16 participants (mean age 23, SD 0.69 years) were divided into a control group (n=8) and an experimental group (n=8). A 2 {\texttimes} 2 factorial design was used in each session. Participants in the experimental condition were trained in breathing techniques. Results: Changes in the frequency and time domain parameters of HRV and the game's performance features were evaluated. Significant changes in the average RR intervals and root mean square of differences between adjacent RR intervals (RMSSD) were found between the groups (P=.02 and P=.04, respectively). Regarding performance, both groups showed a tendency to increase the evaluated outcomes from baseline to the test condition. Conclusions: The results may indicate that playing different levels leads to an improvement in the game's final score by repeated training. The tendency of changes in HRV may reflect a higher activation of the mental system of attention and control in the experimental group versus the control group. In this context, learning simple, voluntary strategies through a serious game can aid the improvement of self-control and arousal management. The FitLab Game appears to be a promising serious game owing to its ease of use, high engagement, and enjoyability provided by the instantaneous feedback. ",
doi="10.2196/46351",
url="https://games.jmir.org/2023/1/e46351",
url="http://www.ncbi.nlm.nih.gov/pubmed/37616033"
}


@Article{info:doi/10.2196/46359,
author="Zhong, Wen
and Liu, Rui
and Cheng, Hongxin
and Xu, Lin
and Wang, Lu
and He, Chengqi
and Wei, Quan",
title="Longer-Term Effects of Cardiac Telerehabilitation on Patients With Coronary Artery Disease: Systematic Review and Meta-Analysis",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jul",
day="28",
volume="11",
pages="e46359",
keywords="cardiac telerehabilitation",
keywords="coronary artery disease",
keywords="CAD",
keywords="cardiac rehabilitation",
keywords="CR",
keywords="long-term effect",
keywords="meta-analysis",
abstract="Background: Cardiac telerehabilitation offers a flexible and accessible model for patients with coronary artery disease (CAD), effectively transforming the traditional cardiac rehabilitation (CR) approach. Objective: This systematic review and meta-analysis aimed to evaluate the long-term effectiveness of cardiac telerehabilitation. Methods: We searched randomized controlled trials (RCTs) in 7 electronic databases: PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the China National Knowledge Infrastructure, and WANFANG. The primary outcome focused on cardiopulmonary fitness. For secondary outcomes, we examined cardiovascular risk factors (blood pressure, BMI, and serum lipids), psychological scales of depression and anxiety, quality of life (QoL), cardiac telerehabilitation adherence, and adverse events. Results: In total, 10 RCTs fulfilled the predefined criteria, which were reviewed in our meta-analysis. The results showed that after cardiac telerehabilitation, there was a significant difference in the improvement in long-term peak oxygen uptake compared to center-based CR (mean difference [MD] 1.61, 95\% CI 0.38-2.85, P=.01), particularly after 6-month rehabilitation training (MD 1.87, 95\% CI 0.34-3.39, P=.02). The pooled effect size of the meta-analysis indicated that there were no significant differences in the reduction in cardiovascular risk factor control. There was also no practical demonstration of anxiety scores or depression scores. However, cardiac telerehabilitation demonstrated an improvement in the long-term QoL of patients (MD 0.92, 95\% CI 0.06-1.78, P=.04). In addition, the study reported a high completion rate (80\%) for cardiac telerehabilitation interventions. The incidence of adverse events was also low during long-term follow-up. Conclusions: Cardiac telerehabilitation proves to be more effective in improving cardiopulmonary fitness and QoL during the long-term follow-up for patients with CAD. Our study highlights monitoring-enabled and patient-centered telerehabilitation programs, which play a vital role in the recovery and development of CAD and in the long-term prognosis of patients. ",
doi="10.2196/46359",
url="https://mhealth.jmir.org/2023/1/e46359",
url="http://www.ncbi.nlm.nih.gov/pubmed/37505803"
}


@Article{info:doi/10.2196/46092,
author="Xu, Jianing
and Qu, Mingyu
and Dong, Xuejie
and Chen, Yihe
and Yin, Hongfan
and Qu, Fangge
and Zhang, Lin",
title="Tele-Instruction Tool for Multiple Lay Responders Providing Cardiopulmonary Resuscitation in Telehealth Emergency Dispatch Services: Mixed Methods Study",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="26",
volume="25",
pages="e46092",
keywords="cardiac arrest",
keywords="lay responder",
keywords="teamwork",
keywords="telehealth",
keywords="telephone-assisted cardiopulmonary resuscitation",
abstract="Background: Telephone-assisted cardiopulmonary resuscitation (T-CPR) has proven to be a crucial intervention in enhancing the ability of lay responders to perform cardiopulmonary resuscitation (CPR) during telehealth emergency services. While the majority of established T-CPR protocols primarily focus on guiding individual rescuers, there is a lack of emphasis on instructing and coordinating multiple lay responders to perform resuscitation collaboratively. Objective: This study aimed to develop an innovative team-based tele-instruction tool to efficiently organize and instruct multiple lay responders on the CPR process and to evaluate the effectiveness and feasibility of the tool. Methods: We used a mixed methods design in this study. We conducted a randomized controlled simulation trial to conduct the quantitative analysis. The intervention groups used the team-based tele-instruction tool for team resuscitation, while the control groups did not have access to the tool. Baseline resuscitation was performed during the initial phase (phase I test). Subsequently, all teams watched a team-based CPR education training video and finished a 3-person practice session with teaching followed by a posttraining test (phase II test). In the qualitative analysis, we randomly selected an individual from each team and 4 experts in emergency medical services to conduct semistructured interviews. The purpose of these interviews was to evaluate the effectiveness and feasibility of this tool. Results: The team-based tele-instruction tool significantly improved the quality of chest compression in both phase I and phase II tests. The average compression rates were more appropriate in the intervention groups compared to the control groups (median 104.5, IQR 98.8-111.8 min--1 vs median 112, IQR 106-120.8 min--1; P=.04 in phase I and median 117.5, IQR 112.3-125 min--1 vs median 111, IQR 105.3-119 min--1; P=.03 in phase II). In the intervention group, there was a delay in the emergency response time compared to that in the control group (time to first chest compression: median 20, IQR 15-24.8 seconds vs median 25, IQR 20.5-40.3 seconds; P=.03; time to open the airway: median 48, IQR 36.3-62 seconds vs median 73.5, IQR 54.5-227.8 seconds; P=.01). However, this delay was partially mitigated after the phase II test. The qualitative results confirmed the compatibility and generalizability of the team-based tele-instruction tool, demonstrating its ability to effectively guide multiple lay responders through teamwork and effective communication with telecommunicators. Conclusions: The use of the team-based tele-instruction tool offers an effective solution to enhance the quality of chest compression among multiple lay responders. This tool facilitated the organization of resuscitation teams by dispatchers and enabled efficient cooperation. Further assessment of the widespread adoption and practical application of the team-based tele-instruction tools in real-life rescue scenarios within the telehealth emergency services system is warranted. ",
doi="10.2196/46092",
url="https://www.jmir.org/2023/1/e46092",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494107"
}


@Article{info:doi/10.2196/44003,
author="Zepeda-Echavarria, Alejandra
and van de Leur, R. Rutger
and van Sleuwen, Meike
and Hassink, J. Rutger
and Wildbergh, X. Thierry
and Doevendans, A. Pieter
and Jaspers, Joris
and van Es, Ren{\'e}",
title="Electrocardiogram Devices for Home Use: Technological and Clinical Scoping Review",
journal="JMIR Cardio",
year="2023",
month="Jul",
day="7",
volume="7",
pages="e44003",
keywords="electrocardiogram",
keywords="mobile ECG",
keywords="home use ECG",
keywords="wearables",
keywords="medical devices",
keywords="ECG clinical validation, ECG technical characteristics",
abstract="Background: Electrocardiograms (ECGs) are used by physicians to record, monitor, and diagnose the electrical activity of the heart. Recent technological advances have allowed ECG devices to move out of the clinic and into the home environment. There is a great variety of mobile ECG devices with the capabilities to be used in home environments. Objective: This scoping review aimed to provide a comprehensive overview of the current landscape of mobile ECG devices, including the technology used, intended clinical use, and available clinical evidence. Methods: We conducted a scoping review to identify studies concerning mobile ECG devices in the electronic database PubMed. Secondarily, an internet search was performed to identify other ECG devices available in the market. We summarized the devices' technical information and usability characteristics based on manufacturer data such as datasheets and user manuals. For each device, we searched for clinical evidence on the capabilities to record heart disorders by performing individual searches in PubMed and ClinicalTrials.gov, as well as the Food and Drug Administration (FDA) 510(k) Premarket Notification and De Novo databases. Results: From the PubMed database and internet search, we identified 58 ECG devices with available manufacturer information. Technical characteristics such as shape, number of electrodes, and signal processing influence the capabilities of the devices to record cardiac disorders. Of the 58 devices, only 26 (45\%) had clinical evidence available regarding their ability to detect heart disorders such as rhythm disorders, more specifically atrial fibrillation. Conclusions: ECG devices available in the market are mainly intended to be used for the detection of arrhythmias. No devices are intended to be used for the detection of other cardiac disorders. Technical and design characteristics influence the intended use of the devices and use environments. For mobile ECG devices to be intended to detect other cardiac disorders, challenges regarding signal processing and sensor characteristics should be solved to increase their detection capabilities. Devices recently released include the use of other sensors on ECG devices to increase their detection capabilities. ",
doi="10.2196/44003",
url="https://cardio.jmir.org/2023/1/e44003",
url="http://www.ncbi.nlm.nih.gov/pubmed/37418308"
}


@Article{info:doi/10.2196/45611,
author="Zaman, Sameer
and Padayachee, Yorissa
and Shah, Moulesh
and Samways, Jack
and Auton, Alice
and Quaife, M. Nicholas
and Sweeney, Mark
and Howard, P. James
and Tenorio, Indira
and Bachtiger, Patrik
and Kamalati, Tahereh
and Pabari, A. Punam
and Linton, F. Nick W.
and Mayet, Jamil
and Peters, S. Nicholas
and Barton, Carys
and Cole, D. Graham
and Plymen, M. Carla",
title="Smartphone-Based Remote Monitoring in Heart Failure With Reduced Ejection Fraction: Retrospective Cohort Study of Secondary Care Use and Costs",
journal="JMIR Cardio",
year="2023",
month="Jun",
day="23",
volume="7",
pages="e45611",
keywords="heart failure",
keywords="remote monitoring",
keywords="smartphone care",
keywords="telemonitoring",
keywords="self-management",
keywords="admission prevention",
keywords="cohort study",
keywords="hospitalization",
keywords="noninvasive",
keywords="smartphone",
keywords="vital signs",
keywords="diagnosis",
abstract="Background: Despite effective therapies, the economic burden of heart failure with reduced ejection fraction (HFrEF) is driven by frequent hospitalizations. Treatment optimization and admission avoidance rely on frequent symptom reviews and monitoring of vital signs. Remote monitoring (RM) aims to prevent admissions by facilitating early intervention, but the impact of noninvasive, smartphone-based RM of vital signs on secondary health care use and costs in the months after a new diagnosis of HFrEF is unknown. Objective: The purpose of this study is to conduct a secondary care health use and health-economic evaluation for patients with HFrEF using smartphone-based noninvasive RM and compare it with matched controls receiving usual care without RM. Methods: We conducted a retrospective study of 2 cohorts of newly diagnosed HFrEF patients, matched 1:1 for demographics, socioeconomic status, comorbidities, and HFrEF severity. They are (1) the RM group, with patients using the RM platform for >3 months and (2) the control group, with patients referred before RM was available who received usual heart failure care without RM. Emergency department (ED) attendance, hospital admissions, outpatient use, and the associated costs of this secondary care activity were extracted from the Discover data set for a 3-month period after diagnosis. Platform costs were added for the RM group. Secondary health care use and costs were analyzed using Kaplan-Meier event analysis and Cox proportional hazards modeling. Results: A total of 146 patients (mean age 63 years; 42/146, 29\% female) were included (73 in each group). The groups were well-matched for all baseline characteristics except hypertension (P=.03). RM was associated with a lower hazard of ED attendance (hazard ratio [HR] 0.43; P=.02) and unplanned admissions (HR 0.26; P=.02). There were no differences in elective admissions (HR 1.03, P=.96) or outpatient use (HR 1.40; P=.18) between the 2 groups. These differences were sustained by a univariate model controlling for hypertension. Over a 3-month period, secondary health care costs were approximately 4-fold lower in the RM group than the control group, despite the additional cost of RM itself (mean cost per patient GBP {\textsterling}465, US \$581 vs GBP {\textsterling}1850, US \$2313, respectively; P=.04). Conclusions: This retrospective cohort study shows that smartphone-based RM of vital signs is feasible for HFrEF. This type of RM was associated with an approximately 2-fold reduction in ED attendance and a 4-fold reduction in emergency admissions over just 3 months after a new diagnosis with HFrEF. Costs were significantly lower in the RM group without increasing outpatient demand. This type of RM could be adjunctive to standard care to reduce admissions, enabling other resources to help patients unable to use RM. ",
doi="10.2196/45611",
url="https://cardio.jmir.org/2023/1/e45611",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351921"
}


@Article{info:doi/10.2196/45230,
author="Nishizaki, Yuji
and Kuroki, Haruo
and Ishii, So
and Ohtsu, Shigeyuki
and Watanabe, Chizuru
and Nishizawa, Hiroto
and Nagao, Masashi
and Nojima, Masanori
and Watanabe, Ryo
and Sato, Daisuke
and Sato, Kensuke
and Kawata, Yumi
and Wada, Hiroo
and Toyoda, Goichiro
and Ohbayashi, Katsumi",
title="Determining Optimal Intervals for In-Person Visits During Video-Based Telemedicine Among Patients With Hypertension: Cluster Randomized Controlled Trial",
journal="JMIR Cardio",
year="2023",
month="Jun",
day="8",
volume="7",
pages="e45230",
keywords="hypertension",
keywords="Japan",
keywords="lost productivity time",
keywords="patient satisfaction",
keywords="telemedicine",
abstract="Background: Introducing telemedicine in outpatient treatment may improve patient satisfaction and convenience. However, the optimal in-person visit interval for video-based telemedicine among patients with hypertension remains unreported in Japan. Objective: We determined the optimal in-person visit interval for video-based telemedicine among patients with hypertension. Methods: This was a cluster randomized controlled noninferiority trial. The target sites were 8 clinics in Japan that had a telemedicine system, and the target patients were individuals with essential hypertension. Among patients receiving video-based telemedicine, those who underwent in-person visits at 6-month intervals were included in the intervention group, and those who underwent in-person visits at 3-month intervals were included in the control group. The follow-up period of the participants was 6 months. The primary end point of the study was the change in systolic blood pressure, and the secondary end points were the rate of treatment continuation after 6 months, patient satisfaction, health economic evaluation, and safety evaluation. Results: Overall, 64 patients were enrolled. Their mean age was 54.5 (SD 10.3) years, and 60.9\% (39/64) of patients were male. For the primary end point, the odds ratio for the estimated difference in the change in systolic blood pressure between the 2 groups was 1.18 (90\% CI --3.68 to 6.04). Notably, the criteria for noninferiority were met. Patient satisfaction was higher in the intervention group than in the control group. Furthermore, the indirect costs indicated that lost productivity was significantly lesser in the intervention group than in the control group. Moreover, the treatment continuation rate did not differ between the intervention and control groups, and there were no adverse events in either group. Conclusions: Blood pressure control status and safety did not differ between the intervention and control groups. In-person visits at 6-month intervals may cause a societal cost reduction and improve patient satisfaction during video-based telemedicine. Trial Registration: UMIN Clinical Trials Registry (UMIN-CTR) UMIN000040953; https://tinyurl.com/2p8devm9 ",
doi="10.2196/45230",
url="https://cardio.jmir.org/2023/1/e45230",
url="http://www.ncbi.nlm.nih.gov/pubmed/37161483"
}


@Article{info:doi/10.2196/45247,
author="Ashikaga, Kohei
and Doi, Shunichi
and Yoneyama, Kihei
and Suzuki, Norio
and Kuwata, Shingo
and Koga, Masashi
and Takeichi, Naoya
and Watanabe, Satoshi
and Izumo, Masaki
and Kida, Keisuke
and Akashi, J. Yoshihiro",
title="Efficacy and Safety of Home-Based Cardiac Telemonitoring Rehabilitation in Patients After Transcatheter Aortic Valve Implantation: Single-Center Usability and Feasibility Study",
journal="JMIR Rehabil Assist Technol",
year="2023",
month="May",
day="17",
volume="10",
pages="e45247",
keywords="transcatheter aortic valve implantation",
keywords="telerehabilitation",
keywords="cardiac rehabilitation",
keywords="remote",
keywords="telemonitoring",
abstract="Background: No consensus exists on the efficacy of home-based cardiac rehabilitation (CR) in patients who have undergone transcatheter aortic valve implantation (TAVI). Additionally, there are no reports on home-based cardiac telemonitoring rehabilitation (HBTR) in patients after TAVI. Objective: We aimed to investigate the efficacy of HBTR in patients who have undergone TAVI. Methods: This single-center preliminary study introduced HBTR to patients after TAVI, and the efficacy outcomes of the rehabilitation method were compared to that of a historical control cohort. The historical control cohort (control group) consisted of 6 consecutive patients who underwent ordinary outpatient CR after TAVI from February 2016 to March 2020. Patients who participated in the HBTR program were only recruited after the TAVI procedure and before discharge between April 2021 and May 2022. In the first 2 weeks after TAVI, patients underwent outpatient CR and were trained using telemonitoring rehabilitation systems. Thereafter, patients underwent HBTR twice a week for 12 weeks. The control group performed standard outpatient CR at least once a week for 12 to 16 weeks. Efficacy was assessed using peak oxygen uptake (VO2) prior to and after CR. Results: Eleven patients were included in the HBTR group. All patients underwent 24 HBTR sessions during the 12-week training period, and no adverse events were observed. The control group participants performed 19 (SD 7) sessions during the training period, and no adverse events were observed. Participants in the HBTR and control groups had a mean age of 80.4 (SD 6.0) years and 79.0 (SD 3.9) years, respectively. In the HBTR group, preintervention and postintervention peak VO2 values were 12.0 (SD 1.7) mL/min/kg and 14.3 (SD 2.7) mL/min/kg (P=.03), respectively. The peak VO2 changes in the HBTR and control groups were 2.4 (SD 1.4) mL/min/kg and 1.3 (SD 5.0) mL/min/kg (P=.64), respectively. Conclusions: Home-based CR using a telemonitoring system is a safe outpatient rehabilitation method. Its efficacy is not inferior to that of standard CR in patients who have undergone TAVI. Trial Registration: Japan Registry of Clinical Trials jRCTs032200122; https://jrct.niph.go.jp/latest-detail/jRCTs032200122 ",
doi="10.2196/45247",
url="https://rehab.jmir.org/2023/1/e45247",
url="http://www.ncbi.nlm.nih.gov/pubmed/37195764"
}


@Article{info:doi/10.2196/45190,
author="Zoodsma, S. Ruben
and Bosch, Rian
and Alderliesten, Thomas
and Bollen, W. Casper
and Kappen, H. Teus
and Koomen, Erik
and Siebes, Arno
and Nijman, Joppe",
title="Continuous Data-Driven Monitoring in Critical Congenital Heart Disease: Clinical Deterioration Model Development",
journal="JMIR Cardio",
year="2023",
month="May",
day="16",
volume="7",
pages="e45190",
keywords="artificial intelligence",
keywords="aberration detection",
keywords="clinical deterioration",
keywords="classification model",
keywords="paediatric intensive care",
keywords="pediatric intensive care",
keywords="congenital heart disease",
keywords="cardiac monitoring",
keywords="machine learning",
keywords="peri-operative",
keywords="perioperative",
keywords="surgery",
abstract="Background: Critical congenital heart disease (cCHD)---requiring cardiac intervention in the first year of life for survival---occurs globally in 2-3 of every 1000 live births. In the critical perioperative period, intensive multimodal monitoring at a pediatric intensive care unit (PICU) is warranted, as their organs---especially the brain---may be severely injured due to hemodynamic and respiratory events. These 24/7 clinical data streams yield large quantities of high-frequency data, which are challenging in terms of interpretation due to the varying and dynamic physiology innate to cCHD. Through advanced data science algorithms, these dynamic data can be condensed into comprehensible information, reducing the cognitive load on the medical team and providing data-driven monitoring support through automated detection of clinical deterioration, which may facilitate timely intervention. Objective: This study aimed to develop a clinical deterioration detection algorithm for PICU patients with cCHD. Methods: Retrospectively, synchronous per-second data of cerebral regional oxygen saturation (rSO2) and 4 vital parameters (respiratory rate, heart rate, oxygen saturation, and invasive mean blood pressure) in neonates with cCHD admitted to the University Medical Center Utrecht, the Netherlands, between 2002 and 2018 were extracted. Patients were stratified based on mean oxygen saturation during admission to account for physiological differences between acyanotic and cyanotic cCHD. Each subset was used to train our algorithm in classifying data as either stable, unstable, or sensor dysfunction. The algorithm was designed to detect combinations of parameters abnormal to the stratified subpopulation and significant deviations from the patient's unique baseline, which were further analyzed to distinguish clinical improvement from deterioration. Novel data were used for testing, visualized in detail, and internally validated by pediatric intensivists. Results: A retrospective query yielded 4600 hours and 209 hours of per-second data in 78 and 10 neonates for, respectively, training and testing purposes. During testing, stable episodes occurred 153 times, of which 134 (88\%) were correctly detected. Unstable episodes were correctly noted in 46 of 57 (81\%) observed episodes. Twelve expert-confirmed unstable episodes were missed in testing. Time-percentual accuracy was 93\% and 77\% for, respectively, stable and unstable episodes. A total of 138 sensorial dysfunctions were detected, of which 130 (94\%) were correct. Conclusions: In this proof-of-concept study, a clinical deterioration detection algorithm was developed and retrospectively evaluated to classify clinical stability and instability, achieving reasonable performance considering the heterogeneous population of neonates with cCHD. Combined analysis of baseline (ie, patient-specific) deviations and simultaneous parameter-shifting (ie, population-specific) proofs would be promising with respect to enhancing applicability to heterogeneous critically ill pediatric populations. After prospective validation, the current---and comparable---models may, in the future, be used in the automated detection of clinical deterioration and eventually provide data-driven monitoring support to the medical team, allowing for timely intervention. ",
doi="10.2196/45190",
url="https://cardio.jmir.org/2023/1/e45190",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191988"
}


@Article{info:doi/10.2196/44179,
author="Calvo-L{\'o}pez, Margarita
and Arranz Tol{\'o}s, Raquel
and Marin Exp{\'o}sito, Josefa
and Gruosso, Domenico
and Andrea, Rut
and Roque, Merc{\`e}
and Falces, Carles
and Yago, Gemma
and Saura Araguas, Judith
and Pastor, Nuria
and Sitges, Marta
and Sanz-de la Garza, Maria",
title="Cardio4Health Study, a Cardiac Telerehabilitation Pilot Program Aimed at Patients After an Ischemic Event: Cross-sectional Study",
journal="JMIR Cardio",
year="2023",
month="Apr",
day="24",
volume="7",
pages="e44179",
keywords="cardiac rehabilitation",
keywords="web-based platform",
keywords="telemedicine",
keywords="remote care",
keywords="ischemic heart disease",
abstract="Background: Center-based cardiac rehabilitation programs (CRPs) reduce morbidity and mortality after an ischemic cardiac event; however, they are widely underused. Home-based CRP has emerged as an alternative to improve patient adherence; however, its safety and efficacy remain unclear, especially for older patients and female patients. Objective: This study aimed to develop a holistic home-based CRP for patients with ischemic heart disease and evaluate its safety and impact on functional capacity, adherence to a healthy lifestyle, and quality of life. Methods: The 8-week home-based CRP included patients of both sexes, with no age limit, who had overcome an acute myocardial infarction in the previous 3 months, had a left ventricular ejection fraction of ?40\%, and had access to a tablet or mobile device. The CRP was developed using a dedicated platform designed explicitly for this purpose and included 3 weekly exercise sessions combining tailored aerobic and strength training and 2 weekly educational session focused on lifestyle habits, therapeutic adherence, and patient empowerment. Results: We initially included 62 patients, of whom 1 was excluded for presenting with ventricular arrhythmias during the initial stress test, 5 were excluded because of incompatibility, and 6 dropped out because of a technological barrier. Ultimately, 50 patients completed the program: 85\% (42/50) were male, with a mean age of 58.9 (SD 10.3) years, a mean left ventricular ejection fraction of 52.1\% (SD 6.72\%), and 25 (50\%) New York Heart Association functional class I and 25 (50\%) New York Heart Association II-III. The CRP significantly improved functional capacity (+1.6 metabolic equivalent tasks), muscle strength (arm curl test +15.5\% and sit-to-stand test +19.7\%), weekly training volume (+803 metabolic equivalent tasks), adherence to the Mediterranean diet, emotional state (anxiety), and quality of life. No major complications occurred, and adherence was excellent (>80\%) in both the exercise and educational sessions. In the subgroup analysis, CRP showed equivalent beneficial effects irrespective of sex and age. In addition, patient preferences for CRP approaches were equally distributed, with one-third (14/50, 29\%) of the patients preferring a face-to-face CRP, one-third (17/50, 34\%) preferring a telematic CRP, and one-third (18/50, 37\%) preferring a hybrid approach. Regarding CRP duration, 63\% (31/50) of the patients considered it adequate, whereas the remaining 37\% (19/50) preferred a longer program. Conclusions: A holistic telematic CRP dedicated to patients after an ischemic cardiac event, irrespective of sex and age, is safe and, in our population, has achieved positive results in improving maximal aerobic capacity, weekly training volume, muscle strength, quality of life, compliance with diet, and anxiety symptoms. The preference for a center- or home-based CRP approach is diverse among the study population, emphasizing the need for a tailored CRP to improve adherence and completion rates. ",
doi="10.2196/44179",
url="https://cardio.jmir.org/2023/1/e44179",
url="http://www.ncbi.nlm.nih.gov/pubmed/37093637"
}


@Article{info:doi/10.2196/41775,
author="Ru, Boshu
and Tan, Xi
and Liu, Yu
and Kannapur, Kartik
and Ramanan, Dheepan
and Kessler, Garin
and Lautsch, Dominik
and Fonarow, Gregg",
title="Comparison of Machine Learning Algorithms for Predicting Hospital Readmissions and Worsening Heart Failure Events in Patients With Heart Failure With Reduced Ejection Fraction: Modeling Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="17",
volume="7",
pages="e41775",
keywords="deep learning",
keywords="machine learning",
keywords="hospital readmission",
keywords="heart failure",
keywords="heart failure with reduced ejection fraction",
keywords="worsening heart failure event",
keywords="Bidirectional Encoder Representations From Transformers",
keywords="BERT",
keywords="clinical registry",
keywords="medical claims",
keywords="real-world data",
abstract="Background: Heart failure (HF) is highly prevalent in the United States. Approximately one-third to one-half of HF cases are categorized as HF with reduced ejection fraction (HFrEF). Patients with HFrEF are at risk of worsening HF, have a high risk of adverse outcomes, and experience higher health care use and costs. Therefore, it is crucial to identify patients with HFrEF who are at high risk of subsequent events after HF hospitalization. Objective: Machine learning (ML) has been used to predict HF-related outcomes. The objective of this study was to compare different ML prediction models and feature construction methods to predict 30-, 90-, and 365-day hospital readmissions and worsening HF events (WHFEs). Methods: We used the Veradigm PINNACLE outpatient registry linked to Symphony Health's Integrated Dataverse data from July 1, 2013, to September 30, 2017. Adults with a confirmed diagnosis of HFrEF and HF-related hospitalization were included. WHFEs were defined as HF-related hospitalizations or outpatient intravenous diuretic use within 1 year of the first HF hospitalization. We used different approaches to construct ML features from clinical codes, including frequencies of clinical classification software (CCS) categories, Bidirectional Encoder Representations From Transformers (BERT) trained with CCS sequences (BERT + CCS), BERT trained on raw clinical codes (BERT + raw), and prespecified features based on clinical knowledge. A multilayer perceptron neural network, extreme gradient boosting (XGBoost), random forest, and logistic regression prediction models were applied and compared. Results: A total of 30,687 adult patients with HFrEF were included in the analysis; 11.41\% (3184/27,917) of adults experienced a hospital readmission within 30 days of their first HF hospitalization, and nearly half (9231/21,562, 42.81\%) of the patients experienced at least 1 WHFE within 1 year after HF hospitalization. The prediction models and feature combinations with the best area under the receiver operating characteristic curve (AUC) for each outcome were XGBoost with CCS frequency (AUC=0.595) for 30-day readmission, random forest with CCS frequency (AUC=0.630) for 90-day readmission, XGBoost with CCS frequency (AUC=0.649) for 365-day readmission, and XGBoost with CCS frequency (AUC=0.640) for WHFEs. Our ML models could discriminate between readmission and WHFE among patients with HFrEF. Our model performance was mediocre, especially for the 30-day readmission events, most likely owing to limitations of the data, including an imbalance between positive and negative cases and high missing rates of many clinical variables and outcome definitions. Conclusions: We predicted readmissions and WHFEs after HF hospitalizations in patients with HFrEF. Features identified by data-driven approaches may be comparable with those identified by clinical domain knowledge. Future work may be warranted to validate and improve the models using more longitudinal electronic health records that are complete, are comprehensive, and have a longer follow-up time. ",
doi="10.2196/41775",
url="https://formative.jmir.org/2023/1/e41775",
url="http://www.ncbi.nlm.nih.gov/pubmed/37067873"
}


@Article{info:doi/10.2196/43134,
author="Mekhael, Mario
and Ho, Chan
and Noujaim, Charbel
and Assaf, Ala
and Younes, Hadi
and El Hajjar, Hadi Abdel
and Chaudhry, A. Humza
and Lanier, Brennan
and Chouman, Nour
and Makan, Noor
and Shan, Botao
and Zhang, Yichi
and Dagher, Lilas
and Kreidieh, Omar
and Marrouche, Nassir
and Donnellan, Eoin",
title="Compliance Challenges in a Longitudinal COVID-19 Cohort Using Wearables for Continuous Monitoring: Observational Study",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="5",
volume="25",
pages="e43134",
keywords="COVID-19",
keywords="digital health",
keywords="wearables",
keywords="compliance",
keywords="cardiovascular health",
keywords="heart disease",
keywords="wearable device",
keywords="biometric",
keywords="remote monitoring",
abstract="Background: The WEAICOR (Wearables to Investigate the Long Term Cardiovascular and Behavioral Impacts of COVID-19) study was a prospective observational study that used continuous monitoring to detect and analyze biometrics. Compliance to wearables was a major challenge when conducting the study and was crucial for the results. Objective: The aim of this study was to evaluate patients' compliance to wearable wristbands and determinants of compliance in a prospective COVID-19 cohort. Methods: The Biostrap (Biostrap USA LLC) wearable device was used to monitor participants' biometric data. Compliance was calculated by dividing the total number of days in which transmissions were sent by the total number of days spent in the WEAICOR study. Univariate correlation analyses were performed, with compliance and days spent in the study as dependent variables and age, BMI, sex, symptom severity, and the number of complications or comorbidities as independent variables. Multivariate linear regression was then performed, with days spent in the study as a dependent variable, to assess the power of different parameters in determining the number of days patients spent in the study. Results: A total of 122 patients were included in this study. Patients were on average aged 41.32 years, and 46 (38\%) were female. Age was found to correlate with compliance (r=0.23; P=.01). In addition, age (r=0.30; P=.001), BMI (r=0.19; P=.03), and the severity of symptoms (r=0.19; P=.03) were found to correlate with days spent in the WEAICOR study. Per our multivariate analysis, in which days spent in the study was a dependent variable, only increased age was a significant determinant of compliance with wearables (adjusted R2=0.1; $\beta$=1.6; P=.01). Conclusions: Compliance is a major obstacle in remote monitoring studies, and the reasons for a lack of compliance are multifactorial. Patient factors such as age, in addition to environmental factors, can affect compliance to wearables. ",
doi="10.2196/43134",
url="https://www.jmir.org/2023/1/e43134",
url="http://www.ncbi.nlm.nih.gov/pubmed/36763647"
}


@Article{info:doi/10.2196/42896,
author="Chen, Botian
and Dou, Yuqi
and Yu, Xue
and Ma, Defu",
title="Influence of Internet-Based Health Management on Control of Clinical Parameters in Patients With Hypertension: Four-Year Longitudinal Study",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="20",
volume="25",
pages="e42896",
keywords="hypertension",
keywords="internet-based health management",
keywords="blood pressure control",
keywords="longitudinal study",
keywords="health management",
keywords="primary care",
keywords="online based",
keywords="eHealth",
keywords="telehealth",
keywords="telemedicine",
abstract="Background: In recent years, more and more studies have shown that internet-based health management can help patients with hypertension control their blood pressure. However, there is a lack of similar research in China. Objective: We designed this study to clarify the impact of long-term internet-based health management on the control of clinical parameters in patients with hypertension. These results are also expected to identify the relevant factors affecting the control of clinical parameters in hypertension more accurately toward developing more targeted health management strategies. Methods: This was a longitudinal study of internet-based health management in the five provinces of northwest China. The inclusion criteria were aged ?18 years and no serious cognitive disease or mental disorder. After collecting the physical examination data of 8567 people in the five northwest provinces in 2013, we conducted online health management (including diet, exercise, and behavior) and follow-up. In the physical examination in 2013, 1008 new patients with hypertension were identified, who were divided into a good blood pressure control group and poor blood pressure control group. Physical examination and a questionnaire survey were conducted every 2 years to understand the changes of health management on the subjects' health-related behaviors. We then analyzed the changes of clinical indicators related to hypertension and the influencing factors related to blood pressure control in patients with hypertension. All statistical analyses were performed using R software (version 4.1.2) and a P value <.05 was considered statistically significant. Results: A total of 8567 people met the inclusion criteria and underwent health management. Self-comparison showed that after 4 years of health management, the smoking cessation rate and amount of exercise significantly increased (both P<.001). The low-density lipoprotein-cholesterol levels also increased (P=.005), whereas the high-density lipoprotein-cholesterol levels decreased (P=.007). The newly discovered patients with hypertension in 2013 were further screened. After 4 years of health management, their smoking cessation rate increased significantly (P=.03) and the amount of exercise increased but not significantly (P=.08). In terms of clinical indicators, the diastolic blood pressure considerably decreased (P<.001) and the systolic blood pressure slightly decreased (P=.13). The correlation analysis of blood pressure control in patients with new-onset hypertension showed that gender (female) and changing relevant factors according to health management behaviors (BMI; cereals and potatoes intake; fish, livestock meat, and eggs intake; fruit intake; and physical activity) were the protective factors of blood pressure control. Conclusions: Internet-based health management has a significant and long-term effect on blood pressure control in patients with hypertension. ",
doi="10.2196/42896",
url="https://www.jmir.org/2023/1/e42896",
url="http://www.ncbi.nlm.nih.gov/pubmed/36939826"
}


@Article{info:doi/10.2196/42134,
author="Khalid, Ayisha
and Dong, Quanfang
and Chuluunbaatar, Enkhzaya
and Haldane, Victoria
and Durrani, Hammad
and Wei, Xiaolin",
title="Implementation Science Perspectives on Implementing Telemedicine Interventions for Hypertension or Diabetes Management: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="14",
volume="25",
pages="e42134",
keywords="telemedicine",
keywords="hypertension",
keywords="diabetes",
keywords="implementation science",
keywords="mobile phone",
abstract="Background: Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions for care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension or diabetes worldwide. Objective: We adopted a comprehensive implementation research perspective to synthesize the barriers to and facilitators of implementing telemedicine interventions for the management of hypertension, diabetes, or both. Methods: We performed a scoping review involving searches in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research. Results: Of the 17,687 records identified, 35 (0.2\%) studies were included in our scoping review. We found that facilitators of and barriers to implementation were dispersed across the constructs of the Consolidated Framework for Implementation Research. Barriers related to cost, patient needs and resources (eg, lack of consideration of language needs, culture, and rural residency), and personal attributes of patients (eg, demographics and priorities) were the most common. Facilitators related to the design and packaging of the intervention (eg, user-friendliness), patient needs and resources (eg, personalized information that leveraged existing strengths), implementation climate (eg, intervention embedded into existing infrastructure), knowledge of and beliefs about the intervention (eg, convenience of telemedicine), and other personal attributes (eg, technical literacy) were the most common. Conclusions: Our findings suggest that the successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, execution, engagement, and reflection and evaluation stages of intervention implementation to address challenges at the individual, interpersonal, organizational, and environmental levels. ",
doi="10.2196/42134",
url="https://www.jmir.org/2023/1/e42134",
url="http://www.ncbi.nlm.nih.gov/pubmed/36917174"
}


@Article{info:doi/10.2196/41115,
author="Leiner, Johannes
and K{\"o}nig, Sebastian
and Mouratis, Konstantinos
and Kim, Igor
and Schmitz, Pia
and Joshi, Tanvi
and Schanner, Carolin
and Wohlrab, Lisa
and Hohenstein, Sven
and Pellissier, Vincent
and Nitsche, Anne
and Kuhlen, Ralf
and Hindricks, Gerhard
and Bollmann, Andreas",
title="A Digital Infrastructure for Cardiovascular Patient Care Based on Mobile Health Data and Patient-Reported Outcomes: Concept Details of the Helios TeleWear Project Including Preliminary Experiences",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="3",
volume="7",
pages="e41115",
keywords="mHealth",
keywords="wearable",
keywords="patient-reported outcomes",
keywords="electrocardiogram",
keywords="cardiovascular disease",
keywords="atrial fibrillation",
keywords="telemedicine",
keywords="mobile health",
keywords="telehealth",
abstract="Background: Mobile health (mHealth) approaches are already having a fundamental impact on clinical practice in cardiovascular medicine. A variety of different health apps and wearable devices for capturing health data such as electrocardiograms (ECGs) exist. However, most mHealth technologies focus on distinct variables without integrating patients' quality of life, and the impact on clinical outcome measures of implementing those digital solutions into cardiovascular health care is still to be determined. Objective: Within this document, we describe the TeleWear project, which was recently initiated as an approach for contemporary patient management integrating mobile-collected health data and the standardized mHealth-guided measurement of patient-reported outcomes (PROs) in patients with cardiovascular disease. Methods: The specifically designed mobile app and clinical frontend form the central elements of our TeleWear infrastructure. Because of its flexible framework, the platform allows far-reaching customization with the possibility to add different mHealth data sources and respective questionnaires (patient-reported outcome measures). Results: With initial focus on patients with cardiac arrhythmias, a feasibility study is currently carried out to assess wearable-recorded ECG and PRO transmission and its evaluation by physicians using the TeleWear app and clinical frontend. First experiences made during the feasibility study yielded positive results and confirmed the platform's functionality and usability. Conclusions: TeleWear represents a unique mHealth approach comprising PRO and mHealth data capturing. With the currently running TeleWear feasibility study, we aim to test and further develop the platform in a real-world setting. A randomized controlled trial including patients with atrial fibrillation that investigates PRO- and ECG-based clinical management based on the established TeleWear infrastructure will evaluate its clinical benefits. Widening the spectrum of health data collection and interpretation beyond the ECG and use of the TeleWear infrastructure in different patient subcohorts with focus on cardiovascular diseases are further milestones of the project with the ultimate goal to establish a comprehensive telemedical center entrenched by mHealth. ",
doi="10.2196/41115",
url="https://formative.jmir.org/2023/1/e41115",
url="http://www.ncbi.nlm.nih.gov/pubmed/36867450"
}


