@Article{info:doi/10.2196/57368,
author="Su, Jing Jing
and Lin, Rose
and Batalik, Ladislav
and Wong, Ching Arkers Kwan
and Grace, L. Sherry",
title="Psychological eHealth Interventions for Patients With Cardiovascular Diseases: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="7",
volume="27",
pages="e57368",
keywords="cardiovascular diseases",
keywords="eHealth",
keywords="digital health",
keywords="iCBT",
keywords="mental health",
keywords="psychological intervention",
keywords="cognitive behavioral therapy",
keywords="CBT",
keywords="depression",
keywords="heart",
keywords="cardiology",
keywords="psychological",
keywords="anxiety",
keywords="high-risk",
keywords="systematic review",
keywords="meta-analysis",
keywords="CVD",
keywords="evidence-based",
keywords="psychosocial",
keywords="GRADE approach",
keywords="Cochrane Risk of Bias Tool",
keywords="internet-based",
keywords="psychological therapy",
keywords="psychotherapy",
abstract="Background: Psychological distress is recognized as an independent risk factor for cardiovascular diseases (CVDs), contributing to increased morbidity and mortality. While eHealth is increasingly used to deliver psychological interventions, their effectiveness for patients with CVDs remains unclear. Objective: This meta-analysis aimed to evaluate the effects of eHealth psychological interventions for patients with CVDs. Methods: Eligible studies were retrieved from 5 databases (Embase, Medline, PubMed, CINAHL, and Cochrane Library), covering the period from database inception to December 2024. Randomized controlled trials (RCTs) investigating the effect of evidence-based psychological eHealth interventions to improve psychosocial well-being and cardiovascular outcomes for people with CVDs were included. The Cochrane Risk of Bias tool (version 2) was used to judge the methodological quality of reviewed studies. RevMan (version 5.3) was used for meta-analysis. Results: A total of 12 RCTs, comprising 2319 participants from 10 countries, were included in the review. The results demonstrated significant alleviation of depressive symptoms for patients receiving psychological eHealth intervention compared to controls (number of paper included in that particular analysis, n=7; standardized mean difference=--0.30, 95\% CI --0.47 to --0.14; I2=57\%; P<.001). More specifically, in 6 trials where internet-based cognitive behavioral therapy was delivered, a significant alleviation of depressive symptoms was achieved (standardized mean difference=--0.39, 95\% CI --0.56 to --0.21; I2=53\%; P<.001). There was no significant change in anxiety or quality of life. Synthesis without meta-analysis regarding stress, adverse events, and cardiovascular events showed inconclusive findings. Conclusions: Psychological eHealth interventions, particularly internet-based cognitive behavioral therapy, can significantly reduce depressive symptoms among patients with CVDs. A multidisciplinary approach is crucial for comprehensively improving psychological and cardiovascular outcomes. Future studies should explore integrating persuasive design features into eHealth and involving mental health professionals for intervention delivery. Trial Registration: PROSPERO CRD42023452276; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023452276 ",
doi="10.2196/57368",
url="https://www.jmir.org/2025/1/e57368"
}


@Article{info:doi/10.2196/65366,
author="Lee, Yugyung
and Shelke, Sushil
and Lee, Chi",
title="Cardiac Repair and Regeneration via Advanced Technology: Narrative Literature Review",
journal="JMIR Biomed Eng",
year="2025",
month="Mar",
day="8",
volume="10",
pages="e65366",
keywords="advanced technologies",
keywords="genetics",
keywords="biomaterials",
keywords="bioengineering",
keywords="medical devices",
keywords="implantable devices",
keywords="wearables",
keywords="cardiovascular repair and regeneration",
keywords="cardiac care",
keywords="cardiovascular disease",
abstract="Background: Cardiovascular diseases (CVDs) are the leading cause of death globally, and almost one-half of all adults in the United States have at least one form of heart disease. This review focused on advanced technologies, genetic variables in CVD, and biomaterials used for organ-independent cardiovascular repair systems. Objective: A variety of implantable and wearable devices, including biosensor-equipped cardiovascular stents and biocompatible cardiac patches, have been developed and evaluated. The incorporation of those strategies will hold a bright future in the management of CVD in advanced clinical practice. Methods: This study employed widely used academic search systems, such as Google Scholar, PubMed, and Web of Science. Recent progress in diagnostic and treatment methods against CVD, as described in the content, are extensively examined. The innovative bioengineering, gene delivery, cell biology, and artificial intelligence--based technologies that will continuously revolutionize biomedical devices for cardiovascular repair and regeneration are also discussed. The novel, balanced, contemporary, query-based method adapted in this manuscript defined the extent to which an updated literature review could efficiently provide research on the evidence-based, comprehensive applicability of cardiovascular devices for clinical treatment against CVD. Results: Advanced technologies along with artificial intelligence--based telehealth will be essential to create efficient implantable biomedical devices, including cardiovascular stents. The proper statistical approaches along with results from clinical studies including model-based risk probability prediction from genetic and physiological variables are integral for monitoring and treatment of CVD risk. Conclusions: To overcome the current obstacles in cardiac repair and regeneration and achieve successful therapeutic applications, future interdisciplinary collaborative work is essential. Novel cardiovascular devices and their targeted treatments will accomplish enhanced health care delivery and improved therapeutic efficacy against CVD. As the review articles contain comprehensive sources for state-of-the-art evidence for clinicians, these high-quality reviews will serve as a first outline of the updated progress on cardiovascular devices before undertaking clinical studies. ",
doi="10.2196/65366",
url="https://biomedeng.jmir.org/2025/1/e65366"
}


@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/10.2196/59539,
author="Br{\"u}gger, Victoria
and Kowatsch, Tobias
and Jovanova, Mia",
title="Wearables and Smartphones for Tracking Modifiable Risk Factors in Metabolic Health: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="28",
volume="13",
pages="e59539",
keywords="wearable",
keywords="smartphone",
keywords="mHealth",
keywords="metabolic disease",
keywords="lifestyle",
keywords="physiological",
keywords="risk factor",
keywords="mobile phone",
abstract="Background: Metabolic diseases, such as cardiovascular diseases and diabetes, contribute significantly to global mortality and disability. Wearable devices and smartphones are increasingly used to track and manage modifiable risk factors associated with metabolic diseases. However, no established guidelines exist on how to derive meaningful signals from these devices, often hampering cross-study comparisons. Objective: This study aims to systematically overview the current empirical literature on how wearables and smartphones are used to track modifiable (physiological and lifestyle) risk factors associated with metabolic diseases. Methods: We will conduct a scoping review to overview how wearable and smartphone-based studies measure modifiable risk factors related to metabolic diseases. We will search 5 databases (Scopus, Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and SPORTDiscus) from 2019 to 2024, with search terms related to wearables, smartphones, and modifiable risk factors associated with metabolic diseases. Eligible studies will use smartphones or wearables (worn on the wrist, finger, arm, hip, and chest) to track physiological or lifestyle factors related to metabolic diseases. We will follow the reporting guideline standards from PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) guidance on scoping review methodology. Two reviewers will independently screen articles for inclusion and extract data using a standardized form. The findings will be synthesized and reported qualitatively and quantitatively. Results: Data collection is expected to begin in November 2024; data analysis in the first quarter of 2025; and submission to a peer-reviewed journal by the second quarter of 2025. We expect to identify the degree to which wearable and smartphone-based studies track modifiable risk factors collectively (versus in isolation), and the consistency and variation in how modifiable risk factors are measured across existing studies. Conclusions: Results are expected to inform more standardized guidelines on wearable and smartphone-based measurements, with the goal of aiding cross-study comparison. The final report is planned for submission to a peer-reviewed, indexed journal. This review is among the first to systematically overview the current landscape on how wearables and smartphones measure modifiable risk factors associated with metabolic diseases. International Registered Report Identifier (IRRID): PRR1-10.2196/59539 ",
doi="10.2196/59539",
url="https://www.researchprotocols.org/2024/1/e59539"
}