@Article{info:doi/10.2196/40536,
author="Askman, Sanna
and L{\"o}f, Marie
and Maddison, Ralph
and Nourse, Rebecca",
title="Feasibility and Acceptability of Wearable Cameras to Assess Self-care in People With Heart Failure: Pilot Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="17",
volume="7",
pages="e40536",
keywords="heart failure",
keywords="HF",
keywords="life logging",
keywords="self-management",
keywords="cardiovascular disease",
keywords="wearable devices",
keywords="self management",
keywords="self-care",
abstract="Background: Heart failure (HF) is a common chronic condition that affects over 26 million people worldwide. It is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. People with HF generally do not self-manage their condition well (eg, monitoring symptoms, taking medications regularly, physical activity, etc). A better understanding of self-care activities and what factors may indicate deterioration is warranted. Objective: The aim of this study was to determine the feasibility and acceptability of using wearable cameras to assess self-care activities in people with HF. The study objectives were to (1) explore whether changes in self-care activities could be identified prior to hospitalization and (2) determine the acceptability of wearable cameras to people with HF. Methods: A total of 30 people recently diagnosed with HF wore a camera for a maximum of 30 days; the camera took a photo every 30 seconds in the forward-facing direction. At the end of the study, all 30 participants were presented with 8 statements of acceptability, scored on a 5-point Likert scale. To determine whether camera images could identify changes in self-care activities and lifestyle risk factors before hospitalization, we analyzed images from participants (n=8) who were hospitalized during the 30-day study period. Images from the period immediately prior to hospitalization and a comparison were selected for each participant. Images were manually coded according to 9 different event categories relating to self-care and lifestyle risk factors, and events were compared between the 2 periods. Results: The participants reported high acceptability for wearing the cameras, as most strongly agreed or agreed that they were comfortable to wear (28/30, 93\%) and easy to use (30/30, 100\%). The results of the camera image analysis showed that participants undertook fewer activities of daily living (P=.008) and were more sedentary (P=.02) prior to being hospitalized, compared to a period nonadjacent to hospitalization. Conclusions: Adults with HF were accepting of using a wearable camera for periods within a 30-day time frame. Wearable cameras were a feasible approach for providing data on selected self-care activities and lifestyle risk factors for HF and offer the potential to be a valuable tool for improving our understanding of self-care. ",
doi="10.2196/40536",
url="https://formative.jmir.org/2023/1/e40536",
url="http://www.ncbi.nlm.nih.gov/pubmed/36800215"
}


@Article{info:doi/10.2196/41248,
author="Brons, Maaike
and ten Klooster, Iris
and van Gemert-Pijnen, Lisette
and Jaarsma, Tiny
and Asselbergs, W. Folkert
and Oerlemans, J. Marish I. F.
and Koudstaal, Stefan
and Rutten, H. Frans",
title="Patterns in the Use of Heart Failure Telemonitoring: Post Hoc Analysis of the e-Vita Heart Failure Trial",
journal="JMIR Cardio",
year="2023",
month="Jan",
day="31",
volume="7",
pages="e41248",
keywords="heart failure",
keywords="telemonitoring",
keywords="adherence",
keywords="eHealth",
keywords="remote monitoring",
keywords="electronic personal health record",
keywords="patient monitoring",
abstract="Background: Research on the use of home telemonitoring data and adherence to it can provide new insights into telemonitoring for the daily management of patients with heart failure (HF). Objective: We described the use of a telemonitoring platform---including remote patient monitoring of blood pressure, pulse, and weight---and the use of the electronic personal health record. Patient characteristics were assessed in both adherent and nonadherent patients to weight transmissions. Methods: We used the data of the e-Vita HF study, a 3-arm parallel randomized trial performed in stable patients with HF managed in outpatient clinics in the Netherlands. In this study, data were analyzed from the participants in the intervention arm (ie, e-Vita HF platform). Adherence to weight transmissions was defined as transmitting weight ?3 times per week for at least 42 weeks during a year. Results: Data from 150 patients (mean age 67, SD 11 years; n=37, 25\% female; n=123, 82\% self-assessed New York Heart Association class I-II) were analyzed. One-year adherence to weight transmissions was 74\% (n=111). Patients adherent to weight transmissions were less often hospitalized for HF in the 6 months before enrollment in the study compared to those who were nonadherent (n=9, 8\% vs n=9, 23\%; P=.02). The percentage of patients visiting the personal health record dropped steadily over time (n=140, 93\% vs n=59, 39\% at one year). With univariable analyses, there was no significant correlation between patient characteristics and adherence to weight transmissions. Conclusions: Adherence to remote patient monitoring was high among stable patients with HF and best for weighing; however, adherence decreased over time. Clinical and demographic variables seem not related to adherence to transmitting weight. Trial Registration: ClinicalTrials.gov NCT01755988; https://clinicaltrials.gov/ct2/show/NCT01755988 ",
doi="10.2196/41248",
url="https://cardio.jmir.org/2023/1/e41248",
url="http://www.ncbi.nlm.nih.gov/pubmed/36719715"
}


@Article{info:doi/10.2196/40630,
author="Goswami, Aumeya
and Poole, Lydia
and Thorlu-Bangura, Zareen
and Khan, Nushrat
and Hanif, Wasim
and Khunti, Kamlesh
and Gill, Paramjit
and Sajid, Madiha
and Blandford, Ann
and Stevenson, Fiona
and Banerjee, Amitava
and Ramasawmy, Mel",
title="The Use of Digital Health Interventions for Cardiometabolic Diseases Among South Asian and Black Minority Ethnic Groups: Realist Review",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="6",
volume="25",
pages="e40630",
keywords="digital health",
keywords="health inequality",
keywords="cardiometabolic disease",
keywords="cardiometabolic",
keywords="ethnic",
keywords="minority",
keywords="cardiology",
keywords="heart",
keywords="eHealth",
keywords="review",
keywords="realist",
keywords="context-mechanism-outcome",
keywords="South Asia",
keywords="Black",
keywords="migrant",
keywords="systematic search",
keywords="literature search",
keywords="African American",
keywords="CVD",
keywords="cardiovascular",
keywords="diabetes",
keywords="diabetic",
keywords="type 2",
keywords="mobile phone",
abstract="Background: Digital health interventions (DHIs) for the prevention and management of cardiometabolic diseases have become increasingly common. However, there is limited evidence for the suitability of these approaches in minority ethnic populations, who are at an increased risk of these diseases. Objective: This study aimed to investigate the use of DHIs for cardiovascular disease and type 2 diabetes among minority ethnic populations in countries with a majority of White, English-speaking populations, focusing on people who identified as South Asian, Black, or African American. Methods: A realist methodology framework was followed. A literature search was conducted to develop context-mechanism-outcome configurations, including the contexts in which DHIs work for the target minority ethnic groups, mechanisms that these contexts trigger, and resulting health outcomes. After systematic searches, a qualitative analysis of the included studies was conducted using deductive and inductive coding. Results: A total of 15 studies on the uptake of DHIs for cardiovascular disease or diabetes were identified, of which 13 (87\%) focused on people with an African-American background. The review found evidence supporting the use of DHIs in minority ethnic populations when specific factors are considered in implementation and design, including patients' beliefs, health needs, education and literacy levels, material circumstances, culture, social networks, and wider community and the supporting health care systems. Conclusions: Our context-mechanism-outcome configurations provide a useful guide for the future development of DHIs targeted at South Asian and Black minority ethnic populations, with specific recommendations for improving cultural competency and promoting accessibility and inclusivity of design. ",
doi="10.2196/40630",
url="https://www.jmir.org/2023/1/e40630",
url="http://www.ncbi.nlm.nih.gov/pubmed/36607732"
}


@Article{info:doi/10.2196/39566,
author="Hughes, Zachary
and Simkowski, Julia
and Mendapara, Parry
and Fink, Nicolas
and Gupta, Sparsh
and Youmans, Quentin
and Khan, Sadiya
and Wilcox, Jane
and Mutharasan, Kannan R.",
title="Racial and Socioeconomic Differences in Heart Failure Hospitalizations and Telemedicine Follow-up During the COVID-19 Pandemic: Retrospective Cohort Study",
journal="JMIR Cardio",
year="2022",
month="Nov",
day="28",
volume="6",
number="2",
pages="e39566",
keywords="heart failure",
keywords="disparities",
keywords="disparity",
keywords="SARS-CoV-2",
keywords="Coronavirus",
keywords="pandemic",
keywords="COVID-19",
keywords="hospitalization",
keywords="telemedicine",
keywords="heart disease",
keywords="heart",
keywords="socioeconomic",
keywords="cardiology",
keywords="cardiac",
keywords="hospital admission",
keywords="intensive care unit",
keywords="ICU admission",
keywords="mortality",
keywords="inequality",
keywords="inequalities",
keywords="minority",
keywords="health disparity",
keywords="racial",
keywords="ethnic",
abstract="Background: Low rates of heart failure (HF) hospitalizations were observed during the 2020 peak of the COVID-19 pandemic. Additionally, posthospitalization follow-up transitioned to a predominantly telemedicine model. It is unknown whether the shift to telemedicine impacted disparities in posthospitalization follow-up or HF readmissions. Objective: The aim of this paper is to determine whether the shift to telemedicine impacted racial and ethnic as well as socioeconomic disparities in acute decompensated heart failure (ADHF) follow-up and HF readmissions. We additionally sought to investigate the impact of the COVID-19 pandemic on the severity of ADHF hospitalizations. Methods: This was a retrospective cohort study of HF admissions across 8 participating hospitals during the initial peak of the COVID-19 pandemic (March 15 to June 1, 2020), compared to the same time frame in 2019. Patients were stratified by race, ethnicity, and median neighborhood income. Hospital and intensive care unit (ICU) admission rates, inpatient mortality, 7-day follow-up, and 30-day readmissions were assessed. Results: From March 15, 2019, to June 1, 2020, there were 1162 hospitalizations for ADHF included in the study. There were significantly fewer admissions for ADHF in 2020, compared with 2019 (442 vs 720; P<.001). Patients in 2020 had higher rates of ICU admission, compared with 2019 (15.8\% vs 11.1\%; P=.02). This trend was seen across all subgroups and was significant for patients from the highest income quartile (17.89\% vs 10.99\%; P=.02). While there was a trend toward higher inpatient mortality in 2020 versus 2019 (4.3\% vs 2.8\%; P=.17), no difference was seen among different racial and socioeconomic groups. Telemedicine comprised 81.6\% of 7-day follow-up in 2020, with improvement in 7-day follow-up rates (40.5\% vs 29.6\%; P<.001). Inequities in 7-day follow-up for patients from non-Hispanic Black racial backgrounds compared to those from non-Hispanic White backgrounds decreased during the pandemic. Additionally, those with telemedicine follow-up were less likely to be readmitted in 30 days when compared to no follow-up (13.8\% vs 22.4\%; P=.03). Conclusions: There were no major differences in HF ICU admissions or inpatient mortality for different racial and socioeconomic groups during the COVID-19 pandemic. Inequalities in 7-day follow-up were reduced with the advent of telemedicine and decreased 30-day readmission rates for those who had telemedicine follow-up. ",
doi="10.2196/39566",
url="https://cardio.jmir.org/2022/2/e39566",
url="http://www.ncbi.nlm.nih.gov/pubmed/36409959"
}


@Article{info:doi/10.2196/37501,
author="Anugu, Pramod
and Ansari, Yusuf Md Abu
and Min, Yuan-I
and Benjamin, J. Emelia
and Murabito, Joanne
and Winters, Karen
and Turner, Erica
and Correa, Adolfo",
title="Digital Connectedness in the Jackson Heart Study: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="21",
volume="24",
number="11",
pages="e37501",
keywords="teleresearch",
keywords="mobile technology",
keywords="cardiovascular disease",
keywords="Jackson Heart Study",
keywords="mobile phone",
abstract="Background: Although new approaches for data collection, such as mobile technology and teleresearch, have demonstrated new opportunities for the conduct of more timely and less costly surveys in community-based studies, literature on the feasibility of conducing cardiovascular disease research using mobile health (mHealth) platforms among middle-aged and older African Americans has been limited. Objective: The purpose of this study was to contribute to the knowledge regarding the penetrance of internet and mobile technologies, such as cellphones or smartphones in existing large cohort studies of cardiovascular disease. Methods: A digital connectedness survey was conducted in the Jackson Heart Study (JHS), a Mississippi-based African American cohort study, as part of the annual follow-up calls with participants from July 2017 to February 2019. Results: Of the 4024 participants contacted, 2564 (63.7\%) completed the survey. Among survey respondents, 2262 (88.2\%) reported use of internet or cellphone, and 1593 (62.1\%) had a smartphone. Compared to nonusers (n=302), internet or cellphone users (n=2262) were younger (mean age 80.1, SD 8.0 vs 68.2, SD 11.3 years), more likely to be affluent (n=778, 40.1\% vs n=39, 15.4\%), and had greater than high school education (n=1636, 72.5\% vs n=85, 28.1\%). Internet or cellphone users were less likely to have cardiovascular disease history compared to nonusers (136/2262, 6.6\% vs 41/302, 15.8\%). The prevalence of current smoking and average BMI were similar between internet or cellphone users and nonusers. Among internet or cellphone users, 1316 (58.3\%) reported use of email, 504 (22.3\%) reported use of apps to track or manage health, and 1269 (56.1\%) expressed interest in using JHS-developed apps. Conclusions: Our findings suggest that it is feasible to use mHealth technologies to collect survey data among African Americans already enrolled in a longitudinal study. Our findings also highlight the need for more efforts to reduce the age and education divide in access and use of internet and smartphones for tracking health and research in African American communities. ",
doi="10.2196/37501",
url="https://www.jmir.org/2022/11/e37501",
url="http://www.ncbi.nlm.nih.gov/pubmed/36409531"
}


@Article{info:doi/10.2196/40546,
author="Sivakumar, Bridve
and Lemonde, Manon
and Stein, Matthew
and Goldstein, Sarah
and Mak, Susanna
and Arcand, JoAnne",
title="Evaluating Health Care Provider Perspectives on the Use of Mobile Apps to Support Patients With Heart Failure Management: Qualitative Descriptive Study",
journal="JMIR Cardio",
year="2022",
month="Oct",
day="26",
volume="6",
number="2",
pages="e40546",
keywords="heart failure",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="mobile apps",
keywords="adherence",
keywords="self-management",
keywords="mobile phone",
abstract="Background: Nonadherence to diet and medical therapies in heart failure (HF) contributes to poor HF outcomes. Mobile apps may be a promising way to improve adherence because they increase knowledge and behavior change via education and monitoring. Well-designed apps with input from health care providers (HCPs) can lead to successful adoption of such apps in practice. However, little is known about HCPs' perspectives on the use of mobile apps to support HF management. Objective: The aim of this study is to determine HCPs' perspectives (needs, motivations, and challenges) on the use of mobile apps to support patients with HF management. Methods: A qualitative descriptive study using one-on-one semistructured interviews, informed by the diffusion of innovation theory, was conducted among HF HCPs, including cardiologists, nurses, and nurse practitioners. Transcripts were independently coded by 2 researchers and analyzed using content analysis. Results: The 21 HCPs (cardiologists: n=8, 38\%; nurses: n=6, 29\%; and nurse practitioners: n=7, 33\%) identified challenges and opportunities for app adoption across 5 themes: participant-perceived factors that affect app adoption---these include patient age, technology savviness, technology access, and ease of use; improved delivery of care---apps can support remote care; collect, share, and assess health information; identify adverse events; prevent hospitalizations; and limit clinic visits; facilitating patient engagement in care---apps can provide feedback and reinforcement, facilitate connection and communication between patients and their HCPs, support monitoring, and track self-care; providing patient support through education---apps can provide HF-related information (ie, diet and medications); and participant views on app features for their patients---HCPs felt that useful apps would have reminders and alarms and participative elements (gamification, food scanner, and quizzes). Conclusions: HCPs had positive views on the use of mobile apps to support patients with HF management. These findings can inform effective development and implementation strategies of HF management apps in clinical practice. ",
doi="10.2196/40546",
url="https://cardio.jmir.org/2022/2/e40546",
url="http://www.ncbi.nlm.nih.gov/pubmed/36287588"
}


@Article{info:doi/10.2196/37100,
author="Lewinski, A. Allison
and Walsh, Conor
and Rushton, Sharron
and Soliman, Diana
and Carlson, M. Scott
and Luedke, W. Matthew
and Halpern, J. David
and Crowley, J. Matthew
and Shaw, J. Ryan
and Sharpe, A. Jason
and Alexopoulos, Anastasia-Stefania
and Tabriz, Alishahi Amir
and Dietch, R. Jessica
and Uthappa, M. Diya
and Hwang, Soohyun
and Ball Ricks, A. Katharine
and Cantrell, Sarah
and Kosinski, S. Andrzej
and Ear, Belinda
and Gordon, M. Adelaide
and Gierisch, M. Jennifer
and Williams Jr, W. John
and Goldstein, M. Karen",
title="Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="26",
volume="24",
number="8",
pages="e37100",
keywords="telemedicine",
keywords="diabetes mellitus, type 2",
keywords="heart failure",
keywords="pulmonary disease",
keywords="chronic obstructive",
keywords="veterans",
keywords="delivery of health care",
keywords="systematic review",
abstract="Background: Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of telehealth as an equivalent and equitable replacement for in-person care and to assess potential adverse effects. Objective: We conducted a systematic review to address the following question: among adults, what is the effect of synchronous telehealth (real-time response among individuals via phone or phone and video) compared with in-person care (or compared with phone, if synchronous video care) for chronic management of CHF, chronic obstructive pulmonary disease, and T2DM on key disease-specific clinical outcomes and health care use? Methods: We followed systematic review methodologies and searched two databases (MEDLINE and Embase). We included randomized or quasi-experimental studies that evaluated the effect of synchronously delivered telehealth for relevant chronic conditions that occurred over ?2 encounters and in which some or all in-person care was supplanted by care delivered via phone or video. We assessed the bias using the Cochrane Effective Practice and Organization of Care risk of bias (ROB) tool and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation. We described the findings narratively and did not conduct meta-analysis owing to the small number of studies and the conceptual heterogeneity of the identified interventions. Results: We identified 8662 studies, and 129 (1.49\%) were reviewed at the full-text stage. In total, 3.9\% (5/129) of the articles were retained for data extraction, all of which (5/5, 100\%) were randomized controlled trials. The CHF study (1/5, 20\%) was found to have high ROB and randomized patients (n=210) to receive quarterly automated asynchronous web-based review and follow-up of telemetry data versus synchronous personal follow-up (in-person vs phone-based) for 1 year. A 3-way comparison across study arms found no significant differences in clinical outcomes. Overall, 80\% (4/5) of the studies (n=466) evaluated synchronous care for patients with T2DM (ROB was judged to be low for 2, 50\% of studies and high for 2, 50\% of studies). In total, 20\% (1/5) of the studies were adequately powered to assess the difference in glycosylated hemoglobin level between groups; however, no significant difference was found. Intervention design varied greatly from remote monitoring of blood glucose combined with video versus in-person visits to an endocrinology clinic to a brief, 3-week remote intervention to stabilize uncontrolled diabetes. No articles were identified for chronic obstructive pulmonary disease. Conclusions: This review found few studies with a variety of designs and interventions that used telehealth as a replacement for in-person care. Future research should consider including observational studies and studies on additional highly prevalent chronic diseases. ",
doi="10.2196/37100",
url="https://www.jmir.org/2022/8/e37100",
url="http://www.ncbi.nlm.nih.gov/pubmed/36018711"
}


@Article{info:doi/10.2196/36972,
author="Cakmak, S. Ayse
and Perez Alday, A. Erick
and Densen, Samuel
and Najarro, Gabriel
and Rout, Pratik
and Rozell, J. Christopher
and Inan, T. Omer
and Shah, J. Amit
and Clifford, D. Gari",
title="Passively Captured Interpersonal Social Interactions and Motion From Smartphones for Predicting Decompensation in Heart Failure: Observational Cohort Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="24",
volume="6",
number="8",
pages="e36972",
keywords="heart failure",
keywords="mobile device",
keywords="social interaction",
keywords="heart disease",
keywords="mobile health",
keywords="hospitalization",
abstract="Background: Heart failure (HF) is a major cause of frequent hospitalization and death. Early detection of HF symptoms using smartphone-based monitoring may reduce adverse events in a low-cost, scalable way. Objective: We examined the relationship of HF decompensation events with smartphone-based features derived from passively and actively acquired data. Methods: This was a prospective cohort study in which we monitored HF participants' social and movement activities using a smartphone app and followed them for clinical events via phone and chart review and classified the encounters as compensated or decompensated by reviewing the provider notes in detail. We extracted motion, location, and social interaction passive features and self-reported quality of life weekly (active) with the short Kansas City Cardiomyopathy Questionnaire (KCCQ-12) survey. We developed and validated an algorithm for classifying decompensated versus compensated clinical encounters (hospitalizations or clinic visits). We evaluated models based on single modality as well as early and late fusion approaches combining patient-reported outcomes and passive smartphone data. We used Shapley additive explanation values to quantify the contribution and impact of each feature to the model. Results: We evaluated 28 participants with a mean age of 67 years (SD 8), among whom 11\% (3/28) were female and 46\% (13/28) were Black. We identified 62 compensated and 48 decompensated clinical events from 24 and 22 participants, respectively. The highest area under the precision-recall curve (AUCPr) for classifying decompensation was with a late fusion approach combining KCCQ-12, motion, and social contact features using leave-one-subject-out cross-validation for a 2-day prediction window. It had an AUCPr of 0.80, with an area under the receiver operator curve (AUC) of 0.83, a positive predictive value (PPV) of 0.73, a sensitivity of 0.77, and a specificity of 0.88 for a 2-day prediction window. Similarly, the 4-day window model had an AUC of 0.82, an AUCPr of 0.69, a PPV of 0.62, a sensitivity of 0.68, and a specificity of 0.87. Passive social data provided some of the most informative features, with fewer calls of longer duration associating with a higher probability of future HF decompensation. Conclusions: Smartphone-based data that includes both passive monitoring and actively collected surveys may provide important behavioral and functional health information on HF status in advance of clinical visits. This proof-of-concept study, although small, offers important insight into the social and behavioral determinants of health and the feasibility of using smartphone-based monitoring in this population. Our strong results are comparable to those of more active and expensive monitoring approaches, and underscore the need for larger studies to understand the clinical significance of this monitoring method. ",
doi="10.2196/36972",
url="https://formative.jmir.org/2022/8/e36972",
url="http://www.ncbi.nlm.nih.gov/pubmed/36001367"
}


@Article{info:doi/10.2196/36442,
author="Chu, Cherry
and Stamenova, Vess
and Fang, Jiming
and Shakeri, Ahmad
and Tadrous, Mina
and Bhatia, Sacha R.",
title="The Association Between Telemedicine Use and Changes in Health Care Usage and Outcomes in Patients With Congestive Heart Failure: Retrospective Cohort Study",
journal="JMIR Cardio",
year="2022",
month="Aug",
day="4",
volume="6",
number="2",
pages="e36442",
keywords="telemedicine",
keywords="telehealth",
keywords="eHealth",
keywords="digital health",
keywords="population",
keywords="outcomes",
keywords="health service",
keywords="health system",
keywords="utilization",
keywords="congestive heart failure",
keywords="cardiology",
keywords="health outcome",
keywords="clinical outcome",
keywords="patient outcome",
keywords="heart",
keywords="cardiac",
keywords="ambulatory",
keywords="COVID-19",
abstract="Background: Telemedicine use has become widespread owing to the COVID-19 pandemic, but its impact on patient outcomes remains unclear. Objective: We sought to investigate the effect of telemedicine use on changes in health care usage and clinical outcomes in patients diagnosed with congestive heart failure (CHF). Methods: We conducted a population-based retrospective cohort study using administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14 and September 30, 2020, and a heart failure diagnosis any time prior to March 14, 2020. Telemedicine users were propensity score--matched with unexposed users based on several baseline characteristics. Monthly use of various health care services was compared between the 2 groups during 12 months before to 3 months after their index in-person or telemedicine ambulatory visit after March 14, 2020, using generalized estimating equations. Results: A total of 11,131 pairs of telemedicine and unexposed patients were identified after matching (49\% male; mean age 78.9, SD 12.0 years). All patients showed significant reductions in health service usage from pre- to postindex visit. There was a greater decline across time in the unexposed group than in the telemedicine group for CHF admissions (ratio of slopes for high- vs low-frequency users 1.02, 95\% CI 1.02-1.03), cardiovascular admissions (1.03, 95\% CI 1.02-1.04), any-cause admissions (1.03, 95\% CI 1.02-1.04), any-cause ED visits (1.03, 95\% CI 1.03-1.04), visits with any cardiologist (1.01, 95\% CI 1.01-1.02), laboratory tests (1.02, 95\% CI 1.02-1.03), diagnostic tests (1.04, 95\% CI 1.03-1.05), and new prescriptions (1.02, 95\% CI 1.01-1.03). However, the decline in primary care visit rates was steeper among telemedicine patients than among unexposed patients (ratio of slopes 0.99, 95\% CI 0.99-1.00). Conclusions: Overall health care usage over time appeared higher among telemedicine users than among low-frequency users or nonusers, suggesting that telemedicine was used by patients with the greatest need or that it allowed patients to have better access or continuity of care among those who received it. ",
doi="10.2196/36442",
url="https://cardio.jmir.org/2022/2/e36442",
url="http://www.ncbi.nlm.nih.gov/pubmed/35881831"
}


@Article{info:doi/10.2196/31302,
author="Albuquerque de Almeida, Fernando
and Corro Ramos, Isaac
and Al, Maiwenn
and Rutten-van M{\"o}lken, Maureen",
title="Home Telemonitoring and a Diagnostic Algorithm in the Management of Heart Failure in the Netherlands: Cost-effectiveness Analysis",
journal="JMIR Cardio",
year="2022",
month="Aug",
day="4",
volume="6",
number="2",
pages="e31302",
keywords="discrete event simulation",
keywords="cost-effectiveness",
keywords="early warning systems",
keywords="home telemonitoring",
keywords="diagnostic algorithm",
keywords="heart failure",
abstract="Background: Heart failure is a major health concern associated with significant morbidity, mortality, and reduced quality of life in patients. Home telemonitoring (HTM) facilitates frequent or continuous assessment of disease signs and symptoms, and it has shown to improve compliance by involving patients in their own care and prevent emergency admissions by facilitating early detection of clinically significant changes. Diagnostic algorithms (DAs) are predictive mathematical relationships that make use of a wide range of collected data for calculating the likelihood of a particular event and use this output for prioritizing patients with regard to their treatment. Objective: This study aims to assess the cost-effectiveness of HTM and a DA in the management of heart failure in the Netherlands. Three interventions were analyzed: usual care, HTM, and HTM plus a DA. Methods: A previously published discrete event simulation model was used. The base-case analysis was performed according to the Dutch guidelines for economic evaluation. Sensitivity, scenario, and value of information analyses were performed. Particular attention was given to the cost-effectiveness of the DA at various levels of diagnostic accuracy of event prediction and to different patient subgroups. Results: HTM plus the DA extendedly dominates HTM alone, and it has a deterministic incremental cost-effectiveness ratio compared with usual care of {\texteuro}27,712 (currency conversion rate in purchasing power parity at the time of study: {\texteuro}1=US \$1.29; further conversions are not applicable in cost-effectiveness terms) per quality-adjusted life year. The model showed robustness in the sensitivity and scenario analyses. HTM plus the DA had a 96.0\% probability of being cost-effective at the appropriate {\texteuro}80,000 per quality-adjusted life year threshold. An optimal point for the threshold value for the alarm of the DA in terms of its cost-effectiveness was estimated. New York Heart Association class IV patients were the subgroup with the worst cost-effectiveness results versus usual care, while HTM plus the DA was found to be the most cost-effective for patients aged <65 years and for patients in New York Heart Association class I. Conclusions: Although the increased costs of adopting HTM plus the DA in the management of heart failure may seemingly be an additional strain on scarce health care resources, the results of this study demonstrate that, by increasing patient life expectancy by 1.28 years and reducing their hospitalization rate by 23\% when compared with usual care, the use of this technology may be seen as an investment, as HTM plus the DA in its current form extendedly dominates HTM alone and is cost-effective compared with usual care at normally accepted thresholds in the Netherlands. ",
doi="10.2196/31302",
url="https://cardio.jmir.org/2022/2/e31302",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925670"
}


@Article{info:doi/10.2196/34959,
author="Buhr, Lorina
and Kaufmann, Martiana Pauline Lucie
and J{\"o}r{\ss}, Katharina",
title="Attitudes of Patients With Chronic Heart Failure Toward Digital Device Data for Self-documentation and Research in Germany: Cross-sectional Survey Study",
journal="JMIR Cardio",
year="2022",
month="Aug",
day="3",
volume="6",
number="2",
pages="e34959",
keywords="mobile health",
keywords="mHealth",
keywords="digital devices",
keywords="wearables",
keywords="heart failure",
keywords="data sharing",
keywords="consent",
keywords="mobile phone",
abstract="Background: In recent years, the use of digital mobile measurement devices (DMMDs) for self-documentation in cardiovascular care in Western industrialized health care systems has increased. For patients with chronic heart failure (cHF), digital self-documentation plays an increasingly important role in self-management. Data from DMMDs can also be integrated into telemonitoring programs or data-intensive medical research to collect and evaluate patient-reported outcome measures through data sharing. However, the implementation of data-intensive devices and data sharing poses several challenges for doctors and patients as well as for the ethical governance of data-driven medical research. Objective: This study aims to explore the potential and challenges of digital device data in cardiology research from patients' perspectives. Leading research questions of the study concerned the attitudes of patients with cHF toward health-related data collected in the use of digital devices for self-documentation as well as sharing these data and consenting to data sharing for research purposes. Methods: A cross-sectional survey of patients of a research in cardiology was conducted at a German university medical center (N=159) in 2020 (March to July). Eligible participants were German-speaking adult patients with cHF at that center. A pen-and-pencil questionnaire was sent by mail. Results: Most participants (77/105, 73.3\%) approved digital documentation, as they expected the device data to help them observe their body and its functions more objectively. Digital device data were believed to provide cognitive support, both for patients' self-assessment and doctors' evaluation of their patients' current health condition. Interestingly, positive attitudes toward DMMD data providing cognitive support were, in particular, voiced by older patients aged >65 years. However, approximately half of the participants (56/105, 53.3\%) also reported difficulty in dealing with self-documented data that lay outside the optimal medical target range. Furthermore, our findings revealed preferences for the self-management of DMMD data disclosed for data-intensive medical research among German patients with cHF, which are best implemented with a dynamic consent model. Conclusions: Our findings provide potentially valuable insights for introducing DMMD in cardiovascular research in the German context. They have several practical implications, such as a high divergence in attitudes among patients with cHF toward different data-receiving organizations as well as a large variance in preferences for the modes of receiving information included in the consenting procedure for data sharing for research. We suggest addressing patients' multiple views on consenting and data sharing in institutional normative governance frameworks for data-intensive medical research. ",
doi="10.2196/34959",
url="https://cardio.jmir.org/2022/2/e34959",
url="http://www.ncbi.nlm.nih.gov/pubmed/35921134"
}


@Article{info:doi/10.2196/32873,
author="Bhatia, Ankit
and Ewald, Gregory
and Maddox, Thomas",
title="The Novel Data Collection and Analytics Tools for Remote Patient Monitoring in Heart Failure (Nov-RPM-HF) Trial: Protocol for a Single-Center Prospective Trial",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="30",
volume="11",
number="6",
pages="e32873",
keywords="heart failure",
keywords="remote patient monitoring",
keywords="clinical innovation",
keywords="digital health",
keywords="mHealth",
keywords="mobile health",
keywords="cardiology",
abstract="Background: Heart failure remains a leading cause of mortality and a major driver of health care utilization. Despite numerous medical advances in heart failure, associated hospitalizations continue to increase, owing largely to suboptimal outpatient management. Remote patient monitoring (RPM) aims to further address this current need in heart failure care by providing data to clinical teams to act pre-emptively to address clinical decompensation. However, to date, RPM approaches using noninvasive home-based patient sensors have failed to demonstrate clinical efficacy. Objective: The Novel Data Collection and Analytics Tools for Remote Patient Monitoring in Heart Failure (Nov-RPM-HF) Trial aims to address current noninvasive RPM limitations. Nov-RPM-HF will evaluate a clinician co-designed RPM platform using emerging data collection and presentation tools for heart failure management. These tools include a ballistocardiograph to monitor nocturnal patient biometrics, clinical alerts for abnormal biometrics, and longitudinal data presentation for clinician review. Methods: Nov-RPM-HF is a 100-patient single-center prospective trial, evaluating patients over 6 months. The outcomes will include patient adherence to data collection, patient/clinician-perceived utility of the RPM platform, medication changes including the titration of guideline-directed medical therapy to target doses, heart failure symptoms/performance status, and unplanned heart failure hospitalizations or emergency department visits. Results: This prospective trial began enrollment in March 2020 and anticipates enrollment completion by June 2022, with trial completion by December 2022. Conclusions: This trial protocol aims to provide a systematic framework for the evaluation of heart failure RPM strategies, which are currently heavily used but seldom robustly studied. The trial results will help to inform the role of noninvasive RPM as a viable clinical management strategy in heart failure care. International Registered Report Identifier (IRRID): DERR1-10.2196/32873 ",
doi="10.2196/32873",
url="https://www.researchprotocols.org/2022/6/e32873",
url="http://www.ncbi.nlm.nih.gov/pubmed/35771609"
}


@Article{info:doi/10.2196/35488,
author="Kim, Byeol
and Nguyen, Phong
and Loke, Yue-Hin
and Cleveland, Vincent
and Liu, Xiaolong
and Mass, Paige
and Hibino, Narutoshi
and Olivieri, Laura
and Krieger, Axel",
title="Virtual Reality Cardiac Surgical Planning Software (CorFix) for Designing Patient-Specific Vascular Grafts: Development and Pilot Usability Study",
journal="JMIR Cardio",
year="2022",
month="Jun",
day="17",
volume="6",
number="1",
pages="e35488",
keywords="virtual reality",
keywords="congenital heart disease",
keywords="surgical planning",
keywords="usability study",
keywords="heart",
keywords="surgery",
abstract="Background: Patients with single ventricle heart defects receive 3 stages of operations culminating in the Fontan procedure. During the Fontan procedure, a vascular graft is sutured between the inferior vena cava and pulmonary artery to divert deoxygenated blood flow to the lungs via passive flow. Customizing the graft configuration can maximize the long-term benefits. However, planning patient-specific procedures has several challenges, including the ability for physicians to customize grafts and evaluate their hemodynamic performance. Objective: The aim of this study was to develop a virtual reality (VR) Fontan graft modeling and evaluation software for physicians. A user study was performed to achieve 2 additional goals: (1) to evaluate the software when used by medical doctors and engineers, and (2) to explore the impact of viewing hemodynamic simulation results in numerical and graphical formats. Methods: A total of 5 medical professionals including 4 physicians (1 fourth-year resident, 1 third-year cardiac fellow, 1 pediatric intensivist, and 1 pediatric cardiac surgeon) and 1 biomedical engineer voluntarily participated in the study. The study was pre-scripted to minimize the variability of the interactions between the experimenter and the participants. All participants were trained to use the VR gear and our software, CorFix. Each participant designed 1 bifurcated and 1 tube-shaped Fontan graft for a single patient. A hemodynamic performance evaluation was then completed, allowing the participants to further modify their tube-shaped design. The design time and hemodynamic performance for each graft design were recorded. At the end of the study, all participants were provided surveys to evaluate the usability and learnability of the software and rate the intensity of VR sickness. Results: The average times for creating 1 bifurcated and 1 tube-shaped graft after a single 10-minute training session were 13.40 and 5.49 minutes, respectively, with 3 out 5 bifurcated and 1 out of 5 tube-shaped graft designs being in the benchmark range of hepatic flow distribution. Reviewing hemodynamic performance results and modifying the tube-shaped design took an average time of 2.92 minutes. Participants who modified their tube-shaped graft designs were able to improve the nonphysiologic wall shear stress (WSS) percentage by 7.02\%. All tube-shaped graft designs improved the WSS percentage compared to the native surgical case of the patient. None of the designs met the benchmark indexed power loss. Conclusions: VR graft design software can quickly be taught to physicians with no engineering background or VR experience. Improving the CorFix system could improve performance of the users in customizing and optimizing grafts for patients. With graphical visualization, physicians were able to improve WSS percentage of a tube-shaped graft, lowering the chance of thrombosis. Bifurcated graft designs showed potential strength in better flow split to the lungs, reducing the risk for pulmonary arteriovenous malformations. ",
doi="10.2196/35488",
url="https://cardio.jmir.org/2022/1/e35488",
url="http://www.ncbi.nlm.nih.gov/pubmed/35713940"
}


@Article{info:doi/10.2196/32147,
author="Apantaku, Glory
and Mitton, Craig
and Wong, Hubert
and Ho, Kendall",
title="Home Telemonitoring Technology for Patients With Heart Failure: Cost-Consequence Analysis of a Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="2",
volume="6",
number="6",
pages="e32147",
keywords="cost-consequence analysis",
keywords="feasibility study",
keywords="pilot study",
keywords="heart failure",
keywords="cardiology",
keywords="cardiovascular disease",
keywords="economic analysis",
keywords="telehealth",
keywords="health care cost",
keywords="home monitoring",
keywords="digital monitor",
keywords="health monitor",
abstract="Background: Heart failure (HF) is a costly health condition and a major public health problem. It is estimated that 2\%-3\% of the population in developed countries has HF, and the prevalence increases to 8\% among patients aged ?75 years. Home telemonitoring is a form of noninvasive, remote patient monitoring that aims to improve the care and management of patients with chronic HF. Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring (TEC4Home) is a project that implements and evaluates a comprehensive home monitoring protocol designed to support patients with HF as they transition from the emergency department to home. Objective: The aim of this study is to assess the cost of using the home monitoring platform (TEC4Home) relative to usual care for patients with HF. Methods: This study is a cost-consequence analysis of the TEC4Home pilot study. The analysis was conducted from a partial societal perspective, including direct and indirect health care costs. The aim is to assess the costs of the home monitoring platform relative to usual care and track costs related to health care utilization during the 90-day postdischarge period. Results: Economic analysis of the TEC4Home pilot study showed a positive trend in cost savings for patients using TEC4Home. From both the health system perspective (Pre TEC4Home cost per patient: CAD \$2924 vs post TEC4Home cost per patient: CAD \$1293; P=.01) and partial societal perspective (Pre TEC4Home cost per patient: CAD \$2411 vs post TEC4Home cost per patient: CAD \$1108; P=.01), we observed a statistically significant cost saving per patient. Conclusions: In line with the advantages of conducting an economic analysis alongside a feasibility study, the economic analysis of the TEC4Home pilot study facilitated the piloting of patient questionnaires and informed the methodology for a full clinical trial. ",
doi="10.2196/32147",
url="https://formative.jmir.org/2022/6/e32147",
url="http://www.ncbi.nlm.nih.gov/pubmed/35653179"
}


@Article{info:doi/10.2196/36086,
author="Yeung, Kan Andy Wai
and Kulnik, Tino Stefan
and Parvanov, D. Emil
and Fassl, Anna
and Eibensteiner, Fabian
and V{\"o}lkl-Kernstock, Sabine
and Kletecka-Pulker, Maria
and Crutzen, Rik
and Gutenberg, Johanna
and H{\"o}ppchen, Isabel
and Niebauer, Josef
and Smeddinck, David Jan
and Willschke, Harald
and Atanasov, G. Atanas",
title="Research on Digital Technology Use in Cardiology: Bibliometric Analysis",
journal="J Med Internet Res",
year="2022",
month="May",
day="11",
volume="24",
number="5",
pages="e36086",
keywords="cardiovascular",
keywords="heart",
keywords="hypertension",
keywords="atrial fibrillation",
keywords="cardiopulmonary resuscitation",
keywords="electrocardiography",
keywords="photoplethysmography",
keywords="wearable device, digital health, mHealth",
keywords="cardiology",
keywords="cardiac",
keywords="health application",
abstract="Background: Digital technology uses in cardiology have become a popular research focus in recent years. However, there has been no published bibliometric report that analyzed the corresponding academic literature in order to derive key publishing trends and characteristics of this scientific area. Objective: We used a bibliometric approach to identify and analyze the academic literature on digital technology uses in cardiology, and to unveil popular research topics, key authors, institutions, countries, and journals. We further captured the cardiovascular conditions and diagnostic tools most commonly investigated within this field. Methods: The Web of Science electronic database was queried to identify relevant papers on digital technology uses in cardiology. Publication and citation data were acquired directly from the database. Complete bibliographic data were exported to VOSviewer, a dedicated bibliometric software package, and related to the semantic content of titles, abstracts, and keywords. A term map was constructed for findings visualization. Results: The analysis was based on data from 12,529 papers. Of the top 5 most productive institutions, 4 were based in the United States. The United States was the most productive country (4224/12,529, 33.7\%), followed by United Kingdom (1136/12,529, 9.1\%), Germany (1067/12,529, 8.5\%), China (682/12,529, 5.4\%), and Italy (622/12,529, 5.0\%). Cardiovascular diseases that had been frequently investigated included hypertension (152/12,529, 1.2\%), atrial fibrillation (122/12,529, 1.0\%), atherosclerosis (116/12,529, 0.9\%), heart failure (106/12,529, 0.8\%), and arterial stiffness (80/12,529, 0.6\%). Recurring modalities were electrocardiography (170/12,529, 1.4\%), angiography (127/12,529, 1.0\%), echocardiography (127/12,529, 1.0\%), digital subtraction angiography (111/12,529, 0.9\%), and photoplethysmography (80/12,529, 0.6\%). For a literature subset on smartphone apps and wearable devices, the Journal of Medical Internet Research (20/632, 3.2\%) and other JMIR portfolio journals (51/632, 8.0\%) were the major publishing venues. Conclusions: Digital technology uses in cardiology target physicians, patients, and the general public. Their functions range from assisting diagnosis, recording cardiovascular parameters, and patient education, to teaching laypersons about cardiopulmonary resuscitation. This field already has had a great impact in health care, and we anticipate continued growth. ",
doi="10.2196/36086",
url="https://www.jmir.org/2022/5/e36086",
url="http://www.ncbi.nlm.nih.gov/pubmed/35544307"
}