@Article{info:doi/10.2196/54318,
author="Chen, Yang
and Jin, Xingsheng
and Chen, Guochong
and Wang, Ru
and Tian, Haili",
title="Dose-Response Relationship Between Physical Activity and the Morbidity and Mortality of Cardiovascular Disease Among Individuals With Diabetes: Meta-Analysis of Prospective Cohort Studies",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="19",
volume="10",
pages="e54318",
keywords="cardiovascular risk",
keywords="diabetics",
keywords="exercise",
keywords="dose-response association",
keywords="meta-analysis",
keywords="physical activity",
keywords="diabetes",
abstract="Background: Diabetes, a chronic condition affecting various organs, is frequently associated with abnormal lipid metabolism, notably increased cholesterol and triglyceride levels. These lipid abnormalities are closely linked to the development and advancement of cardiovascular disease (CVD). Although regular physical activity (PA) has consistently shown benefits in reducing CVD risk in the general population, its precise influence on CVD risk among patients with diabetes remains uncertain, particularly regarding dose-response relationships. Objective: This study aimed to summarize the evidence from prospective studies on the association between PA and CVD morbidity and mortality in individuals with diabetes and explore the optimal levels for public health recommendation. Methods: We systematically reviewed prospective cohort studies in PubMed, Embase, and Web of Science up to December 2022, with inclusion criteria specifying the studies published in English and included adult participants diagnosed with diabetes. A random effects model was used to pool the relative risk (RR) with the corresponding 95\% CI comparing the highest with the lowest PA categories in each study for qualitative evaluation. In addition, linear and spline regression analyses were used to estimate dose-response associations. Results: The meta-analysis included 12 prospective cohort studies, involving a total of 109,820 participants with diabetes. The combined results revealed that higher levels of PA were associated with a reduced risk of CVD. The RR of CVD for the highest compared with the lowest PA category was 0.62 (95\% CI 0.51-0.73). In addition, there were 4 studies describing leisure-time PA, and the pooled RR was 0.68 (95\% CI 0.52-0.83) for the highest versus the lowest activity. The linear regression model revealed that each 10 MET (metabolic equivalent of task)-hours per week of incrementally higher PA was associated with a 19\% (95\% CI 11.6-25.7) and a 6.9\% (95\% CI 4.5-9.3) reduction in CVD morbidity and mortality. Additionally, spline regression curves showed nonlinear relationships between PA levels and the risk of CVD and CVD mortality (both Pnonlinearity<.001), with a limited reduction in CVD risk and some further reduction in CVD mortality above 20 MET-hours per week of PA levels. Conclusions: For patients with diabetes, especially type 2 diabetes, there was a dose-response relationship between increased PA and reduced risk of CVD morbidity and mortality. The observed PA threshold is consistent with the recommended level for the general population. Gradually moving from inactivity to a guideline-recommended PA level could therefore significantly reduce the burden of CVD in patients with diabetes. ",
doi="10.2196/54318",
url="https://publichealth.jmir.org/2024/1/e54318",
url="http://www.ncbi.nlm.nih.gov/pubmed/38780218"
}


@Article{info:doi/10.2196/52973,
author="Kashyap, Nick
and Sebastian, Tresa Ann
and Lynch, Chris
and Jansons, Paul
and Maddison, Ralph
and Dingler, Tilman
and Oldenburg, Brian",
title="Engagement With Conversational Agent--Enabled Interventions in Cardiometabolic Disease Management: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="7",
volume="13",
pages="e52973",
keywords="cardiometabolic disease",
keywords="cardiovascular disease",
keywords="diabetes",
keywords="chronic disease",
keywords="chatbot",
keywords="acceptability",
keywords="technology acceptance model",
keywords="design",
keywords="natural language processing",
keywords="adult",
keywords="heart failure",
keywords="digital health intervention",
keywords="Australia",
keywords="systematic review",
keywords="meta-analysis",
keywords="digital health",
keywords="conversational agent--enabled",
keywords="health informatics",
keywords="management",
abstract="Background: Cardiometabolic diseases (CMDs) are a group of interrelated conditions, including heart failure and diabetes, that increase the risk of cardiovascular and metabolic complications. The rising number of Australians with CMDs has necessitated new strategies for those managing these conditions, such as digital health interventions. The effectiveness of digital health interventions in supporting people with CMDs is dependent on the extent to which users engage with the tools. Augmenting digital health interventions with conversational agents, technologies that interact with people using natural language, may enhance engagement because of their human-like attributes. To date, no systematic review has compiled evidence on how design features influence the engagement of conversational agent--enabled interventions supporting people with CMDs. This review seeks to address this gap, thereby guiding developers in creating more engaging and effective tools for CMD management. Objective: The aim of this systematic review is to synthesize evidence pertaining to conversational agent--enabled intervention design features and their impacts on the engagement of people managing CMD. Methods: The review is conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches will be conducted in the Ovid (Medline), Web of Science, and Scopus databases, which will be run again prior to manuscript submission. Inclusion criteria will consist of primary research studies reporting on conversational agent--enabled interventions, including measures of engagement, in adults with CMD. Data extraction will seek to capture the perspectives of people with CMD on the use of conversational agent--enabled interventions. Joanna Briggs Institute critical appraisal tools will be used to evaluate the overall quality of evidence collected. Results: This review was initiated in May 2023 and was registered with the International Prospective Register of Systematic Reviews (PROSPERO) in June 2023, prior to title and abstract screening. Full-text screening of articles was completed in July 2023 and data extraction began August 2023. Final searches were conducted in April 2024 prior to finalizing the review and the manuscript was submitted for peer review in July 2024. Conclusions: This review will synthesize diverse observations pertaining to conversational agent--enabled intervention design features and their impacts on engagement among people with CMDs. These observations can be used to guide the development of more engaging conversational agent--enabled interventions, thereby increasing the likelihood of regular intervention use and improved CMD health outcomes. Additionally, this review will identify gaps in the literature in terms of how engagement is reported, thereby highlighting areas for future exploration and supporting researchers in advancing the understanding of conversational agent--enabled interventions. Trial Registration: PROSPERO CRD42023431579; https://tinyurl.com/55cxkm26 International Registered Report Identifier (IRRID): DERR1-10.2196/52973 ",
doi="10.2196/52973",
url="https://www.researchprotocols.org/2024/1/e52973",
url="http://www.ncbi.nlm.nih.gov/pubmed/39110504"
}