@Article{info:doi/10.2196/37970,
author="Kwon, Soonil
and Lee, So-Ryoung
and Choi, Eue-Keun
and Ahn, Hyo-Jeong
and Song, Hee-Seok
and Lee, Young-Shin
and Oh, Seil
and Lip, H. Gregory Y.",
title="Comparison Between the 24-hour Holter Test and 72-hour Single-Lead Electrocardiogram Monitoring With an Adhesive Patch-Type Device for Atrial Fibrillation Detection: Prospective Cohort Study",
journal="J Med Internet Res",
year="2022",
month="May",
day="9",
volume="24",
number="5",
pages="e37970",
keywords="atrial fibrillation",
keywords="diagnosis",
keywords="electrocardiogram",
keywords="wearable device",
keywords="health monitoring",
keywords="Holter",
keywords="cardiac",
keywords="arrhythmia",
keywords="ECG",
keywords="EKG",
keywords="digital tool",
keywords="cardiology",
keywords="patient monitoring",
keywords="outpatient clinic",
keywords="cardiac health",
keywords="diagnostic",
keywords="patient",
keywords="clinician",
keywords="digital health",
abstract="Background: There is insufficient evidence for the use of single-lead electrocardiogram (ECG) monitoring with an adhesive patch-type device (APD) over an extended period compared to that of the 24-hour Holter test for atrial fibrillation (AF) detection. Objective: In this paper, we aimed to compare AF detection by the 24-hour Holter test and 72-hour single-lead ECG monitoring using an APD among patients with AF. Methods: This was a prospective, single-center cohort study. A total of 210 patients with AF with clinical indications for the Holter test at cardiology outpatient clinics were enrolled in the study. The study participants were equipped with both the Holter device and APD for the first 24 hours. Subsequently, only the APD continued ECG monitoring for an additional 48 hours. AF detection during the first 24 hours was compared between the two devices. The diagnostic benefits of extended monitoring using the APD were evaluated. Results: A total of 200 patients (mean age 60 years; n=141, 70.5\% male; and n=59, 29.5\% female) completed 72-hour ECG monitoring with the APD. During the first 24 hours, both monitoring methods detected AF in the same 40/200 (20\%) patients (including 20 patients each with paroxysmal and persistent AF). Compared to the 24-hour Holter test, the APD increased the AF detection rate by 1.5-fold (58/200; 29\%) and 1.6-fold (64/200; 32\%) with 48- and 72-hour monitoring, respectively. With the APD, the number of newly discovered patients with paroxysmal AF was 20/44 (45.5\%), 18/44 (40.9\%), and 6/44 (13.6\%) at 24-, 48-, and 72-hour monitoring, respectively. Compared with 24-hour Holter monitoring, 72-hour monitoring with the APD increased the detection rate of paroxysmal AF by 2.2-fold (44/20). Conclusions: Compared to the 24-hour Holter test, AF detection could be improved with 72-hour single-lead ECG monitoring with the APD. ",
doi="10.2196/37970",
url="https://www.jmir.org/2022/5/e37970",
url="http://www.ncbi.nlm.nih.gov/pubmed/35532989"
}


@Article{info:doi/10.2196/32348,
author="Hammond, M. Michael
and Zhang, Yuankai
and Pathiravasan, H. Chathurangi
and Lin, Honghuang
and Sardana, Mayank
and Trinquart, Ludovic
and Benjamin, J. Emelia
and Borrelli, Belinda
and Manders, S. Emily
and Fusco, Kelsey
and Kornej, Jelena
and Spartano, L. Nicole
and Kheterpal, Vik
and Nowak, Christopher
and McManus, D. David
and Liu, Chunyu
and Murabito, M. Joanne",
title="Relations Between BMI Trajectories and Habitual Physical Activity Measured by a Smartwatch in the Electronic Cohort of the Framingham Heart Study: Cohort Study",
journal="JMIR Cardio",
year="2022",
month="Apr",
day="27",
volume="6",
number="1",
pages="e32348",
keywords="mobile health",
keywords="BMI",
keywords="smartwatch",
keywords="physical activity",
keywords="cardiovascular diseases",
keywords="cardiology",
keywords="digital health",
keywords="mHealth",
keywords="mobile health apps",
abstract="Background: The prevalence of obesity is rising. Most previous studies that examined the relations between BMI and physical activity (PA) measured BMI at a single timepoint. The association between BMI trajectories and habitual PA remains unclear. Objective: This study assesses the relations between BMI trajectories and habitual step-based PA among participants enrolled in the electronic cohort of the Framingham Heart Study (eFHS). Methods: We used a semiparametric group-based modeling to identify BMI trajectories from eFHS participants who attended research examinations at the Framingham Research Center over 14 years. Daily steps were recorded from the smartwatch provided at examination 3. We excluded participants with <30 days or <5 hours of smartwatch wear data. We used generalized linear models to examine the association between BMI trajectories and daily step counts. Results: We identified 3 trajectory groups for the 837 eFHS participants (mean age 53 years; 57.8\% [484/837] female). Group 1 included 292 participants whose BMI was stable (slope 0.005; P=.75), group 2 included 468 participants whose BMI increased slightly (slope 0.123; P<.001), and group 3 included 77 participants whose BMI increased greatly (slope 0.318; P<.001). The median follow-up period for step count was 516 days. Adjusting for age, sex, wear time, and cohort, participants in groups 2 and 3 took 422 (95\% CI --823 to --21) and 1437 (95\% CI --2084 to --790) fewer average daily steps, compared with participants in group 1. After adjusting for metabolic and social risk factors, group 2 took 382 (95\% CI --773 to 10) and group 3 took 1120 (95\% CI --1766 to --475) fewer steps, compared with group 1. Conclusions: In this community-based eFHS, participants whose BMI trajectory increased greatly over time took significantly fewer steps, compared with participants with stable BMI trajectories. Our findings suggest that greater weight gain may correlate with lower levels of step-based physical activity. ",
doi="10.2196/32348",
url="https://cardio.jmir.org/2022/1/e32348",
url="http://www.ncbi.nlm.nih.gov/pubmed/35476038"
}


@Article{info:doi/10.2196/34819,
author="Brocki, Cristina Barbara
and Andreasen, Jesper Jan
and Aaroe, Jens
and Andreasen, Jane
and Thorup, Brun Charlotte",
title="Exercise-Based Real-time Telerehabilitation for Older Adult Patients Recently Discharged After Transcatheter Aortic Valve Implantation: Mixed Methods Feasibility Study",
journal="JMIR Rehabil Assist Technol",
year="2022",
month="Apr",
day="26",
volume="9",
number="2",
pages="e34819",
keywords="telerehabilitation",
keywords="transcatheter aortic valve implantation",
keywords="cardiac surgery",
keywords="cardiac rehabilitation",
keywords="exercise training",
keywords="older adults",
keywords="tablet",
abstract="Background: The use of telehealth technology to improve functional recovery following transcatheter aortic valve implantation (TAVI) has not been investigated. Objective: In this study, we aimed to examine the feasibility of exercise-based cardiac telerehabilitation after TAVI. Methods: This was a single-center, prospective, nonrandomized study using a mixed methods approach. Data collection included testing, researchers' observations, logbooks, and individual patient interviews, which were analyzed using a content analysis approach. The intervention lasted 3 weeks and consisted of home-based web-based exercise training, an activity tracker, a TAVI information website, and 1 web-based session with a nurse. Results: Of the initially included 13 patients, 5 (40\%) completed the study and were interviewed; the median age was 82 (range 74-84) years, and the sample comprised 3 men and 2 women. Easy access to supervised exercise training at home with real-time feedback and use of the activity tracker to count daily steps were emphasized by the patients who completed the intervention. Reasons for patients not completing the program included poor data coverage, participants' limited information technology skills, and a lack of functionality in the systems used. No adverse events were reported. Conclusions: Exercise-based telerehabilitation for older people after TAVI, in the population as included in this study, and delivered as a web-based intervention, does not seem feasible, as 60\% (8/13) of patients did not complete the study. Those completing the intervention highly appreciated the real-time feedback during the web-based training sessions. Future studies should address aspects that support retention rates and enhance patients' information technology skills. ",
doi="10.2196/34819",
url="https://rehab.jmir.org/2022/2/e34819",
url="http://www.ncbi.nlm.nih.gov/pubmed/35471263"
}


@Article{info:doi/10.2196/30236,
author="Treskes, Willem Roderick
and van den Akker-van Marle, Elske M.
and van Winden, Louise
and van Keulen, Nicole
and van der Velde, Tjeerd Enno
and Beeres, Saskia
and Atsma, Douwe
and Schalij, Jan Martin",
title="The Box---eHealth in the Outpatient Clinic Follow-up of Patients With Acute Myocardial Infarction: Cost-Utility Analysis",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="25",
volume="24",
number="4",
pages="e30236",
keywords="smart technology",
keywords="myocardial infarction",
keywords="cost-utility",
keywords="outpatients",
keywords="cost-effectiveness",
keywords="eHealth",
keywords="remote monitoring",
keywords="cost of care",
keywords="quality of life",
abstract="Background: Smartphone compatible wearables have been released on the consumers market, enabling remote monitoring. Remote monitoring is often named as a tool to reduce the cost of care. Objective: The primary purpose of this paper is to describe a cost-utility analysis of an eHealth intervention compared to regular follow-up in patients with acute myocardial infarction (AMI). Methods: In this trial, of which clinical results have been published previously, patients with an AMI were randomized in a 1:1 fashion between an eHealth intervention and regular follow-up. The remote monitoring intervention consisted of a blood pressure monitor, weight scale, electrocardiogram device, and step counter. Furthermore, two in-office outpatient clinic visits were replaced by e-visits. The control group received regular care. The differences in mean costs and quality of life per patient between both groups during one-year follow-up were calculated. Results: Mean costs per patient were {\texteuro}2417{\textpm}2043 (US \$2657{\textpm}2246) for the intervention and {\texteuro}2888{\textpm}2961 (US \$3175{\textpm}3255) for the control group. This yielded a cost reduction of {\texteuro}471 (US \$518) per patient. This difference was not statistically significant (95\% CI --{\texteuro}275 to {\texteuro}1217; P=.22, US \$--302 to \$1338). The average quality-adjusted life years in the first year of follow-up was 0.74 for the intervention group and 0.69 for the control (difference --0.05, 95\% CI --0.09 to --0.01; P=.01). Conclusions: eHealth in the outpatient clinic setting for patients who suffered from AMI is likely to be cost-effective compared to regular follow-up. Further research should be done to corroborate these findings in other patient populations and different care settings. Trial Registration: ClinicalTrials.gov NCT02976376; https://clinicaltrials.gov/ct2/show/NCT02976376 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8038 ",
doi="10.2196/30236",
url="https://www.jmir.org/2022/4/e30236",
url="http://www.ncbi.nlm.nih.gov/pubmed/35468091"
}


@Article{info:doi/10.2196/33992,
author="Bezerra Giordan, Leticia
and Ronto, Rimante
and Chau, Josephine
and Chow, Clara
and Laranjo, Liliana",
title="Use of Mobile Apps in Heart Failure Self-management: Qualitative Study Exploring the Patient and Primary Care Clinician Perspective",
journal="JMIR Cardio",
year="2022",
month="Apr",
day="20",
volume="6",
number="1",
pages="e33992",
keywords="mobile app",
keywords="mHealth",
keywords="heart failure",
keywords="self-management",
keywords="eHealth",
keywords="telehealth",
abstract="Background: Mobile apps have the potential to support patients with heart failure and facilitate disease self-management, but this area of research is recent and rapidly evolving, with inconsistent results for efficacy. So far, most of the published studies evaluated the feasibility of a specific app or assessed the quality of apps available in app stores. Research is needed to explore patients' and clinicians' perspectives to guide app development, evaluation, and implementation into models of care. Objective: This study aims to explore the patient and primary care clinician perspective on the facilitators and barriers to using mobile apps, as well as desired features, to support heart failure self-management. Methods: This is a qualitative phenomenological study involving face-to-face semistructured interviews. Interviews were conducted in a general practice clinic in Sydney, Australia. Eligible participants were adult patients with heart failure and health care professionals who provided care to these patients at the clinic. Patients did not need to have previous experience using heart failure mobile apps to be eligible for this study. The interviews were audio-recorded, transcribed, and analyzed using inductive thematic data analysis in NVivo 12. Results: A total of 12 participants were interviewed: 6 patients (mean age 69 [SD 7.9] years) and 6 clinicians. The interviews lasted from 25 to 45 minutes. The main facilitators to the use of apps to support heart failure self-management were communication ability, personalized feedback and education, and automated self-monitoring. Patients mentioned that chat-like features and ability to share audio-visual information can be helpful for getting support outside of clinical appointments. Clinicians considered helpful to send motivational messages to patients and ask them about signs and symptoms of heart failure decompensation. Overall, participants highlighted the importance of personalization, particularly in terms of feedback and educational content. Automated self-monitoring with wireless devices was seen to alleviate the burden of tracking measures such as weight and blood pressure. Other desired features included tools to monitor patient-reported outcomes and support patients' mental health and well-being. The main barriers identified were the patients' unwillingness to engage in a new strategy to manage their condition using an app, particularly in the case of low digital literacy. However, clinicians mentioned this barrier could potentially be overcome by introducing the app soon after an exacerbation, when patients might be more willing to improve their self-management and avoid rehospitalization. Conclusions: The use of mobile apps to support heart failure self-management may be facilitated by features that increase the usefulness and utility of the app, such as communication ability in-between consultations and personalized feedback. Also important is facilitating ease of use by supporting automated self-monitoring through integration with wireless devices. Future research should consider these features in the co-design and testing of heart failure mobile apps with patients and clinicians. ",
doi="10.2196/33992",
url="https://cardio.jmir.org/2022/1/e33992",
url="http://www.ncbi.nlm.nih.gov/pubmed/35442205"
}


@Article{info:doi/10.2196/33839,
author="Bezerra Giordan, Leticia
and Tong, Ly Huong
and Atherton, J. John
and Ronto, Rimante
and Chau, Josephine
and Kaye, David
and Shaw, Tim
and Chow, Clara
and Laranjo, Liliana",
title="The Use of Mobile Apps for Heart Failure Self-management: Systematic Review of Experimental and Qualitative Studies",
journal="JMIR Cardio",
year="2022",
month="Mar",
day="31",
volume="6",
number="1",
pages="e33839",
keywords="heart failure",
keywords="self-management",
keywords="mobile health",
keywords="mobile app",
keywords="secondary prevention",
keywords="mobile phone",
abstract="Background: Heart failure self-management is essential to avoid decompensation and readmissions. Mobile apps seem promising in supporting heart failure self-management, and there has been a rapid growth in publications in this area. However, to date, systematic reviews have mostly focused on remote monitoring interventions using nonapp types of mobile technologies to transmit data to health care providers, rarely focusing on supporting patient self-management of heart failure. Objective: This study aims to systematically review the evidence on the effect of heart failure self-management apps on health outcomes, patient-reported outcomes, and patient experience. Methods: Four databases (PubMed, Embase, CINAHL, and PsycINFO) were searched for studies examining interventions that comprised a mobile app targeting heart failure self-management and reported any health-related outcomes or patient-reported outcomes or perspectives published from 2008 to December 2021. The studies were independently screened. The risk of bias was appraised using Cochrane tools. We performed a narrative synthesis of the results. The protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42020158041). Results: A total of 28 articles (randomized controlled trials [RCTs]: n=10, 36\%), assessing 23 apps, and a total of 1397 participants were included. The most common app features were weight monitoring (19/23, 83\%), symptom monitoring (18/23, 78\%), and vital sign monitoring (15/23, 65\%). Only 26\% (6/23) of the apps provided all guideline-defined core components of heart failure self-management programs: education, symptom monitoring, medication support, and physical activity support. RCTs were small, involving altogether 717 participants, had ?6 months of follow-up, and outcomes were predominantly self-reported. Approximately 20\% (2/10) of RCTs reported a significant improvement in their primary outcomes: heart failure knowledge (P=.002) and self-care (P=.004). One of the RCTs found a significant reduction in readmissions (P=.02), and 20\% (2/10) of RCTs reported higher unplanned clinic visits. Other experimental studies also found significant improvements in knowledge, self-care, and readmissions, among others. Less than half of the studies involved patients and clinicians in the design of apps. Engagement with the intervention was poorly reported, with only 11\% (3/28) of studies quantifying app engagement metrics such as frequency of use over the study duration. The most desirable app features were automated self-monitoring and feedback, personalization, communication with clinicians, and data sharing and integration. Conclusions: Mobile apps may improve heart failure self-management; however, more robust evaluation studies are needed to analyze key end points for heart failure. On the basis of the results of this review, we provide a road map for future studies in this area. ",
doi="10.2196/33839",
url="https://cardio.jmir.org/2022/1/e33839",
url="http://www.ncbi.nlm.nih.gov/pubmed/35357311"
}


@Article{info:doi/10.2196/35490,
author="Shan, Rongzi
and Chandra, V. Neha
and Hsu, J. Jeffrey
and Fraschilla, Stephanie
and Moore, Melissa
and Ardehali, Abbas
and Nsair, Ali
and Parikh, V. Rushi",
title="The Impact of Transitioning From In-Person to Virtual Heart Transplantation Selection Committee Meetings: Observational Study",
journal="JMIR Cardio",
year="2022",
month="Mar",
day="30",
volume="6",
number="1",
pages="e35490",
keywords="telemedicine",
keywords="transplantation",
keywords="heart failure",
keywords="physician",
keywords="heart transplant",
keywords="virtual meeting",
keywords="interprofessional relations",
keywords="health systems",
keywords="selection committee",
abstract="Background: Heart transplant selection committee meetings have transitioned from in-person to remote video meetings during the COVID-19 pandemic, but how this impacts committee members and patient outcomes is unknown. Objective: The aim of this study is to determine the perceived impact of remote video transplant selection meetings on usability and patient care and to measure patient selection outcomes during the transition period from in-person to virtual meetings. Methods: A 35-item anonymous survey was developed and distributed electronically to the heart transplant selection committee. We reviewed medical records to compare the outcomes of patients presented at in-person meetings (January-March 2020) to those presented during video meetings (March-June 2020). Results: Among 83 committee members queried, 50 were regular attendees. Of the 50 regular attendees, 24 (48\%) were physicians and 26 (52\%) were nonphysicians, including nurses, social workers, and coordinators; 46 responses were received, 23 (50\%) from physicians and 23 (50\%) from nonphysicians, with 41 responses fully completed. Overall, respondents were satisfied with the videoconference format and felt that video meetings did not impact patient care and were an acceptable alternative to in-person meetings. However, 54\% (22/41) preferred in-person meetings, with 71\% (15/21) of nonphysicians preferring in-person meetings compared to only 35\% (7/20) of physicians (P=.02). Of the 46 new patient evaluations presented, there was a statistically nonsignificant trend toward fewer patients initially declined at video meetings compared with in-person meetings (6/24, 25\% compared to 10/22, 45\%; P=.32). Conclusions: The transition from in-person to video heart transplant selection committee meetings was well-received and did not appear to affect committee members' perceived ability to deliver patient care. Patient selection outcomes were similar between meeting modalities. ",
doi="10.2196/35490",
url="https://cardio.jmir.org/2022/1/e35490",
url="http://www.ncbi.nlm.nih.gov/pubmed/35353041"
}


@Article{info:doi/10.2196/32403,
author="Ye, Siqin
and Anstey, Edmund D.
and Grauer, Anne
and Metser, Gil
and Moise, Nathalie
and Schwartz, Joseph
and Kronish, Ian
and Abdalla, Marwah",
title="The Impact of Telemedicine Visits on the Controlling High Blood Pressure Quality Measure During the COVID-19 Pandemic: Retrospective Cohort Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="23",
volume="6",
number="3",
pages="e32403",
keywords="telemedicine",
keywords="hypertension",
keywords="blood pressure",
keywords="quality of care",
keywords="impact",
keywords="COVID-19",
keywords="cohort",
keywords="cardiology",
keywords="telehealth",
keywords="retrospective",
abstract="Background: Telemedicine visit use vastly expanded during the COVID-19 pandemic, and this has had an uncertain impact on cardiovascular care quality. Objective: We sought to examine the association between telemedicine visits and the failure to meet the Controlling High Blood Pressure (BP) quality measure from the Centers for Medicare \& Medicaid Services. Methods: This was a retrospective cohort study of 32,727 adult patients with hypertension who were seen in primary care and cardiology clinics at an urban, academic medical center from February to December 2020. The primary outcome was a failure to meet the Controlling High Blood Pressure quality measure, which was defined as having no BP recorded or having a last recorded BP of ?140/90 mm Hg (ie, poor BP control). Multivariable logistic regression was used to assess the association between telemedicine visit use during the study period (none, 1 telemedicine visit, or ?2 telemedicine visits) and poor BP control; we adjusted for demographic and clinical characteristics. Results: During the study period, no BP was recorded for 2.3\% (486/20,745) of patients with in-person visits only, 27.1\% (1863/6878) of patients with 1 telemedicine visit, and 25\% (1277/5104) of patients with ?2 telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (1 telemedicine visit: odds ratio [OR] 2.06, 95\% CI 1.94-2.18; P<.001; ?2 telemedicine visits: OR 2.49, 95\% CI 2.31-2.68; P<.001; reference: in-person visits only). This effect disappeared when the analysis was restricted to patients with at least 1 recorded BP (1 telemedicine visit: OR 0.89, 95\% CI 0.83-0.95; P=.001; ?2 telemedicine visits: OR 0.91, 95\% CI 0.83-0.99; P=.03). Conclusions: Increased telemedicine visit use is associated with poorer performance on the Controlling High Blood Pressure quality measure. However, telemedicine visit use may not negatively impact BP control when BP is recorded. ",
doi="10.2196/32403",
url="https://formative.jmir.org/2022/3/e32403",
url="http://www.ncbi.nlm.nih.gov/pubmed/35138254"
}


@Article{info:doi/10.2196/33286,
author="Johnson, E. Amber
and Routh, Shuvodra
and Taylor, N. Christy
and Leopold, Meagan
and Beatty, Kathryn
and McNamara, M. Dennis
and Davis, M. Esa",
title="Developing and Implementing an mHealth Heart Failure Self-care Program to Reduce Readmissions: Randomized Controlled Trial",
journal="JMIR Cardio",
year="2022",
month="Mar",
day="21",
volume="6",
number="1",
pages="e33286",
keywords="mHealth",
keywords="heart failure",
keywords="self-care",
keywords="remote monitoring",
keywords="telehealth",
keywords="cardiology",
keywords="hospital readmission",
keywords="self-management",
keywords="mobile health",
keywords="patient-centered",
abstract="Background: Patients admitted with decompensated heart failure (HF) are at risk for hospital readmission and poor quality of life during the discharge period. Lifestyle behavior modifications that promote the self-management of chronic cardiac diseases have been associated with an improved quality of life. However, whether a mobile health (mHealth) program can assist patients in the self-management of HF during the acute posthospital discharge period is unknown. Objective: We aimed to develop an mHealth program designed to enhance patients' self-management of HF by increasing knowledge, self-efficacy, and symptom detection. We hypothesized that patients hospitalized with HF would be willing to use a feasibly deployed mHealth program after their hospital discharge. Methods: We employed a patient-centered outcomes research methodology to design a stakeholder-informed mHealth program. Adult patients with HF admitted to a large academic hospital were enrolled and randomized to receive the mHealth intervention versus usual care. Our feasibility outcomes included ease of program deployment, use of the clinical escalation process, duration of participant recruitment, and participant attrition. Surveys assessing the demographics and clinical characteristics of HF were measured at baseline and at 30 and 90 days after discharge. Results: The study period was between July 1, 2019, and April 7, 2020. The mean cohort (N=31) age was 60.4 (range 22-85) years. Over half of the participants were men (n=18, 58\%) and 77\% (n=24) were White. There were no significant differences in baseline measures. We determined that an educational mHealth program tailored for patients with HF is feasibly deployed and acceptable by patients. Though not significant, we found notable trends including a higher mean quality of life at 30 days posthospitalization among program users and a longer duration before rehospitalization, which are suggestive of better HF prognosis. Conclusions: Our mHealth tool should be further assessed in a larger comparative effectiveness trial. Our pilot intervention offers promise as an innovative means to help HF patients lead healthy, independent lives. These preliminary data suggest that patient-centered mHealth tools can enable high-risk patients to play a role in the management of their HF after discharge. Trial Registration: ClinicalTrials.gov NCT03982017; https://clinicaltrials.gov/ct2/show/NCT03982017 ",
doi="10.2196/33286",
url="https://cardio.jmir.org/2022/1/e33286",
url="http://www.ncbi.nlm.nih.gov/pubmed/35311679"
}


@Article{info:doi/10.2196/31501,
author="Larsen, Hoejkjaer Lisbeth
and Lauritzen, Hedegaard Maja
and Sinkjaer, Mikkel
and Kjaer, W. Troels",
title="The Effect of Wearable Tracking Devices on Cardiorespiratory Fitness Among Inactive Adults: Crossover Study",
journal="JMIR Cardio",
year="2022",
month="Mar",
day="15",
volume="6",
number="1",
pages="e31501",
keywords="activity tracking",
keywords="cardiorespiratory fitness",
keywords="mHealth",
keywords="mobile health",
keywords="motivation",
keywords="physical activity",
keywords="self-monitoring",
keywords="wearable",
keywords="cardio",
keywords="fitness",
keywords="cardiorespiratory",
keywords="behavior change",
abstract="Background: Modern lifestyle is associated with a high prevalence of physical inactivity. Objective: This study aims to investigate the effect of a wearable tracking device on cardiorespiratory fitness among inactive adults and to explore if personal characteristics and health outcomes can predict adoption of the device. Methods: In total, 62 inactive adults were recruited for this study. A control period (4 weeks) was followed by an intervention period (8 weeks) where participants were instructed to register and follow their physical activity (PA) behavior on a wrist-worn tracking device. Data collected included estimated cardiorespiratory fitness, body composition, blood pressure, perceived stress levels, and self-reported adoption of using the tracking device. Results: In total, 50 participants completed the study (mean age 48, SD 13 years, 84\% women). Relative to the control period, participants increased cardiorespiratory fitness by 1.52 mL/kg/minute (95\% CI 0.82-2.22; P<.001), self-reported PA by 140 minutes per week (95\% CI 93.3-187.1; P<.001), daily step count by 982 (95\% CI 492-1471; P<.001), and participants' fat percentage decreased by 0.48\% (95\% CI --0.84 to --0.13; P=.009). No difference was observed in blood pressure (systolic: 95\% CI --2.16 to 3.57, P=.63; diastolic: 95\% CI --0.70 to 2.55; P=.27) or perceived stress (95\% CI --0.86 to 1.78; P=.49). No associations were found between adoption of the wearable tracking device and age, gender, personality, or education. However, participants with a low perceived stress at baseline were more likely to rate the use of a wearable tracking device highly motivating. Conclusions: Tracking health behavior using a wearable tracking device increases PA resulting in an improved cardiorespiratory fitness among inactive adults. ",
doi="10.2196/31501",
url="https://cardio.jmir.org/2022/1/e31501",
url="http://www.ncbi.nlm.nih.gov/pubmed/35289763"
}


@Article{info:doi/10.2196/32946,
author="Morken, Margreta Ingvild
and Storm, Marianne
and S{\o}reide, Arne Jon
and Urstad, Hjorthaug Kristin
and Karlsen, Bj{\o}rg
and Huseb{\o}, Lunde Anne Marie",
title="Posthospitalization Follow-Up of Patients With Heart Failure Using eHealth Solutions: Restricted Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="15",
volume="24",
number="2",
pages="e32946",
keywords="adherence",
keywords="eHealth",
keywords="heart failure",
keywords="posthospitalization follow-up",
keywords="patient outcome",
keywords="review",
abstract="Background: Heart failure (HF) is a clinical syndrome with high incidence rates, a substantial symptom and treatment burden, and a significant risk of readmission within 30 days after hospitalization. The COVID-19 pandemic has revealed the significance of using eHealth interventions to follow up on the care needs of patients with HF to support self-care, increase quality of life (QoL), and reduce readmission rates during the transition between hospital and home. Objective: The aims of this review are to summarize research on the content and delivery modes of HF posthospitalization eHealth interventions, explore patient adherence to the interventions, and examine the effects on the patient outcomes of self-care, QoL, and readmissions. Methods: A restricted systematic review study design was used. Literature searches and reviews followed the (PRISMA-S) Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension checklist, and the CINAHL, MEDLINE, Embase, and Cochrane Library databases were searched for studies published between 2015 and 2020. The review process involved 3 groups of researchers working in pairs. The Mixed Methods Appraisal Tool was used to assess the included studies' methodological quality. A thematic analysis method was used to analyze data extracted from the studies. Results: A total of 18 studies were examined in this review. The studies were published between 2015 and 2019, with 56\% (10/18) of them published in the United States. Of the 18 studies, 16 (89\%) were randomized controlled trials, and 14 (78\%) recruited patients upon hospital discharge to eHealth interventions lasting from 14 days to 12 months. The studies involved structured telephone calls, interactive voice response, and telemonitoring and included elements of patient education, counseling, social and emotional support, and self-monitoring of symptoms and vital signs. Of the 18 studies, 11 (61\%) provided information on patient adherence, and the adherence levels were 72\%-99\%. When used for posthospitalization follow-up of patients with HF, eHealth interventions can positively affect QoL, whereas its impact is less evident for self-care and readmissions. Conclusions: This review suggests that patients with HF should receive prompt follow-up after hospitalization and eHealth interventions have the potential to improve these patients' QoL. Patient adherence in eHealth follow-up trials shows promise for successful future interventions and adherence research. Further studies are warranted to examine the effects of eHealth interventions on self-care and readmissions among patients with HF. ",
doi="10.2196/32946",
url="https://www.jmir.org/2022/2/e32946",
url="http://www.ncbi.nlm.nih.gov/pubmed/35166680"
}


@Article{info:doi/10.2196/32545,
author="Aquino, Maria
and Griffith, Janessa
and Vattaparambil, Tessy
and Munce, Sarah
and Hladunewich, Michelle
and Seto, Emily",
title="Patients' and Providers' Perspectives on and Needs of Telemonitoring to Support Clinical Management and Self-care of People at High Risk for Preeclampsia: Qualitative Study",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="7",
volume="9",
number="1",
pages="e32545",
keywords="high-risk pregnancy",
keywords="blood pressure",
keywords="preeclampsia",
keywords="telemonitoring",
keywords="home monitoring",
keywords="mHealth",
abstract="Background: Preeclampsia is one of the leading causes of maternal mortality worldwide, with a global prevalence at 2\%-8\% of pregnancies. Patients at high risk for preeclampsia (PHRPE) have an increased risk of complications, such as fetal growth restriction, preterm delivery, abnormal clotting, and liver and kidney disease. Telemonitoring for PHRPE may allow for timelier diagnosis and enhanced management, which may improve maternal and perinatal outcomes. Objective: The objective of this study is to determine the perceptions and needs of PHRPE and their health care providers with respect to telemonitoring through semistructured interviews with both groups. This study explored (1) what the needs and challenges of monitoring PHRPE are during pregnancy and in the postpartum period and (2) what features are required in a telemonitoring program to support self-care and clinical management of PHRPE. Methods: This study used a qualitative descriptive approach, and thematic analysis was conducted. PHRPE and health care providers from a high-risk obstetrical clinic in a large academic hospital in Toronto, Canada, were asked to participate in individual semistructured interviews. Two researchers jointly developed a coding framework and separately coded each interview to ensure that the interviews were double-coded. The software program NVivo version 12 was used to help organize the codes. Results: In total, 7 PHRPE and 5 health care providers, which included a nurse practitioner and physicians, participated in the semistructured interviews. Using thematic analysis, perceptions on the benefits, barriers, and desired features were determined. Perceived benefits of telemonitoring for PHRPE included close monitoring of home blood pressure (BP) measurements and appropriate interventions for abnormal BP readings; the development of a tailored telemonitoring system for pregnant patients; and facilitation of self-management. Perceived barriers to telemonitoring for PHRPE included financial and personal barriers, as well as the potential for increased clinician workload. Desired features of a secure platform for PHRPE included the facilitation of self-management for patients and decision making for clinicians, as well as the inclusion of evidence-based action prompts. Conclusions: The perceptions of patients and providers on the use of telemonitoring for PHRPE support the need for a telemonitoring program for the management of PHRPE. Recommendations from this study include the specific features of a telemonitoring program for PHRPE, as well as the use of frameworks and design processes in the design and implementation of a telemonitoring program for PHRPE. ",
doi="10.2196/32545",
url="https://humanfactors.jmir.org/2022/1/e32545",
url="http://www.ncbi.nlm.nih.gov/pubmed/35129445"
}


@Article{info:doi/10.2196/34778,
author="Wong, Cheong Kam
and Nguyen, N. Tu
and Marschner, Simone
and Turnbull, Samual
and Burns, Jenner Mason
and Ne, Anna Jia Yi
and Gopal, Vishal
and Indrawansa, Balasuriya Anupama
and Trankle, A. Steven
and Usherwood, Tim
and Kumar, Saurabh
and Lindley, I. Richard
and Chow, K. Clara",
title="Patient-Led Mass Screening for Atrial Fibrillation in the Older Population Using Handheld Electrocardiographic Devices Integrated With a Clinician-Coordinated Remote Central Monitoring System: Protocol for a Randomized Controlled Trial and Process Evaluation",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="1",
volume="11",
number="2",
pages="e34778",
keywords="atrial fibrillation",
keywords="screening",
keywords="handheld",
keywords="electrocardiogram",
keywords="ECG",
keywords="acceptability",
keywords="user perception",
keywords="user experience",
keywords="barrier",
keywords="enabler",
keywords="older adults",
keywords="elderly",
keywords="feasibility",
keywords="effectiveness",
keywords="implementation",
keywords="monitoring",
keywords="aging",
keywords="cardiovascular",
keywords="cardiology",
keywords="heart disease",
keywords="mobile phone",
abstract="Background: Atrial fibrillation (AF) is common in older people and increases the risk of stroke. The feasibility and effectiveness of the implementation of a patient-led AF screening program for older people are unknown. Objective: This study aims to examine the feasibility and effectiveness of an AF screening program comprising patient-led monitoring of single-lead electrocardiograms (ECGs) with clinician-coordinated central monitoring to diagnose AF among community-dwelling people aged ?75 years in Australia. Methods: This is a nationwide randomized controlled implementation trial conducted via the internet and remotely among 200 community-dwelling adults aged ?75 years with no known AF. Randomization will be performed in a 1:1 allocation ratio for the intervention versus control. Intervention group participants will be enrolled in the monitoring program at randomization. They will receive a handheld single-lead ECG device and training on the self-recording of ECGs on weekdays and submit their ECGs via their smartphones. The control group participants will receive usual care from their general practitioners for the initial 6 months and then commence the 6-month monitoring program. The ECGs will be reviewed centrally by trained personnel. Participants and their general practitioners will be notified of AF and other clinically significant ECG abnormalities. Results: This study will establish the feasibility and effectiveness of implementing the intervention in this patient population. The primary clinical outcome is the AF detection rate, and the primary feasibility outcome is the patient satisfaction score. Other outcomes include appropriate use of anticoagulant therapy, participant recruitment rate, program engagement (eg, frequency of ECG transmission), agreement in ECG interpretation between the device automatic algorithm and clinicians, the proportion of participants who complete the trial and number of dropouts, and the impact of frailty on feasibility and outcomes. We will conduct a qualitative evaluation to examine the barriers to and acceptability and enablers of implementation. Ethics approval was obtained from the human research ethics committee at the University of Sydney (project number 2020/680). The results will be disseminated via conventional scienti?c forums, including peer-reviewed publications and presentations at national and international conferences. Conclusions: By incorporating an integrated health care approach involving patient empowerment, centralized clinician-coordinated ECG monitoring, and facilitation of primary care and specialist services, it is possible to diagnose and treat AF early to reduce stroke risk. This study will provide new information on how to implement AF screening using digital health technology practicably and feasibly for older and frail populations residing in the community. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000184875; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380877 International Registered Report Identifier (IRRID): DERR1-10.2196/34778 ",
doi="10.2196/34778",
url="https://www.researchprotocols.org/2022/2/e34778",
url="http://www.ncbi.nlm.nih.gov/pubmed/35103614"
}


@Article{info:doi/10.2196/31754,
author="Ware, Patrick
and Shah, Amika
and Ross, Joan Heather
and Logan, Gordon Alexander
and Segal, Phillip
and Cafazzo, Antony Joseph
and Szacun-Shimizu, Katarzyna
and Resnick, Myles
and Vattaparambil, Tessy
and Seto, Emily",
title="Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="26",
volume="24",
number="1",
pages="e31754",
keywords="telemonitoring",
keywords="telemedicine",
keywords="heart failure",
keywords="diabetes",
keywords="hypertension",
keywords="tertiary health care",
keywords="multiple chronic conditions",
keywords="mobile phone",
abstract="Background: Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on telemonitoring for this population. Objective: This randomized controlled trial and embedded qualitative study aims to evaluate the impact on and experiences of patients and health care providers (HCPs) using a telemonitoring system with decision support to manage patients with complex conditions, including those with multiple chronic conditions, compared with the standard of care. Methods: A pragmatic, unblinded, 6-month randomized controlled trial sought to recruit 146 patients with ?1 diagnosis of heart failure (HF), uncontrolled hypertension (HT), and insulin-requiring diabetes mellitus (DM) from outpatient specialty settings in Toronto, Ontario, Canada. Participants were randomized into the control and telemonitoring groups, with the latter being instructed to take readings relevant to their conditions. The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status (36-Item Short Form Health Survey questionnaire). Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported health service use. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group was interviewed about their experiences. Results: A total of 96 patients were recruited and randomized. Recruitment was terminated early because of implementation challenges and the onset of the COVID-19 pandemic. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of patients with HF found improvements in self-care maintenance (P=.04) and physical quality of life (P=.046). Opinions expressed by the 5 HCPs and 13 patients who were interviewed differed based on the monitored conditions. Although patients with HF reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care and the design of the decision support, whereby fluctuations in the status of HT and DM typically required less urgent interventions compared with patients with HF. Conclusions: We recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary but not sufficient components of such programs for patients with complex conditions and lower acuity. We conclude that telemonitoring for patients with complex conditions or within multidisciplinary care settings may be best operationalized through nurse-led models of care. Trial Registration: ClinicalTrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8367 ",
doi="10.2196/31754",
url="https://www.jmir.org/2022/1/e31754",
url="http://www.ncbi.nlm.nih.gov/pubmed/35080502"
}