@Article{info:doi/10.2196/55699,
author="Markovi{\v c}, Rene
and Ternar, Luka
and Trstenjak, Tim
and Marhl, Marko
and Grubelnik, Vladimir",
title="Cardiovascular Comorbidities in COVID-19: Comprehensive Analysis of Key Topics",
journal="Interact J Med Res",
year="2024",
month="Jul",
day="24",
volume="13",
pages="e55699",
keywords="COVID-19",
keywords="cardiovascular diseases",
keywords="metabolic disorders",
keywords="embolism and thrombosis",
keywords="hypertension",
keywords="hyperglycemia",
keywords="iron metabolism disorders",
keywords="MeSH",
keywords="embolism",
keywords="thrombosis",
keywords="heart failure",
keywords="nutritional",
keywords="vascular disease",
keywords="glucose",
keywords="effective",
abstract="Background: The interrelation between COVID-19 and various cardiovascular and metabolic disorders has been a critical area of study. There is a growing need to understand how comorbidities such as cardiovascular diseases (CVDs) and metabolic disorders affect the risk and severity of COVID-19. Objective: The objective of this study is to systematically analyze the association between COVID-19 and cardiovascular and metabolic disorders. The focus is on comorbidity, examining the roles of CVDs such as embolism, thrombosis, hypertension, and heart failure, as well as metabolic disorders such as disorders of glucose and iron metabolism. Methods: Our study involved a systematic search in PubMed for literature published from 2000 to 2022. We established 2 databases: one for COVID-19--related articles and another for CVD-related articles, ensuring all were peer-reviewed. In terms of data analysis, statistical methods were applied to compare the frequency and relevance of MeSH (Medical Subject Headings) terms between the 2 databases. This involved analyzing the differences and ratios in the usage of these terms and employing statistical tests to determine their significance in relation to key CVDs within the COVID-19 research context. Results: The study revealed that ``Cardiovascular Diseases'' and ``Nutritional and Metabolic Diseases'' were highly relevant as level 1 Medical Subject Headings descriptors in COVID-19 comorbidity research. Detailed analysis at level 2 and level 3 showed ``Vascular Disease'' and ``Heart Disease'' as prominent descriptors under CVDs. Significantly, ``Glucose Metabolism Disorders'' were frequently associated with COVID-19 comorbidities such as embolism, thrombosis, and heart failure. Furthermore, iron deficiency (ID) was notably different in its occurrence between COVID-19 and CVD articles, underlining its significance in the context of COVID-19 comorbidities. Statistical analysis underscored these differences, highlighting the importance of both glucose and iron metabolism disorders in COVID-19 research. Conclusions: This work lays the foundation for future research that utilizes a knowledge-based approach to elucidate the intricate relationships between these conditions, aiming to develop more effective health care strategies and interventions in the face of ongoing pandemic challenges. ",
doi="10.2196/55699",
url="https://www.i-jmr.org/2024/1/e55699"
}


@Article{info:doi/10.2196/49515,
author="Agyei, Frimponmaa Eunice Eno Yaa
and Ekpezu, Akon
and Oinas-Kukkonen, Harri",
title="Persuasive Systems Design Trends in Coronary Heart Disease Management: Scoping Review of Randomized Controlled Trials",
journal="JMIR Cardio",
year="2024",
month="Jun",
day="19",
volume="8",
pages="e49515",
keywords="coronary heart disease",
keywords="persuasive systems design",
keywords="behavior change",
keywords="randomized controlled trial",
keywords="RCT",
keywords="controlled trials",
keywords="heart",
keywords="CHD",
keywords="cardiovascular",
abstract="Background: Behavior change support systems (BCSSs) have the potential to help people maintain healthy lifestyles and aid in the self-management of coronary heart disease (CHD). The Persuasive Systems Design (PSD) model is a framework for designing and evaluating systems designed to support lifestyle modifications and health behavior change using information and communication technology. However, evidence for the underlying design principles behind BCSSs for CHD has not been extensively reported in the literature. Objective: This scoping review aims to identify existing health BCSSs for CHD, report the characteristics of these systems, and describe the persuasion context and persuasive design principles of these systems based on the PSD framework. Methods: Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, 3 digital databases (Scopus, Web of Science, and MEDLINE) were searched between 2010 to 2022. The major inclusion criteria for studies were in accordance with the PICO (Population, Intervention, Comparison, and Outcome) approach. Results: Searches conducted in the databases identified 1195 papers, among which 30 were identified as eligible for the review. The most interesting characteristics of the BCSSs were the predominant use of primary task support principles, followed by dialogue support and credibility support and the sparing use of social support principles. Theories of behavior change such as the Social Cognitive Theory and Self-Efficacy Theory were used often to underpin these systems. However, significant trends in the use of persuasive system features on par with behavior change theories could not be established from the reviewed studies. This points to the fact that there is still no theoretical consensus on how best to design interventions to promote behavior change in patients with CHD. Conclusions: Our results highlight key software features for designing BCSSs for the prevention and management of CHD. We encourage designers of behavior change interventions to evaluate the techniques that contributed to the success of the intervention. Future research should focus on evaluating the effectiveness of the interventions, persuasive design principles, and behavior change theories using research methodologies such as meta-analysis. ",
doi="10.2196/49515",
url="https://cardio.jmir.org/2024/1/e49515"
}