@Article{info:doi/10.2196/31982,
author="Leigh, W. Jonathan
and Gerber, S. Ben
and Gans, P. Christopher
and Kansal, M. Mayank
and Kitsiou, Spyros",
title="Smartphone Ownership and Interest in Mobile Health Technologies for Self-care Among Patients With Chronic Heart Failure: Cross-sectional Survey Study",
journal="JMIR Cardio",
year="2022",
month="Jan",
day="14",
volume="6",
number="1",
pages="e31982",
keywords="mHealth",
keywords="smartphone",
keywords="mobile phone",
keywords="heart failure",
keywords="self-care",
keywords="self-management",
abstract="Background: Heart failure (HF) is a highly prevalent chronic condition that places a substantial burden on patients, families, and health care systems worldwide. Recent advances in mobile health (mHealth) technologies offer great opportunities for supporting many aspects of HF self-care. There is a need to better understand patients' adoption of and interest in using mHealth for self-monitoring and management of HF symptoms. Objective: The purpose of this study is to assess smartphone ownership and patient attitudes toward using mHealth technologies for HF self-care in a predominantly minority population in an urban clinical setting. Methods: We conducted a cross-sectional survey of adult outpatients (aged ?18 years) at an academic outpatient HF clinic in the Midwest. The survey comprised 34 questions assessing patient demographics, ownership of smartphones and other mHealth devices, frequently used smartphone features, use of mHealth apps, and interest in using mHealth technologies for vital sign and HF symptom self-monitoring and management. Results: A total of 144 patients were approached, of which 100 (69.4\%) participated in the study (63/100, 63\% women). The participants had a mean age of 61.3 (SD 12.25) years and were predominantly Black or African American (61/100, 61\%) and Hispanic or Latino (18/100, 18\%). Almost all participants (93/100, 93\%) owned a cell phone. The share of patients who owned a smartphone was 68\% (68/100). Racial and ethnic minorities that identified as Black or African American or Hispanic or Latino reported higher smartphone ownership rates compared with White patients with HF (45/61, 74\% Black or African American and 11/18, 61\% Hispanic or Latino vs 9/17, 53\% White). There was a moderate and statistically significant association between smartphone ownership and age (Cram{\'e}r V [$\Phi$C]=0.35; P<.001), education ($\Phi$C=0.29; P=.001), and employment status ($\Phi$C=0.3; P=.01). The most common smartphone features used by the participants were SMS text messaging (51/68, 75\%), internet browsing (43/68, 63\%), and mobile apps (41/68, 60\%). The use of mHealth apps and wearable activity trackers (eg, Fitbits) for self-monitoring of HF-related parameters was low (15/68, 22\% and 15/100, 15\%, respectively). The most popular HF-related self-care measures participants would like to monitor using mHealth technologies were physical activity (46/68, 68\%), blood pressure (44/68, 65\%), and medication use (40/68, 59\%). Conclusions: Most patients with HF have smartphones and are interested in using commercial mHealth apps and connected health devices to self-monitor their condition. Thus, there is a great opportunity to capitalize on the high smartphone ownership among racial and ethnic minority patients to increase reach and enhance HF self-management through mHealth interventions. ",
doi="10.2196/31982",
url="https://cardio.jmir.org/2022/1/e31982",
url="http://www.ncbi.nlm.nih.gov/pubmed/35029533"
}


@Article{info:doi/10.2196/22957,
author="Chen, Ying-Hsien
and Hung, Chi-Sheng
and Huang, Ching-Chang
and Lee, Jen-Kuang
and Yu, Jiun-Yu
and Ho, Yi-Lwun",
title="The Impact of Synchronous Telehealth Services With a Digital Platform on Day-by-Day Home Blood Pressure Variability in Patients with Cardiovascular Diseases: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="10",
volume="24",
number="1",
pages="e22957",
keywords="blood pressure",
keywords="variability",
keywords="telehealth",
keywords="hypertension",
keywords="cardiovascular disease",
keywords="chronic disease",
keywords="heart",
keywords="digital platform",
keywords="cohort",
keywords="management",
keywords="intervention",
abstract="Background: Hypertension is associated with a large global disease burden with variable control rates across different regions and races. Telehealth has recently emerged as a health care strategy for managing chronic diseases, but there are few reports regarding the effects of synchronous telehealth services on home blood pressure (BP) control and variability. Objective: The objective of this study is to investigate the effect of synchronous telehealth services with a digital platform on home BP. Methods: This retrospective study was conducted by the Taiwan ELEctroHEALTH study group at the Telehealth Center of the National Taiwan University Hospital. We analyzed home BP data taken from 2888 patients with cardiovascular disease (CVD) enrolled in our telehealth program between 2009 to 2017. Of the 2888 patients with CVD, 348 (12.05\%) patients who received home BP surveillance for ?56 days were selected for BP analysis. Patients were stratified into three groups: (1) poorly controlled hypertension, (2) well-controlled hypertension, and (3) nonhypertension. The mean, SD, coefficient of variation (CV), and average real variability were calculated. Results: Telehealth interventions significantly and steadily reduced systolic blood pressure (SBP) in the poorly controlled hypertension group from 144.8.2{\textpm}9.2 to 133.7{\textpm}10.2 mmHg after 2 months (P<.001). BP variability reduced in all patients: SBP-SD decreased from 7.8{\textpm}3.4 to 7.3{\textpm}3.4 after 2 months (P=.004), and SBP-CV decreased from 6.3{\textpm}2.5 to 5.9{\textpm}2.6 after 2 months (P=.004). Event-free survival (admission) analysis stratified by SBP-SD showed longer time to first hospitalization for Q1 patients compared with Q4 patients (P=.02, odds ratio 2.15, 95\% CI 1.18-3.89). Conclusions: Synchronous telehealth intervention may improve home BP control and decrease day-by-day home BP variability in patients with CVD. ",
doi="10.2196/22957",
url="https://www.jmir.org/2022/1/e22957",
url="http://www.ncbi.nlm.nih.gov/pubmed/35006089"
}


@Article{info:doi/10.2196/34657,
author="Ramachandran, Joann Hadassah
and Jiang, Ying
and Teo, Claire Jun Yi
and Yeo, Joo Tee
and Wang, Wenru",
title="Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="7",
volume="24",
number="1",
pages="e34657",
keywords="technology acceptance",
keywords="coronary heart disease",
keywords="home-based",
keywords="telerehabilitation",
keywords="web-based",
keywords="mobile application",
keywords="acceptance",
keywords="heart",
keywords="rehabilitation",
keywords="app",
keywords="review",
keywords="evaluation",
keywords="cardiac",
keywords="cardiology",
keywords="perspective",
keywords="usability",
keywords="acceptability",
abstract="Background: An understanding of the technology acceptance of home-based cardiac telerehabilitation programs is paramount if they are to be designed and delivered to target the needs and preferences of patients with coronary heart disease; however, the current state of technology acceptance of home-based cardiac telerehabilitation has not been systematically evaluated in the literature. Objective: We aimed to provide a comprehensive summary of home-based cardiac telerehabilitation technology acceptance in terms of (1) the timing and approaches used and (2) patients' perspectives on its usability, utility, acceptability, acceptance, and external variables. Methods: We searched PubMed, CENTRAL, Embase, CINAHL, PsycINFO, and Scopus (inception to July 2021) for English-language papers that reported empirical evidence on the technology acceptance of early-phase home-based cardiac telerehabilitation in patients with coronary heart disease. Content analysis was undertaken. Results: The search identified 1798 studies, of which 18 studies, with 14 unique home-based cardiac telerehabilitation programs, met eligibility criteria. Technology acceptance (of the home-based cardiac telerehabilitation programs) was mostly evaluated at intra- and posttrial stages using questionnaires (n=10) and usage data (n=11). The least used approach was evaluation through qualitative interviews (n=3). Usability, utility, acceptability, and acceptance were generally favored. External variables that influenced home-based cardiac telerehabilitation usage included component quality, system quality, facilitating conditions, and intrinsic factors. Conclusions: Home-based cardiac telerehabilitation usability, utility, acceptability, and acceptance were high; yet, a number of external variables influenced acceptance. Findings and recommendations from this review can provide guidance for developing and evaluating patient-centered home-based cardiac telerehabilitation programs to stakeholders and clinicians. ",
doi="10.2196/34657",
url="https://www.jmir.org/2022/1/e34657",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994711"
}


@Article{info:doi/10.2196/31890,
author="Elzinga, O. Willem
and Prins, Samantha
and Borghans, M. Laura G. J.
and Gal, Pim
and Vargas, A. Gabriel
and Groeneveld, J. Geert
and Doll, J. Robert",
title="Detection of Clenbuterol-Induced Changes in Heart Rate Using At-Home Recorded Smartwatch Data: Randomized Controlled Trial",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="30",
volume="5",
number="12",
pages="e31890",
keywords="photoplethysmography",
keywords="smartwatch",
keywords="wearable",
keywords="at-home",
keywords="heart rate",
keywords="RCT",
keywords="wearable device",
keywords="digital health",
keywords="cardiovascular",
keywords="cardiology",
keywords="sensors",
keywords="heart rate sensor",
keywords="smart technology",
abstract="Background: Although electrocardiography is the gold standard for heart rate (HR) recording in clinical trials, the increasing availability of smartwatch-based HR monitors opens up possibilities for drug development studies. Smartwatches allow for inexpensive, unobtrusive, and continuous HR estimation for potential detection of treatment effects outside the clinic, during daily life. Objective: The aim of this study is to evaluate the repeatability and sensitivity of smartwatch-based HR estimates collected during a randomized clinical trial. Methods: The data were collected as part of a multiple-dose, investigator-blinded, randomized, placebo-controlled, parallel-group study of 12 patients with Parkinson disease. After a 6-day baseline period, 4 and 8 patients were treated for 7 days with an ascending dose of placebo and clenbuterol, respectively. Throughout the study, the smartwatch provided HR and sleep state estimates. The HR estimates were quantified as the 2.5th, 50th, and 97.5th percentiles within awake and asleep segments. Linear mixed models were used to calculate the following: (1) the intraclass correlation coefficient (ICC) of estimated sleep durations, (2) the ICC and minimum detectable effect (MDE) of the HR estimates, and (3) the effect sizes of the HR estimates. Results: Sleep duration was moderately repeatable (ICC=0.64) and was not significantly affected by study day (P=.83), clenbuterol (P=.43), and study day by clenbuterol (P=.73). Clenbuterol-induced changes were detected in the asleep HR as of the first night (+3.79 beats per minute [bpm], P=.04) and in the awake HR as of the third day (+8.79 bpm, P=.001). The median HR while asleep had the highest repeatability (ICC=0.70). The MDE (N=12) was found to be smaller when patients were asleep (6.8 bpm to 11.7 bpm) than while awake (10.7 bpm to 22.1 bpm). Overall, the effect sizes for clenbuterol-induced changes were higher while asleep (0.49 to 2.75) than while awake (0.08 to 1.94). Conclusions: We demonstrated the feasibility of using smartwatch-based HR estimates to detect clenbuterol-induced changes during clinical trials. The asleep HR estimates were most repeatable and sensitive to treatment effects. We conclude that smartwatch-based HR estimates obtained during daily living in a clinical trial can be used to detect and track treatment effects. Trial Registration: Netherlands Trials Register NL8002; https://www.trialregister.nl/trial/8002 ",
doi="10.2196/31890",
url="https://formative.jmir.org/2021/12/e31890",
url="http://www.ncbi.nlm.nih.gov/pubmed/34967757"
}


@Article{info:doi/10.2196/26072,
author="Biersteker, Tom
and Hilt, Alexander
and van der Velde, Enno
and Schalij, Jan Martin
and Treskes, Willem Roderick",
title="Real-World Experience of mHealth Implementation in Clinical Practice (the Box): Design and Usability Study",
journal="JMIR Cardio",
year="2021",
month="Dec",
day="16",
volume="5",
number="2",
pages="e26072",
keywords="eHealth",
keywords="mHealth",
keywords="remote patient monitoring",
keywords="cardiology",
keywords="patient satisfaction",
keywords="patient empowerment",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) is an emerging field of scientific interest worldwide. Potential benefits include increased patient engagement, improved clinical outcomes, and reduced health care costs. However, mHealth is often studied in projects or trials, and structural implantation in clinical practice is less common. Objective: The purpose of this paper is to outline the design of the Box and its implementation and use in an outpatient clinic setting. The impact on logistical outcomes and patient and provider satisfaction is discussed. Methods: In 2016, an mHealth care track including smartphone-compatible devices, named the Box, was implemented in the cardiology department of a tertiary medical center in the Netherlands. Patients with myocardial infarction, rhythm disorders, cardiac surgery, heart failure, and congenital heart disease received devices to measure daily weight, blood pressure, heart rate, temperature, and oxygen saturation. In addition, professional and patient user comments on the experience with the care track were obtained via structured interviews. Results: From 2016 to April 2020, a total of 1140 patients were connected to the mHealth care track. On average, a Box cost {\texteuro}350 (US \$375), not including extra staff costs. The median patient age was 60.8 (IQR 52.9-69.3) years, and 73.59\% (839/1140) were male. A median of 260 (IQR 105-641) measurements was taken on a median of 189 (IQR 98-372) days. Patients praised the ease of use of the devices and felt more involved with their illness and care. Professionals reported more productive outpatient consultations as well as improved insight into health parameters such as blood pressure and weight. A feedback loop from the hospital to patient to focus on measurements was commented as an important improvement by both patients and professionals. Conclusions: In this study, the design and implementation of an mHealth care track for outpatient follow-up of patients with various cardiovascular diseases is described. Data from these 4 years indicate that mHealth is feasible to incorporate in outpatient management and is generally well-accepted by patients and providers. Limitations include the need for manual measurement data checks and the risk of data overload. Moreover, the tertiary care setting in which the Box was introduced may limit the external validity of logistical and financial end points to other medical centers. More evidence is needed to show the effects of mHealth on clinical outcomes and on cost-effectiveness. ",
doi="10.2196/26072",
url="https://cardio.jmir.org/2021/2/e26072",
url="http://www.ncbi.nlm.nih.gov/pubmed/34642159"
}


@Article{info:doi/10.2196/26794,
author="Ali, Lilas
and Wallstr{\"o}m, Sara
and Fors, Andreas
and Barenfeld, Emmelie
and Fredholm, Eva
and Fu, Michael
and Goudarzi, Mahboubeh
and Gyllensten, Hanna
and Lindstr{\"o}m Kjellberg, Irma
and Swedberg, Karl
and Vanfleteren, W. Lowie E. G.
and Ekman, Inger",
title="Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="13",
volume="23",
number="12",
pages="e26794",
keywords="chronic heart failure",
keywords="chronic obstructive pulmonary disease",
keywords="digital platform",
keywords="eHealth",
keywords="patient-centered care",
keywords="person-centered care",
keywords="randomized controlled trial",
keywords="telehealth",
abstract="Background: Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce. Objective: The aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF. Methods: A multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5\%) or PCC combined with usual care (110/222, 49.5\%). The intervention's main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention. Results: No significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (P=.047), although it was not maintained until the end of the 6-month follow-up (P=.24). This effect was driven by a change in general self-efficacy from baseline. Conclusions: PCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF. Trial Registration: ClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817 ",
doi="10.2196/26794",
url="https://www.jmir.org/2021/12/e26794",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898447"
}


@Article{info:doi/10.2196/22557,
author="Ghorbani, Banafsheh
and Jackson, C. Alun
and Noorchenarboo, Mohammad
and Mandegar, H. Mohammad
and Sharifi, Farshad
and Mirmoghtadaie, Zohrehsadat
and Bahramnezhad, Fatemeh",
title="Comparing the Effects of Gamification and Teach-Back Training Methods on Adherence to a Therapeutic Regimen in Patients After Coronary Artery Bypass Graft Surgery: Randomized Clinical Trial",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="10",
volume="23",
number="12",
pages="e22557",
keywords="teach back",
keywords="gamification",
keywords="treatment regimen",
keywords="coronary artery bypass graft",
keywords="patient training",
abstract="Background: Patients undergoing coronary artery bypass graft surgery (CABGS) may fail to adhere to their treatment regimen for many reasons. Among these, one of the most important reasons for nonadherence is the inadequate training of such patients or training using inappropriate methods. Objective: This study aimed to compare the effect of gamification and teach-back training methods on adherence to a therapeutic regimen in patients after CABGS. Methods: This randomized clinical trial was conducted on 123 patients undergoing CABGS in Tehran, Iran, in 2019. Training was provided to the teach-back group individually. In the gamification group, an app developed for the purpose was installed on each patient's smartphone, with training given via this device. The control group received usual care, or routine training. Adherence to the therapeutic regimen was assessed using a questionnaire on adherence to a therapeutic regimen (physical activity and dietary regimen) and an adherence scale as a pretest and a 1-month posttest. Results: One-way analysis of variance (ANOVA) for comparing the mean scores of teach-back and gamification training methods showed that the mean normalized scores for the dietary regimen (P<.001, F=71.80), movement regimen (P<.001, F=124.53), and medication regimen (P<.001, F=9.66) before and after intervention were significantly different between the teach-back, gamification, and control groups. In addition, the results of the Dunnett test showed that the teach-back and gamification groups were significantly different from the control group in all three treatment regimen methods. There was no statistically significant difference in adherence to the therapeutic regimen between the teach-back and control groups. Conclusions: Based on the results of this study, the use of teach-back and gamification training approaches may be suggested for patients after CABGS to facilitate adherence to the therapeutic regimen. Trial Registration: Iranian Registry of Clinical Trials IRCT20111203008286N8; https://en.irct.ir/trial/41507 ",
doi="10.2196/22557",
url="https://www.jmir.org/2021/12/e22557",
url="http://www.ncbi.nlm.nih.gov/pubmed/34890346"
}


@Article{info:doi/10.2196/26185,
author="Dorsch, P. Michael
and Farris, B. Karen
and Rowell, E. Brigid
and Hummel, L. Scott
and Koelling, M. Todd",
title="The Effects of the ManageHF4Life Mobile App on Patients With Chronic Heart Failure: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="7",
volume="9",
number="12",
pages="e26185",
keywords="mHealth",
keywords="remote monitoring",
keywords="self-management",
keywords="self-care",
keywords="heart failure",
keywords="medical therapy",
keywords="mobile app",
abstract="Background: The successful management of heart failure (HF) involves guideline-based medical therapy as well as self-management behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. Objective: The aim of this paper was to evaluate the efficacy of enhanced self-management via a mobile app intervention on health-related quality of life, self-management, and HF readmissions. Methods: A single-center randomized controlled trial was performed. Participants older than 45 years and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group (``app group'') used a mobile app, and the intervention prompted daily self-monitoring and promoted self-management. The control group (``no-app group'') received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire score and recurrent HF admissions. Results: A total of 83 participants were enrolled and completed all baseline assessments. Baseline characteristics were similar between the groups except for the prevalence of ischemic HF. The app group had a reduced MLHFQ at 6 weeks (mean 37.5, SD 3.5 vs mean 48.2, SD 3.7; P=.04) but not at 12 weeks (mean 44.2, SD 4 vs mean 45.9, SD 4; P=.78), compared to the no-app group. There was no effect of the app on the SCHFI at 6 or 12 weeks. The time to first HF readmission was not statistically different between the app group and the no-app group (app group 11/42, 26\% vs no-app group 12/41, 29\%; hazard ratio 0.89, 95\% CI 0.39-2.02; P=.78) over 12 weeks. Conclusions: The adaptive mobile app intervention, which focused on promoting self-monitoring and self-management, improved the MLHFQ at 6 weeks but did not sustain its effects at 12 weeks. No effect was seen on HF self-management measured by self-report. Further research is needed to enhance engagement in the app for a longer period and to determine if the app can reduce HF readmissions in a larger study. Trial Registration: ClinicalTrials.gov NCT03149510; https://clinicaltrials.gov/ct2/show/NCT03149510 ",
doi="10.2196/26185",
url="https://mhealth.jmir.org/2021/12/e26185",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878990"
}


@Article{info:doi/10.2196/28259,
author="Artanian, Veronica
and Ware, Patrick
and Rac, E. Valeria
and Ross, J. Heather
and Seto, Emily",
title="Experiences and Perceptions of Patients and Providers Participating in Remote Titration of Heart Failure Medication Facilitated by Telemonitoring: Qualitative Study",
journal="JMIR Cardio",
year="2021",
month="Nov",
day="25",
volume="5",
number="2",
pages="e28259",
keywords="telemonitoring",
keywords="remote",
keywords="titration",
keywords="monitoring",
keywords="mHealth",
keywords="heart failure",
keywords="qualitative",
keywords="mobile phone",
abstract="Background: Guideline-directed medical therapy (GDMT), optimized to target doses, improves health outcomes in patients with heart failure. However, GDMT remains underused, with <25\% of patients receiving target doses in clinical practice. A randomized controlled trial was conducted at the Peter Munk Cardiac Centre in Toronto to compare a remote GDMT titration intervention with standard in-office titration. This randomized controlled trial found that remote titration increased the proportion of patients who achieved optimal GDMT doses, decreased the time to dose optimization, and reduced the number of essential clinic visits. This paper presents findings from the qualitative component of the mixed methods study, which evaluated the implementation of the remote titration intervention. Objective: The objective of the qualitative component is to assess the perceptions and experiences of clinicians and patients with heart failure who participated in the remote titration intervention to identify factors that affected the implementation of the intervention. Methods: We conducted semistructured interviews with clinicians (n=5) and patients (n=11) who participated in the remote titration intervention. Questions probed the experiences of the participants to identify factors that can serve as barriers and facilitators to its implementation. Conventional content analysis was first used to analyze the interviews and gain direct information based on the participants' unique perspectives. Subsequently, the generated themes were delineated and mapped following a multilevel framework. Results: Patients and clinicians indicated that the intervention was easy to use, integrated well into their routines, and removed practical barriers to titration. Key implementation facilitators from the patients' perspective included the reduction in clinic visits and daily monitoring of their condition, whereas clinicians emphasized the benefits of rapid drug titration and efficient patient management. Key implementation barriers included the resources necessary to support the intervention and lack of physician remuneration. Conclusions: This study presents results from a real-world implementation assessment of remote titration facilitated by telemonitoring. It is among the first to provide insight into the perception of the remote titration process by clinicians and patients. Our findings indicate that the relative advantages that remote titration presents over standard care strongly appeal to both clinicians and patients. However, to ensure uptake and adherence, it is important to ensure that suitable patients are enrolled and the impact on the physicians' workload is minimized. The implementation of remote titration is now more critical than ever, as it can help provide access to care for patients during times when physical distancing is required. Trial Registration: ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID): RR2-10.2196/19705 ",
doi="10.2196/28259",
url="https://cardio.jmir.org/2021/2/e28259",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842546"
}


@Article{info:doi/10.2196/27720,
author="Seiler, Amber
and Biundo, Eliana
and Di Bacco, Marco
and Rosemas, Sarah
and Nicolle, Emmanuelle
and Lanctin, David
and Hennion, Juliette
and de Melis, Mirko
and Van Heel, Laura",
title="Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation",
journal="JMIR Cardio",
year="2021",
month="Oct",
day="15",
volume="5",
number="2",
pages="e27720",
keywords="cardiac implantable electronic devices",
keywords="remote monitoring",
keywords="patient management",
keywords="clinic efficiency",
keywords="digital health",
keywords="mobile phone",
abstract="Background: The number of patients with cardiac implantable electronic device (CIED) is increasing, creating a substantial workload for device clinics. Objective: This study aims to characterize the workflow and quantify clinic staff time requirements for managing patients with CIEDs. Methods: A time and motion workflow evaluation was performed in 11 US and European CIEDs clinics. Workflow tasks were repeatedly timed during 1 business week of observation at each clinic; these observations included all device models and manufacturers. The mean cumulative staff time required to review a remote device transmission and an in-person clinic visit were calculated, including all necessary clinical and administrative tasks. The annual staff time to manage a patient with a CIED was modeled using CIED transmission volumes, clinical guidelines, and the published literature. Results: A total of 276 in-person clinic visits and 2173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4 to 13.5 minutes for therapeutic devices (pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy) and from 11.3 to 12.9 minutes for diagnostic devices such as insertable cardiac monitors (ICMs). Mean staff time per in-person visit ranged from 37.8 to 51.0 and from 39.9 to 45.8 minutes for therapeutic devices and ICMs, respectively. Including all remote and in-person follow-ups, the estimated annual time to manage a patient with a CIED ranged from 1.6 to 2.4 hours for therapeutic devices and from 7.7 to 9.3 hours for ICMs. Conclusions: The CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs the implementation of efficiency improvements, including remote solutions. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow. ",
doi="10.2196/27720",
url="https://cardio.jmir.org/2021/2/e27720",
url="http://www.ncbi.nlm.nih.gov/pubmed/34156344"
}


@Article{info:doi/10.2196/25163,
author="Stollfuss, Barbara
and Richter, Manuel
and Dr{\"o}mann, Daniel
and Klose, Hans
and Schwaiblmair, Martin
and Gruenig, Ekkehard
and Ewert, Ralf
and Kirchner, C. Martin
and Kleinjung, Frank
and Irrgang, Valeska
and Mueller, Christian",
title="Digital Tracking of Physical Activity, Heart Rate, and Inhalation Behavior in Patients With Pulmonary Arterial Hypertension Treated With Inhaled Iloprost: Observational Study (VENTASTEP)",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="8",
volume="23",
number="10",
pages="e25163",
keywords="6-minute walk distance",
keywords="6MWD",
keywords="Breelib",
keywords="daily physical activity",
keywords="digital monitoring",
keywords="health-related quality of life",
keywords="iloprost",
keywords="Ventavis",
keywords="inhalation behavior",
keywords="mobile phone",
keywords="pulmonary arterial hypertension",
keywords="PAH",
keywords="sleeping behavior",
keywords="behavior",
keywords="sleep",
keywords="monitoring",
keywords="physical activity",
keywords="heart",
keywords="cardiology",
abstract="Background: Pulmonary arterial hypertension restricts the ability of patients to perform routine physical activities. As part of pulmonary arterial hypertension treatment, inhaled iloprost can be administered via a nebulizer that tracks inhalation behavior. Pulmonary arterial hypertension treatment is guided by intermittent clinical measurements, such as 6-minute walk distance, assessed during regular physician visits. Continuous digital monitoring of physical activity may facilitate more complete assessment of the impact of pulmonary arterial hypertension on daily life. Physical activity tracking with a wearable has not yet been assessed with simultaneous tracking of pulmonary arterial hypertension medication intake. Objective: We aimed to digitally track the physical parameters of patients with pulmonary arterial hypertension who were starting treatment with iloprost using a Breelib nebulizer. The primary objective was to investigate correlations between changes in digital physical activity measures and changes in traditional clinical measures and health-related quality of life over 3 months. Secondary objectives were to evaluate inhalation behavior, adverse events, and changes in heart rate and sleep quality. Methods: We conducted a prospective, multicenter observational study of adults with pulmonary arterial hypertension in World Health Organization functional class III who were adding inhaled iloprost to existing pulmonary arterial hypertension therapy. Daily distance walked, step count, number of standing-up events, heart rate, and 6-minute walk distance were digitally captured using smartwatch (Apple Watch Series 2) and smartphone (iPhone 6S) apps during a 3-month observation period (which began when iloprost treatment began). Before and at the end of the observation period (within 2 weeks), we also evaluated 6-minute walk distance, Borg dyspnea, functional class, B-type natriuretic peptide (or N-terminal pro--B-type natriuretic peptide) levels, health-related quality of life (EQ-5D questionnaire), and sleep quality (Pittsburgh Sleep Quality Index). Results: Of 31 patients, 18 were included in the full analysis (observation period: median 91.5 days, IQR 88.0 to 92.0). Changes from baseline in traditional and digital 6-minute walk distance were moderately correlated (r=0.57). Physical activity (daily distance walked: median 0.4  km, IQR --0.2 to 1.9; daily step count: median 591, IQR ?509 to 2413) and clinical measures (traditional 6-minute walk distance: median 26 m, IQR 0 to 40) changed concordantly from baseline to the end of the observation period. Health-related quality of life showed little change. Total sleep score and resting heart rate slightly decreased. Distance walked and step count showed short-term increases after each iloprost inhalation. No new safety signals were identified (safety analysis set: n=30). Conclusions: Our results suggest that despite challenges, parallel monitoring of physical activity, heart rate, and iloprost inhalation is feasible in patients with pulmonary arterial hypertension and may complement traditional measures in guiding treatment; however, the sample size of this study limits generalizability. Trial Registration: ClinicalTrials.gov NCT03293407; https://clinicaltrials.gov/ct2/show/NCT03293407 International Registered Report Identifier (IRRID): RR2-10.2196/12144 ",
doi="10.2196/25163",
url="https://www.jmir.org/2021/10/e25163",
url="http://www.ncbi.nlm.nih.gov/pubmed/34623313"
}


@Article{info:doi/10.2196/28873,
author="Ranjan, Yatharth
and Althobiani, Malik
and Jacob, Joseph
and Orini, Michele
and Dobson, JB Richard
and Porter, Joanna
and Hurst, John
and Folarin, A. Amos",
title="Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="7",
volume="10",
number="10",
pages="e28873",
keywords="mHealth",
keywords="COVID-19",
keywords="mobile health",
keywords="remote monitoring",
keywords="wearables",
keywords="internet of things",
keywords="lung diseases",
keywords="respiratory health",
keywords="mental health",
keywords="cardiopulmonary diseases",
abstract="Background: Chronic lung disorders like chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are characterized by exacerbations. They are unpleasant for patients and sometimes severe enough to cause hospital admission and death. Moreover, due to the COVID-19 pandemic, vulnerable populations with these disorders are at high risk, and their routine care cannot be done properly. Remote monitoring offers a low cost and safe solution for gaining visibility into the health of people in their daily lives, making it useful for vulnerable populations. Objective: The primary objective is to assess the feasibility and acceptability of remote monitoring using wearables and mobile phones in patients with pulmonary diseases. The secondary objective is to provide power calculations for future studies centered around understanding the number of exacerbations according to sample size and duration. Methods: Twenty participants will be recruited in each of three cohorts (COPD, IPF, and posthospitalization COVID). Data collection will be done remotely using the RADAR-Base (Remote Assessment of Disease And Relapse) mobile health (mHealth) platform for different devices, including Garmin wearable devices and smart spirometers, mobile app questionnaires, surveys, and finger pulse oximeters. Passive data include wearable-derived continuous heart rate, oxygen saturation, respiration rate, activity, and sleep. Active data include disease-specific patient-reported outcome measures, mental health questionnaires, and symptom tracking to track disease trajectory. Analyses will assess the feasibility of lung disorder remote monitoring (including data quality, data completeness, system usability, and system acceptability). We will attempt to explore disease trajectory, patient stratification, and identification of acute clinical events such as exacerbations. A key aspect is understanding the potential of real-time data collection. We will simulate an intervention to acquire responses at the time of the event to assess model performance for exacerbation identification. Results: The Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH) study provides a unique opportunity to assess the use of remote monitoring in the evaluation of lung disorders. The study started in the middle of June 2021. The data collection apparatus, questionnaires, and wearable integrations were setup and tested by the clinical teams prior to the start of recruitment. While recruitment is ongoing, real-time exacerbation identification models are currently being constructed. The models will be pretrained daily on data of previous days, but the inference will be run in real time. Conclusions: The RALPMH study will provide a reference infrastructure for remote monitoring of lung diseases. It specifically involves information regarding the feasibility and acceptability of remote monitoring and the potential of real-time data collection and analysis in the context of chronic lung disorders. It will help plan and inform decisions in future studies in the area of respiratory health. Trial Registration: ISRCTN Registry ISRCTN16275601; https://www.isrctn.com/ISRCTN16275601 International Registered Report Identifier (IRRID): PRR1-10.2196/28873 ",
doi="10.2196/28873",
url="https://www.researchprotocols.org/2021/10/e28873",
url="http://www.ncbi.nlm.nih.gov/pubmed/34319235"
}


@Article{info:doi/10.2196/30051,
author="Schukraft, Sara
and Boukhayma, Assim
and Cook, St{\'e}phane
and Caizzone, Antonino",
title="Remote Blood Pressure Monitoring With a Wearable Photoplethysmographic Device (Senbiosys): Protocol for a Single-Center Prospective Clinical Trial",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="7",
volume="10",
number="10",
pages="e30051",
keywords="continuous blood pressure monitoring",
keywords="photoplethysmography",
keywords="arterial line",
keywords="Senbiosys",
keywords="wearable devices",
keywords="blood pressure",
keywords="remote monitoring",
keywords="continuous monitoring",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Wearable devices can provide user-friendly, accurate, and continuous blood pressure (BP) monitoring to assess patients' vital signs and achieve remote patient management. Remote BP monitoring can substantially improve BP control. The newest cuffless BP monitoring devices have emerged in patient care using photoplethysmography. Objective: The Senbiosys trial aims to compare BP measurements of a new device capturing a photoplethysmography signal on the finger versus invasive measurements performed in patients with an arterial catheter in the intensive care unit (ICU) or referred for a coronarography at the Hospital of Fribourg. Methods: The Senbiosys study is a single-center, single-arm, prospective trial. The study population consists of adult patients undergoing coronarography or patients in the ICU with an arterial catheter in place. This study will enroll 35 adult patients, including 25 patients addressed for a coronarography and 10 patients in the ICU. The primary outcome is the assessment of mean bias (95\% CI) for systolic BP, diastolic BP, and mean BP between noninvasive and invasive BP measurements. Secondary outcomes include a reliability index (Qualification Index) for BP epochs and count of qualified epochs. Results: Patient recruitment started in June 2021. Results are expected to be published by December 2021. Conclusions: The findings of the Senbiosys trial are expected to improve remote BP monitoring. The diagnosis and treatment of hypertension should benefit from these advancements. Trial Registration: ClinicalTrials.gov NCT04379986; https://clinicaltrials.gov/ct2/show/NCT04379986 International Registered Report Identifier (IRRID): PRR1-10.2196/30051 ",
doi="10.2196/30051",
url="https://www.researchprotocols.org/2021/10/e30051",
url="http://www.ncbi.nlm.nih.gov/pubmed/34617912"
}


@Article{info:doi/10.2196/30725,
author="Itoh, Hidetaka
and Amiya, Eisuke
and Narita, Koichi
and Shimbo, Mai
and Taya, Masanobu
and Komuro, Issei
and Hasegawa, Takashi
and Makita, Shigeru
and Kimura, Yutaka",
title="Efficacy and Safety of Remote Cardiac Rehabilitation in the Recovery Phase of Cardiovascular Diseases: Protocol for a Multicenter, Nonrandomized, Single-Arm, Interventional Trial",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="4",
volume="10",
number="10",
pages="e30725",
keywords="cardiac rehabilitation",
keywords="remote system",
keywords="e-learning",
keywords="exercise capacity",
keywords="rehabilitation",
keywords="cardiovascular disease",
keywords="monitoring system",
keywords="disease prevention",
keywords="cardiology",
abstract="Background: Conventional group-based outpatient cardiac rehabilitation through monitoring and center-based approaches for patients in the recovery phase has shown strong evidence for the prevention of cardiovascular diseases. However, there are some cases in which maintaining attendance of center-based cardiac rehabilitation is difficult. Objective: This study aims to ascertain the safety and efficacy of remote cardiac rehabilitation (RCR) in the recovery phase in patients with cardiovascular disease. Methods: Patients satisfying the study criteria will be recruited from multiple institutions (approximately 30) across Japan. In total, 75 patients (approximately 2 or 3 patients from each institution) are proposed to be recruited. Patients enrolled in the RCR group will be lent devices necessary for RCR (including calibrated ergometers and tablets). Patients will perform anaerobic exercise at home using ergometer for 30-40 minutes at least 3 times weekly. During exercise, an instructor will monitor the patient in real time (using interactive video tools and monitoring tools for various vital data). Moreover, educational instructions will be given 3 times weekly using e-learning methods. Results: The primary endpoint is the peak oxygen uptake 2-3 months from the start of exercise or 6-min walk test. The extracted data will be compared between RCR patients and controls without RCR. Conclusions: The establishment of the system of RCR proposed in this study will lead to the development of more extensive applications, which have been insufficient through conventional interventions. Trial Registration: University Hospital Medical Information Network---Clinical Trials Registry UMIN--CTR UMIN000042942; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000048983 International Registered Report Identifier (IRRID): DERR1-10.2196/30725 ",
doi="10.2196/30725",
url="https://www.researchprotocols.org/2021/10/e30725",
url="http://www.ncbi.nlm.nih.gov/pubmed/34407925"
}


@Article{info:doi/10.2196/26744,
author="Auener, L. Stefan
and Remers, P. Toine E.
and van Dulmen, A. Simone
and Westert, P. Gert
and Kool, B. Rudolf
and Jeurissen, T. Patrick P.",
title="The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="29",
volume="23",
number="9",
pages="e26744",
keywords="heart failure",
keywords="telemonitoring",
keywords="remote monitoring",
keywords="health care utilization",
keywords="eHealth",
abstract="Background: Chronic heart failure accounts for approximately 1\%-2\% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear. Objective: This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs. Methods: We searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used P<.05 and CIs not including 1.00 to determine whether the effect was statistically significant. Results: We included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38\% (9/24) of studies, whereas emergency department visits were reduced in 13\% (1/8) of studies. An increase in nonemergency department visits (6/9, 67\% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization. Conclusions: Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs. ",
doi="10.2196/26744",
url="https://www.jmir.org/2021/9/e26744",
url="http://www.ncbi.nlm.nih.gov/pubmed/34586072"
}


@Article{info:doi/10.2196/31129,
author="Han, Changho
and Song, Youngjae
and Lim, Hong-Seok
and Tae, Yunwon
and Jang, Jong-Hwan
and Lee, Tak Byeong
and Lee, Yeha
and Bae, Woong
and Yoon, Dukyong",
title="Automated Detection of Acute Myocardial Infarction Using Asynchronous Electrocardiogram Signals---Preview of Implementing Artificial Intelligence With Multichannel Electrocardiographs Obtained From Smartwatches: Retrospective Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="10",
volume="23",
number="9",
pages="e31129",
keywords="wearables",
keywords="smartwatches",
keywords="asynchronous electrocardiogram",
keywords="artificial intelligence",
keywords="deep learning",
keywords="automatic diagnosis",
keywords="myocardial infarction",
keywords="timely diagnosis",
keywords="machine learning",
keywords="digital health",
keywords="cardiac health",
keywords="cardiology",
abstract="Background: When using a smartwatch to obtain electrocardiogram (ECG) signals from multiple leads, the device has to be placed on different parts of the body sequentially. The ECG signals measured from different leads are asynchronous. Artificial intelligence (AI) models for asynchronous ECG signals have barely been explored. Objective: We aimed to develop an AI model for detecting acute myocardial infarction using asynchronous ECGs and compare its performance with that of the automatic ECG interpretations provided by a commercial ECG analysis software. We sought to evaluate the feasibility of implementing multiple lead--based AI-enabled ECG algorithms on smartwatches. Moreover, we aimed to determine the optimal number of leads for sufficient diagnostic power. Methods: We extracted ECGs recorded within 24 hours from each visit to the emergency room of Ajou University Medical Center between June 1994 and January 2018 from patients aged 20 years or older. The ECGs were labeled on the basis of whether a diagnostic code corresponding to acute myocardial infarction was entered. We derived asynchronous ECG lead sets from standard 12-lead ECG reports and simulated a situation similar to the sequential recording of ECG leads via smartwatches. We constructed an AI model based on residual networks and self-attention mechanisms by randomly masking each lead channel during the training phase and then testing the model using various targeting lead sets with the remaining lead channels masked. Results: The performance of lead sets with 3 or more leads compared favorably with that of the automatic ECG interpretations provided by a commercial ECG analysis software, with 8.1\%-13.9\% gain in sensitivity when the specificity was matched. Our results indicate that multiple lead-based AI-enabled ECG algorithms can be implemented on smartwatches. Model performance generally increased as the number of leads increased (12-lead sets: area under the receiver operating characteristic curve [AUROC] 0.880; 4-lead sets: AUROC 0.858, SD 0.008; 3-lead sets: AUROC 0.845, SD 0.011; 2-lead sets: AUROC 0.813, SD 0.018; single-lead sets: AUROC 0.768, SD 0.001). Considering the short amount of time needed to measure additional leads, measuring at least 3 leads---ideally more than 4 leads---is necessary for minimizing the risk of failing to detect acute myocardial infarction occurring in a certain spatial location or direction. Conclusions: By developing an AI model for detecting acute myocardial infarction with asynchronous ECG lead sets, we demonstrated the feasibility of multiple lead-based AI-enabled ECG algorithms on smartwatches for automated diagnosis of cardiac disorders. We also demonstrated the necessity of measuring at least 3 leads for accurate detection. Our results can be used as reference for the development of other AI models using sequentially measured asynchronous ECG leads via smartwatches for detecting various cardiac disorders. ",
doi="10.2196/31129",
url="https://www.jmir.org/2021/9/e31129",
url="http://www.ncbi.nlm.nih.gov/pubmed/34505839"
}


@Article{info:doi/10.2196/28246,
author="Kalwani, M. Neil
and Johnson, N. Austin
and Parameswaran, Vijaya
and Dash, Rajesh
and Rodriguez, Fatima",
title="Initial Outcomes of CardioClick, a Telehealth Program for Preventive Cardiac Care: Observational Study",
journal="JMIR Cardio",
year="2021",
month="Sep",
day="9",
volume="5",
number="2",
pages="e28246",
keywords="telehealth",
keywords="telemedicine",
keywords="digital health",
keywords="eHealth",
keywords="preventive medicine",
keywords="prevention",
keywords="outpatient care",
keywords="cardiovascular disease",
keywords="cardiology",
keywords="South Asian",
abstract="Background: Telehealth use has increased in specialty clinics, but there is limited evidence on the outcomes of telehealth in primary cardiovascular disease (CVD) prevention. Objective: The objective of this study was to evaluate the initial outcomes of CardioClick, a telehealth primary CVD prevention program. Methods: In 2017, the Stanford South Asian Translational Heart Initiative (a preventive cardiology clinic focused on high-risk South Asian patients) introduced CardioClick, which is a clinical pathway replacing in-person follow-up visits with video visits. We assessed patient engagement and changes in CVD risk factors in CardioClick patients and in a historical in-person cohort from the same clinic. Results: In this study, 118 CardioClick patients and 441 patients who received in-person care were included. CardioClick patients were more likely to complete the clinic's CVD prevention program (76/118, 64.4\% vs 173/441, 39.2\%, respectively; P<.001) and they did so in lesser time (mean, 250 days vs 307 days, respectively; P<.001) than the patients in the historical in-person cohort. Patients who completed the CardioClick program achieved reductions in CVD risk factors, including blood pressure, lipid concentrations, and BMI, which matched or exceeded those observed in the historical in-person cohort. Conclusions: Telehealth can be used to deliver care effectively in a preventive cardiology clinic setting and may result in increased patient engagement. Further studies on telehealth outcomes are needed to determine the optimal role of virtual care models across diverse preventive medicine clinics. ",
doi="10.2196/28246",
url="https://cardio.jmir.org/2021/2/e28246",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499037"
}


@Article{info:doi/10.2196/29018,
author="Park, Sulki
and Kum, Hye-Chung
and Morrisey, A. Michael
and Zheng, Qi
and Lawley, A. Mark",
title="Adherence to Telemonitoring Therapy for Medicaid Patients With Hypertension: Case Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="6",
volume="23",
number="9",
pages="e29018",
keywords="telemedicine",
keywords="hypertension",
keywords="Medicaid",
keywords="blood pressure",
keywords="pulse",
keywords="telemonitoring",
keywords="mobile phone",
abstract="Background: Almost 50\% of the adults in the United States have hypertension. Although clinical trials indicate that home blood pressure monitoring can be effective in managing hypertension, the reported results might not materialize in practice because of patient adherence problems. Objective: The aims of this study are to characterize the adherence of Medicaid patients with hypertension to daily telemonitoring, identify the impacts of adherence reminder calls, and investigate associations with blood pressure control. Methods: This study targeted Medicaid patients with hypertension from the state of Texas. A total of 180 days of blood pressure and pulse data in 2016-2018 from a telemonitoring company were analyzed for mean transmission rate and mean blood pressure change. The first 30 days of data were excluded because of startup effects. The protocols required the patients to transmit readings by a specified time daily. Patients not transmitting their readings received an adherence reminder call to troubleshoot problems and encourage transmission. The patients were classified into adherent and nonadherent cohorts; adherent patients were those who transmitted data on at least 80\% of the days. Results: The mean patient age was 73.2 (SD 11.7) years. Of the 823 patients, 536 (65.1\%) were women, and 660 (80.2\%) were urban residents. The adherent cohort (475/823, 57.7\%) had mean transmission rates of 74.9\% before the adherence reminder call and 91.3\% after the call, whereas the nonadherent cohort (348/823, 42.3\%) had mean transmission rates of 39\% and 58\% before and after the call, respectively. From month 1 to month 5, the transmission rates dropped by 1.9\% and 10.2\% for the adherent and nonadherent cohorts, respectively. The systolic and diastolic blood pressure values improved by an average of 2.2 and 0.7 mm Hg (P<.001 and P=.004), respectively, for the adherent cohort during the study period, whereas only the systolic blood pressure value improved by an average of 1.6 mm Hg (P=.02) for the nonadherent cohort. Conclusions: Although we found that patients can achieve high levels of adherence, many experience adherence problems. Although adherence reminder calls help, they may not be sufficient. Telemonitoring lowered blood pressure, as has been observed in clinical trials. Furthermore, blood pressure control was positively associated with adherence. ",
doi="10.2196/29018",
url="https://www.jmir.org/2021/9/e29018",
url="http://www.ncbi.nlm.nih.gov/pubmed/34486977"
}


@Article{info:doi/10.2196/27347,
author="Yatabe, Junichi
and Yatabe, Sasaki Midori
and Okada, Rika
and Ichihara, Atsuhiro",
title="Efficacy of Telemedicine in Hypertension Care Through Home Blood Pressure Monitoring and Videoconferencing: Randomized Controlled Trial",
journal="JMIR Cardio",
year="2021",
month="Aug",
day="31",
volume="5",
number="2",
pages="e27347",
keywords="blood pressure management",
keywords="digital health",
keywords="web-based medicine",
keywords="prospective study",
keywords="telemonitoring",
keywords="blood pressure",
keywords="monitoring",
keywords="telemedicine",
keywords="telehealth",
keywords="efficacy",
keywords="hypertension",
keywords="video conference",
keywords="safety",
keywords="Japan",
abstract="Background: The burden of time is often the primary reason why patients discontinue their treatment. Telemedicine may help patients adhere to treatment by offering convenience. Objective: This study examined the efficacy and safety of telemedicine for the management of hypertension in Japan. Methods: Patients with uncomplicated hypertension were recruited through web advertising between November 2015 and February 2017. They were then screened, stratified by office systolic blood pressure (SBP), and randomized into two groups: usual care (UC) and telemedicine. The telemedicine group used a 3G network--attached home blood pressure (BP) monitoring device, consulted hypertension specialists from an academic hospital through web-based video visits, and received prescription medication by mail for 1 year. The UC group used the same BP monitoring device but was managed using self-recorded BP readings, which included their diary entries and office BP taken in a community practice setting. Results: Initial screening was completed by 99 patients, 54\% of whom had untreated hypertension. Baseline BP was similar between the groups, but the weekly average SBP at the end of the 1-year study period was significantly lower in the telemedicine group (125, SD 9 mmHg vs 131, SD 12 mmHg, respectively; P=.02). SBP in the telemedicine group was 3.4 mmHg lower in the morning and 5.8 mmHg lower in the evening. The rate of SBP control (135 mmHg) was better in the telemedicine group (85.3\% vs 70.0\%; P=.01), and significant adverse events were not observed. Conclusions: We present evidence suggesting that antihypertensive therapy via home BP telemonitoring and web-based video visits achieve better BP control than conventional care and is a safe treatment alternative that warrants further investigation. Trial Registration: UMIN-CTR UMIN000025372; https://tinyurl.com/47ejkn4b ",
doi="10.2196/27347",
url="https://cardio.jmir.org/2021/2/e27347",
url="http://www.ncbi.nlm.nih.gov/pubmed/34321194"
}


@Article{info:doi/10.2196/26544,
author="Skov Schacksen, Cathrine
and Dyrvig, Anne-Kirstine
and Henneberg, Celina Nanna
and Dam Gade, Josefine
and Spindler, Helle
and Refsgaard, Jens
and Hollingdal, Malene
and Dittman, Lars
and Dremstrup, Kim
and Dinesen, Birthe",
title="Patient-Reported Outcomes From Patients With Heart Failure Participating in the Future Patient Telerehabilitation Program: Data From the Intervention Arm of a Randomized Controlled Trial",
journal="JMIR Cardio",
year="2021",
month="Jul",
day="2",
volume="5",
number="2",
pages="e26544",
keywords="adherence",
keywords="cardiology",
keywords="cardiomyopathy",
keywords="compliance",
keywords="heart failure",
keywords="heart",
keywords="Kansas City Cardiomyopathy Questionnaire",
keywords="monitoring",
keywords="patient-reported outcome",
keywords="patients",
keywords="quality of life",
keywords="rehabilitation",
keywords="self-reporting",
keywords="telehealth",
keywords="telemonitoring",
abstract="Background: More than 37 million people worldwide have been diagnosed with heart failure, which is a growing burden on the health sector. Cardiac rehabilitation aims to improve patients' recovery, functional capacity, psychosocial well-being, and health-related quality of life. However, cardiac rehabilitation programs have poor compliance and adherence. Telerehabilitation may be a solution to overcome some of these challenges to cardiac rehabilitation by making it more individualized. As part of the Future Patient Telerehabilitation program, a digital toolbox aimed at enabling patients with heart failure to monitor and evaluate their own current status has been developed and tested using data from a patient-reported outcome questionnaire that the patient filled in every alternate week for 1 year. Objective: The aim of this study is to evaluate the changes in quality of life and well-being among patients with heart failure, who are participants in the Future Patient Telerehabilitation program over the course of 1 year. Methods: In total, 140 patients were enrolled in the Future Patient Telerehabilitation program and randomized into either the telerehabilitation group (n=70) or the control group (n=70). Of the 70 patients in the telerehabilitation group, 56 (80.0\%) answered the patient-reported outcome questionnaire and completed the program, and these 56 patients comprised the study population. The patient-reported outcomes consisted of three components: (1) questions regarding the patients' sleep patterns assessed using the Spiegel Sleep Questionnaire; (2) measurements of physical limitations, symptoms, self-efficacy, social interaction, and quality of life assessed using the Kansas City Cardiomyopathy Questionnaire in 10 dimensions; and (3) 5 additional questions regarding psychological well-being that were developed by the research group. Results: The changes in scores during 1 year of the study were examined using 1-sample Wilcoxon signed-rank tests. There were significant differences in the scores for most of the slopes of the scores from the dimensions of the Kansas City Cardiomyopathy Questionnaire (P<.05). Conclusions: There was a significant increase in clinical and social well-being and quality of life during the 1-year period of participating in a telerehabilitation program. These results suggest that patient-reported outcome questionnaires may be used as a tool for patients in a telerehabilitation program that can both monitor and guide patients in mastering their own symptoms. Trial Registration: ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918 ",
doi="10.2196/26544",
url="https://cardio.jmir.org/2021/2/e26544",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255642"
}


@Article{info:doi/10.2196/24116,
author="Lv, Meina
and Wu, Tingting
and Jiang, Shaojun
and Chen, Wenjun
and Zhang, Jinhua",
title="Effects of Telemedicine and mHealth on Systolic Blood Pressure Management in Stroke Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="11",
volume="9",
number="6",
pages="e24116",
keywords="stroke",
keywords="systolic blood pressure",
keywords="mHealth",
keywords="telemedicine",
keywords="meta-analysis",
keywords="self-management",
abstract="Background: Stroke is a common, harmful disease with high recurrence and mortality rates. Uncontrolled blood pressure is an important and changeable risk factor for stroke recurrence. Telemedicine and mobile health (mHealth) interventions may have the potential to facilitate the control of blood pressure among stroke survivors, but their effect has not been established. Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of telemedicine and mHealth interventions on the control of systolic blood pressure among stroke survivors. Methods: The research literature published up to June 28, 2020, and consisting of RCTs related to telemedicine and mHealth interventions was searched in PubMed, EMBASE, Web of Science, and the Cochrane Library. The Cochrane risk of bias tool (RoB 2.0) was used to evaluate the quality of the studies. The Cochran Q test and I2 statistic were used to assess heterogeneity. Data were meta-analyzed using a random-effects model. Mean difference (MD) with 95\% CI and 95\% prediction interval (PI) were calculated. Results: In total, 9 RCTs with a total sample size of 1583 stroke survivors met the inclusion criteria. Compared with the usual care, telemedicine and mHealth had a significantly greater impact on the control of systolic blood pressure (MD --5.49; 95\% CI --7.87 to --3.10; P<.001; 95\% PI --10.46 to --0.51). A subgroup analysis showed that the intervention mode of telephone plus SMS text messaging (MD --9.09; 95\% CI --12.71 to --5.46; P<.001) or only telephone (MD --4.34; 95\% CI --6.55 to --2.13; P<.001; 95\% PI --7.24 to --1.45) had a greater impact on the control of systolic blood pressure than usual care. Among the stroke survivors with an intervention interval ?1 week (MD --6.51; 95\% CI --9.36 to --3.66; P<.001; 95\% PI --12.91 to --0.10) or a baseline systolic blood pressure ?140 mm Hg (MD --6.15; 95\% CI --9.44 to --2.86; P<.001; 95\% PI --13.55 to 1.26), the control of systolic blood pressure using telemedicine and mHealth was better than that of usual care. Conclusions: In general, telemedicine and mHealth reduced the systolic blood pressure of stroke survivors by an average of 5.49 mm Hg compared with usual care. Telemedicine and mHealth are a relatively new intervention mode with potential applications for the control of systolic blood pressure among stroke survivors, especially those with hypertensive stroke. ",
doi="10.2196/24116",
url="https://mhealth.jmir.org/2021/6/e24116",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114961"
}


@Article{info:doi/10.2196/27496,
author="Bilger, Marcel
and Koong, Leng Agnes Ying
and Phoon, Yun Ian Kwong
and Tan, Chuan Ngiap
and Bahadin, Juliana
and Bairavi, Joann
and Batcagan-Abueg, M. Ada Portia
and Finkelstein, A. Eric",
title="Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="9",
volume="10",
number="6",
pages="e27496",
keywords="telemedicine",
keywords="home blood pressure monitoring",
keywords="behavior change",
keywords="hypertension",
keywords="financial incentive",
keywords="medication adherence",
keywords="remote titration",
abstract="Background: Hypertension is prevalent in Singapore and is a major risk factor for cardiovascular morbidity and mortality and increased health care costs. Strategies to lower blood pressure include lifestyle modifications and home blood pressure monitoring. Nonetheless, adherence to home blood pressure monitoring remains low. This protocol details an algorithm for remote management of primary care patients with hypertension. Objective: The objective of this study was to determine whether wireless home blood pressure monitoring with or without financial incentives is more effective at reducing systolic blood pressure than nonwireless home blood pressure monitoring (usual care). Methods: This study was designed as a randomized controlled open-label superiority study. A sample size of 224 was required to detect differences of 10 mmHg in average systolic blood pressure. Participants were to be randomized, in the ratio of 2:3:3, into 1 of 3 parallel study arms :(1) usual care, (2) wireless home blood pressure monitoring, and (3) wireless home blood pressure monitoring with financial incentives. The primary outcome was the mean change in systolic blood pressure at month 6. The secondary outcomes were the mean reduction in diastolic blood pressure, cost of financial incentives, time taken for the intervention, adherence to home blood pressure monitoring, effectiveness of the framing of financial incentives in decreasing nonadherence to blood pressure self-monitoring and the adherence to antihypertensive medication at month 6. Results: This study was approved by SingHealth Centralised Institutional Review Board and registered. Between January 24, 2018 and July 10, 2018, 42 participants (18.75\% of the required sample size) were enrolled, and 33 participants completed the month 6 assessment by January 31, 2019. Conclusions: Due to unforeseen events, the study was stopped prematurely; therefore, no results are available. Depending on the blood pressure information received from the patients, the algorithm can trigger immediate blood pressure advice (eg, Accident and Emergency department visit advice for extremely high blood pressure), weekly feedback on blood pressure monitoring, medication titration, or skipping of routine follow-ups. The inclusion of financial incentives framed as health capital provides a novel idea on how to promote adherence to remote monitoring, and ultimately, improve chronic disease management. Trial Registration: ClinicalTrials.gov NCT 03368417; https://clinicaltrials.gov/ct2/show/NCT03368417 International Registered Report Identifier (IRRID): DERR1-10.2196/27496 ",
doi="10.2196/27496",
url="https://www.researchprotocols.org/2021/6/e27496",
url="http://www.ncbi.nlm.nih.gov/pubmed/34106085"
}


@Article{info:doi/10.2196/26605,
author="Huang, Ching-Chang
and Chen, Ying-Hsien
and Hung, Chi-Sheng
and Lee, Jen-Kuang
and Hsu, Tse-Pin
and Wu, Hui-Wen
and Chuang, Pao-Yu
and Chen, Ming-Fong
and Ho, Yi-Lwun",
title="The Association Between Short-term Exposure to Ambient Air Pollution and Patient-Level Home Blood Pressure Among Patients With Chronic Cardiovascular Diseases in a Web-Based Synchronous Telehealth Care Program: Retrospective Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jun",
day="8",
volume="7",
number="6",
pages="e26605",
keywords="ambient air pollution",
keywords="blood pressure",
keywords="cardiovascular disease",
keywords="chronic disease",
keywords="climate",
keywords="home blood pressure",
keywords="particulate matter",
keywords="pollution",
keywords="remote monitoring",
keywords="telehealth care",
keywords="telemonitoring",
keywords="weather",
abstract="Background: The association between short-term exposure to ambient air pollution and blood pressure has been inconsistent, as reported in the literature. Objective: This study aimed to investigate the relationship between short-term ambient air pollution exposure and patient-level home blood pressure (HBP). Methods: Patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital were enrolled as the study population. HBP was measured by patients or their caregivers. Hourly meteorological data (including temperature, relative humidity, wind speed, and rainfall) and ambient air pollution monitoring data (including CO, NO2, particulate matter with a diameter of <10 {\textmu}m, particulate matter with a diameter of <2.5 {\textmu}m, and SO2) during the same time period were obtained from the Central Weather Bureau and the Environmental Protection Administration in Taiwan, respectively. A stepwise multivariate repeated generalized estimating equation model was used to assess the significant factors for predicting systolic and diastolic blood pressure (SBP and DBP). Results: A total of 253 patients and 110,715 HBP measurements were evaluated in this study. On multivariate analysis, demographic, clinical, meteorological factors, and air pollutants significantly affected the HBP (both SBP and DBP). All 5 air pollutants evaluated in this study showed a significant, nonlinear association with both home SBP and DBP. Compared with demographic and clinical factors, environmental factors (meteorological factors and air pollutants) played a minor yet significant role in the regulation of HBP. Conclusions: Short-term exposure to ambient air pollution significantly affects HBP in patients with chronic cardiovascular disease. ",
doi="10.2196/26605",
url="https://publichealth.jmir.org/2021/6/e26605",
url="http://www.ncbi.nlm.nih.gov/pubmed/34100764"
}


@Article{info:doi/10.2196/24509,
author="Ho, Kendall
and Novak Lauscher, Helen
and Cordeiro, Jennifer
and Hawkins, Nathaniel
and Scheuermeyer, Frank
and Mitton, Craig
and Wong, Hubert
and McGavin, Colleen
and Ross, Dianne
and Apantaku, Glory
and Karim, Ehsan Mohammad
and Bhullar, Amrit
and Abu-Laban, Riyad
and Nixon, Suzanne
and Smith, Tyler",
title="Testing the Feasibility of Sensor-Based Home Health Monitoring (TEC4Home) to Support the Convalescence of Patients With Heart Failure: Pre--Post Study",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="3",
volume="5",
number="6",
pages="e24509",
keywords="telemonitoring",
keywords="heart failure",
keywords="home health monitoring",
keywords="technology",
keywords="telehealth",
keywords="emergency care",
keywords="community care",
keywords="emergency department",
keywords="quality of life",
keywords="self-efficacy",
abstract="Background: Patients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life. Objective: Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial. Methods: Patients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient's condition. In our evaluation, the primary outcome was the combination of unscheduled emergency department revisits of discharged participants or death within 90 days. Secondary outcomes included 90-day hospital readmissions, patient quality of life (as measured by Veterans Rand 12-Item Health Survey and Kansas City Cardiomyopathy Scale), self-efficacy (as measured by European Heart Failure Self-Care Behaviour Scale 9), end-user experience, and health system cost-effectiveness including cost reduction and hospital bed capacity. In this feasibility study, we also tested the recruitment strategy, clinical protocols, evaluation framework, and data collection methods. Results: Seventy participants were enrolled into this trial. Participant engagement to monitoring was measured at 94\% (N=70; ie, data submitted 56/60 days on average). Our evaluation framework allowed us to collect sound data, which also showed encouraging trends: a 79\% reduction of emergency department revisits post monitoring, an 87\% reduction in hospital readmissions, and a 60\% reduction in the median hospital length of stay (n=36). Cost of hospitalization for participants decreased by 71\%, and emergency department visit costs decreased by 58\% (n=30). Overall health system costs for our participants showed a 56\% reduction post monitoring (n=30). HF-specific quality of life (Kansas City Cardiomyopathy Scale) scores showed a significant increase of 101\% (n=35) post monitoring (P<.001). General quality of life (Veterans Rand 12-Item Health Survey) improved by 19\% (n=35) on the mental component score (P<.001) and 19\% (n=35) on the physical component score (P=.02). Self-efficacy improved by 6\% (n=35). Interviews with participants revealed that they were satisfied overall with the monitoring program and its usability, and participants reported being more engaged, educated, and involved in their self-management. Conclusions: Results from this small-sample feasibility study suggested that our HHM intervention can be beneficial in supporting patients post discharge. Additionally, key insights from the trial allowed us to refine our methods and procedures, such as shifting our recruitment methods to in-patient wards and increasing our scope of data collection. Although these findings are promising, a more rigorous trial design is required to test the true efficacy of the intervention. The results from this feasibility trial will inform our next step as we proceed with a randomized controlled trial across British Columbia. Trial Registration: ClinicalTrials.gov NCT03439384; https://clinicaltrials.gov/ct2/show/NCT03439384 ",
doi="10.2196/24509",
url="https://formative.jmir.org/2021/6/e24509",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081015"
}


@Article{info:doi/10.2196/29101,
author="Friedman, M. Daniel
and Goldberg, M. Jana
and Molinsky, L. Rebecca
and Hanson, A. Mark
and Casta{\~n}o, Adam
and Raza, Syed-Samar
and Janas, Nodar
and Celano, Peter
and Kapoor, Karen
and Telaraja, Jina
and Torres, L. Maria
and Jain, Nayan
and Wessler, D. Jeffrey",
title="A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population: Retrospective Analysis",
journal="JMIR Cardio",
year="2021",
month="Jun",
day="1",
volume="5",
number="1",
pages="e29101",
keywords="heart failure",
keywords="readmissions",
keywords="skilled nursing facilities",
keywords="posthospitalization",
keywords="cardiovascular",
keywords="cardiology",
keywords="outcome",
keywords="cost",
keywords="virtual care",
keywords="telehealth",
keywords="telemedicine",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
abstract="Background: Patients with heart failure (HF) in skilled nursing facilities (SNFs) have 30-day hospital readmission rates as high as 43\%. A virtual cardiovascular care program, consisting of patient selection, initial televisit, postconsultation care planning, and follow-up televisits, was developed and delivered by Heartbeat Health, Inc., a cardiovascular digital health company, to 11 SNFs (3510 beds) in New York. The impact of this program on the expected SNF 30-day HF readmission rate is unknown, particularly in the COVID-19 era. Objective: The aim of the study was to assess whether a virtual cardiovascular care program could reduce the 30-day hospital readmission rate for patients with HF discharged to SNF relative to the expected rate for this population. Methods: We performed a retrospective case review of SNF patients who received a virtual cardiology consultation between August 2020 and February 2021. Virtual cardiologists conducted 1 or more telemedicine visit via smartphone, tablet, or laptop for cardiac patients identified by a SNF care team. Postconsult care plans were communicated to SNF clinical staff. Patients included in this analysis had a preceding index admission for HF. Results: We observed lower hospital readmission among patients who received 1 or more virtual consultations compared with the expected readmission rate for both cardiac (3\% vs 10\%, respectively) and all-cause etiologies (18\% vs 27\%, respectively) in a population of 3510 patients admitted to SNF. A total of 185/3510 patients (5.27\%) received virtual cardiovascular care via the Heartbeat Health program, and 40 patients met study inclusion criteria and were analyzed, with 26 (65\%) requiring 1 televisit and 14 (35\%) requiring more than 1. Cost savings associated with this reduction in readmissions are estimated to be as high as US \$860 per patient. Conclusions: The investigation provides initial evidence for the potential effectiveness and efficiency of virtual and digitally enabled virtual cardiovascular care on 30-day hospital readmissions. Further research is warranted to optimize the use of novel virtual care programs to transform delivery of cardiovascular care to high-risk populations. ",
doi="10.2196/29101",
url="https://cardio.jmir.org/2021/1/e29101",
url="http://www.ncbi.nlm.nih.gov/pubmed/34061037"
}


@Article{info:doi/10.2196/26469,
author="Gwon, Danbi
and Cho, Hakyung
and Shin, Hangsik",
title="Feasibility of a Waistband-Type Wireless Wearable Electrocardiogram Monitoring System Based on a Textile Electrode: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="11",
volume="9",
number="5",
pages="e26469",
keywords="electrocardiogram",
keywords="telehealth",
keywords="telemetry",
keywords="telemonitoring",
keywords="textile electrode",
keywords="wearable system",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Electrocardiogram (ECG) monitoring in daily life is essential for effective management of cardiovascular disease, a leading cause of death. Wearable ECG measurement systems in the form of clothing have been proposed to replace Holter monitors used for clinical ECG monitoring; however, they have limitations in daily use because they compress the upper body and, in doing so, cause discomfort during wear. Objective: The purpose of this study was to develop a wireless wearable ECG monitoring system that includes a textile ECG electrode that can be applied to the lining of pants and can be used in the same way that existing lower clothing is worn, without compression to the upper body. Methods: A textile electrode with stretchable characteristics was fabricated by knitting a conductive yarn together with polyester-polyurethane fiber, which was then coated with silver compound; an ECG electrode was developed by placing it on an elastic band in a modified limb lead configuration. In addition, a system with analog-to-digital conversion, wireless communication, and a smartphone app was developed, allowing users to be able to check and store their own ECGs in real time. A signal processing algorithm was also developed to remove noise from the obtained signal and to calculate the heart rate. To evaluate the ECG and heart rate measurement performance of the developed module, a comparative evaluation with a commercial device was performed. ECGs were measured for 5 minutes each in standing, sitting, and lying positions; the mean absolute percentage errors of heart rates measured with both systems were then compared. Results: The system was developed in the form of a belt buckle with a size of 53 {\texttimes} 45 {\texttimes} 12 mm (width {\texttimes} height {\texttimes} depth) and a weight of 23 g. In a qualitative evaluation, it was confirmed that the P-QRS-T waveform was clearly observed in ECGs obtained with the wearable system. From the results of the heart rate estimation, the developed system could track changes in heart rate as calculated by a commercial ECG measuring device; in addition, the mean absolute percentage errors of heart rates were 1.80\%, 2.84\%, and 2.48\% in the standing, sitting, and lying positions, respectively. Conclusions: The developed system was able to effectively measure ECG and calculate heart rate simply through being worn as existing clothing without upper body pressure. It is anticipated that general usability can be secured through further evaluation under more diverse conditions. ",
doi="10.2196/26469",
url="https://mhealth.jmir.org/2021/5/e26469",
url="http://www.ncbi.nlm.nih.gov/pubmed/33973860"
}


@Article{info:doi/10.2196/25277,
author="Shah, Amika
and Guessi, Milena
and Wali, Sahr
and Ware, Patrick
and McDonald, Michael
and O'Sullivan, Mary
and Posada, Duero Juan
and Ross, Heather
and Seto, Emily",
title="The Resilience of Cardiac Care Through Virtualized Services During the COVID-19 Pandemic: Case Study of a Heart Function Clinic",
journal="JMIR Cardio",
year="2021",
month="May",
day="5",
volume="5",
number="1",
pages="e25277",
keywords="telemedicine",
keywords="telehealth",
keywords="digital health",
keywords="digital medicine",
keywords="COVID-19",
keywords="coronavirus",
keywords="SARS-CoV-2",
keywords="public health",
keywords="surveillance",
keywords="outbreak",
keywords="pandemic",
keywords="infectious disease",
keywords="cardiology",
keywords="patient",
keywords="organizational innovation",
keywords="organizational objectives",
keywords="global health",
keywords="resilience",
abstract="Background: Virtual care has historically faced barriers to widespread adoption. However, the COVID-19 pandemic has necessitated the rapid adoption and expansion of virtual care technologies. Although the intense and prolonged nature of the COVID-19 pandemic has renewed people's interest in health systems resilience, which includes how services adapt or transform in response to shocks, evidence regarding the role of virtual care technologies in health systems resilience is scarce. Objective: At Toronto General Hospital in Ontario, Canada, the rapid virtualization of cardiac care began on March 9, 2020, as a response to the pandemic. The objective of this study was to understand people's experiences with and the barriers and facilitators of the rapid virtualization and expansion of cardiac care resulting from the pandemic. Methods: A single-case study was conducted with 3 embedded units of analysis. Patients, clinicians, and staff were recruited purposively from an existing mobile, phone-based telemonitoring program at a heart function clinic in Toronto, Canada. Individual, semistructured phone interviews were conducted by two researchers and transcribed verbatim. An inductive thematic analysis at the semantic level was used to analyze transcripts and develop themes. Results: A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and staff (n=4). The following five themes were identified: (1) patient safety as a catalyst for virtual care adoption; (2) piecemeal virtual care solutions; (3) confronting new roles and workloads; (4) missing pieces in virtual care; and (5) the inequity paradox. The motivation to protect patient safety and a piecemeal approach to virtual care adoption facilitated the absorptive and adaptive resilience of cardiac care during the COVID-19 pandemic. However, ad hoc changes to clinic roles and workflows, challenges in building relationships through remote methods, and widened inequities were barriers that threatened virtual care sustainment. Conclusions: We contend that sustaining virtual care hinges upon transformative actions (rather than adaptive actions) that strengthen health systems so that they can face the dynamic and emergent challenges associated with COVID-19 and other shocks. Based on the barriers and facilitators we identified, we present the lessons we learned and recommend transformations for sustaining virtual care during and beyond the COVID-19 pandemic. ",
doi="10.2196/25277",
url="https://cardio.jmir.org/2021/1/e25277",
url="http://www.ncbi.nlm.nih.gov/pubmed/33878021"
}


@Article{info:doi/10.2196/26240,
author="Iqbal, Mujtaba Fahad
and Joshi, Meera
and Khan, Sadia
and Ashrafian, Hutan
and Darzi, Ara",
title="Implementation of Wearable Sensors and Digital Alerting Systems in Secondary Care: Protocol for a Real-World Prospective Study Evaluating Clinical Outcomes",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="4",
volume="10",
number="5",
pages="e26240",
keywords="remote sensing technology",
keywords="clinical trial",
keywords="patient deterioration",
keywords="monitoring",
keywords="ambulatory",
keywords="wearable",
abstract="Background: Advancements in wearable sensors have caused a resurgence in their use, particularly because their miniaturization offers ambulatory advantages while performing continuous vital sign monitoring. Digital alerts can be generated following early recognition of clinical deterioration through breaches of set parameter thresholds, permitting earlier intervention. However, a systematic real-world evaluation of these alerting systems has yet to be conducted, and their efficacy remains unknown. Objective: The aim of this study is to implement wearable sensors and digital alerting systems in acute general wards to evaluate the resultant clinical outcomes. Methods: Participants on acute general wards will be screened and recruited into a trial with a pre-post implementation design. In the preimplementation phase, the SensiumVitals monitoring system, which continuously measures temperature, heart, and respiratory rates, will be used for monitoring alongside usual care. In the postimplementation phase, alerts will be generated from the SensiumVitals system when pre-established thresholds for vital parameters have been crossed, requiring acknowledgement from health care staff; subsequent clinical outcomes will be analyzed. Results: Enrolment is currently underway, having started in September 2017, and is anticipated to end shortly. Data analysis is expected to be completed in 2021. Conclusions: This study will offer insight into the implementation of digital health technologies within a health care trust and aims to describe the effectiveness of wearable sensors for ambulatory continuous monitoring and digital alerts on clinical outcomes in acute general ward settings. Trial Registration: ClinicalTrials.gov NCT04638738; https://clinicaltrials.gov/ct2/show/NCT04638738. International Registered Report Identifier (IRRID): DERR1-10.2196/26240 ",
doi="10.2196/26240",
url="https://www.researchprotocols.org/2021/5/e26240",
url="http://www.ncbi.nlm.nih.gov/pubmed/33944790"
}


@Article{info:doi/10.2196/24908,
author="Huygens, J. Martine W.
and Voogdt-Pruis, R. Helene
and Wouters, Myrah
and Meurs, M. Maaike
and van Lettow, Britt
and Kleijweg, Conchita
and Friele, D. Roland",
title="The Uptake and Use of Telemonitoring in Chronic Care Between 2014 and 2019: Nationwide Survey Among Patients and Health Care Professionals in the Netherlands",
journal="J Med Internet Res",
year="2021",
month="May",
day="3",
volume="23",
number="5",
pages="e24908",
keywords="eHealth",
keywords="telemonitoring",
keywords="self-management",
keywords="telemedicine",
keywords="telehealth",
abstract="Background: Telemonitoring could offer solutions to the mounting challenges for health care and could improve patient self-management. Studies have addressed the benefits and challenges of telemonitoring for certain patient groups. Objective: This paper will examine the nationwide uptake of telemonitoring in chronic care in the Netherlands from 2014 to 2019 by means of an annual representative survey among patients and health care professionals. Methods: Between 2014 and 2019, approximately 2900 patients with chronic diseases, 700 nurses, and 500 general practitioners (GPs) and medical specialists received a questionnaire. About 30 questions addressed topics about the use of eHealth and experiences with it, including data about telemonitoring. Results: Between 2014 and 2019, the use of telemonitoring remained stable for all groups except medical specialists. In medical specialist departments, the use of telemonitoring increased from 11.2\% (18/161) in 2014 to 19.6\% (36/184) in 2019 ($\chi$24=12.3; P=.02). In 2019, telemonitoring was used by 5.8\% (28/485) of people with chronic disease. This was 18.2\% (41/225) in GP organizations and 40.4\% (44/109), 38.0\% (78/205), and 8.9\% (29/325) in the organizations of nurses working in primary, secondary, and elderly care, respectively. Up to 10\% of the targeted patient group such as diabetics were regarded by health care professionals as suitable for using telemonitoring. The main benefits mentioned by the patients were ``comfort'' (421/1043, 40.4\%) and ``living at home for longer/more comfortably'' (334/1047, 31.9\%). Health care professionals added ``improvement of self-management'' (63/176, 35.8\% to 57/71, 80.3\%), ``better understanding of the patient's condition'' (47/176, 26.7\% to 42/71, 59.2\%), ``reduction of workload'' (53/134, 39.6\% of nurses in elderly care), ``better tailoring of care plan to the patient's situation'' (95/225, 42.2\% of GPs), and ``saves time for patients/caregivers'' (61/176, 34.7\% of medical specialists). Disadvantages mentioned by professionals were that ``it takes time to monitor data'' (13/130, 10\% to 108/225, 48.0\%), ``it takes time to follow up alerts'' (15/130, 11.5\% to 117/225, 52.0\%), and ``it is difficult to estimate which patients can work with telemonitoring'' (22/113, 19.5\% to 94/225, 41.8\%). Conclusions: The uptake of telemonitoring in Dutch chronic care remained stable during 2014-2019 but increased among medical specialists. According to both patients and professionals, telemonitoring improves the quality of life and quality of care. Skills for suitably including eligible patients and for allocating the tasks of data monitoring and follow-up care within the team would help to further increase the use of telemonitoring. ",
doi="10.2196/24908",
url="https://www.jmir.org/2021/5/e24908",
url="http://www.ncbi.nlm.nih.gov/pubmed/33938808"
}


@Article{info:doi/10.2196/26516,
author="Jiang, Xinchan
and Yao, Jiaqi
and You, Hoi-Sze Joyce",
title="Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="3",
volume="23",
number="3",
pages="e26516",
keywords="telemonitoring",
keywords="mobile health",
keywords="smartphone",
keywords="heart failure",
keywords="COVID-19",
keywords="health care avoidance",
keywords="cost-effectiveness",
abstract="Background: The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). Objective: We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. Methods: A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. Results: In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US \$15,888) compared to the CUC group (1.8345 QALYs at US \$15,603). Adopting US \$48,937/QALY (1 {\texttimes} the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US \$4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22\% of 10,000 Monte Carlo simulations. Conclusions: Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong. ",
doi="10.2196/26516",
url="https://www.jmir.org/2021/3/e26516",
url="http://www.ncbi.nlm.nih.gov/pubmed/33656440"
}


@Article{info:doi/10.2196/21061,
author="Akinosun, Samuel Adewale
and Polson, Rob
and Diaz - Skeete, Yohanca
and De Kock, Hendrikus Johannes
and Carragher, Lucia
and Leslie, Stephen
and Grindle, Mark
and Gorely, Trish",
title="Digital Technology Interventions for Risk Factor Modification in Patients With Cardiovascular Disease: Systematic Review and Meta-analysis",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="3",
volume="9",
number="3",
pages="e21061",
keywords="digital technologies",
keywords="mHealth",
keywords="eHealth",
keywords="risk factors",
keywords="cardiovascular diseases",
keywords="telehealth",
keywords="cardiac rehabilitation",
keywords="behavior",
keywords="systematic review",
keywords="meta-analysis",
keywords="mobile phone",
abstract="Background: Approximately 50\% of cardiovascular disease (CVD) cases are attributable to lifestyle risk factors. Despite widespread education, personal knowledge, and efficacy, many individuals fail to adequately modify these risk factors, even after a cardiovascular event. Digital technology interventions have been suggested as a viable equivalent and potential alternative to conventional cardiac rehabilitation care centers. However, little is known about the clinical effectiveness of these technologies in bringing about behavioral changes in patients with CVD at an individual level. Objective: The aim of this study is to identify and measure the effectiveness of digital technology (eg, mobile phones, the internet, software applications, wearables, etc) interventions in randomized controlled trials (RCTs) and determine which behavior change constructs are effective at achieving risk factor modification in patients with CVD. Methods: This study is a systematic review and meta-analysis of RCTs designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. Mixed data from studies extracted from selected research databases and filtered for RCTs only were analyzed using quantitative methods. Outcome hypothesis testing was set at 95\% CI and P=.05 for statistical significance. Results: Digital interventions were delivered using devices such as cell phones, smartphones, personal computers, and wearables coupled with technologies such as the internet, SMS, software applications, and mobile sensors. Behavioral change constructs such as cognition, follow-up, goal setting, record keeping, perceived benefit, persuasion, socialization, personalization, rewards and incentives, support, and self-management were used. The meta-analyzed effect estimates (mean difference [MD]; standard mean difference [SMD]; and risk ratio [RR]) calculated for outcomes showed benefits in total cholesterol SMD at ?0.29 [?0.44, ?0.15], P<.001; high-density lipoprotein SMD at --0.09 [--0.19, 0.00], P=.05; low-density lipoprotein SMD at ?0.18 [?0.33, ?0.04], P=.01; physical activity (PA) SMD at 0.23 [0.11, 0.36], P<.001; physical inactivity (sedentary) RR at 0.54 [0.39, 0.75], P<.001; and diet (food intake) RR at 0.79 [0.66, 0.94], P=.007. Initial effect estimates showed no significant benefit in body mass index (BMI) MD at ?0.37 [?1.20, 0.46], P=.38; diastolic blood pressure (BP) SMD at ?0.06 [?0.20, 0.08], P=.43; systolic BP SMD at ?0.03 [?0.18, 0.13], P=.74; Hemoglobin A1C blood sugar (HbA1c) RR at 1.04 [0.40, 2.70], P=.94; alcohol intake SMD at ?0.16 [?1.43, 1.10], P=.80; smoking RR at 0.87 [0.67, 1.13], P=.30; and medication adherence RR at 1.10 [1.00, 1.22], P=.06. Conclusions: Digital interventions may improve healthy behavioral factors (PA, healthy diet, and medication adherence) and are even more potent when used to treat multiple behavioral outcomes (eg, medication adherence plus). However, they did not appear to reduce unhealthy behavioral factors (smoking, alcohol intake, and unhealthy diet) and clinical outcomes (BMI, triglycerides, diastolic and systolic BP, and HbA1c). ",
doi="10.2196/21061",
url="https://mhealth.jmir.org/2021/3/e21061",
url="http://www.ncbi.nlm.nih.gov/pubmed/33656444"
}