@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/10.2196/52697,
author="Bhagavathula, Srikanth Akshaya
and Aldhaleei, Ali Wafa
and Atey, Mehari Tesfay
and Assefa, Solomon
and Tesfaye, Wubshet",
title="Efficacy of eHealth Technologies on Medication Adherence in Patients With Acute Coronary Syndrome: Systematic Review and Meta-Analysis",
journal="JMIR Cardio",
year="2023",
month="Dec",
day="19",
volume="7",
pages="e52697",
keywords="medication adherence",
keywords="eHealth",
keywords="secondary prevention",
keywords="acute coronary syndrome",
keywords="heart disease",
keywords="text messaging",
keywords="mobile app",
keywords="cardiology",
keywords="cardioprotective",
keywords="prevention",
keywords="efficacy",
keywords="statins",
abstract="Background: Suboptimal adherence to cardiac pharmacotherapy, recommended by the guidelines after acute coronary syndrome (ACS) has been recognized and is associated with adverse outcomes. Several randomized controlled trials (RCTs) have shown that eHealth technologies are useful in reducing cardiovascular risk factors. However, little is known about the effect of eHealth interventions on medication adherence in patients following ACS. Objective: The aim of this study is to examine the efficacy of the eHealth interventions on medication adherence to selected 5 cardioprotective medication classes in patients with ACS. Methods: A systematic literature search of PubMed, Embase, Scopus, and Web of Science was conducted between May and October 2022, with an update in October 2023 to identify RCTs that evaluated the effectiveness of eHealth technologies, including texting, smartphone apps, or web-based apps, to improve medication adherence in patients after ACS. The risk of bias was evaluated using the modified Cochrane risk-of-bias tool for RCTs. A pooled meta-analysis was performed using a fixed-effect Mantel-Haenszel model and assessed the medication adherence to the medications of statins, aspirin, P2Y12 inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and $\beta$-blockers. Results: We identified 5 RCTs, applicable to 4100 participants (2093 intervention vs 2007 control), for inclusion in the meta-analysis. In patients who recently had an ACS, compared to the control group, the use of eHealth intervention was not associated with improved adherence to statins at different time points (risk difference [RD] --0.01, 95\% CI --0.03 to 0.03 at 6 months and RD --0.02, 95\% CI --0.05 to 0.02 at 12 months), P2Y12 inhibitors (RD --0.01, 95\% CI --0.04 to 0.02 and RD --0.01, 95\% CI --0.03 to 0.02), aspirin (RD 0.00, 95\% CI --0.06 to 0.07 and RD --0.00, 95\% CI --0.07 to 0.06), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RD --0.01, 95\% CI --0.04 to 0.02 and RD 0.01, 95\% CI --0.04 to 0.05), and $\beta$-blockers (RD 0.00, 95\% CI --0.03 to 0.03 and RD --0.01, 95\% CI --0.05 to 0.03). The intervention was also not associated with improved adherence irrespective of the adherence assessment method used (self-report or objective). Conclusions: This review identified limited evidence on the effectiveness of eHealth interventions on adherence to guideline-recommended medications after ACS. While the pooled analyses suggested a lack of effectiveness of such interventions on adherence improvement, further studies are warranted to better understand the role of different eHealth approaches in the post-ACS context. ",
doi="10.2196/52697",
url="https://cardio.jmir.org/2023/1/e52697",
url="http://www.ncbi.nlm.nih.gov/pubmed/38113072"
}


@Article{info:doi/10.2196/47292,
author="Simonson, K. Julie
and Anderson, Misty
and Polacek, Cate
and Klump, Erika
and Haque, N. Saira",
title="Characterizing Real-World Implementation of Consumer Wearables for the Detection of Undiagnosed Atrial Fibrillation in Clinical Practice: Targeted Literature Review",
journal="JMIR Cardio",
year="2023",
month="Nov",
day="3",
volume="7",
pages="e47292",
keywords="arrhythmias",
keywords="atrial fibrillation",
keywords="clinical workflow",
keywords="consumer wearable devices",
keywords="smartwatches",
keywords="wearables",
keywords="remote patient monitoring",
keywords="virtual care",
keywords="mobile phone",
abstract="Background: Atrial fibrillation (AF), the most common cardiac arrhythmia, is often undiagnosed because of lack of awareness and frequent asymptomatic presentation. As AF is associated with increased risk of stroke, early detection is clinically relevant. Several consumer wearable devices (CWDs) have been cleared by the US Food and Drug Administration for irregular heart rhythm detection suggestive of AF. However, recommendations for the use of CWDs for AF detection in clinical practice, especially with regard to pathways for workflows and clinical decisions, remain lacking. Objective: We conducted a targeted literature review to identify articles on CWDs characterizing the current state of wearable technology for AF detection, identifying approaches to implementing CWDs into the clinical workflow, and characterizing provider and patient perspectives on CWDs for patients at risk of AF. Methods: PubMed, ClinicalTrials.gov, UpToDate Clinical Reference, and DynaMed were searched for articles in English published between January 2016 and July 2023. The searches used predefined Medical Subject Headings (MeSH) terms, keywords, and search strings. Articles of interest were specifically on CWDs; articles on ambulatory monitoring tools, tools available by prescription, or handheld devices were excluded. Search results were reviewed for relevancy and discussed among the authors for inclusion. A qualitative analysis was conducted and themes relevant to our study objectives were identified. Results: A total of 31 articles met inclusion criteria: 7 (23\%) medical society reports or guidelines, 4 (13\%) general reviews, 5 (16\%) systematic reviews, 5 (16\%) health care provider surveys, 7 (23\%) consumer or patient surveys or interviews, and 3 (10\%) analytical reports. Despite recognition of CWDs by medical societies, detailed guidelines regarding CWDs for AF detection were limited, as was the availability of clinical tools. A main theme was the lack of pragmatic studies assessing real-world implementation of CWDs for AF detection. Clinicians expressed concerns about data overload; potential for false positives; reimbursement issues; and the need for clinical tools such as care pathways and guidelines, preferably developed or endorsed by professional organizations. Patient-facing challenges included device costs and variability in digital literacy or technology acceptance. Conclusions: This targeted literature review highlights the lack of a comprehensive body of literature guiding real-world implementation of CWDs for AF detection and provides insights for informing additional research and developing appropriate tools and resources for incorporating these devices into clinical practice. The results should also provide an impetus for the active involvement of medical societies and other health care stakeholders in developing appropriate tools and resources for guiding the real-world use of CWDs for AF detection. These resources should target clinicians, patients, and health care systems with the goal of facilitating clinician or patient engagement and using an evidence-based approach for establishing guidelines or frameworks for administrative workflows and patient care pathways. ",
doi="10.2196/47292",
url="https://cardio.jmir.org/2023/1/e47292",
url="http://www.ncbi.nlm.nih.gov/pubmed/37921865"
}


@Article{info:doi/10.2196/44983,
author="Stremmel, Christopher
and Breitschwerdt, R{\"u}diger",
title="Digital Transformation in the Diagnostics and Therapy of Cardiovascular Diseases: Comprehensive Literature Review",
journal="JMIR Cardio",
year="2023",
month="Aug",
day="30",
volume="7",
pages="e44983",
keywords="cardiovascular",
keywords="digital medicine",
keywords="telehealth",
keywords="artificial intelligence",
keywords="telemedicine",
keywords="mobile phone",
keywords="review",
abstract="Background: The digital transformation of our health care system has experienced a clear shift in the last few years due to political, medical, and technical innovations and reorganization. In particular, the cardiovascular field has undergone a significant change, with new broad perspectives in terms of optimized treatment strategies for patients nowadays. Objective: After a short historical introduction, this comprehensive literature review aimed to provide a detailed overview of the scientific evidence regarding digitalization in the diagnostics and therapy of cardiovascular diseases (CVDs). Methods: We performed an extensive literature search of the PubMed database and included all related articles that were published as of March 2022. Of the 3021 studies identified, 1639 (54.25\%) studies were selected for a structured analysis and presentation (original articles: n=1273, 77.67\%; reviews or comments: n=366, 22.33\%). In addition to studies on CVDs in general, 829 studies could be assigned to a specific CVD with a diagnostic and therapeutic approach. For data presentation, all 829 publications were grouped into 6 categories of CVDs. Results: Evidence-based innovations in the cardiovascular field cover a wide medical spectrum, starting from the diagnosis of congenital heart diseases or arrhythmias and overoptimized workflows in the emergency care setting of acute myocardial infarction to telemedical care for patients having chronic diseases such as heart failure, coronary artery disease, or hypertension. The use of smartphones and wearables as well as the integration of artificial intelligence provides important tools for location-independent medical care and the prevention of adverse events. Conclusions: Digital transformation has opened up multiple new perspectives in the cardiovascular field, with rapidly expanding scientific evidence. Beyond important improvements in terms of patient care, these innovations are also capable of reducing costs for our health care system. In the next few years, digital transformation will continue to revolutionize the field of cardiovascular medicine and broaden our medical and scientific horizons. ",
doi="10.2196/44983",
url="https://cardio.jmir.org/2023/1/e44983",
url="http://www.ncbi.nlm.nih.gov/pubmed/37647103"
}