@Article{info:doi/10.2196/18385,
author="Schenck-Gustafsson, Karin
and Carnl{\"o}f, Carina
and Jensen-Urstad, Mats
and Insulander, Per",
title="Improving Efficiency of Clinical Studies Using a Total Digital Approach: Prospective Observational Study",
journal="JMIR Form Res",
year="2021",
month="Feb",
day="18",
volume="5",
number="2",
pages="e18385",
keywords="ECG recordings",
keywords="women",
keywords="palpitations",
keywords="full digitalization",
keywords="eAuthentication",
keywords="BankID",
keywords="clinical trial",
keywords="mHealth",
keywords="electrocardiogram",
abstract="Background: In general, most clinical studies have long recruitment periods. Signing the informed consent is particularly time-consuming when the participant must meet physically with the researchers. Therefore, introducing fully web-based techniques with the use of eAuthentication (BankID) and new digital electrocardiogram (ECG) monitoring could speed up inclusion time, increase adherence, and also reach out to more remote regions. Objective: The objectives of this study were to explore whether inclusion of a large number of participants could be realized quickly by using a total digital approach both for information and signing of informed consent, along with ECG monitoring and instant feedback on a mobile device. We also explored whether this approach can increase adherence in registration of ECG recordings and answering questionnaires, and if it would result in a more geographically uniform distribution of participants covering a wide age span. Methods: Women with palpitations were intensively studied over 2 months by means of a handheld ECG monitoring device (Coala Heart Monitor). The device connects to a smartphone or tablet, which allows the participants to obtain the results immediately. Recruitment, study information, and signing the informed consent form with the help of BankID were performed in a completely digital manner. Results: Between March and May 2018, 2424 women indicated their interest in participating in the study. On June 19, 2018, presumptive participants were invited to log in and register. After 25 days, 1082 women were included in the study; among these, 1020 women fulfilled the inclusion criteria, 913 of whom completed all phases of the study: recording ECG using the handheld device, completion of the prestudy questionnaires, and completion of the poststudy questionnaires 2 months after the ECG recordings. The dropout rate was 9\%. In total, 101,804 ECG recordings were made. The mean age was 56 (SD 11) years (range 21-88 years) and 35 participants were 75 years or older. The participants were evenly distributed between living in the countryside and in cities. Conclusions: Total digital inclusion recruitment of 1082 participants was achieved in only 25 days, and resulted in a good geographical distribution, excellent adherence, and ability to reach a vast age span, including elderly women. Studies using a total digital design would be particularly appealing during a pandemic since physical contact should be avoided as much as possible. Trial Registration: ISRCTN Registry ISRCTN22495299; http://www.isrctn.com/ISRCTN22495299 ",
doi="10.2196/18385",
url="http://formative.jmir.org/2021/2/e18385/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33599617"
}


@Article{info:doi/10.2196/26165,
author="Wali, Sahr
and Guessi Margarido, Milena
and Shah, Amika
and Ware, Patrick
and McDonald, Michael
and O'Sullivan, Mary
and Duero Posada, Juan
and Ross, Heather
and Seto, Emily",
title="Expanding Telemonitoring in a Virtual World: A Case Study of the Expansion of a Heart Failure Telemonitoring Program During the COVID-19 Pandemic",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="22",
volume="23",
number="1",
pages="e26165",
keywords="telemedicine",
keywords="telehealth",
keywords="digital health",
keywords="digital medicine",
keywords="virtual care",
keywords="COVID-19",
keywords="coronavirus",
keywords="SARS-CoV-2",
keywords="public health",
keywords="surveillance",
keywords="outbreak",
keywords="pandemic",
keywords="infectious disease",
keywords="cardiology",
keywords="patient",
abstract="Background: To minimize the spread and risk of a COVID-19 outbreak, societal norms have been challenged with respect to how essential services are delivered. With pressures to reduce the number of in-person ambulatory visits, innovative models of telemonitoring have been used during the pandemic as a necessary alternative to support access to care for patients with chronic conditions. The pandemic has led health care organizations to consider the adoption of telemonitoring interventions for the first time, while others have seen existing programs rapidly expand. Objective: At the Toronto General Hospital in Ontario, Canada, the rapid expansion of a telemonitoring program began on March 9, 2020, in response to COVID-19. The objective of this study was to understand the experiences related to the expanded role of a telemonitoring program under the changing conditions of the pandemic. Methods: A single-case qualitative study was conducted with 3 embedded units of analysis. Semistructured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program at a heart function clinic in Toronto, Canada. Data were analyzed using inductive thematic analysis as well as Eakin and Gladstone's value-adding approach to enhance the analytic interpretation of the study findings. Results: A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and operational staff (n=4). Four themes were identified: (1) providing care continuity through telemonitoring; (2) adapting telemonitoring operations for a more virtual health care system; (3) confronting virtual workflow challenges; and (4) fostering a meaningful patient-provider relationship. Beyond supporting virtual visits, the program's ability to provide a more comprehensive picture of the patient's health was valued. However, issues relating to the lack of system integration and alert-driven interactions jeopardized the perceived sustainability of the program. Conclusions: With the reduction of in-person visits during the pandemic, virtual services such as telemonitoring have demonstrated significant value. Based on our study findings, we offer recommendations to proactively adapt and scale telemonitoring programs under the changing conditions of an increasingly virtual health care system. These include revisiting the scope and expectations of telemedicine interventions, streamlining virtual patient onboarding processes, and personalizing the collection of patient information to build a stronger virtual relationship and a more holistic assessment of patient well-being. ",
doi="10.2196/26165",
url="http://www.jmir.org/2021/1/e26165/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33444153"
}


@Article{info:doi/10.2196/25074,
author="Singh, Aniruddha
and Mountjoy, Natalie
and McElroy, Doug
and Mittal, Shilpi
and Al Hemyari, Bashar
and Coffey, Nicholas
and Miller, Kristen
and Gaines, Kenneth",
title="Patient Perspectives With Telehealth Visits in Cardiology During COVID-19: Online Patient Survey Study",
journal="JMIR Cardio",
year="2021",
month="Jan",
day="22",
volume="5",
number="1",
pages="e25074",
keywords="COVID-19",
keywords="telehealth",
keywords="cardiology",
keywords="internet",
keywords="broadband",
keywords="patient satisfaction",
keywords="restriction",
keywords="survey",
abstract="Background: The rise of COVID-19 and the issue of a mandatory stay-at-home order in March 2020 led to the use of a direct-to-consumer model for cardiology telehealth in Kentucky. Kentucky has poor health outcomes and limited broadband connectivity. Given these and other practice-specific constraints, the region serves as a unique context to explore the efficacy of telehealth in cardiology. Objective: This study aims to determine the limitations of telehealth accessibility, patient satisfaction with telehealth relative to in-person visits, and the perceived advantages and disadvantages to telehealth. Our intent was two-fold. First, we wanted to conduct a rapid postassessment of the mandated overhaul of the health care delivery system, focusing on a representative specialty field, and how it was affecting patients. Second, we intend to use our findings to make suggestions about the future application of a telehealth model in specialty fields such as cardiology. Methods: We constructed an online survey in Qualtrics following the Patient Assessment of Communication During Telemedicine, a patient self-report questionnaire that has been previously developed and validated. We invited all patients who had a visit scheduled during the COVID-19 telehealth-only time frame to participate. Questions included factors for declining telehealth, patient satisfaction ratings of telehealth and in-person visits, and perceived advantages and disadvantages associated with telehealth. We also used electronic medical records to collect no-show data for in-person versus telehealth visits to check for nonresponse bias. Results: A total of 224 respondents began our survey (11\% of our sample of 2019 patients). Our recruitment rate was 86\% (n=193) and our completion rate was 62\% (n=120). The no-show rate for telehealth visits (345/2019, 17\%) was nearly identical to the typical no-show rate for in-person appointments. Among the 32 respondents who declined a telehealth visit, 20 (63\%) cited not being aware of their appointment as a primary factor, and 15 (47\%) respondents cited their opinion that a telehealth appointment was not medically necessary as at least somewhat of a factor in their decision. Both in-person and telehealth were viewed favorably, but in-person was rated higher across all domains of patient satisfaction. The only significantly lower mean score for telehealth (3.7 vs 4.2, P=.007) was in the clinical competence domain. Reduced travel time, lower visit wait time, and cost savings were seen as big advantages. Poor internet connectivity was rated as at least somewhat of a factor by 33.0\% (35/106) of respondents. Conclusions: This study takes advantage of the natural experiment provided by the COVID-19 pandemic to assess the efficacy of telehealth in cardiology. Patterns of satisfaction are consistent across modalities and show that telehealth appears to be a viable alternative to in-person appointments. However, we found evidence that scheduling of telehealth visits may be problematic and needs additional attention. Additionally, we include a note of caution that patient satisfaction with telehealth may be artificially inflated during COVID-19 due to external health concerns connected with in-person visits. ",
doi="10.2196/25074",
url="http://cardio.jmir.org/2021/1/e25074/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33385234"
}


@Article{info:doi/10.2196/20571,
author="Herkert, Cyrille
and Kraal, Johannes Jos
and Spee, Ferdinand Rudolph
and Serier, Anouk
and Graat-Verboom, Lidwien
and Kemps, Clemens Hareld Marijn",
title="Quality Assessment of an Integrated Care Pathway Using Telemonitoring in Patients with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease: Protocol for a Quasi-Experimental Study",
journal="JMIR Res Protoc",
year="2020",
month="Nov",
day="19",
volume="9",
number="11",
pages="e20571",
keywords="chronic heart failure",
keywords="chronic obstructive pulmonary disease",
keywords="integrated care pathway",
keywords="telemonitoring",
abstract="Background: Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often coexist and are associated with a high morbidity and reduced quality of life (QoL). Although these diseases share similarities in symptoms and clinical course, and exacerbations of both diseases often overlap, care pathways for both conditions are usually not integrated. This results in frequent outpatient consultations and suboptimal treatment during exacerbations, leading to frequent hospital admissions. Therefore, we propose an integrated care pathway for both diseases, using telemonitoring to detect deterioration at an early stage and a single case manager for both diseases. Objective: This study aims to investigate whether an integrated care pathway using telemonitoring in patients with combined CHF and COPD results in a higher general health-related QoL (HRQoL) as compared with the traditional care pathways. Secondary end points include disease-specific HRQoL, level of self-management, patient satisfaction, compliance to the program, and cost-effectiveness. Methods: This is a monocenter, prospective study using a quasi-experimental interrupted time series design. Thirty patients with combined CHF and COPD are included. The study period of 2.5 years per patient is divided into a preintervention phase (6 months) and a postintervention phase (2 years) in which end points are assessed. The intervention consists of an on-demand treatment strategy based on monitoring symptoms related to CHF/COPD and vital parameters (weight, blood pressure, heart rate, oxygen saturation, temperature), which are uploaded on a digital platform. The monitoring frequency and the limit values of the measurements to detect abnormalities are determined individually. Monitoring is performed by a case manager, who has the opportunity for a daily multidisciplinary meeting with both the cardiologist and the pulmonologist. Routine appointments at the outpatient clinic are cancelled and replaced by telemonitoring-guided treatment. Results: Following ethical approval of the study protocol, the first patient was included in May 2018. Inclusion is expected to be complete in May 2021. Conclusions: This study is the first to evaluate the effects of a novel integrated care pathway using telemonitoring for patients with combined CHF and COPD. Unique to this study is the concept of remote on-demand disease management by a single case manager for both diseases, combined with multidisciplinary meetings. Moreover, modern telemonitoring technology is used instead of, rather than as an addition to, regular care. Trial Registration: Netherlands Trial Register NL6741; https://www.trialregister.nl/trial/6741 International Registered Report Identifier (IRRID): DERR1-10.2196/20571 ",
doi="10.2196/20571",
url="https://www.researchprotocols.org/2020/11/e20571",
url="http://www.ncbi.nlm.nih.gov/pubmed/33211017"
}


@Article{info:doi/10.2196/20032,
author="Ding, Hang
and Chen, Huey Sheau
and Edwards, Iain
and Jayasena, Rajiv
and Doecke, James
and Layland, Jamie
and Yang, A. Ian
and Maiorana, Andrew",
title="Effects of Different Telemonitoring Strategies on Chronic Heart Failure Care: Systematic Review and Subgroup Meta-Analysis",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="13",
volume="22",
number="11",
pages="e20032",
keywords="telehealth",
keywords="telemonitoring",
keywords="mobile health",
keywords="chronic heart failure",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Telemonitoring studies in chronic heart failure are characterized by mixed mortality and hospitalization outcomes, which have deterred the uptake of telemonitoring in clinical practice. These mixed outcomes may reflect the diverse range of patient management strategies incorporated in telemonitoring. To address this, we compared the effects of different telemonitoring strategies on clinical outcomes. Objective: The aim of this systematic review and subgroup meta-analysis was to identify noninvasive telemonitoring strategies attributing to improvements in all-cause mortality or hospitalization outcomes for patients with chronic heart failure. Methods: We reviewed and analyzed telemonitoring strategies from randomized controlled trials (RCTs) comparing telemonitoring intervention with usual care. For each strategy, we examined whether RCTs that applied the strategy in the telemonitoring intervention (subgroup 1) resulted in a significantly lower risk ratio (RR) of all-cause mortality or incidence rate ratio (IRR) of all-cause hospitalization compared with RCTs that did not apply this strategy (subgroup 2). Results: We included 26 RCTs (N=11,450) incorporating 18 different telemonitoring strategies. RCTs that provided medication support were found to be associated with a significantly lower IRR value than RCTs that did not provide this type of support (P=.01; subgroup 1 IRR=0.83, 95\% CI 0.72-0.95 vs subgroup 2 IRR=1.02, 95\% CI 0.93-1.12). RCTs that applied mobile health were associated with a significantly lower IRR (P=.03; IRR=0.79, 95\% CI 0.64-0.96 vs IRR=1.00, 95\% CI 0.94-1.06) and RR (P=.01; RR=0.67, 95\% CI 0.53-0.85 vs RR=0.95, 95\% CI 0.84-1.07). Conclusions: Telemonitoring strategies involving medication support and mobile health were associated with improvements in all-cause mortality or hospitalization outcomes. These strategies should be prioritized in telemonitoring interventions for the management of patients with chronic heart failure. ",
doi="10.2196/20032",
url="http://www.jmir.org/2020/11/e20032/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33185554"
}


@Article{info:doi/10.2196/18025,
author="Tadas, Shreya
and Coyle, David",
title="Barriers to and Facilitators of Technology in Cardiac Rehabilitation and Self-Management: Systematic Qualitative Grounded Theory Review",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="11",
volume="22",
number="11",
pages="e18025",
keywords="telemedicine",
keywords="cardiovascular diseases",
keywords="self-management",
keywords="self-care",
keywords="systematic review",
keywords="grounded theory",
keywords="mobile phone",
abstract="Background: Dealing with cardiovascular disease is challenging, and people often struggle to follow rehabilitation and self-management programs. Several systematic reviews have explored quantitative evidence on the potential of digital interventions to support cardiac rehabilitation (CR) and self-management. However, although promising, evidence regarding the effectiveness and uptake of existing interventions is mixed. This paper takes a different but complementary approach, focusing on qualitative data related to people's experiences of technology in this space. Objective: Through a qualitative approach, this review aims to engage more directly with people's experiences of technology that supports CR and self-management. The primary objective of this paper is to provide answers to the following research question: What are the primary barriers to and facilitators and trends of digital interventions to support CR and self-management? This question is addressed by synthesizing evidence from both medical and computer science literature. Given the strong evidence from the field of human-computer interaction that user-centered and iterative design methods increase the success of digital health interventions, we also assess the degree to which user-centered and iterative methods have been applied in previous work. Methods: A grounded theory literature review of articles from the following major electronic databases was conducted: ACM Digital Library, PsycINFO, Scopus, and PubMed. Papers published in the last 10 years, 2009 to 2019, were considered, and a systematic search with predefined keywords was conducted. Papers were screened against predefined inclusion and exclusion criteria. Comparative and in-depth analysis of the extracted qualitative data was carried out through 3 levels of iterative coding and concept development. Results: A total of 4282 articles were identified in the initial search. After screening, 61 articles remained, which were both qualitative and quantitative studies and met our inclusion criteria for technology use and health condition. Of the 61 articles, 16 qualitative articles were included in the final analysis. Key factors that acted as barriers and facilitators were background knowledge and in-the-moment understanding, personal responsibility and social connectedness, and the need to support engagement while avoiding overburdening people. Although some studies applied user-centered methods, only 6 involved users throughout the design process. There was limited evidence of studies applying iterative approaches. Conclusions: The use of technology is acceptable to many people undergoing CR and self-management. Although background knowledge is an important facilitator, technology should also support greater ongoing and in-the-moment understanding. Connectedness is valuable, but to avoid becoming a barrier, technology must also respect and enable individual responsibility. Personalization and gamification can also act as facilitators of engagement, but care must be taken to avoid overburdening people. Further application of user-centered and iterative methods represents a significant opportunity in this space. ",
doi="10.2196/18025",
url="http://www.jmir.org/2020/11/e18025/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33174847"
}


@Article{info:doi/10.2196/21962,
author="Artanian, Veronica
and Ross, J. Heather
and Rac, E. Valeria
and O'Sullivan, Mary
and Brahmbhatt, H. Darshan
and Seto, Emily",
title="Impact of Remote Titration Combined With Telemonitoring on the Optimization of Guideline-Directed Medical Therapy for Patients With Heart Failure: Internal Pilot of a Randomized Controlled Trial",
journal="JMIR Cardio",
year="2020",
month="Nov",
day="3",
volume="4",
number="1",
pages="e21962",
keywords="telemonitoring",
keywords="remote",
keywords="titration",
keywords="monitoring",
keywords="mHealth",
keywords="heart failure",
abstract="Background: To improve health outcomes in patients with heart failure, guideline-directed medical therapy (GDMT) should be optimized to target doses. However, GDMT remains underutilized, with less than?25\% of patients receiving target doses in clinical practice. Telemonitoring could provide reliable and real-time physiological data for clinical decision support to facilitate remote GDMT titration. Objective: This paper aims to present findings from an internal pilot study regarding the effectiveness of remote titration facilitated by telemonitoring. Methods: A 2-arm randomized controlled pilot trial comparing remote titration versus standard care in a heart function clinic was conducted. Patients were randomized to undergo remote medication titration facilitated by data from a smartphone-based telemonitoring system or standard titration performed during clinic visits. Results: A total of 42 patients with new-onset (10/42, 24\%) and existing (32/42, 76\%) heart failure and a mean age of 55.29 (SD 11.28) years were randomized between January and June 2019. Within 6 months of enrollment, 86\% (18/21) of patients in the intervention group achieved optimal doses versus 48\% (10/21) of patients in the control group. The median time to dose optimization was 11.0 weeks for the intervention group versus 18.8 weeks for the control group. The number of in-person visits in the intervention group was 54.5\% lower than in the control group. Conclusions: The results of this pilot study suggest that remote titration facilitated by telemonitoring has the potential to increase the proportion of patients who achieve optimal GDMT doses, decrease time to dose optimization, and reduce the number of clinic visits. Remote titration may facilitate optimal and efficient titration of patients with heart failure while reducing the burden for patients to attend in-person clinic visits. Trial Registration: ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID): RR2-10.2196/preprints.19705 ",
doi="10.2196/21962",
url="http://cardio.jmir.org/2020/1/e21962/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33141094"
}


@Article{info:doi/10.2196/18426,
author="Cui, Fangfang
and Ma, Qianqian
and He, Xianying
and Zhai, Yunkai
and Zhao, Jie
and Chen, Baozhan
and Sun, Dongxu
and Shi, Jinming
and Cao, Mingbo
and Wang, Zhenbo",
title="Implementation and Application of Telemedicine in China: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="23",
volume="8",
number="10",
pages="e18426",
keywords="telemedicine",
keywords="Chinese hospital",
keywords="implementation",
keywords="application",
keywords="influencing factors",
abstract="Background: Telemedicine has been used widely in China and has benefited a large number of patients, but little is known about the overall development of telemedicine. Objective: The aim of this study was to perform a national survey to identify the overall implementation and application of telemedicine in Chinese tertiary hospitals and provide a scientific basis for the successful expansion of telemedicine in the future. Methods: The method of probability proportionate to size sampling was adopted to collect data from 161 tertiary hospitals in 29 provinces, autonomous regions, and municipalities. Charts and statistical tests were applied to compare the development of telemedicine, including management, network, data storage, software and hardware equipment, and application of telemedicine. Ordinal logistic regression was used to analyze the relationship between these factors and telemedicine service effect. Results: Approximately 93.8\% (151/161) of the tertiary hospitals carried out telemedicine services in business-to-business mode. The most widely used type of telemedicine network was the virtual private network with a usage rate of 55.3\% (89/161). Only a few tertiary hospitals did not establish data security and cybersecurity measures. Of the 161 hospitals that took part in the survey, 100 (62.1\%) conducted remote videoconferencing supported by hardware instead of software. The top 5 telemedicine services implemented in the hospitals were teleconsultation, remote education, telediagnosis of medical images, tele-electrocardiography, and telepathology, with coverage rates of 86.3\% (139/161), 57.1\% (92/161), 49.7\% (80/161), 37.9\% (61/161), and 33.5\% (54/161), respectively. The average annual service volume of teleconsultation reached 714 cases per hospital. Teleconsultation and telediagnosis were the core charging services. Multivariate analysis indicated that the adoption of direct-to-consumer mode (P=.003), support from scientific research funds (P=.01), charging for services (P<.001), number of medical professionals (P=.04), network type (P=.02), sharing data with other hospitals (P=.04), and expertise level (P=.03) were related to the effect of teleconsultation. Direct-to-consumer mode (P=.01), research funding (P=.01), charging for services (P=.01), establishment of professional management departments (P=.04), and 15 or more instances of remote education every month (P=.01) were found to significantly influence the effect of remote education. Conclusions: A variety of telemedicine services have been implemented in tertiary hospitals in China with a promising prospect, but the sustainability and further standardization of telemedicine in China are still far from accomplished. ",
doi="10.2196/18426",
url="http://mhealth.jmir.org/2020/10/e18426/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33095175"
}


@Article{info:doi/10.2196/19705,
author="Artanian, Veronica
and Rac, E. Valeria
and Ross, J. Heather
and Seto, Emily",
title="Impact of Remote Titration Combined With Telemonitoring on the Optimization of Guideline-Directed Medical Therapy for Patients With Heart Failure: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Oct",
day="13",
volume="9",
number="10",
pages="e19705",
keywords="telemonitoring",
keywords="telemedicine",
keywords="remote titration",
keywords="mHealth",
keywords="heart failure",
abstract="Background: Guideline-directed medical therapy (GDMT), optimized to maximum tolerated doses, has been shown to improve clinical outcomes in patients with heart failure (HF). Timely use and optimization of GDMT can improve HF symptoms, reduce the burden of hospitalization, and increase survival rates, whereas GDMT deferral may worsen the progression of HF, decrease survival rates, and predispose patients to poor outcomes. However, studies indicate that GDMT remains underused, with less than?25\% of patients receiving target doses in clinical practice. Telemonitoring is a potential component in the management of HF that can provide reliable and real-time physiological data for clinical decision support and facilitate remote titration of medication. Objective: The primary objective of this study is to evaluate the impact of remote titration facilitated by telemonitoring on health care outcomes, with a primary outcome measure being the proportion of patients achieving target doses. The secondary objective is to identify the barriers and facilitators that can affect the implementation and effectiveness of the intervention. Methods: A mixed methods study of a smartphone-based telemonitoring system is being conducted at the Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto. The study is based on an effectiveness-implementation hybrid design and incorporates process evaluations alongside the assessment of clinical outcomes. The effectiveness research component is assessed by a two-arm randomized controlled trial (RCT) aiming to enroll 108 patients. The RCT compares a remote titration strategy that uses data from a smartphone-based telemonitoring system with a standard titration program consisting of in-office visits. The implementation research component consists of a qualitative study based on semistructured interviews with a purposive sample of clinicians and patients. Results: Patient recruitment began in January 2019 at PMCC, with a total of 76 participants recruited by February 24, 2020 (39 in the intervention group and 37 in the control group). The final analysis is expected to be completed by the winter of 2021. Conclusions: This study will be among the first to provide evidence on the implementation of remote titration facilitated by telemonitoring and its impact on patient health outcomes. The successful use of telemonitoring for this purpose has the potential to alter the existing approach to titration of HF medication and support the development of a care delivery model that combines clinic visits with virtual follow-ups. Trial Registration: ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID): DERR1-10.2196/19705 ",
doi="10.2196/19705",
url="https://www.researchprotocols.org/2020/10/e19705",
url="http://www.ncbi.nlm.nih.gov/pubmed/33048057"
}


@Article{info:doi/10.2196/18917,
author="Boodoo, Chris
and Zhang, Qi
and Ross, J. Heather
and Alba, Carolina Ana
and Laporte, Audrey
and Seto, Emily",
title="Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="6",
volume="22",
number="10",
pages="e18917",
keywords="cost utility analysis",
keywords="cost effectiveness",
keywords="telemedicine",
keywords="heart failure",
keywords="microsimulation",
keywords="mobile phone",
abstract="Background: Heart failure (HF) is a major public health issue in Canada that is associated with high prevalence, morbidity, and mortality rates and high financial and social burdens. Telemonitoring (TM) has been shown to improve all-cause mortality and hospitalization rates in patients with HF. The Medly program is a TM intervention integrated as standard of care at a large Canadian academic hospital for ambulatory patients with HF that has been found to improve patient outcomes. However, the cost-effectiveness of the Medly program is yet to be determined. Objective: This study aims to conduct a cost-utility analysis of the Medly program compared with the standard of care for HF in Ontario, Canada, from the perspective of the public health care payer. Methods: Using a microsimulation model, individual patient data were simulated over a 25-year time horizon to compare the costs and quality-adjusted life years (QALYs) between the Medly program and standard care for patients with HF treated in the ambulatory care setting. Data were sourced from a Medly Program Evaluation study and literature to inform model parameters, such as Medly's effectiveness in reducing mortality and hospitalizations, health care and intervention costs, and model transition probabilities. Scenario analyses were conducted in relation to HF severity and TM deployment models. One-way deterministic effectiveness analysis and probabilistic sensitivity analysis were performed to explore the impact on the results of uncertainty in model parameters. Results: The Medly program was associated with an average total cost of Can \$102,508 (US \$77,626) per patient and total QALYs of 5.51 per patient compared with the average cost of Can \$97,497 (US \$73,831) and QALYs of 4.95 per patient in the Standard Care Group. This led to an incremental cost of Can \$5011 (US \$3794) and incremental QALY of 0.566, resulting in an incremental cost-effectiveness ratio of Can \$8850 (US \$6701)/QALY. Cost-effectiveness improved in relation to patients with advanced HF and with deployment models in which patients used their own equipment. Baseline and alternative scenarios consistently showed probabilities of cost-effectiveness greater than 85\% at a willingness-to-pay threshold of Can \$50,000 (US \$37,718). Although the results showed some sensitivity to assumptions about effectiveness parameters, the intervention was found to remain cost-effective. Conclusions: The Medly program for patients with HF is cost-effective compared with standard care using commonly reported willingness-to-pay thresholds. This study provides evidence for decision makers on the use of TM for HF, supports the use of a nurse-led model of TM that embeds clinically validated algorithms, and informs the use of economic modeling for future evaluations of early-stage health informatics technology. ",
doi="10.2196/18917",
url="https://www.jmir.org/2020/10/e18917",
url="http://www.ncbi.nlm.nih.gov/pubmed/33021485"
}


@Article{info:doi/10.2196/18835,
author="Waqas, Ahmed
and Teoh, Huat Soo
and Lap{\~a}o, Velez Lu{\'i}s
and Messina, Ary Luiz
and Correia, C{\'e}sar Jorge",
title="Harnessing Telemedicine for the Provision of Health Care: Bibliometric and Scientometric Analysis",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="2",
volume="22",
number="10",
pages="e18835",
keywords="telemedicine",
keywords="scientometric analysis",
keywords="evidence synthesis",
keywords="health information technology",
keywords="research",
keywords="theme",
abstract="Background: In recent decades, advances in information technology have given new momentum to telemedicine research. These advances in telemedicine range from individual to population levels, allowing the exchange of patient information for diagnosis and management of health problems, primary care prevention, and education of physicians via distance learning. Objective: This scientometric investigation aims to examine collaborative research networks, dominant research themes and disciplines, and seminal research studies that have contributed most to the field of telemedicine. This information is vital for scientists, institutions, and policy stakeholders to evaluate research areas where more infrastructural or scholarly contributions are required. Methods: For analyses, we used CiteSpace (version 4.0 R5; Drexel University), which is a Java-based software that allows scientometric analysis, especially visualization of collaborative networks and research themes in a specific field. Results: We found that scholarly activity has experienced a significant increase in the last decade. Most important works were conducted by institutions located in high-income countries. A discipline-specific shift from radiology to telestroke, teledermatology, telepsychiatry, and primary care was observed. The most important innovations that yielded a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational health, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and geriatrics. Conclusions: Despite a continuous rise in scholarly activity in telemedicine, we noticed several gaps in the literature. For instance, all the primary and secondary research central to telemedicine was conducted in the context of high-income countries, including the evidence synthesis approaches that pertained to implementation aspects of telemedicine. Furthermore, the research landscape and implementation of telemedicine infrastructure are expected to see exponential progress during and after the COVID-19 era. ",
doi="10.2196/18835",
url="https://www.jmir.org/2020/10/e18835",
url="http://www.ncbi.nlm.nih.gov/pubmed/33006571"
}


@Article{info:doi/10.2196/19550,
author="Liljeroos, Maria
and Thyl{\'e}n, Ingela
and Str{\"o}mberg, Anna",
title="Patients' and Nurses' Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="28",
volume="22",
number="9",
pages="e19550",
keywords="heart failure",
keywords="remote patient monitoring",
keywords="implantable cardioverter-defibrillator",
abstract="Background: The new generation of implantable cardioverter-defibrillators (ICDs) supports wireless technology, which enables remote patient monitoring (RPM) of the device. In Sweden, it is mainly registered nurses with advanced education and training in ICD devices who handle the arrhythmias and technical issues of the remote transmissions. Previous studies have largely focused on the perceptions of physicians, and it has not been explored how the patients' and nurses' experiences of RPM correspond to each other. Objective: Our objective is to describe, explore, and compare the experiences and perceptions, concerning RPM of ICD, of patients with heart failure (HF) and nurses performing ICD follow-up. Methods: This study has a cross-sectional, descriptive, mixed methods design. All patients with HF and an ICD with RPM from one region in Sweden, who had transitioned from office-based visits to implementing RPM, and ICD nurses from all ICD clinics in Sweden were invited to complete a purpose-designed, 8-item questionnaire to assess experiences of RPM. The questionnaire started with a neutral question: ``What are your experiences of RPM in general?'' This was followed by one positive subscale with three questions (score range 3-12), with higher scores reflecting more positive experiences, and one negative subscale with three questions (score range 3-12), with lower scores reflecting more negative experiences. One open-ended question was analyzed with qualitative content analysis. Results: The sample consisted of 175 patients (response rate 98.9\%) and 30 ICD nurses (response rate 60\%). The majority of patients (154/175, 88.0\%) and nurses (23/30, 77\%) experienced RPM as very good; however, the nurses noted more downsides than did the patients. The mean scores of the negative experiences subscale were 11.5 (SD 1.1) for the patients and 10.7 (SD 0.9) for the nurses (P=.08). The mean scores of the positive experiences subscale were 11.1 (SD 1.6) for the patients and 8.5 (SD 1.9) for the nurses (P=.04). A total of 11 out of 175 patients (6.3\%) were worried or anxious about what the RPM entailed, while 15 out of 30 nurses (50\%) felt distressed by the responsibility that accompanied their work with RPM (P=.04). Patients found that RPM increased their own (173/175, 98.9\%) and their relatives' (169/175, 96.6\%) security, and all nurses (30/30, 100\%) answered that they found RPM to be necessary from a safety perspective. Most patients found it to be an advantage with fewer office-based visits. Nurses found it difficult to handle different systems with different platforms, especially for smaller clinics with few patients. Another difficulty was to set the correct number of alarms for the individual patient. This caused a high number of transmissions and a risk to miss important information. Conclusions: Both patients and nurses found that RPM increased assurance, reliance, and safety. Few patients were anxious about what the RPM entailed, while about half of the nurses felt distressed by the responsibility that accompanied their work with RPM. To increase nurses' sense of security, it seems important to adjust organizational routines and reimbursement systems and to balance the workload. ",
doi="10.2196/19550",
url="http://www.jmir.org/2020/9/e19550/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32985997"
}


@Article{info:doi/10.2196/19781,
author="Mazoteras-Pardo, Victoria
and Becerro-De-Bengoa-Vallejo, Ricardo
and Losa-Iglesias, Elena Marta
and Mart{\'i}nez-Jim{\'e}nez, Mar{\'i}a Eva
and Calvo-Lobo, C{\'e}sar
and Romero-Morales, Carlos
and L{\'o}pez-L{\'o}pez, Daniel
and Palomo-L{\'o}pez, Patricia",
title="QardioArm Blood Pressure Monitoring in a Population With Type 2 Diabetes: Validation Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="24",
volume="22",
number="7",
pages="e19781",
keywords="blood pressure",
keywords="hypertension",
keywords="type 2 diabetes",
keywords="mobile applications",
keywords="software validation",
abstract="Background: Home blood pressure monitoring has many benefits, even more so, in populations prone to high blood pressure, such as persons with diabetes. Objective: The purpose of this research was to validate the QardioArm mobile device in a sample of individuals with noninsulin-dependent type 2 diabetes in accordance with the guidelines of the second International Protocol of the European Society of Hypertension. Methods: The sample consisted of 33 patients with type 2 diabetes. To evaluate the validity of QardioArm by comparing its data with that obtained with a digital sphygmomanometer (Omron M3 Intellisense), two nurses collected diastolic blood pressure, systolic blood pressure, and heart rate with both devices. Results: The analysis indicated that the test device QardioArm met all the validation requirements using a sample population with type 2 diabetes. Conclusions: This paper reports the first validation of QardioArm in a population of individuals with noninsulin-dependent type 2 diabetes. QardioArm for home monitoring of blood pressure and heart rate met the requirements of the second International Protocol of the European Society of Hypertension. ",
doi="10.2196/19781",
url="http://www.jmir.org/2020/7/e19781/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706672"
}


@Article{info:doi/10.2196/17846,
author="Jiang, Xinchan
and Yao, Jiaqi
and You, HS Joyce",
title="Telemonitoring Versus Usual Care for Elderly Patients With Heart Failure Discharged From the Hospital in the United States: Cost-Effectiveness Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="6",
volume="8",
number="7",
pages="e17846",
keywords="telemedicine",
keywords="heart failure",
keywords="hospitalization",
keywords="cost",
keywords="quality-adjusted life year",
keywords="cost-effectiveness analysis",
abstract="Background: Telemonitoring-guided interventional management reduces the need for hospitalization and mortality of patients with chronic heart failure (CHF). Objective: This study aimed to analyze the cost-effectiveness of usual care with and without telemonitoring-guided management in patients with CHF discharged from the hospital, from the perspective of US health care providers. Methods: A lifelong Markov model was designed to estimate outcomes of (1) usual care alone for all postdischarge patients with CHF (New York Heart Association [NYHA] class I-IV), (2) usual care and telemonitoring for all postdischarge patients with CHF, (3) usual care for all postdischarge patients with CHF and telemonitoring for patients with NYHA class III to IV, and (4) usual care for all postdischarge patients with CHF plus telemonitoring for patients with NYHA class II to IV. Model inputs were derived from the literature and public data. Sensitivity analyses were conducted to assess the robustness of model. The primary outcomes were total direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Results: In the base case analysis, universal telemonitoring group gained the highest QALYs (6.2967 QALYs), followed by the telemonitoring for NYHA class II to IV group (6.2960 QALYs), the telemonitoring for NYHA class III to IV group (6.2450 QALYs), and the universal usual care group (6.1530 QALYs). ICERs of the telemonitoring for NYHA class III to IV group (US \$35,393 per QALY) and the telemonitoring for NYHA class II to IV group (US \$38,261 per QALY) were lower than the ICER of the universal telemonitoring group (US \$100,458 per QALY). One-way sensitivity analysis identified five critical parameters: odds ratio of hospitalization for telemonitoring versus usual care, hazard ratio of all-cause mortality for telemonitoring versus usual care, CHF hospitalization cost and monthly outpatient costs for NYHA class I, and CHF hospitalization cost for NYHA class II. In probabilistic sensitivity analysis, probabilities of the universal telemonitoring, telemonitoring for NYHA class II to IV, telemonitoring for NYHA class III to IV, and universal usual care groups to be accepted as cost-effective at US \$50,000 per QALY were 2.76\%, 76.31\%, 18.6\%, and 2.33\%, respectively. Conclusions: Usual care for all discharged patients with CHF plus telemonitoring-guided management for NYHA class II to IV patients appears to be the preferred cost-effective strategy. ",
doi="10.2196/17846",
url="https://mhealth.jmir.org/2020/7/e17846",
url="http://www.ncbi.nlm.nih.gov/pubmed/32407288"
}


@Article{info:doi/10.2196/16695,
author="Indraratna, Praveen
and Tardo, Daniel
and Yu, Jennifer
and Delbaere, Kim
and Brodie, Matthew
and Lovell, Nigel
and Ooi, Sze-Yuan",
title="Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="6",
volume="8",
number="7",
pages="e16695",
keywords="mobile phone",
keywords="text messaging",
keywords="telemedicine",
keywords="myocardial ischemia",
keywords="heart failure",
keywords="hypertension",
abstract="Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide. Mobile phones have become ubiquitous in most developed societies. Smartphone apps, telemonitoring, and clinician-driven SMS allow for novel opportunities and methods in managing chronic CVD, such as ischemic heart disease, heart failure, and hypertension, and in the conduct and support of cardiac rehabilitation. Objective: A systematic review was conducted using seven electronic databases, identifying all relevant randomized control trials (RCTs) featuring a mobile phone intervention (MPI) used in the management of chronic CVD. Outcomes assessed included mortality, hospitalizations, blood pressure (BP), and BMI. Methods: Electronic data searches were performed using seven databases from January 2000 to June 2019. Relevant articles were reviewed and analyzed. Meta-analysis was performed using standard techniques. The odds ratio (OR) was used as a summary statistic for dichotomous variables. A random effect model was used. Results: A total of 26 RCTs including 6713 patients were identified and are described in this review, and 12 RCTs were included in the meta-analysis. In patients with heart failure, MPIs were associated with a significantly lower rate of hospitalizations (244/792, 30.8\% vs 287/803, 35.7\%; n=1595; OR 0.77, 95\% CI 0.62 to 0.97; P=.03; I2=0\%). In patients with hypertension, patients exposed to MPIs had a significantly lower systolic BP (mean difference 4.3 mm Hg; 95\% CI ?7.8 to ?0.78 mm Hg; n=2023; P=.02). Conclusions: The available data suggest that MPIs may have a role as a valuable adjunct in the management of chronic CVD. ",
doi="10.2196/16695",
url="https://mhealth.jmir.org/2020/7/e16695",
url="http://www.ncbi.nlm.nih.gov/pubmed/32628615"
}


@Article{info:doi/10.2196/19771,
author="Vandekerckhove, Pieter
and Vandekerckhove, Yves
and Tavernier, Rene
and De Jaegher, Kelly
and de Mul, Marleen",
title="Leveraging User Experience to Improve Video Consultations in a Cardiology Practice During the COVID-19 Pandemic: Initial Insights",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="25",
volume="22",
number="6",
pages="e19771",
keywords="telemedicine",
keywords="design thinking",
keywords="cardiology",
keywords="patient",
keywords="COVID-19",
keywords="user experience",
doi="10.2196/19771",
url="http://www.jmir.org/2020/6/e19771/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32519964"
}


@Article{info:doi/10.2196/17299,
author="Ferguson, Caleb
and Inglis, C. Sally
and Breen, P. Paul
and Gargiulo, D. Gaetano
and Byiers, Victoria
and Macdonald, S. Peter
and Hickman, D. Louise",
title="Clinician Perspectives on the Design and Application of Wearable Cardiac Technologies for Older Adults: Qualitative Study",
journal="JMIR Aging",
year="2020",
month="Jun",
day="18",
volume="3",
number="1",
pages="e17299",
keywords="technology",
keywords="arrhythmia",
keywords="monitoring",
keywords="older people",
keywords="cardiology",
keywords="qualitative",
keywords="wearable",
abstract="Background: New wearable devices (for example, AliveCor or Zio patch) offer promise in detecting arrhythmia and monitoring cardiac health status, among other clinically useful parameters in older adults. However, the clinical utility and usability from the perspectives of clinicians is largely unexplored. Objective: This study aimed to explore clinician perspectives on the use of wearable cardiac monitoring technology for older adults. Methods: A descriptive qualitative study was conducted using semistructured focus group interviews. Clinicians were recruited through purposive sampling of physicians, nurses, and allied health staff working in 3 tertiary-level hospitals. Verbatim transcripts were analyzed using thematic content analysis to identify themes. Results: Clinicians representing physicians, nurses, and allied health staff working in 3 tertiary-level hospitals completed 4 focus group interviews between May 2019 and July 2019. There were 50 participants (28 men and 22 women), including cardiologists, geriatricians, nurses, and allied health staff. The focus groups generated the following 3 overarching, interrelated themes: (1) the current state of play, understanding the perceived challenges of patient cardiac monitoring in hospitals, (2) priorities in cardiac monitoring, what parameters new technologies should measure, and (3) cardiac monitoring of the future, ``the ideal device.'' Conclusions: There remain pitfalls related to the design of wearable cardiac technology for older adults that present clinical challenges. These pitfalls and challenges likely negatively impact the uptake of wearable cardiac monitoring in routine clinical care. Partnering with clinicians and patients in the co-design of new wearable cardiac monitoring technologies is critical to optimize the use of these devices and their uptake in clinical care. ",
doi="10.2196/17299",
url="http://aging.jmir.org/2020/1/e17299/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32554377"
}


@Article{info:doi/10.2196/16157,
author="Cruz-Mart{\'i}nez, Rafael Roberto
and Wentzel, Jobke
and Asbj{\o}rnsen, Aune Rikke
and Noort, Daniel Peter
and van Niekerk, Magnus Johan
and Sanderman, Robbert
and van Gemert-Pijnen, EWC Julia",
title="Supporting Self-Management of Cardiovascular Diseases Through Remote Monitoring Technologies: Metaethnography Review of Frameworks, Models, and Theories Used in Research and Development",
journal="J Med Internet Res",
year="2020",
month="May",
day="21",
volume="22",
number="5",
pages="e16157",
keywords="eHealth",
keywords="telemedicine",
keywords="development",
keywords="implementation",
keywords="evaluation",
keywords="multidisciplinary",
keywords="qualitative evidence synthesis",
keywords="meta-ethnography",
keywords="systematic review",
keywords="remote monitoring",
keywords="self-management",
keywords="cardiovascular diseases",
keywords="framework",
keywords="model",
keywords="theory",
abstract="Background: Electronic health (eHealth) is a rapidly evolving field informed by multiple scientific disciplines. Because of this, the use of different terms and concepts to explain the same phenomena and lack of standardization in reporting interventions often leaves a gap that hinders knowledge accumulation. Interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies are a cross-disciplinary area potentially affected by this gap. A review of the underlying frameworks, models, and theories that have informed projects at this crossroad could advance future research and development efforts. Objective: This research aimed to identify and compare underlying approaches that have informed interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies. The objective was to achieve an understanding of the distinct approaches by highlighting common or conflicting principles, guidelines, and methods. Methods: The metaethnography approach was used to review and synthesize researchers' reports on how they applied frameworks, models, and theories in their projects. Literature was systematically searched in 7 databases: Scopus, Web of Science, EMBASE, CINAHL, PsycINFO, Association for Computing Machinery Digital Library, and Cochrane Library. Included studies were thoroughly read and coded to extract data for the synthesis. Studies were mainly related by the key ingredients of the underlying approaches they applied. The key ingredients were finally translated across studies and synthesized into thematic clusters. Results: Of 1224 initial results, 17 articles were included. The articles described research and development of 10 different projects. Frameworks, models, and theories (n=43) applied by the projects were identified. Key ingredients (n=293) of the included articles were mapped to the following themes of eHealth development: (1) it is a participatory process; (2) it creates new infrastructures for improving health care, health, and well-being; (3) it is intertwined with implementation; (4) it integrates theory, evidence, and participatory approaches for persuasive design; (5) it requires continuous evaluation cycles; (6) it targets behavior change; (7) it targets technology adoption; and (8) it targets health-related outcomes. Conclusions: The findings of this review support and exemplify the numerous possibilities in the use of frameworks, models, and theories to guide research and development of eHealth. Participatory, user-centered design, and integration with empirical evidence and theoretical modeling were widely identified principles in the literature. On the contrary, less attention has been given to the integration of implementation in the development process and supporting novel eHealth-based health care infrastructures. To better integrate theory and evidence, holistic approaches can combine patient-centered studies with consolidated knowledge from expert-based approaches. Trial Registration: PROSPERO CRD42018104397; https://tinyurl.com/y8ajyajt International Registered Report Identifier (IRRID): RR2-10.2196/13334 ",
doi="10.2196/16157",
url="http://www.jmir.org/2020/5/e16157/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32436852"
}


@Article{info:doi/10.2196/17669,
author="Winchester, E. David
and Cagino, Leigh",
title="A Redesigned Order Entry System for Reducing Low-Value Preprocedural Cardiology Consultations: Quality-Improvement Cohort Study",
journal="JMIR Perioper Med",
year="2020",
month="May",
day="1",
volume="3",
number="1",
pages="e17669",
keywords="quality improvement",
keywords="preoperative care",
keywords="medical order entry systems",
abstract="Background: Preprocedural cardiac evaluation is a common reason for outpatient cardiology visits. Many patients who are referred to cardiology clinics for preprocedural evaluation are at low risk of perioperative events and do not require any further management. Our facility treats patients over a large geographic area; avoiding low-value consultations reduces time and travel burdens for patients. Objective: Our study objective was to assess the impact of a novel algorithm in the electronic order entry system aimed to guide clinicians toward patients who may benefit from cardiovascular referral. Methods: We retrospectively reviewed in-person consultations and electronic consultations (e-consults) to our cardiology service before and after implementation of the novel algorithm to assess changes in patterns of care. Data were stored in a custom electronic database on internal servers. Results: We reviewed 603 consultations to our cardiology clinic and found that 89 (14.7\%) were sent for preprocedural evaluation. Of these, 39 (43.8\% of preprocedural consultations) were e-consults. After implementation, we reviewed 360 consultations. The proportion of consultations for preprocedural evaluation did not decrease (n=47, 13.0\%; P=.39). We observed an absolute increase of 13.6\% in the proportion of consultations ordered as e-consults (27/47, 57.4\%). During the postintervention period, we received no remarks, concerns, or criticisms from ordering clinicians about the process change and no reports of adverse events. Conclusions: Implementation of an ordering algorithm to reduce low-value preprocedural cardiology evaluations did not lead to a reduction in the number of overall preprocedural cardiology consultations. The number of patients seen electronically increased, potentially improving clinic access and reducing travel burden for patients. ",
doi="10.2196/17669",
url="https://periop.jmir.org/2020/1/e17669",
url="http://www.ncbi.nlm.nih.gov/pubmed/33393916"
}


@Article{info:doi/10.2196/15548,
author="McGillion, Michael
and Ouellette, Carley
and Good, Amber
and Bird, Marissa
and Henry, Shaunattonie
and Clyne, Wendy
and Turner, Andrew
and Ritvo, Paul
and Ritvo, Sarah
and Dvirnik, Nazari
and Lamy, Andre
and Whitlock, Richard
and Lawton, Christopher
and Walsh, Jake
and Paterson, Ken
and Duquette, Janine
and Sanchez Medeiros, Karla
and Elias, Fadi
and Scott, Ted
and Mills, Joseph
and Harrington, Deborah
and Field, Mark
and Harsha, Prathiba
and Yang, Stephen
and Peter, Elizabeth
and Bhavnani, Sanjeev
and Devereaux, PJ",
title="Postoperative Remote Automated Monitoring and Virtual Hospital-to-Home Care System Following Cardiac and Major Vascular Surgery: User Testing Study",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="18",
volume="22",
number="3",
pages="e15548",
keywords="monitoring, physiologic",
keywords="postoperative care",
keywords="user testing",
abstract="Background: Cardiac and major vascular surgeries are common surgical procedures associated with high rates of postsurgical complications and related hospital readmission. In-hospital remote automated monitoring (RAM) and virtual hospital-to-home patient care systems have major potential to improve patient outcomes following cardiac and major vascular surgery. However, the science of deploying and evaluating these systems is complex and subject to risk of implementation failure. Objective: As a precursor to a randomized controlled trial (RCT), this user testing study aimed to examine user performance and acceptance of a RAM and virtual hospital-to-home care intervention, using Philip's Guardian and Electronic Transition to Ambulatory Care (eTrAC) technologies, respectively. Methods: Nurses and patients participated in systems training and individual case-based user testing at two participating sites in Canada and the United Kingdom. Participants were video recorded and asked to think aloud while completing required user tasks and while being rated on user performance. Feedback was also solicited about the user experience, including user satisfaction and acceptance, through use of the Net Promoter Scale (NPS) survey and debrief interviews. Results: A total of 37 participants (26 nurses and 11 patients) completed user testing. The majority of nurse and patient participants were able to complete most required tasks independently, demonstrating comprehension and retention of required Guardian and eTrAC system workflows. Tasks which required additional prompting by the facilitator, for some, were related to the use of system features that enable continuous transmission of patient vital signs (eg, pairing wireless sensors to the patient) and assigning remote patient monitoring protocols. NPS scores by user group (nurses using Guardian: mean 8.8, SD 0.89; nurses using eTrAC: mean 7.7, SD 1.4; patients using eTrAC: mean 9.2, SD 0.75), overall NPS scores, and participant debrief interviews indicated nurse and patient satisfaction and acceptance of the Guardian and eTrAC systems. Both user groups stressed the need for additional opportunities to practice in order to become comfortable and proficient in the use of these systems. Conclusions: User testing indicated a high degree of user acceptance of Philips' Guardian and eTrAC systems among nurses and patients. Key insights were provided that informed refinement of clinical workflow training and systems implementation. These results were used to optimize workflows before the launch of an international RCT of in-hospital RAM and virtual hospital-to-home care for patients undergoing cardiac and major vascular surgery. ",
doi="10.2196/15548",
url="https://www.jmir.org/2020/3/e15548",
url="http://www.ncbi.nlm.nih.gov/pubmed/32186521"
}


@Article{info:doi/10.2196/15445,
author="Aamodt, Thon Ina
and Lycholip, Edita
and Celutkiene, Jelena
and von Lueder, Thomas
and Atar, Dan
and Falk, S{\o}rum Ragnhild
and Helles{\o}, Ragnhild
and Jaarsma, Tiny
and Str{\"o}mberg, Anna
and Lie, Irene",
title="Self-Care Monitoring of Heart Failure Symptoms and Lung Impedance at Home Following Hospital Discharge: Longitudinal Study",
journal="J Med Internet Res",
year="2020",
month="Jan",
day="7",
volume="22",
number="1",
pages="e15445",
keywords="heart failure",
keywords="telemedicine",
keywords="lung impedance",
keywords="diary",
keywords="self-care",
keywords="prospective study",
abstract="Background: Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. Objective: This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. Methods: This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals---one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90\% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the CardioSet Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. Results: The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. Conclusions: Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions. ",
doi="10.2196/15445",
url="https://www.jmir.org/2020/1/e15445",
url="http://www.ncbi.nlm.nih.gov/pubmed/31909717"
}


@Article{info:doi/10.2196/15045,
author="Herkert, Cyrille
and Kraal, Johannes Jos
and van Loon, Agnes Eline Maria
and van Hooff, Martijn
and Kemps, Clemens Hareld Marijn",
title="Usefulness of Modern Activity Trackers for Monitoring Exercise Behavior in Chronic Cardiac Patients: Validation Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Dec",
day="19",
volume="7",
number="12",
pages="e15045",
keywords="cardiac diseases",
keywords="activity trackers",
keywords="energy metabolism",
keywords="physical activity",
keywords="validation studies",
abstract="Background: Improving physical activity (PA) is a core component of secondary prevention and cardiac (tele)rehabilitation. Commercially available activity trackers are frequently used to monitor and promote PA in cardiac patients. However, studies on the validity of these devices in cardiac patients are scarce. As cardiac patients are being advised and treated based on PA parameters measured by these devices, it is highly important to evaluate the accuracy of these parameters in this specific population. Objective: The aim of this study was to determine the accuracy and responsiveness of 2 wrist-worn activity trackers, Fitbit Charge 2 (FC2) and Mio Slice (MS), for the assessment of energy expenditure (EE) in cardiac patients. Methods: EE assessed by the activity trackers was compared with indirect calorimetry (Oxycon Mobile [OM]) during a laboratory activity protocol. Two groups were assessed: patients with stable coronary artery disease (CAD) with preserved left ventricular ejection fraction (LVEF) and patients with heart failure with reduced ejection fraction (HFrEF). Results: A total of 38 patients were included: 19 with CAD and 19 with HFrEF (LVEF 31.8\%, SD 7.6\%). The CAD group showed no significant difference in total EE between FC2 and OM (47.5 kcal, SD 112 kcal; P=.09), in contrast to a significant difference between MS and OM (88 kcal, SD 108 kcal; P=.003). The HFrEF group showed significant differences in EE between FC2 and OM (38 kcal, SD 57 kcal; P=.01), as well as between MS and OM (106 kcal, SD 167 kcal; P=.02). Agreement of the activity trackers was low in both groups (CAD: intraclass correlation coefficient [ICC] FC2=0.10, ICC MS=0.12; HFrEF: ICC FC2=0.42, ICC MS=0.11). The responsiveness of FC2 was poor, whereas MS was able to detect changes in cycling loads only. Conclusions: Both activity trackers demonstrated low accuracy in estimating EE in cardiac patients and poor performance to detect within-patient changes in the low-to-moderate exercise intensity domain. Although the use of activity trackers in cardiac patients is promising and could enhance daily exercise behavior, these findings highlight the need for population-specific devices and algorithms. ",
doi="10.2196/15045",
url="http://mhealth.jmir.org/2019/12/e15045/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31855191"
}


@Article{info:doi/10.2196/cardio.9815,
author="Giannola, Gabriele
and Torcivia, Riccardo
and Air{\`o} Farulla, Riccardo
and Cipolla, Tommaso",
title="Outsourcing the Remote Management of Cardiac Implantable Electronic Devices: Medical Care Quality Improvement Project",
journal="JMIR Cardio",
year="2019",
month="Dec",
day="18",
volume="3",
number="2",
pages="e9815",
keywords="remote monitoring",
keywords="telemonitoring",
keywords="cardiac implantable electronic devices",
keywords="implantable defibrillators",
keywords="pacemaker",
keywords="implantable cardioverter defibrillator",
keywords="triage outsourcing",
keywords="follow-up",
abstract="Background: Remote management is partially replacing routine follow-up in patients implanted with cardiac implantable electronic devices (CIEDs). Although it reduces clinical staff time compared with standard in-office follow-up, a new definition of roles and responsibilities may be needed to review remote transmissions in an effective, efficient, and timely manner. Whether remote triage may be outsourced to an external remote monitoring center (ERMC) is still unclear. Objective: The aim of this health care quality improvement project was to evaluate the feasibility of outsourcing remote triage to an ERMC to improve patient care and health care resource utilization. Methods: Patients (N=153) with implanted CIEDs were followed up for 8 months. An ERMC composed of nurses and physicians reviewed remote transmissions daily following a specific remote monitoring (RM) protocol. A 6-month benchmarking phase where patients' transmissions were managed directly by hospital staff was evaluated as a term of comparison. Results: A total of 654 transmissions were recorded in the RM system and managed by the ERMC team within 2 working days, showing a significant time reduction compared with standard RM management (100\% vs 11\%, respectively, within 2 days; P<.001). A total of 84.3\% (551/654) of the transmissions did not include a prioritized event and did not require escalation to the hospital clinician. High priority was assigned to 2.3\% (15/654) of transmissions, which were communicated to the hospital team by email within 1 working day. Nonurgent device status events occurred in 88 cases and were communicated to the hospital within 2 working days. Of these, 11\% (10/88) were followed by a hospitalization. Conclusions: The outsourcing of RM management to an ERMC safely provides efficacy and efficiency gains in patients' care compared with a standard in-hospital management. Moreover, the externalization of RM management could be a key tool for saving dedicated staff and facility time with possible positive economic impact. Trial Registration: ClinicalTrials.gov NCT01007474; http://clinicaltrials.gov/ct2/show/NCT01007474 ",
doi="10.2196/cardio.9815",
url="https://cardio.jmir.org/2019/2/e9815",
url="http://www.ncbi.nlm.nih.gov/pubmed/31845898"
}


@Article{info:doi/10.2196/13229,
author="Guo, Xiaorong
and Gu, Xiang
and Jiang, Jiang
and Li, Hongxiao
and Duan, Ruoyu
and Zhang, Yi
and Sun, Lei
and Bao, Zhengyu
and Shen, Jianhua
and Chen, Fukun",
title="A Hospital-Community-Family--Based Telehealth Program for Patients With Chronic Heart Failure: Single-Arm, Prospective Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Dec",
day="13",
volume="7",
number="12",
pages="e13229",
keywords="telehealth",
keywords="chronic heart failure",
keywords="feasibility studies",
keywords="precise follow-up",
keywords="self-management",
abstract="Background: An increasing number of patients with chronic heart failure (CHF) are demanding more convenient and efficient modern health care systems, especially in remote areas away from central cities. Telehealth is receiving increasing attention, which may be useful to patients with CHF. Objective: This study aimed to evaluate the feasibility of a hospital-community-family (HCF)--based telehealth program, which was designed to implement remote hierarchical management in patients with CHF. Methods: This was a single-arm prospective study in which 70 patients with CHF participated in the HCF-based telehealth program for remote intervention for at least 4 months. The participants were recruited from the clinic and educated on the use of smart health tracking devices and mobile apps to collect and manually upload comprehensive data elements related to the risk of CHF self-care management. They were also instructed on how to use the remote platform and mobile app to send text messages, check notifications, and open video channels. The general practitioners viewed the index of each participant on the mobile app and provided primary care periodically, and cardiologists in the regional central hospital offered remote guidance, if necessary. The assessed outcomes included accomplishments of the program, usability and satisfaction, engagement with the intervention, and changes of heart failure--related health behaviors. Results: As of February 2018, a total of 66 individuals, aged 40-79 years, completed the 4-month study. Throughout the study period, 294 electronic medical records were formed on the remote monitoring service platform. In addition, a total of 89 remote consultations and 196 remote ward rounds were conducted. Participants indicated that they were generally satisfied with the intervention for its ease of use and usefulness. More than 91\% (21/23) of physicians believed the program was effective, and 87\% (20/23) of physicians stated that their professional knowledge could always be refreshed and enhanced through a library hosted on the platform and remote consultation. More than 60\% (40/66) of participants showed good adherence to the care plan in the study period, and 79\% (52/66) of patients maintained a consistent pattern of reporting and viewing their data over the course of the 4-month follow-up period. The program showed a positive effect on self-management for patients (healthy diet: P=.046, more fruit and vegetable intake: P=.02, weight monitoring: P=.002, blood pressure: P<.001, correct time: P=.049, and daily dosages of medicine taken: P=.006). Conclusions: The HCF-based telehealth program is feasible and provided researchers with evidence of remote hierarchical management for patients with CHF, which can enhance participants' and their families' access and motivation to engage in self-management. Further prospective studies with a larger sample size are necessary to confirm the program's effectiveness. ",
doi="10.2196/13229",
url="https://mhealth.jmir.org/2019/12/e13229",
url="http://www.ncbi.nlm.nih.gov/pubmed/31833835"
}


@Article{info:doi/10.2196/14603,
author="Harsha, Prathiba
and Paul, E. James
and Chong, A. Matthew
and Buckley, Norm
and Tidy, Antonella
and Clarke, Anne
and Buckley, Diane
and Sirko, Zenon
and Vanniyasingam, Thuva
and Walsh, Jake
and McGillion, Michael
and Thabane, Lehana",
title="Challenges With Continuous Pulse Oximetry Monitoring and Wireless Clinician Notification Systems After Surgery: Reactive Analysis of a Randomized Controlled Trial",
journal="JMIR Med Inform",
year="2019",
month="Oct",
day="28",
volume="7",
number="4",
pages="e14603",
keywords="continuous pulse oximetry",
keywords="wireless notification",
keywords="issues",
keywords="evaluation of issues",
keywords="clinical adoption framework",
keywords="remote monitoring",
keywords="postoperative monitoring",
keywords="false alarm",
abstract="Background: Research has shown that introducing electronic Health (eHealth) patient monitoring interventions can improve healthcare efficiency and clinical outcomes. The VIGILANCE (VItal siGns monItoring with continuous puLse oximetry And wireless cliNiCian notification aftEr surgery) study was a randomized controlled trial (n=2049) designed to assess the impact of continuous vital sign monitoring with alerts sent to nursing staff when respiratory resuscitations with naloxone, code blues, and intensive care unit transfers occurred in a cohort of postsurgical patients in a ward setting. This report identifies and evaluates key issues and challenges associated with introducing wireless monitoring systems into complex hospital infrastructure during the VIGILANCE eHealth intervention implementation. Potential solutions and suggestions for future implementation research are presented. Objective: The goals of this study were to: (1) identify issues related to the deployment of the eHealth intervention system of the VIGILANCE study; and (2) evaluate the influence of these issues on intervention adoption. Methods: During the VIGILANCE study, issues affecting the implementation of the eHealth intervention were documented on case report forms, alarm event forms, and a nursing user feedback questionnaire. These data were collated by the research and nursing personnel and submitted to the research coordinator. In this evaluation report, the clinical adoption framework was used as a guide to organize the identified issues and evaluate their impact. Results: Using the clinical adoption framework, we identified issues within the framework dimensions of people, organization, and implementation at the meso level, as well as standards and funding issues at the macro level. Key issues included: nursing workflow changes with blank alarm forms (24/1030, 2.33\%) and missing alarm forms (236/1030, 22.91\%), patient withdrawal (110/1030, 10.68\%), wireless network connectivity, false alarms (318/1030, 30.87\%), monitor malfunction (36/1030, 3.49\%), probe issues (16/1030, 1.55\%), and wireless network standards. At the micro level, these issues affected the quality of the service in terms of support provided, the quality of the information yielded by the monitors, and the functionality, reliability, and performance of the monitoring system. As a result, these issues impacted access through the decreased ability of nurses to make complete use of the monitors, impacted care quality of the trial intervention through decreased effectiveness, and impacted productivity through interference in the coordination of care, thus decreasing clinical adoption of the monitoring system. Conclusions: Patient monitoring with eHealth technology in surgical wards has the potential to improve patient outcomes. However, proper planning that includes engagement of front-line nurses, installation of appropriate wireless network infrastructure, and use of comfortable cableless devices is required to maximize the potential of eHealth monitoring. Trial Registration: ClinicalTrials.gov NCT02907255; https://clinicaltrials.gov/ct2/show/NCT02907255 ",
doi="10.2196/14603",
url="http://medinform.jmir.org/2019/4/e14603/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31661079"
}


@Article{info:doi/10.2196/13137,
author="Mazoteras-Pardo, Victoria
and Becerro-De-Bengoa-Vallejo, Ricardo
and Losa-Iglesias, Elena Marta
and L{\'o}pez-L{\'o}pez, Daniel
and Palomo-L{\'o}pez, Patricia
and Rodr{\'i}guez-Sanz, David
and Calvo-Lobo, C{\'e}sar",
title="Validation in the General Population of the iHealth Track Blood Pressure Monitor for Self-Measurement According to the European Society of Hypertension International Protocol Revision 2010: Descriptive Investigation",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Mar",
day="19",
volume="7",
number="3",
pages="e13137",
keywords="blood pressure determination",
keywords="heart rate determination",
keywords="validation studies",
keywords="telemedicine",
abstract="Background: High blood pressure is one of the most common reasons why patients seek assistance in daily clinical practice. Screening for hypertension is fundamental and, because hypertension is identified only when blood pressure is measured, accurate measurements are key to the diagnosis and management of this disease. The European Society of Hypertension International Protocol revision 2010 (ESH-IP2) was developed to assess the validity of automatic blood pressure measuring devices that are increasingly being used to replace mercury sphygmomanometers. Objective: We sought to determine whether the iHealth Track blood pressure monitor meets ESH-IP2 requirements for self-measurement of blood pressure and heart rate at the brachial level and is appropriate for use in the general population. Methods: This study was a descriptive investigation. ESH-IP2 requires a total number of 33 participants. For each measure, the difference between observer and device blood pressure and heart rate values is calculated. In all, 99 pairs of blood pressure differences are classified into 3 categories (?5, ?10, and ?15 mm Hg), and 99 pairs of heart rate differences are classified into 3 categories (?3, ?5, and ?8 beats/min). We followed these protocol procedures in a convenience sample of 33 participants. Results: iHealth Track fulfilled ESH-IP2 requirements and passed the validation process successfully. We observed an absolute difference within 5 mm Hg in 75 of 99 comparisons for systolic blood pressure, 78 of 99 comparisons for diastolic blood pressure, and 89 of 99 comparisons for heart rate. The mean differences between the test and standard readings were 4.19 (SD 4.48) mm Hg for systolic blood pressure, 3.74 (SD 4.55) mm Hg for diastolic blood pressure, and 1.95 (SD 3.27) beats/min for heart rate. With regard to part 2 of ESH-IP2, we observed a minimum of 2 of 3 measurements within a 5-mm Hg difference in 29 of 33 participants for systolic blood pressure and 26 of 33 for diastolic blood pressure, and a minimum of 2 of 3 measurements within a 3-beat/min difference in 30 of 33 participants for heart rate. Conclusions: iHealth Track readings differed from the standard by less than 5, 10, and 15 mm Hg, fulfilling ESH-IP2 requirements. Consequently, this device is suitable for use in the general population. ",
doi="10.2196/13137",
url="http://mhealth.jmir.org/2019/3/e13137/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30888331"
}


@Article{info:doi/10.2196/11889,
author="Falter, Maarten
and Budts, Werner
and Goetschalckx, Kaatje
and Cornelissen, V{\'e}ronique
and Buys, Roselien",
title="Accuracy of Apple Watch Measurements for Heart Rate and Energy Expenditure in Patients With Cardiovascular Disease: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Mar",
day="19",
volume="7",
number="3",
pages="e11889",
keywords="mobile health",
keywords="heart rate",
keywords="energy expenditure",
keywords="validation",
keywords="Apple Watch",
keywords="wrist-worn devices",
keywords="cardiovascular rehabilitation",
abstract="Background: Wrist-worn tracking devices such as the Apple Watch are becoming more integrated in health care. However, validation studies of these consumer devices remain scarce. Objectives: This study aimed to assess if mobile health technology can be used for monitoring home-based exercise in future cardiac rehabilitation programs. The purpose was to determine the accuracy of the Apple Watch in measuring heart rate (HR) and estimating energy expenditure (EE) during a cardiopulmonary exercise test (CPET) in patients with cardiovascular disease. Methods: Forty patients (mean age 61.9 [SD 15.2] yrs, 80\% male) with cardiovascular disease (70\% ischemic, 22.5\% valvular, 7.5\% other) completed a graded maximal CPET on a cycle ergometer while wearing an Apple Watch. A 12-lead electrocardiogram (ECG) was used to measure HR; indirect calorimetry was used for EE. HR was analyzed at three levels of intensity (seated rest, HR1; moderate intensity, HR2; maximal performance, HR3) for 30 seconds. The EE of the entire test was used. Bias or mean difference (MD), standard deviation of difference (SDD), limits of agreement (LoA), mean absolute error (MAE), mean absolute percentage error (MAPE), and intraclass correlation coefficients (ICCs) were calculated. Bland-Altman plots and scatterplots were constructed. Results: SDD for HR1, HR2, and HR3 was 12.4, 16.2, and 12.0 bpm, respectively. Bias and LoA (lower, upper LoA) were 3.61 (--20.74, 27.96) for HR1, 0.91 (--30.82, 32.63) for HR2, and --1.82 (--25.27, 21.63) for HR3. MAE was 6.34 for HR1, 7.55 for HR2, and 6.90 for HR3. MAPE was 10.69\% for HR1, 9.20\% for HR2, and 6.33\% for HR3. ICC was 0.729 (P<.001) for HR1, 0.828 (P<.001) for HR2, and 0.958 (P<.001) for HR3. Bland-Altman plots and scatterplots showed good correlation without systematic error when comparing Apple Watch with ECG measurements. SDD for EE was 17.5 kcal. Bias and LoA were 30.47 (--3.80, 64.74). MAE was 30.77; MAPE was 114.72\%. ICC for EE was 0.797 (P<.001). The Bland-Altman plot and a scatterplot directly comparing Apple Watch and indirect calorimetry showed systematic bias with an overestimation of EE by the Apple Watch. Conclusions: In patients with cardiovascular disease, the Apple Watch measures HR with clinically acceptable accuracy during exercise. If confirmed, it might be considered safe to incorporate the Apple Watch in HR-guided training programs in the setting of cardiac rehabilitation. At this moment, however, it is too early to recommend the Apple Watch for cardiac rehabilitation. Also, the Apple Watch systematically overestimates EE in this group of patients. Caution might therefore be warranted when using the Apple Watch for measuring EE. ",
doi="10.2196/11889",
url="http://mhealth.jmir.org/2019/3/e11889/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30888332"
}


@Article{info:doi/10.2196/12369,
author="Huang, Ching-Chang
and Chen, Ying-Hsien
and Hung, Chi-Sheng
and Lee, Jen-Kuang
and Hsu, Tse-Pin
and Wu, Hui-Wen
and Chuang, Pao-Yu
and Chen, Ming-Fong
and Ho, Yi-Lwun",
title="Assessment of the Relationship Between Ambient Temperature and Home Blood Pressure in Patients From a Web-Based Synchronous Telehealth Care Program: Retrospective Study",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="04",
volume="21",
number="3",
pages="e12369",
keywords="ambient temperature",
keywords="home blood pressure",
keywords="antihypertensive agents",
keywords="retrospective studies",
abstract="Background: Decreased ambient temperature significantly increases office blood pressure, but few studies have evaluated the effect of ambient temperature on home blood pressure. Objective: We aimed to investigate the relationship between short-term ambient temperature exposure and home blood pressure. Methods: We recruited patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital. Blood pressure was measured at home by patients or their caregivers. We obtained hourly meteorological data for Taipei (temperature, relative humidity, and wind speed) for the same time period from the Central Weather Bureau, Taiwan. Results: From 2009 to 2013, we enrolled a total of 253 patients. Mean patient age was 70.28 (SD 13.79) years, and 66.0\% (167/253) of patients were male. We collected a total of 110,715 home blood pressure measurements. Ambient temperature had a negative linear effect on all 3 home blood pressure parameters after adjusting for demographic and clinical factors and antihypertensive agents. A 1{\textdegree}C decrease was associated with a 0.5492-mm Hg increase in mean blood pressure, a 0.6841-mm Hg increase in systolic blood pressure, and a 0.2709-mm Hg increase in diastolic blood pressure. This temperature effect on home blood pressure was less prominent in patients with diabetes or hypertension. Antihypertensive agents modified this negative effect of temperature on home blood pressure to some extent, and angiotensin receptor blockers had the most favorable results. Conclusions: Short-term exposure to low ambient temperature significantly increased home blood pressure in patients with chronic cardiovascular diseases. Antihypertensive agents may modify this effect. ",
doi="10.2196/12369",
url="http://www.jmir.org/2019/3/e12369/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30829574"
}


@Article{info:doi/10.2196/13259,
author="Ware, Patrick
and Dorai, Mala
and Ross, J. Heather
and Cafazzo, A. Joseph
and Laporte, Audrey
and Boodoo, Chris
and Seto, Emily",
title="Patient Adherence to a Mobile Phone--Based Heart Failure Telemonitoring Program: A Longitudinal Mixed-Methods Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Feb",
day="26",
volume="7",
number="2",
pages="e13259",
keywords="telemonitoring",
keywords="mHealth",
keywords="adherence",
keywords="heart failure",
abstract="Background: Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients consistently adhere to taking prescribed home readings. Objective: The objectives of this study were to (1) quantify the degree to which patients adhered to taking prescribed home readings in the context of a mobile phone--based TM program and (2) explain longitudinal adherence rates based on the duration of program enrollment, patient characteristics, and patient perceptions of the TM program. Methods: A mixed-methods explanatory sequential design was used to meet the 2 research objectives, and all explanatory methods were guided by the unified theory of acceptance and use of technology 2 (UTAUT2). Overall adherence rates were calculated as the proportion of days patients took weight, blood pressure, heart rate, and symptom readings over the total number of days they were enrolled in the program up to 1 year. Monthly adherence rates were also calculated as the proportion of days patients took the same 4 readings over each 30-day period following program enrollment. Next, simple and multivariate regressions were performed to determine the influence of time, age, sex, and disease severity on adherence rates. Additional explanatory methods included questionnaires at 6 and 12 months probing patients on the perceived benefits and ease of use of the TM program, an analysis of reasons for patients leaving the program, and semistructured interviews conducted with a purposeful sampling of patients (n=24) with a range of adherence rates and demographics. Results: Overall average adherence was 73.6\% (SD 25.0) with average adherence rates declining over time at a rate of 1.4\% per month (P<.001). The multivariate regressions found no significant effect of sex and disease severity on adherence rates. When grouping patients' ages by decade, age was a significant predictor (P=.04) whereby older patients had higher adherence rates over time. Adherence rates were further explained by patients' perceptions with regard to the themes of (1) performance expectancy (improvements in HF management and peace of mind), (2) effort expectancy (ease of use and technical issues), (3) facilitating conditions (availability of technical support and automated adherence calls), (4) social influence (support from family, friends, and trusted clinicians), and (5) habit (degree to which taking readings became automatic). Conclusions: The decline in adherence rates over time is consistent with findings from other studies. However, this study also found adherence to be the highest and most consistent over time in older age groups and progressively lower over time for younger age groups. These findings can inform the design and implementation of TM interventions that maximize patient adherence, which will enable a more accurate evaluation of impact and optimization of resources. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9911 ",
doi="10.2196/13259",
url="http://mhealth.jmir.org/2019/2/e13259/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30806625"
}


@Article{info:doi/10.2196/11332,
author="Warner, E. Bronwen
and Velardo, Carmelo
and Salvi, Dario
and Lafferty, Kathryn
and Crosbie, Sarah
and Herrington, G. William
and Haynes, Richard",
title="Feasibility of Telemonitoring Blood Pressure in Patients With Kidney Disease (Oxford Heart and Renal Protection Study-1): Observational Study",
journal="JMIR Cardio",
year="2018",
month="Dec",
day="21",
volume="2",
number="2",
pages="e11332",
keywords="chronic kidney disease",
keywords="blood pressure",
keywords="telemonitoring",
keywords="mobile phone",
abstract="Background: Blood pressure (BP) is a key modifiable risk factor for patients with chronic kidney disease (CKD), with current guidelines recommending strict control to reduce the risk of progression of both CKD and cardiovascular disease. Trials involving BP lowering require multiple visits to achieve target BP, which increases the costs of such trials, and in routine care, BP measured in the clinic may not accurately reflect the usual BP. Objective: We sought to assess whether a telemonitoring system for BP (using a Bluetooth-enabled BP machine that could transmit BP measurements to a tablet device installed with a bespoke app to guide the measurement of BP and collect questionnaire data) was acceptable to patients with CKD and whether patients would provide sufficient BP readings to assess variability and guide treatment. Methods: A total of 25 participants with CKD were trained to use the telemonitoring equipment and asked to record BP daily for 30 days, attend a study visit, and then record BP on alternate days for the next 60 days. They were also offered a wrist-worn applanation tonometry device (BPro) which measures BP every 15 minutes over a 24-hour period. Participants were given questionnaires at the 1- and 3-month time points; the questionnaires were derived from the System Usability Scale and Technology Acceptance Model. All eligible participants completed the study. Results: Mean participant age was 58 (SD 11) years, and mean estimated glomerular filtration rate was 36 (SD 13) mL/min/1.73m2. 13/25 (52\%) participants provided >90\% of the expected data and 18/25 (72\%) provided >80\% of the expected data. The usability of the telemonitoring system was rated highly, with mean scores of 84.9/100 (SE 2.8) after 30 days and 84.2/100 (SE 4.1) after 90 days. The coefficient of variation for the variability of systolic BP telemonitoring was 9.4\% (95\% CI 7.8-10.9) compared with 7.9\% (95\% CI 6.4-9.5) for the BPro device, P=.05 (and was 9.0\% over 1 year in a recently completed trial with identical eligibility criteria), indicating that most variation in BP was short term. Conclusions: Telemonitoring is acceptable for patients with CKD and provides sufficient data to inform titration of antihypertensive therapies in either a randomized trial setting (comparing BP among different targets) or routine clinical practice. Such methods could be employed in both scenarios and reduce costs currently associated with such activities. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN13725286; http://www.isrctn.com/ISRCTN13725286 (Archived by WebCite at http://www.webcitation.org/74PAX51Ji). ",
doi="10.2196/11332",
url="http://cardio.jmir.org/2018/2/e11332/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30596204"
}


@Article{info:doi/10.2196/10319,
author="Isaranuwatchai, Wanrudee
and Redwood, Olwen
and Schauer, Adrian
and Van Meer, Tim
and Vall{\'e}e, Jonathan
and Clifford, Patrick",
title="A Remote Patient Monitoring Intervention for Patients With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Pre-Post Economic Analysis of the Smart Program",
journal="JMIR Cardio",
year="2018",
month="Dec",
day="20",
volume="2",
number="2",
pages="e10319",
keywords="chronic heart failure",
keywords="chronic obstructive pulmonary disease",
keywords="costs",
keywords="economic analysis",
keywords="emergency department visits",
keywords="hospitalizations",
keywords="health service utilization",
keywords="remote patient monitoring",
abstract="Background: Exacerbation of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are associated with high health care costs owing to increased emergency room (ER) visits and hospitalizations. Remote patient monitoring (RPM) interventions aim to improve the monitoring of symptoms to detect early deterioration and provide self-management strategies. As a result, RPM aims to reduce health resource utilization. To date, studies have inconsistently reported the benefits of RPM in chronic illnesses. The Smart Program is an RPM intervention that aims to provide clinical benefit to patients and economic benefit to health care payers. Objective: This study aims to economically evaluate the potential benefits of the Smart Program in terms of hospitalizations and ER visits and, thus, associated health care costs from the perspective of the public health care system. Methods: Seventy-four patients diagnosed with COPD or CHF from one hospital site were included in this one-group, pre-post study. The study involved a secondary data analysis of deidentified data collected during the study period -- from 3 months before program initiation (baseline), during the program, to 3 months after program completion (follow-up). Descriptive analysis was conducted for the study population characteristics at baseline, the clinical frailty score at baseline and 3-month follow-up, client satisfaction at 3-month follow-up, and number and costs of ER visits and hospitalizations throughout the study period. Furthermore, the cost of the Smart Program over a 3-month period was calculated from the perspective of the potential implementer. Results: The baseline characteristics of the study population (N=74) showed that the majority of patients had COPD (50/74, 68\%), were female (42/74, 57\%), and had an average age of 72 (SD 12) years. Using the Wilcoxon signed-rank test, the number of ER visits and hospitalizations, including their associated costs, were significantly reduced between baseline and 3-month follow-up (P<.001). The intervention showed a potential 68\% and 35\% reduction in ER visits and hospitalizations, respectively, between the 3-month pre- and 3-month postintervention period. The average cost of ER visits reduced from Can \$243 at baseline to Can \$67 during the 3-month follow-up, and reduced from Can \$3842 to Can \$1399 for hospitalizations. Conclusions: In this study, the number and cost of ER visits and hospitalizations appeared to be markedly reduced for patients with COPD or CHF when comparing data before and after the Smart Program implementation. Recognizing the limitations of the one-group, pre-post study design, RPM requires an upfront investment, but it has the potential to reduce health care costs to the system over time. This study represents another piece of evidence to support the potential value of RPM among patients with COPD or CHF. ",
doi="10.2196/10319",
url="http://cardio.jmir.org/2018/2/e10319/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758770"
}