@Article{info:doi/10.2196/40557,
author="Newport, Rochelle
and Grey, Corina
and Dicker, Bridget
and Ameratunga, Shanthi
and Harwood, Matire",
title="Reasons for Ethnic Disparities in the Prehospital Care Pathway Following an Out-of-Hospital Cardiac Event: Protocol of a Systematic Review",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="12",
volume="12",
pages="e40557",
keywords="health equity",
keywords="ethnicity",
keywords="Indigenous peoples",
keywords="out-of-hospital cardiac arrest",
keywords="emergency responders",
keywords="health care",
keywords="patient care",
keywords="cardiovascular",
keywords="cardiology",
abstract="Background: Substantial inequities in cardiovascular disease occur between and within countries, driving much of the current burden of global health inequities. Despite well-established treatment protocols and clinical interventions, the extent to which the prehospital care pathway for people who have experienced an out-of-hospital cardiac event (OHCE) varies by ethnicity and race is inconsistently documented. Timely access to care in this context is important for good outcomes. Therefore, identifying any barriers and enablers that influence timely prehospital care can inform equity-focused interventions. Objective: This systematic review aims to answer the question: Among adults who experience an OHCE, to what extent and why might the care pathways in the community and outcomes differ for minoritized ethnic populations compared to nonminoritized populations? In addition, we will investigate the barriers and enablers that could influence variations in the access to care for minoritized ethnic populations. Methods: This review will use Kaupapa M?ori theory to underpin the process and analysis, thus prioritizing Indigenous knowledge and experiences. A comprehensive search of the CINAHL, Embase, MEDLINE (OVID), PubMed, Scopus, Google Scholar, and Cochrane Library databases will be done using Medical Subject Headings terms themed to the 3 domains of context, health condition, and setting. All identified articles will be managed using an Endnote library. To be included in the research, papers must be published in English; have adult study populations; have an acute, nontraumatic cardiac condition as the primary health condition of interest; and be in the prehospital setting. Studies must also include comparisons by ethnicity or race to be eligible. Those studies considered suitable for inclusion will be critically appraised by multiple authors using the Mixed Methods Appraisal Tool and CONSIDER (Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples) framework. Risk of bias will be assessed using the Graphic Appraisal Tool for Epidemiology. Disagreements on inclusion or exclusion will be settled by a discussion with all reviewers. Data extraction will be done independently by 2 authors and collated in a Microsoft Excel spreadsheet. The outcomes of interest will include (1) symptom recognition, (2) patient decision-making, (3) health care professional decision-making, (4) the provision of cardiopulmonary resuscitation, (5) access to automated external defibrillator, and (6) witnessed status. Data will be extracted and categorized under key domains. A narrative review of these domains will be conducted using Indigenous data sovereignty approaches as a guide. Findings will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Results: Our research is in progress. We anticipate the systematic review will be completed and submitted for publication in October 2023. Conclusions: The review findings will inform researchers and health care professionals on the experience of minoritized populations when accessing the OHCE care pathway. Trial Registration: PROSPERO CRD42022279082; https://tinyurl.com/bdf6s4h2 International Registered Report Identifier (IRRID): PRR1-10.2196/40557 ",
doi="10.2196/40557",
url="https://www.researchprotocols.org/2023/1/e40557",
url="http://www.ncbi.nlm.nih.gov/pubmed/37436809"
}


@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/10.2196/40342,
author="?uki{\'c}, Milena
and Savi{\'c}, Danka
and Sidorova, Julia",
title="When Heart Beats Differently in Depression: Review of Nonlinear Heart Rate Variability Measures",
journal="JMIR Ment Health",
year="2023",
month="Jan",
day="17",
volume="10",
pages="e40342",
keywords="heart rate variability",
keywords="HRV",
keywords="electrocardiogram",
keywords="ECG",
keywords="depression",
keywords="autonomous nervous system",
keywords="ANS",
keywords="nonlinear measures",
keywords="cardiac risk",
keywords="cardiovascular",
keywords="mortality",
keywords="heart dynamics",
keywords="ECG analysis",
keywords="analysis",
keywords="online",
abstract="Background: Disturbed heart dynamics in depression seriously increases mortality risk. Heart rate variability (HRV) is a rich source of information for studying this dynamics. This paper is a meta-analytic review with methodological commentary of the application of nonlinear analysis of HRV and its possibility to address cardiovascular diseases in depression. Objective: This paper aimed to appeal for the introduction of cardiological screening to patients with depression, because it is still far from established practice. The other (main) objective of the paper was to show that nonlinear methods in HRV analysis give better results than standard ones. Methods: We systematically searched on the web for papers on nonlinear analyses of HRV in depression, in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 framework recommendations. We scrutinized the chosen publications and performed random-effects meta-analysis, using the esci module in jamovi software where standardized effect sizes (ESs) are corrected to yield the proof of the practical utility of their results. Results: In all, 26 publications on the connection of nonlinear HRV measures and depression meeting our inclusion criteria were selected, examining a total of 1537 patients diagnosed with depression and 1041 healthy controls (N=2578). The overall ES (unbiased) was 1.03 (95\% CI 0.703-1.35; diamond ratio 3.60). We performed 3 more meta-analytic comparisons, demonstrating the overall effectiveness of 3 groups of nonlinear analysis: detrended fluctuation analysis (overall ES 0.364, 95\% CI 0.237-0.491), entropy-based measures (overall ES 1.05, 95\% CI 0.572-1.52), and all other nonlinear measures (overall ES 0.702, 95\% CI 0.422-0.982). The effectiveness of the applied methods of electrocardiogram analysis was compared and discussed in the light of detection and prevention of depression-related cardiovascular risk. Conclusions: We compared the ESs of nonlinear and conventional time and spectral methods (found in the literature) and demonstrated that those of the former are larger, which recommends their use for the early screening of cardiovascular abnormalities in patients with depression to prevent possible deleterious events. ",
doi="10.2196/40342",
url="https://mental.jmir.org/2023/1/e40342",
url="http://www.ncbi.nlm.nih.gov/pubmed/36649063"
}