@Article{info:doi/10.2196/11466,
author="Ware, Patrick
and Ross, J. Heather
and Cafazzo, A. Joseph
and Laporte, Audrey
and Gordon, Kayleigh
and Seto, Emily",
title="User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study",
journal="JMIR Cardio",
year="2018",
month="Dec",
day="06",
volume="2",
number="2",
pages="e11466",
keywords="telemonitoring",
keywords="mHealth",
keywords="diffusion of innovation",
keywords="heart failure",
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. ",
doi="10.2196/11466",
url="http://cardio.jmir.org/2018/2/e11466/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758774"
}


@Article{info:doi/10.2196/12048,
author="Lee, Ho Jang
and Park, Rang Yu
and Kweon, Solbi
and Kim, Seulgi
and Ji, Wonjun
and Choi, Chang-Min",
title="A Cardiopulmonary Monitoring System for Patient Transport Within Hospitals Using Mobile Internet of Things Technology: Observational Validation Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Nov",
day="14",
volume="6",
number="11",
pages="e12048",
keywords="wearable device",
keywords="patient safety",
keywords="intrahospital transport",
keywords="oxygen saturation",
keywords="heart rate",
keywords="mobile application",
keywords="real-time monitoring",
abstract="Background: During intrahospital transport, adverse events are inevitable. Real-time monitoring can be helpful for preventing these events during intrahospital transport. Objective: We attempted to determine the viability of risk signal detection using wearable devices and mobile apps during intrahospital transport. An alarm was sent to clinicians in the event of oxygen saturation below 90\%, heart rate above 140 or below 60 beats per minute (bpm), and network errors. We validated the reliability of the risk signal transmitted over the network. Methods: We used two wearable devices to monitor oxygen saturation and heart rate for 23 patients during intrahospital transport for diagnostic workup or rehabilitation. To determine the agreement between the devices, records collected every 4 seconds were matched and imputation was performed if no records were collected at the same time by both devices. We used intraclass correlation coefficients (ICC) to evaluate the relationships between the two devices. Results: Data for 21 patients were delivered to the cloud over LTE, and data for two patients were delivered over Wi-Fi. Monitoring devices were used for 20 patients during intrahospital transport for diagnostic work up and for three patients during rehabilitation. Three patients using supplemental oxygen before the study were included. In our study, the ICC for the heart rate between the two devices was 0.940 (95\% CI 0.939-0.942) and that of oxygen saturation was 0.719 (95\% CI 0.711-0.727). Systemic error analyzed with Bland-Altman analysis was 0.428 for heart rate and --1.404 for oxygen saturation. During the study, 14 patients had 20 risk signals: nine signals for eight patients with less than 90\% oxygen saturation, four for four patients with a heart rate of 60 bpm or less, and seven for five patients due to network error. Conclusions: We developed a system that notifies the health care provider of the risk level of a patient during transportation using a wearable device and a mobile app. Although there were some problems such as missing values and network errors, this paper is meaningful in that the previously mentioned risk detection system was validated with actual patients. ",
doi="10.2196/12048",
url="http://mhealth.jmir.org/2018/11/e12048/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30429115"
}


@Article{info:doi/10.2196/jmir.9181,
author="Walsh, MJ Deirdre
and Moran, Kieran
and Cornelissen, V{\'e}ronique
and Buys, Roselien
and Cornelis, Nils
and Woods, Catherine",
title="Electronic Health Physical Activity Behavior Change Intervention to Self-Manage Cardiovascular Disease: Qualitative Exploration of Patient and Health Professional Requirements",
journal="J Med Internet Res",
year="2018",
month="May",
day="08",
volume="20",
number="5",
pages="e163",
keywords="telemedicine",
keywords="exercise",
keywords="cardiovascular diseases",
keywords="rehabilitation",
abstract="Background: Cardiovascular diseases are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation. Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based cardiac rehabilitation programs is low, with community-based cardiac rehabilitation rates and individual long-term exercise maintenance even lower. Home-based cardiac rehabilitation programs have been shown to be equally effective in clinical and health-related quality of life outcomes and yet are not readily available. Objective: Given the potential that home-based cardiac rehabilitation programs have, it is important to explore how to appropriately design any such intervention in conjunction with key stakeholders. The aim of this study was to engage with individuals with cardiovascular disease and other professionals within the health ecosystem to (1) understand the personal, social, and physical factors that inhibit or promote their capacity to engage with physical activity and (2) explore their technology competencies, needs, and wants in relation to an eHealth intervention. Methods: Fifty-four semistructured interviews were conducted across two countries. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Barriers to the implementation of PATHway were also explored specifically in relation to physical capability and safety as well as technology readiness and further mapped onto the COM-B model for future intervention design. Results: Key recommendations included collection of patient data and use of measurements, harnessing hospital based social connections, and advice to utilize a patient-centered approach with personalization and tailoring to facilitate optimal engagement. Conclusions: In summary, a multifaceted, personalizable intervention with an inclusively designed interface was deemed desirable for use among cardiovascular disease patients both by end users and key stakeholders. In-depth understanding of core needs of the population can aid intervention development and acceptability. ",
doi="10.2196/jmir.9181",
url="http://www.jmir.org/2018/5/e163/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29739740"
}


@Article{info:doi/10.2196/cardio.9936,
author="Ammenwerth, Elske
and Modre-Osprian, Robert
and Fetz, Bettina
and Gstrein, Susanne
and Krestan, Susanne
and D{\"o}rler, Jakob
and Kastner, Peter
and Welte, Stefan
and Rissbacher, Clemens
and P{\"o}lzl, Gerhard",
title="HerzMobil, an Integrated and Collaborative Telemonitoring-Based Disease Management Program for Patients With Heart Failure: A Feasibility Study Paving the Way to Routine Care",
journal="JMIR Cardio",
year="2018",
month="Apr",
day="30",
volume="2",
number="1",
pages="e11",
keywords="heart failure",
keywords="telemedicine",
keywords="delivery of health care, integrated",
keywords="program evaluation",
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. ",
doi="10.2196/cardio.9936",
url="http://cardio.jmir.org/2018/1/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758765"
}


@Article{info:doi/10.2196/cardio.9075,
author="Hermans, C. Mathilde
and Van Mourik, S. Martijn
and Hermens, J. Hermie
and Baan Jr, Jan
and Vis, M. Marije",
title="Remote Monitoring of Patients Undergoing Transcatheter Aortic Valve Replacement: A Framework for Postprocedural Telemonitoring",
journal="JMIR Cardio",
year="2018",
month="Mar",
day="16",
volume="2",
number="1",
pages="e9",
keywords="transcatheter aortic valve replacement",
keywords="postoperative care",
keywords="electrocardiography",
keywords="telemonitoring",
keywords="telemedicine",
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. ",
doi="10.2196/cardio.9075",
url="http://cardio.jmir.org/2018/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758782"
}


@Article{info:doi/10.2196/cardio.8710,
author="Kropp, Caley
and Ellis, Jordan
and Nekkanti, Rajasekhar
and Sears, Samuel",
title="Monitoring Patients With Implantable Cardioverter Defibrillators Using Mobile Phone Electrocardiogram: Case Study",
journal="JMIR Cardio",
year="2018",
month="Feb",
day="21",
volume="2",
number="1",
pages="e5",
keywords="atrial fibrillation",
keywords="ICD",
keywords="ECG",
keywords="mobile phone monitoring",
keywords="mobile health",
keywords="electrophysiology",
abstract="Background: Preventable poor health outcomes associated with atrial fibrillation continue to make early detection a priority. A one-lead mobile electrocardiogram (mECG) device given to patients with an implantable cardioverter defibrillator (ICD) allowed users to receive real-time ECG readings in 30 seconds. Objective: Three cases were selected from an institutional review board-approved clinical trial aimed at assessing mECG device usage and satisfaction, patient engagement, quality of life (QoL), and cardiac anxiety. These three specific cases were selected to examine a variety of possible patient presentations and user experiences. Methods: Three ICD patients with mobile phones who were being seen in an adult device clinic were asked to participate. The participants chosen represented individuals with varying degrees of reported education and patient engagement. Participants were instructed to use the mECG device at least once per day for 30 days. Positive ECGs for atrial fibrillation were evaluated in clinic. At follow-up, information was collected regarding their frequency of use of the mECG device and three psychological outcomes in the domains of patient engagement, QoL, and cardiac anxiety. Results: Each patient used the technology approximately daily or every other day as prescribed. At the 30-day follow-up, usage reports indicated an average of 32 readings per month per participant. At 90-day follow-up, usage reports indicated an average of 34 readings per month per participant. Two of the three participants self-reported a significant improvement in their physical QoL from baseline to completion, while simultaneously self-reporting a significant decrease in their mental QoL. All three participants reported high levels of device acceptance and technology satisfaction. Conclusions: This case study demonstrates that ICD patients with varying degrees of education and patient engagement were relatively active in their use of mECGs. All three participants using the mECG technology reported high technology satisfaction and device acceptance. High sensitivity, specificity, and accuracy of mECG technology may allow routine atrial fibrillation screening at lower costs, in addition to improving patient outcomes. ",
doi="10.2196/cardio.8710",
url="http://cardio.jmir.org/2018/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758776"
}


@Article{info:doi/10.2196/jmir.7873,
author="Farnia, Troskah
and Jaulent, Marie-Christine
and Steichen, Olivier",
title="Evaluation Criteria of Noninvasive Telemonitoring for Patients With Heart Failure: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Jan",
day="16",
volume="20",
number="1",
pages="e16",
keywords="telemedicine",
keywords="outcome and process assessment (health care)",
keywords="program evaluation",
keywords="heart failure",
abstract="Background: Telemonitoring can improve heart failure (HF) management, but there is no standardized evaluation framework to comprehensively evaluate its impact. Objective: Our objectives were to list the criteria used in published evaluations of noninvasive HF telemonitoring projects, describe how they are used in the evaluation studies, and organize them into a consistent scheme. Methods: Articles published from January 1990 to August 2015 were obtained through MEDLINE, Web of Science, and EMBASE. Articles were eligible if they were original reports of a noninvasive HF telemonitoring evaluation study in the English language. Studies of implantable telemonitoring devices were excluded. Each selected article was screened to extract the description of the telemonitoring project and the evaluation process and criteria. A qualitative synthesis was performed. Results: We identified and reviewed 128 articles leading to 52 evaluation criteria classified into 6 dimensions: clinical, economic, user perspective, educational, organizational, and technical. The clinical and economic impacts were evaluated in more than 70\% of studies, whereas the educational, organizational, and technical impacts were studied in fewer than 15\%. User perspective was the most frequently covered dimension in the development phase of telemonitoring projects, whereas clinical and economic impacts were the focus of later phases. Conclusions: Telemonitoring evaluation frameworks should cover all 6 dimensions appropriately distributed along the telemonitoring project lifecycle. Our next goal is to build such a comprehensive evaluation framework for telemonitoring and test it on an ongoing noninvasive HF telemonitoring project. ",
doi="10.2196/jmir.7873",
url="http://www.jmir.org/2018/1/e16/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29339348"
}


@Article{info:doi/10.2196/mhealth.7058,
author="Lee, Heesun
and Park, Jun-Bean
and Choi, Won Sae
and Yoon, E. Yeonyee
and Park, Eun Hyo
and Lee, Eun Sang
and Lee, Seung-Pyo
and Kim, Hyung-Kwan
and Cho, Hyun-Jai
and Choi, Su-Yeon
and Lee, Hae-Young
and Choi, Jonghyuk
and Lee, Young-Joon
and Kim, Yong-Jin
and Cho, Goo-Yeong
and Choi, Jinwook
and Sohn, Dae-Won",
title="Impact of a Telehealth Program With Voice Recognition Technology in Patients With Chronic Heart Failure: Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Oct",
day="02",
volume="5",
number="10",
pages="e127",
keywords="heart failure",
keywords="telemedicine",
keywords="selfcare",
keywords="compliance",
abstract="Background: Despite the advances in the diagnosis and treatment of heart failure (HF), the current hospital-oriented framework for HF management does not appear to be sufficient to maintain the stability of HF patients in the long term. The importance of self-care management is increasingly being emphasized as a promising long-term treatment strategy for patients with chronic HF. Objective: The objective of this study was to evaluate whether a new information communication technology (ICT)--based telehealth program with voice recognition technology could improve clinical or laboratory outcomes in HF patients. Methods: In this prospective single-arm pilot study, we recruited 31 consecutive patients with chronic HF who were referred to our institute. An ICT-based telehealth program with voice recognition technology was developed and used by patients with HF for 12 weeks. Patients were educated on the use of this program via mobile phone, landline, or the Internet for the purpose of improving communication and data collection. Using these systems, we collected comprehensive data elements related to the risk of HF self-care management such as weight, diet, exercise, medication adherence, overall symptom change, and home blood pressure. The study endpoints were the changes observed in urine sodium concentration (uNa), Minnesota Living with Heart Failure (MLHFQ) scores, 6-min walk test, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) as surrogate markers for appropriate HF management. Results: Among the 31 enrolled patients, 27 (87\%) patients completed the study, and 10 (10/27, 37\%) showed good adherence to ICT-based telehealth program with voice recognition technology, which was defined as the use of the program for 100 times or more during the study period. Nearly three-fourths of the patients had been hospitalized at least once because of HF before the enrollment (20/27, 74\%); 14 patients had 1, 2 patients had 2, and 4 patients had 3 or more previous HF hospitalizations. In the total study population, there was no significant interval change in laboratory and functional outcome variables after 12 weeks of ICT-based telehealth program. In patients with good adherence to ICT-based telehealth program, there was a significant improvement in the mean uNa (103.1 to 78.1; P=.01) but not in those without (85.4 to 96.9; P=.49). Similarly, a marginal improvement in MLHFQ scores was only observed in patients with good adherence (27.5 to 21.4; P=.08) but not in their counterparts (19.0 to 19.7; P=.73). The mean 6-min walk distance and NT-proBNP were not significantly increased in patients regardless of their adherence. Conclusions: Short-term application of ICT-based telehealth program with voice recognition technology showed the potential to improve uNa values and MLHFQ scores in HF patients, suggesting that better control of sodium intake and greater quality of life can be achieved by this program. ",
doi="10.2196/mhealth.7058",
url="https://mhealth.jmir.org/2017/10/e127/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28970189"
}


@Article{info:doi/10.2196/mhealth.8290,
author="Chen, Ying-Hsien
and Hung, Chi-Sheng
and Huang, Ching-Chang
and Hung, Yu-Chien
and Hwang, Juey-Jen
and Ho, Yi-Lwun",
title="Atrial Fibrillation Screening in Nonmetropolitan Areas Using a Telehealth Surveillance System With an Embedded Cloud-Computing Algorithm: Prospective Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Sep",
day="26",
volume="5",
number="9",
pages="e135",
keywords="atrial fibrillation",
keywords="screen",
keywords="cloud-computing algorithm",
keywords="electrocardiography",
abstract="Background: Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. Objective: The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. Methods: We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Results: Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4\%, 22/922) residents with AF were identified by the physician's ECG interpretation, and only 0.2\% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5\% (95\% CI 77.2\%-99.9\%) and specificity of 97.7\% (95\% CI 96.5\%-98.5\%). The overall satisfaction score for the process of AF screening was 92.1\%. Conclusions: AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. ",
doi="10.2196/mhealth.8290",
url="https://mhealth.jmir.org/2017/9/e135/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28951384"
}


@Article{info:doi/10.2196/jmir.6931,
author="Hargreaves, Sarah
and Hawley, S. Mark
and Haywood, Annette
and Enderby, M. Pamela",
title="Informing the Design of ``Lifestyle Monitoring'' Technology for the Detection of Health Deterioration in Long-Term Conditions: A Qualitative Study of People Living With Heart Failure",
journal="J Med Internet Res",
year="2017",
month="Jun",
day="28",
volume="19",
number="6",
pages="e231",
keywords="independent living",
keywords="human activities",
keywords="heart failure",
keywords="biomedical technology",
abstract="Background: Health technologies are being developed to help people living at home manage long-term conditions. One such technology is ``lifestyle monitoring'' (LM), a telecare technology based on the idea that home activities may be monitored unobtrusively via sensors to give an indication of changes in health-state. However, questions remain about LM technology: how home activities change when participants experience differing health-states; and how sensors might capture clinically important changes to inform timely interventions. Objective: The objective of this paper was to report the findings of a study aimed at identifying changes in activity indicative of important changes in health in people with long-term conditions, particularly changes indicative of exacerbation, by exploring the relationship between home activities and health among people with heart failure (HF). We aimed to add to the knowledge base informing the development of home monitoring technologies designed to detect health deterioration in order to facilitate early intervention and avoid hospital admissions. Methods: This qualitative study utilized semistructured interviews to explore everyday activities undertaken during the three health-states of HF: normal days, bad days, and exacerbations. Potential recruits were identified by specialist nurses and attendees at an HF support group. The sample was purposively selected to include a range of experience of living with HF. Results: The sample comprised a total of 20 people with HF aged 50 years and above, and 11 spouses or partners of the individuals with HF. All resided in Northern England. Participant accounts revealed that home activities are in part shaped by the degree of intrusion from HF symptoms. During an exacerbation, participants undertook activities specifically to ease symptoms, and detailed activity changes were identified. Everyday activity was also influenced by a range of factors other than health. Conclusions: The study highlights the importance of careful development of LM technology to identify changes in activities that occur during clinically important changes in health. These detailed activity changes need to be considered by developers of LM sensors, platforms, and algorithms intended to detect early signs of deterioration. Results suggest that for LM to move forward, sensor set-up should be personalized to individual circumstances and targeted at individual health conditions. LM needs to take account of the uncertainties that arise from placing technology within the home, in order to inform sensor set-up and data interpretation. This targeted approach is likely to yield more clinically meaningful data and address some of the ethical issues of remote monitoring. ",
doi="10.2196/jmir.6931",
url="http://www.jmir.org/2017/6/e231/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28659253"
}


@Article{info:doi/10.2196/jmir.6688,
author="Hanlon, Peter
and Daines, Luke
and Campbell, Christine
and McKinstry, Brian
and Weller, David
and Pinnock, Hilary",
title="Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer",
journal="J Med Internet Res",
year="2017",
month="May",
day="17",
volume="19",
number="5",
pages="e172",
keywords="telehealth",
keywords="telemonitoring",
keywords="self-management",
keywords="chronic disease",
keywords="diabetes",
keywords="heart failure",
keywords="asthma",
keywords="COPD",
keywords="pulmonary disease, chronic obstructive",
keywords="cancer",
abstract="Background: Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. Objective: The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. Methods: We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. Results: We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma. Conclusions: While telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established. ",
doi="10.2196/jmir.6688",
url="http://www.jmir.org/2017/5/e172/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28526671"
}


@Article{info:doi/10.2196/jmir.6571,
author="Bashi, Nazli
and Karunanithi, Mohanraj
and Fatehi, Farhad
and Ding, Hang
and Walters, Darren",
title="Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews",
journal="J Med Internet Res",
year="2017",
month="Jan",
day="20",
volume="19",
number="1",
pages="e18",
keywords="systematic review",
keywords="patient monitoring",
keywords="mobile phone",
keywords="telemedicine",
keywords="heart failure",
abstract="Background: Many systematic reviews exist on the use of remote patient monitoring (RPM) interventions to improve clinical outcomes and psychological well-being of patients with heart failure. However, research is broadly distributed from simple telephone-based to complex technology-based interventions. The scope and focus of such evidence also vary widely, creating challenges for clinicians who seek information on the effect of RPM interventions. Objective: The aim of this study was to investigate the effects of RPM interventions on the health outcomes of patients with heart failure by synthesizing review-level evidence. Methods: We searched PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from 2005 to 2015. We screened reviews based on relevance to RPM interventions using criteria developed for this overview. Independent authors screened, selected, and extracted information from systematic reviews. AMSTAR (Assessment of Multiple Systematic Reviews) was used to assess the methodological quality of individual reviews. We used standardized language to summarize results across reviews and to provide final statements about intervention effectiveness. Results: A total of 19 systematic reviews met our inclusion criteria. Reviews consisted of RPM with diverse interventions such as telemonitoring, home telehealth, mobile phone--based monitoring, and videoconferencing. All-cause mortality and heart failure mortality were the most frequently reported outcomes, but others such as quality of life, rehospitalization, emergency department visits, and length of stay were also reported. Self-care and knowledge were less commonly identified. Conclusions: Telemonitoring and home telehealth appear generally effective in reducing heart failure rehospitalization and mortality. Other interventions, including the use of mobile phone--based monitoring and videoconferencing, require further investigation. ",
doi="10.2196/jmir.6571",
url="http://www.jmir.org/2017/1/e18/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28108430"
}



@Article{info:doi/10.2196/mhealth.5882,
author="Masterson Creber, M. Ruth
and Maurer, S. Mathew
and Reading, Meghan
and Hiraldo, Grenny
and Hickey, T. Kathleen
and Iribarren, Sarah",
title="Review and Analysis of Existing Mobile Phone Apps to Support Heart Failure Symptom Monitoring and Self-Care Management Using the Mobile Application Rating Scale (MARS)",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jun",
day="14",
volume="4",
number="2",
pages="e74",
keywords="mobile apps",
keywords="mobile health",
keywords="heart failure",
keywords="self-care",
keywords="self-management",
keywords="review",
keywords="symptom assessment",
keywords="nursing informatics",
abstract="Background: Heart failure is the most common cause of hospital readmissions among Medicare beneficiaries and these hospitalizations are often driven by exacerbations in common heart failure symptoms. Patient collaboration with health care providers and decision making is a core component of increasing symptom monitoring and decreasing hospital use. Mobile phone apps offer a potentially cost-effective solution for symptom monitoring and self-care management at the point of need. Objective: The purpose of this review of commercially available apps was to identify and assess the functionalities of patient-facing mobile health apps targeted toward supporting heart failure symptom monitoring and self-care management. Methods: We searched 3 Web-based mobile app stores using multiple terms and combinations (eg, ``heart failure,'' ``cardiology,'' ``heart failure and self-management''). Apps meeting inclusion criteria were evaluated using the Mobile Application Rating Scale (MARS), IMS Institute for Healthcare Informatics functionality scores, and Heart Failure Society of America (HFSA) guidelines for nonpharmacologic management. Apps were downloaded and assessed independently by 2-4 reviewers, interclass correlations between reviewers were calculated, and consensus was met by discussion. Results: Of 3636 potentially relevant apps searched, 34 met inclusion criteria. Most apps were excluded because they were unrelated to heart failure, not in English or Spanish, or were games. Interrater reliability between reviewers was high. AskMD app had the highest average MARS total (4.9/5). More than half of the apps (23/34, 68\%) had acceptable MARS scores (>3.0). Heart Failure Health Storylines (4.6) and AskMD (4.5) had the highest scores for behavior change. Factoring MARS, functionality, and HFSA guideline scores, the highest performing apps included Heart Failure Health Storylines, Symple, ContinuousCare Health App, WebMD, and AskMD. Peer-reviewed publications were identified for only 3 of the 34 apps. Conclusions: This review suggests that few apps meet prespecified criteria for quality, content, or functionality, highlighting the need for further refinement and mapping to evidence-based guidelines and room for overall quality improvement in heart failure symptom monitoring and self-care related apps. ",
doi="10.2196/mhealth.5882",
url="http://mhealth.jmir.org/2016/2/e74/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27302310"
}


@Article{info:doi/10.2196/jmir.4417,
author="Agboola, Stephen
and Jethwani, Kamal
and Khateeb, Kholoud
and Moore, Stephanie
and Kvedar, Joseph",
title="Heart Failure Remote Monitoring: Evidence From the Retrospective Evaluation of a Real-World Remote Monitoring Program",
journal="J Med Internet Res",
year="2015",
month="Apr",
day="22",
volume="17",
number="4",
pages="e101",
keywords="heart failure",
keywords="telemonitoring",
keywords="remote monitoring",
keywords="self-management",
keywords="hospitalizations",
keywords="mortality",
abstract="Background: Given the magnitude of increasing heart failure mortality, multidisciplinary approaches, in the form of disease management programs and other integrative models of care, are recommended to optimize treatment outcomes. Remote monitoring, either as structured telephone support or telemonitoring or a combination of both, is fast becoming an integral part of many disease management programs. However, studies reporting on the evaluation of real-world heart failure remote monitoring programs are scarce. Objective: This study aims to evaluate the effect of a heart failure telemonitoring program, Connected Cardiac Care Program (CCCP), on hospitalization and mortality in a retrospective database review of medical records of patients with heart failure receiving care at the Massachusetts General Hospital. Methods: Patients enrolled in the CCCP heart failure monitoring program at the Massachusetts General Hospital were matched 1:1 with usual care patients. Control patients received care from similar clinical settings as CCCP patients and were identified from a large clinical data registry. The primary endpoint was all-cause mortality and hospitalizations assessed during the 4-month program duration. Secondary outcomes included hospitalization and mortality rates (obtained by following up on patients over an additional 8 months after program completion for a total duration of 1 year), risk for multiple hospitalizations and length of stay. The Cox proportional hazard model, stratified on the matched pairs, was used to assess primary outcomes. Results: A total of 348 patients were included in the time-to-event analyses. The baseline rates of hospitalizations prior to program enrollment did not differ significantly by group. Compared with controls, hospitalization rates decreased within the first 30 days of program enrollment: hazard ratio (HR)=0.52, 95\% CI 0.31-0.86, P=.01). The differential effect on hospitalization rates remained consistent until the end of the 4-month program (HR=0.74, 95\% CI 0.54-1.02, P=.06). The program was also associated with lower mortality rates at the end of the 4-month program: relative risk (RR)=0.33, 95\% 0.11-0.97, P=.04). Additional 8-months follow-up following program completion did not show residual beneficial effects of the CCCP program on mortality (HR=0.64, 95\% 0.34-1.21, P=.17) or hospitalizations (HR=1.12, 95\% 0.90-1.41, P=.31). Conclusions: CCCP was associated with significantly lower hospitalization rates up to 90 days and significantly lower mortality rates over 120 days of the program. However, these effects did not persist beyond the 120-day program duration. ",
doi="10.2196/jmir.4417",
url="http://www.jmir.org/2015/4/e101/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25903278"
}


@Article{info:doi/10.2196/mhealth.3789,
author="Zan, Shiyi
and Agboola, Stephen
and Moore, A. Stephanie
and Parks, A. Kimberly
and Kvedar, C. Joseph
and Jethwani, Kamal",
title="Patient Engagement With a Mobile Web-Based Telemonitoring System for Heart Failure Self-Management: A Pilot Study",
journal="JMIR mHealth uHealth",
year="2015",
month="Apr",
day="01",
volume="3",
number="2",
pages="e33",
keywords="heart failure",
keywords="disease self-management",
keywords="remote monitoring",
keywords="telemonitoring",
keywords="interactive voice response system",
keywords="mobile health",
keywords="Web portal",
keywords="patient engagement",
keywords="quality of life",
abstract="Background: Intensive remote monitoring programs for congestive heart failure have been successful in reducing costly readmissions, but may not be appropriate for all patients. There is an opportunity to leverage the increasing accessibility of mobile technologies and consumer-facing digital devices to empower patients in monitoring their own health outside of the hospital setting. The iGetBetter system, a secure Web- and telephone-based heart failure remote monitoring program, which leverages mobile technology and portable digital devices, offers a creative solution at lower cost. Objective: The objective of this pilot study was to evaluate the feasibility of using the iGetBetter system for disease self-management in patients with heart failure. Methods: This was a single-arm prospective study in which  21 ambulatory, adult heart failure patients used the intervention for heart failure self-management over a 90-day study period. Patients were instructed to take their weight, blood pressure, and heart rate measurements each morning using a WS-30 bluetooth weight scale, a self-inflating blood pressure cuff (Withings LLC, Issy les Moulineaux, France), and an iPad Mini tablet computer (Apple Inc, Cupertino, CA, USA) equipped with cellular Internet connectivity to view their measurements on the Internet. Outcomes assessed included usability and satisfaction, engagement with the intervention, hospital resource utilization, and heart failure-related quality of life. Descriptive statistics were used to summarize data, and matched controls identified from the electronic medical record were used as comparison for evaluating hospitalizations. Results: There were 20 participants (mean age 53 years) that completed the study. Almost all participants (19/20, 95\%) reported feeling more connected to their health care team and more confident in performing care plan activities, and 18/20 (90\%) felt better prepared to start discussions about their health with their doctor. Although heart failure-related quality of life improved from baseline, it was not statistically significant (P=.55). Over half of the participants had greater than 80\% (72/90 days) weekly and overall engagement with the program, and 15\% (3/20) used the interactive voice response telephone system exclusively for managing their care plan. Hospital utilization did not differ in the intervention group compared to the control group (planned hospitalizations P=.23, and unplanned hospitalizations P=.99). Intervention participants recorded shorter average length of hospital stay, but no significant differences were observed between intervention and control groups (P=.30). Conclusions: This pilot study demonstrated the feasibility of a low-intensive remote monitoring program leveraging commonly used mobile and portable consumer devices in augmenting care for a fairly young population of ambulatory patients with heart failure. Further prospective studies with a larger sample size and within more diverse patient populations is necessary to determine the effect of mobile-based remote monitoring programs such as the iGetBetter system on clinical outcomes in heart failure. ",
doi="10.2196/mhealth.3789",
url="http://mhealth.jmir.org/2015/2/e33/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25842282"
}


@Article{info:doi/10.2196/jmir.3651,
author="Vuorinen, Anna-Leena
and Lepp{\"a}nen, Juha
and Kaijanranta, Hannu
and Kulju, Minna
and Heli{\"o}, Tiina
and van Gils, Mark
and L{\"a}hteenm{\"a}ki, Jaakko",
title="Use of Home Telemonitoring to Support Multidisciplinary Care of Heart Failure Patients in Finland: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2014",
month="Dec",
day="11",
volume="16",
number="12",
pages="e282",
keywords="heart failure",
keywords="telemonitoring",
keywords="hospitalization",
keywords="user experience",
keywords="clinical outcomes",
keywords="EHFSBS",
keywords="health care resources",
abstract="Background: Heart failure (HF) patients suffer from frequent and repeated hospitalizations, causing a substantial economic burden on society. Hospitalizations can be reduced considerably by better compliance with self-care. Home telemonitoring has the potential to boost patients' compliance with self-care, although the results are still contradictory. Objective: A randomized controlled trial was conducted in order to study whether the multidisciplinary care of heart failure patients promoted with telemonitoring leads to decreased HF-related hospitalization. Methods: HF patients were eligible whose left ventricular ejection fraction was lower than 35\%, NYHA functional class ?2, and who needed regular follow-up. Patients in the telemonitoring group (n=47) measured their body weight, blood pressure, and pulse and answered symptom-related questions on a weekly basis, reporting their values to the heart failure nurse using a mobile phone app. The heart failure nurse followed the status of patients weekly and if necessary contacted the patient. The primary outcome was the number of HF-related hospital days. Control patients (n=47) received multidisciplinary treatment according to standard practices. Patients' clinical status, use of health care resources, adherence, and user experience from the patients' and the health care professionals' perspective were studied. Results: Adherence, calculated as a proportion of weekly submitted self-measurements, was close to 90\%. No difference was found in the number of HF-related hospital days (incidence rate ratio [IRR]=0.812, P=.351), which was the primary outcome. The intervention group used more health care resources: they paid an increased number of visits to the nurse (IRR=1.73, P<.001), spent more time at the nurse reception (mean difference of 48.7 minutes, P<.001), and there was a greater number of telephone contacts between the nurse and intervention patients (IRR=3.82, P<.001 for nurse-induced contacts and IRR=1.63, P=.049 for patient-induced contacts). There were no statistically significant differences in patients' clinical health status or in their self-care behavior. The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study. Conclusions: Home telemonitoring did not reduce the number of patients' HF-related hospital days and did not improve the patients' clinical condition. Patients in the telemonitoring group contacted the Cardiology Outpatient Clinic more frequently, and on this way increased the use of health care resources. Trial Registration: Clinicaltrials.gov NCT01759368; http://clinicaltrials.gov/show/NCT01759368 (Archived by WebCite at http://www.webcitation.org/6UFxiCk8Z). ",
doi="10.2196/jmir.3651",
url="http://www.jmir.org/2014/12/e282/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25498992"
}


@Article{info:doi/10.2196/ijmr.2824,
author="Luzi, Mario
and De Simone, Antonio
and Leoni, Loira
and Amellone, Claudia
and Pisan{\`o}, Ennio
and Favale, Stefano
and Iacoviello, Massimo
and Luise, Raffaele
and Bongiorni, Grazia Maria
and Stabile, Giuseppe
and La Rocca, Vincenzo
and Folino, Franco
and Capucci, Alessandro
and D'Onofrio, Antonio
and Accardi, Francesco
and Valsecchi, Sergio
and Buia, Gianfranco",
title="Remote Monitoring for Implantable Defibrillators: A Nationwide Survey in Italy",
journal="Interact J Med Res",
year="2013",
month="Sep",
day="20",
volume="2",
number="2",
pages="e27",
keywords="implantable defibrillator",
keywords="remote monitoring",
keywords="follow-up",
abstract="Background: Remote monitoring (RM) permits home interrogation of implantable cardioverter defibrillator (ICD) and provides an alternative option to frequent in-person visits. Objective: The Italia-RM survey aimed to investigate the current practice of ICD follow-up in Italy and to evaluate the adoption and routine use of RM. Methods: An ad hoc questionnaire on RM adoption and resource use during in-clinic and remote follow-up sessions was completed in 206 Italian implanting centers. Results: The frequency of routine in-clinic ICD visits was 2 per year in 158/206 (76.7\%) centers, 3 per year in 37/206 (18.0\%) centers, and 4 per year in 10/206 (4.9\%) centers. Follow-up examinations were performed by a cardiologist in 203/206 (98.5\%) centers, and by more than one health care worker in 184/206 (89.3\%) centers. There were 137/206 (66.5\%) responding centers that had already adopted an RM system, the proportion of ICD patients remotely monitored being 15\% for single- and dual-chamber ICD and 20\% for cardiac resynchronization therapy ICD. Remote ICD interrogations were scheduled every 3 months, and were performed by a cardiologist in 124/137 (90.5\%) centers. After the adoption of RM, the mean time between in-clinic visits increased from 5 (SD 1) to 8 (SD 3) months (P<.001). Conclusions: In current clinical practice, in-clinic ICD follow-up visits consume a large amount of health care resources. The results of this survey show that RM has only partially been adopted in Italy and, although many centers have begun to implement RM in their clinical practice, the majority of their patients continue to be routinely followed-up by means of in-clinic visits. ",
doi="10.2196/ijmr.2824",
url="http://www.i-jmr.org/2013/2/e27/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24055720"
}


@Article{info:doi/10.2196/jmir.2587,
author="Zanaboni, Paolo
and Landolina, Maurizio
and Marzegalli, Maurizio
and Lunati, Maurizio
and Perego, B. Giovanni
and Guenzati, Giuseppe
and Curnis, Antonio
and Valsecchi, Sergio
and Borghetti, Francesca
and Borghi, Gabriella
and Masella, Cristina",
title="Cost-Utility Analysis of the EVOLVO Study on Remote Monitoring for Heart Failure Patients With Implantable Defibrillators: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2013",
month="May",
day="30",
volume="15",
number="5",
pages="e106",
keywords="telemedicine",
keywords="heart failure",
keywords="implantable defibrillators",
keywords="cost-effectiveness",
abstract="Background: Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. Objective: We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators. Methods: Two hundred patients implanted with a wireless transmission--enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained. Results: Overall, remote monitoring did not show significant annual cost savings for the health care system ({\texteuro}1962.78 versus {\texteuro}2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm ({\texteuro}291.36 versus {\texteuro}381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of {\texteuro}888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution. Conclusions: Remote management of heart failure patients with implantable defibrillators appears to be cost-effective compared to the conventional method of in-person evaluations. Trial Registration: ClinicalTrials.gov NCT00873899; http://clinicaltrials.gov/show/NCT00873899 (Archived by WebCite at http://www.webcitation.org/6H0BOA29f). ",
doi="10.2196/jmir.2587",
url="http://www.jmir.org/2013/5/e106/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23722666"
}


@Article{info:doi/10.2196/jmir.1909,
author="Seto, Emily
and Leonard, J. Kevin
and Cafazzo, A. Joseph
and Barnsley, Jan
and Masino, Caterina
and Ross, J. Heather",
title="Mobile Phone-Based Telemonitoring for Heart Failure Management:  A Randomized Controlled Trial",
journal="J Med Internet Res",
year="2012",
month="Feb",
day="16",
volume="14",
number="1",
pages="e31",
keywords="heart failure",
keywords="telemedicine",
keywords="mobile phone",
keywords="patient monitoring",
keywords="randomized controlled trial",
abstract="Background: Previous trials of telemonitoring for heart failure management have reported inconsistent results, largely due to diverse intervention and study designs. Mobile phones are becoming ubiquitous and economical, but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined. Objective: The objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes. Methods: One hundred patients were recruited from a heart function clinic and randomized into telemonitoring and control groups. The telemonitoring group (N = 50) took daily weight and blood pressure readings and weekly single-lead ECGs, and answered daily symptom questions on a mobile phone over 6 months. Readings were automatically transmitted wirelessly to the mobile phone and then to data servers. Instructions were sent to the patients' mobile phones and alerts to a cardiologist's mobile phone as required. Results: Baseline questionnaires were completed and returned by 94 patients, and 84 patients returned post-study questionnaires. About 70\% of telemonitoring patients completed at least 80\% of their possible daily readings. The change in quality of life from baseline to post-study, as measured with the Minnesota Living with Heart Failure Questionnaire, was significantly greater for the telemonitoring group compared to the control group (P = .05). A between-group analysis also found greater post-study self-care maintenance (measured with the Self-Care of Heart Failure Index) for the telemonitoring group (P = .03). Brain natriuretic peptide (BNP) levels, self-care management, and left ventricular ejection fraction (LVEF) improved significantly for both groups from baseline to post-study, but did not show a between-group difference. However, a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the telemonitoring group had significant improvements from baseline to post-study in BNP (decreased by 150 pg/mL, P = .02), LVEF (increased by 7.4\%, P = .005) and self-care maintenance (increased by 7 points, P = .05) and management (increased by 14 points, P = .03), while the control group did not. No differences were found between the telemonitoring and control groups in terms of hospitalization, mortality, or emergency department visits, but the trial was underpowered to detect differences in these metrics. Conclusions: Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based telemonitoring system. The use of the mobile phone-based system had high adherence and was feasible for patients, including the elderly and those with no experience with mobile phones. Trial Registration: ClinicalTrials.gov NCT00778986 ",
doi="10.2196/jmir.1909",
url="http://www.jmir.org/2012/1/e31/",
url="http://www.ncbi.nlm.nih.gov/pubmed/22356799"
}


@Article{info:doi/10.2196/jmir.1912,
author="Seto, Emily
and Leonard, J. Kevin
and Cafazzo, A. Joseph
and Barnsley, Jan
and Masino, Caterina
and Ross, J. Heather",
title="Perceptions and Experiences of Heart Failure Patients and Clinicians on the Use of Mobile Phone-Based Telemonitoring",
journal="J Med Internet Res",
year="2012",
month="Feb",
day="10",
volume="14",
number="1",
pages="e25",
keywords="heart failure",
keywords="telemonitoring",
keywords="mobile phone",
keywords="patient monitoring",
keywords="self-care",
keywords="qualitative research",
abstract="Background: Previous trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs. Objectives: The objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring. Methods: Semi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based telemonitoring system for 6 months. The telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient's mobile phone based on their physiological values. Alerts were also sent to a cardiologist's mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach. Results: The telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients' heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from telemonitoring. Some clinical concerns included ongoing costs of the telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system. Conclusions: The success of a telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing telemonitoring solutions. Key Words: ",
doi="10.2196/jmir.1912",
url="http://www.jmir.org/2012/1/e25/",
url="http://www.ncbi.nlm.nih.gov/pubmed/22328237"
}