@Article{info:doi/10.2196/36773,
author="Nourse, Rebecca
and Lobo, Elton
and McVicar, Jenna
and Kensing, Finn
and Islam, Shariful Sheikh Mohammed
and Kayser, Lars
and Maddison, Ralph",
title="Characteristics of Smart Health Ecosystems That Support Self-care Among People With Heart Failure: Scoping Review",
journal="JMIR Cardio",
year="2022",
month="Nov",
day="2",
volume="6",
number="2",
pages="e36773",
keywords="digital health",
keywords="review",
keywords="chronic diseases",
keywords="cardiovascular disease",
keywords="information technology",
keywords="digital technology",
keywords="mobile phone",
keywords="self-management",
abstract="Background: The management of heart failure is complex. Innovative solutions are required to support health care providers and people with heart failure with decision-making and self-care behaviors. In recent years, more sophisticated technologies have enabled new health care models, such as smart health ecosystems. Smart health ecosystems use data collection, intelligent data processing, and communication to support the diagnosis, management, and primary and secondary prevention of chronic conditions. Currently, there is little information on the characteristics of smart health ecosystems for people with heart failure. Objective: We aimed to identify and describe the characteristics of smart health ecosystems that support heart failure self-care. Methods: We conducted a scoping review using the Joanna Briggs Institute methodology. The MEDLINE, Embase, CINAHL, PsycINFO, IEEE Xplore, and ACM Digital Library databases were searched from January 2008 to September 2021. The search strategy focused on identifying articles describing smart health ecosystems that support heart failure self-care. A total of 2 reviewers screened the articles and extracted relevant data from the included full texts. Results: After removing duplicates, 1543 articles were screened, and 34 articles representing 13 interventions were included in this review. To support self-care, the interventions used sensors and questionnaires to collect data and used tailoring methods to provide personalized support. The interventions used a total of 34 behavior change techniques, which were facilitated by a combination of 8 features for people with heart failure: automated feedback, monitoring (integrated and manual input), presentation of data, education, reminders, communication with a health care provider, and psychological support. Furthermore, features to support health care providers included data presentation, alarms, alerts, communication tools, remote care plan modification, and health record integration. Conclusions: This scoping review identified that there are few reports of smart health ecosystems that support heart failure self-care, and those that have been reported do not provide comprehensive support across all domains of self-care. This review describes the technical and behavioral components of the identified interventions, providing information that can be used as a starting point for designing and testing future smart health ecosystems. ",
doi="10.2196/36773",
url="https://cardio.jmir.org/2022/2/e36773",
url="http://www.ncbi.nlm.nih.gov/pubmed/36322112"
}


@Article{info:doi/10.2196/35876,
author="Alnooh, Ghadah
and Alessa, Tourkiah
and Hawley, Mark
and de Witte, Luc",
title="The Use of Dietary Approaches to Stop Hypertension (DASH) Mobile Apps for Supporting a Healthy Diet and Controlling Hypertension in Adults: Systematic Review",
journal="JMIR Cardio",
year="2022",
month="Nov",
day="2",
volume="6",
number="2",
pages="e35876",
keywords="DASH diet",
keywords="Dietary Approaches to Stop Hypertension",
keywords="smartphone app",
keywords="mobile app",
keywords="blood pressure",
abstract="Background: Uncontrolled hypertension is a public health issue, with increasing prevalence worldwide. The Dietary Approaches to Stop Hypertension (DASH) diet is one of the most effective dietary approaches for lowering blood pressure (BP). Dietary mobile apps have gained popularity and are being used to support DASH diet self-management, aiming to improve DASH diet adherence and thus lower BP. Objective: This systematic review aimed to assess the effectiveness of smartphone apps that support self-management to improve DASH diet adherence and consequently reduce BP. A secondary aim was to assess engagement, satisfaction, acceptance, and usability related to DASH mobile app use. Methods: The Embase (OVID), Cochrane Library, CINAHL, Web of Science, Scopus, and Google Scholar electronic databases were used to conduct systematic searches for studies conducted between 2008 and 2021 that used DASH smartphone apps to support self-management. The reference lists of the included articles were also checked. Studies were eligible if they (1) were randomized controlled trials (RCTs) or pre-post studies of app-based interventions for adults (aged 18 years or above) with prehypertension or hypertension, without consideration of gender or sociodemographic characteristics; (2) used mobile phone apps alone or combined with another component, such as communication with others; (3) used or did not use any comparator; and (4) had the primary outcome measures of BP level and adherence to the DASH diet. For eligible studies, data were extracted and outcomes were organized into logical categories, including clinical outcomes (eg, systolic BP, diastolic BP, and weight loss), DASH diet adherence, app usability and acceptability, and user engagement and satisfaction. The quality of the studies was evaluated using the Cochrane Collaboration's Risk of Bias tool for RCTs, and nonrandomized quantitative studies were evaluated using a tool provided by the US National Institutes of Health. Results: A total of 5 studies (3 RCTs and 2 pre-post studies) including 334 participants examined DASH mobile apps. All studies found a positive trend related to the use of DASH smartphone apps, but the 3 RCTs had a high risk of bias. One pre-post study had a high risk of bias, while the other had a low risk. As a consequence, no firm conclusions could be drawn regarding the effectiveness of DASH smartphone apps for increasing DASH diet adherence and lowering BP. All the apps appeared to be acceptable and easy to use. Conclusions: There is weak emerging evidence of a positive effect of using DASH smartphone apps for supporting self-management to improve DASH diet adherence and consequently lower BP. Further research is needed to provide high-quality evidence that can determine the effectiveness of DASH smartphone apps. ",
doi="10.2196/35876",
url="https://cardio.jmir.org/2022/2/e35876",
url="http://www.ncbi.nlm.nih.gov/pubmed/36322108"
}


@Article{info:doi/10.2196/37360,
author="Ramasawmy, Mel
and Poole, Lydia
and Thorlu-Bangura, Zareen
and Chauhan, Aneesha
and Murali, Mayur
and Jagpal, Parbir
and Bijral, Mehar
and Prashar, Jai
and G-Medhin, Abigail
and Murray, Elizabeth
and Stevenson, Fiona
and Blandford, Ann
and Potts, W. Henry W.
and Khunti, Kamlesh
and Hanif, Wasim
and Gill, Paramjit
and Sajid, Madiha
and Patel, Kiran
and Sood, Harpreet
and Bhala, Neeraj
and Modha, Shivali
and Mistry, Manoj
and Patel, Vinod
and Ali, N. Sarah
and Ala, Aftab
and Banerjee, Amitava",
title="Frameworks for Implementation, Uptake, and Use of Cardiometabolic Disease--Related Digital Health Interventions in Ethnic Minority Populations: Scoping Review",
journal="JMIR Cardio",
year="2022",
month="Aug",
day="11",
volume="6",
number="2",
pages="e37360",
keywords="eHealth",
keywords="framework",
keywords="cardiometabolic",
keywords="health inequalities",
keywords="health inequality",
keywords="health technology",
keywords="ethnicity",
keywords="minority",
keywords="digital health",
keywords="review",
keywords="cultural",
keywords="diverse",
keywords="diversity",
keywords="cardiology",
keywords="metabolism",
keywords="metabolic",
abstract="Background: Digital health interventions have become increasingly common across health care, both before and during the COVID-19 pandemic. Health inequalities, particularly with respect to ethnicity, may not be considered in frameworks that address the implementation of digital health interventions. We considered frameworks to include any models, theories, or taxonomies that describe or predict implementation, uptake, and use of digital health interventions. Objective: We aimed to assess how health inequalities are addressed in frameworks relevant to the implementation, uptake, and use of digital health interventions; health and ethnic inequalities; and interventions for cardiometabolic disease. Methods: SCOPUS, PubMed, EMBASE, Google Scholar, and gray literature were searched to identify papers on frameworks relevant to the implementation, uptake, and use of digital health interventions; ethnically or culturally diverse populations and health inequalities; and interventions for cardiometabolic disease. We assessed the extent to which frameworks address health inequalities, specifically ethnic inequalities; explored how they were addressed; and developed recommendations for good practice. Results: Of 58 relevant papers, 22 (38\%) included frameworks that referred to health inequalities. Inequalities were conceptualized as society-level, system-level, intervention-level, and individual. Only 5 frameworks considered all levels. Three frameworks considered how digital health interventions might interact with or exacerbate existing health inequalities, and 3 considered the process of health technology implementation, uptake, and use and suggested opportunities to improve equity in digital health. When ethnicity was considered, it was often within the broader concepts of social determinants of health. Only 3 frameworks explicitly addressed ethnicity: one focused on culturally tailoring digital health interventions, and 2 were applied to management of cardiometabolic disease. Conclusions: Existing frameworks evaluate implementation, uptake, and use of digital health interventions, but to consider factors related to ethnicity, it is necessary to look across frameworks. We have developed a visual guide of the key constructs across the 4 potential levels of action for digital health inequalities, which can be used to support future research and inform digital health policies. ",
doi="10.2196/37360",
url="https://cardio.jmir.org/2022/2/e37360",
url="http://www.ncbi.nlm.nih.gov/pubmed/35969455"
}


@Article{info:doi/10.2196/29481,
author="Praus, Friederike
and Krzowski, Bartosz
and Walther, Tabea
and Gratzke, Christian
and Balsam, Pawe?
and Miernik, Arkadiusz
and Pohlmann, Fabian Philippe",
title="Smartphone Apps for Managing Antithrombotic Therapy: Scoping Literature Review",
journal="JMIR Cardio",
year="2022",
month="Jun",
day="21",
volume="6",
number="1",
pages="e29481",
keywords="anticoagulation",
keywords="mobile app",
keywords="telehealth",
keywords="telemedicine",
keywords="mHealth",
keywords="smartphone",
keywords="educational apps",
keywords="digital tools",
keywords="physician support",
abstract="Background: Antithrombotic therapy is complex and requires informed decisions and high therapy adherence. Several mobile phone apps exist to either support physicians in the management of antithrombotic therapies or to educate and support patients. For the majority of these apps, both their medical evidence and their development background are unknown. Objective: This review aims to investigate the available literature describing high-quality apps for managing antithrombotic therapy based on professional scientific information. Methods: Keywords and Medical Subject Heading terms were used to search MEDLINE via PubMed and Ovid between December 2019 and January 2022. Inclusion criteria were the availability of full text and publications in the English language. Apps that solely focused on atrial fibrillation were excluded. Qualitative findings were thematically synthesized and reported narratively. Results: Out of 149 identified records, 32 were classified as eligible. We identified four groups: (1) apps for patients supporting self-management of vitamin K antagonists, (2) apps for patients increasing therapy adherence, (3) educational apps for patients, and (4) apps for physicians in supporting guideline adherence. Conclusions: Throughout the evaluated data, patients from all age groups receiving antithrombotic drugs expressed the desire for a digital tool that could support their therapy management. In addition, physicians using mobile guideline-based apps may have contributed to decreased adverse event rates among their patients. In general, digital apps encompassing both user-friendly designs and scientific backgrounds may enhance the safety of antithrombotic therapies. However, our evaluation did not identify any apps that addressed all antithrombotic drugs in combination with perioperative stratification strategies. Currently, strict regulations for smartphone apps seem to negatively affect the development of new apps. Therefore, new legal policies for medical digital apps are urgently needed. ",
doi="10.2196/29481",
url="https://cardio.jmir.org/2022/1/e29481",
url="http://www.ncbi.nlm.nih.gov/pubmed/35727608"
}


@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/10.2196/33366,
author="Al-Naher, Ahmed
and Downing, Jennifer
and Scott, A. Kathryn
and Pirmohamed, Munir",
title="Factors Affecting Patient and Physician Engagement in Remote Health Care for Heart Failure: Systematic Review",
journal="JMIR Cardio",
year="2022",
month="Apr",
day="6",
volume="6",
number="1",
pages="e33366",
keywords="remote care technology",
keywords="chronic adult heart failure",
keywords="qualitative synthesis",
keywords="thematic analysis",
keywords="patient compliance",
keywords="patient engagement",
keywords="elderly population",
keywords="carers",
keywords="health care professionals",
keywords="technology implementation",
abstract="Background: Adult chronic heart failure mainly affects an elderly population with multiple comorbidities that often require frequent medical visits to prevent poor health outcomes. However, the heart failure disease process reduces their independence by reducing mobility, exercise tolerance, and cognitive decline. Remote care technologies can bridge the gap in care for these patients by allowing them to be followed up within the comfort of their home and encourage their self-care. However, patients, carers, and health care professionals need to engage with the technology for it to be useful. Objective: This systematic review explores qualitative primary studies of remote care technologies used in heart failure, to determine the factors that affect user engagement with the technology. This is explored from the perspective of patients, carers, and health care professionals. Methods: Relevant studies published between January 1, 1990, and September 19, 2020, were identified from EMBASE, Ovid MEDLINE, PubMed, Cochrane Library, and Scopus. These studies were then synthesized using thematic analysis. Relevant user experiences with remote care were extracted using line-by-line coding. These codes were summarized into secondary codes and core concepts, which were further merged into overarching themes that encapsulate user experience with remote care. Results: The review included 47 studies, which led to the generation of 5 overarching themes that affect engagement: (1) ``Convenience'' relates to time saved by the intervention; (2) ``Clinical Care'' relates to perceived quality of care and health outcomes; (3) ``Communication'' involves feedback and interaction between patients, staff, and carers; (4) ``Education'' concerns the tailored information provided; and (5) ``Ease of Use'' relates to accessibility and technical barriers to engagement. Each theme was applied to each user base of patient, carer, and health care professional in a different manner. Conclusions: The 5 themes identified highlight aspects of remote care that facilitate engagement, and should be considered in both future design and trials evaluating these technologies. ",
doi="10.2196/33366",
url="https://cardio.jmir.org/2022/1/e33366",
url="http://www.ncbi.nlm.nih.gov/pubmed/35384851"
}


@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/10.2196/34657,
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/10.2196/31056,
author="Bonner, Carissa
and Batcup, Carys
and Cornell, Samuel
and Fajardo, Anthony Michael
and Hawkes, L. Anna
and Trevena, Lyndal
and Doust, Jenny",
title="Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects",
journal="JMIR Cardio",
year="2021",
month="Nov",
day="5",
volume="5",
number="2",
pages="e31056",
keywords="heart age",
keywords="cardiovascular disease",
keywords="risk assessment",
keywords="risk communication",
keywords="prevention",
abstract="Background: Cardiovascular disease (CVD) risk communication is a challenge for clinical practice, where physicians find it difficult to explain the absolute risk of a CVD event to patients with varying health literacy. Converting the probability to heart age is increasingly used to promote lifestyle change, but a rapid review of biological age interventions found no clear evidence that they motivate behavior change. Objective: In this review, we aim to identify the content and effects of heart age interventions. Methods: We conducted a systematic review of studies presenting heart age interventions to adults for CVD risk communication in April 2020 (later updated in March 2021). The Johanna Briggs risk of bias assessment tool was applied to randomized studies. Behavior change techniques described in the intervention methods were coded. Results: From a total of 7926 results, 16 eligible studies were identified; these included 5 randomized web-based experiments, 5 randomized clinical trials, 2 mixed methods studies with quantitative outcomes, and 4 studies with qualitative analysis. Direct comparisons between heart age and absolute risk in the 5 web-based experiments, comprising 5514 consumers, found that heart age increased positive or negative emotional responses (4/5 studies), increased risk perception (4/5 studies; but not necessarily more accurate) and recall (4/4 studies), reduced credibility (2/3 studies), and generally had no effect on lifestyle intentions (4/5 studies). One study compared heart age and absolute risk to fitness age and found reduced lifestyle intentions for fitness age. Heart age combined with additional strategies (eg, in-person or phone counseling) in applied settings for 9582 patients improved risk control (eg, reduced cholesterol levels and absolute risk) compared with usual care in most trials (4/5 studies) up to 1 year. However, clinical outcomes were no different when directly compared with absolute risk (1/1 study). Mixed methods studies identified consultation time and content as important outcomes in actual consultations using heart age tools. There were differences between people receiving an older heart age result and those receiving a younger or equal to current heart age result. The heart age interventions included a wide range of behavior change techniques, and conclusions were sometimes biased in favor of heart age with insufficient supporting evidence. The risk of bias assessment indicated issues with all randomized clinical trials. Conclusions: The findings of this review provide little evidence that heart age motivates lifestyle behavior change more than absolute risk, but either format can improve clinical outcomes when combined with other behavior change strategies. The label for the heart age concept can affect outcomes and should be pretested with the intended audience. Future research should consider consultation time and differentiate between results of older and younger heart age. International Registered Report Identifier (IRRID): NPRR2-10.1101/2020.05.03.20089938 ",
doi="10.2196/31056",
url="https://cardio.jmir.org/2021/2/e31056",
url="http://www.ncbi.nlm.nih.gov/pubmed/34738908"
}


@Article{info:doi/10.2196/21906,
author="Tuttle, Katherine
and Kelemen, Arpad
and Liang, Yulan",
title="Use of Smartphone Apps for Improving Physical Function Capacity in Cardiac Patient Rehabilitation: Systematic Review",
journal="JMIRx Med",
year="2021",
month="Sep",
day="17",
volume="2",
number="3",
pages="e21906",
keywords="cardiac rehabilitation",
keywords="physical capacity",
keywords="exercise",
keywords="smartphone apps",
abstract="Background: Cardiac rehabilitation (CR) is an evidence-based approach for preventing secondary cardiac events. Smartphone apps are starting to be used in CR to give patients real-time feedback on their health, connect them remotely with their medical team, and allow them to perform their rehabilitation at home. The use of smartphone apps is becoming omnipresent and has real potential in impacting patients in need of CR. Objective: This paper provides critical examinations and summaries of existing research studies with an in-depth analysis of not only the individual studies but also the larger patterns that have emerged with smartphone apps in CR as well as their significance for practice change. Methods: A systematic review was conducted through broad database searches that focused on evaluating randomized controlled trials, in compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) expectations. A total of 43 articles were evaluated, and 6 were chosen for this review. The dates of the articles ranged from 2014-2020, and the studies focused on the population of cardiac outpatients who needed CR after suffering a cardiac event, with interventions using a smartphone that incorporated the CR standards of the American Heart Association. The outcomes measured were directed at focusing on improved exercise function capacity, valued at a significance level of P<.05, for improved 6-minute walk test (6MWT) and peak oxygen uptake (PVO2) results. Results: In the evaluated articles, the results were inconsistent for significant positive effects of CR smartphone apps on cardiac patients' physical function capacity in terms of the 6MWT and PVO2 when using a smartphone app to aid in CR. Conclusions: Because evidence in the literature suggests nonhomogeneous results for successful use of smartphone apps in CR, it is crucial to investigate the potential reasons for this inconsistency. An important observation from this systematic review is that smartphone apps used in CR have better clinical outcomes related to physical function capacity if the app automatically records information or provides real-time feedback to participants about their progress, compared to apps that only educate and encourage use while requiring the participant to manually log their CR activities. Additional factors to consider during these studies include the starting health of the patients, the sample sizes, and the specific components of CR that the smartphone apps are using. Overall, more clinical trials are needed that implement smartphone apps with these factors in mind, while placing stronger emphasis on using biosensing capabilities that can automatically log results and send them to providers on a real-time dashboard. ",
doi="10.2196/21906",
url="https://med.jmirx.org/2021/3/e21906",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725554"
}


@Article{info:doi/10.2196/28759,
author="Roberts, J. Derek
and Nagpal, K. Sudhir
and Stelfox, T. Henry
and Brandys, Tim
and Corrales-Medina, Vicente
and Dubois, Luc
and McIsaac, I. Daniel",
title="Risk Factors for Surgical Site Infection After Lower Limb Revascularization Surgery in Adults With Peripheral Artery Disease: Protocol for a Systematic Review and Meta-analysis",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="16",
volume="10",
number="9",
pages="e28759",
keywords="lower limb revascularization surgery",
keywords="peripheral artery disease",
keywords="risk factors",
keywords="surgical site infection",
keywords="systematic review",
abstract="Background: Surgical site infections (SSIs) are common, costly, and associated with increased morbidity and potential mortality after lower limb revascularization surgery (ie, arterial bypass, endarterectomy, and patch angioplasty). Identifying evidence-informed risk factors for SSI in patients undergoing these surgeries is therefore important. Objective: The aim of this study is to conduct a systematic review and meta-analysis of prognostic studies to identify, synthesize, and determine the certainty in the cumulative evidence associated with reported risk factors for early and delayed SSI after lower limb revascularization surgery in adults with peripheral artery disease. Methods: We will search MEDLINE, Embase, the seven databases in Evidence-Based Medicine Reviews, review articles identified during the search, and included article bibliographies. We will include studies of adults (aged ?18 years) with peripheral artery disease that report odds ratios, risk ratios, or hazard ratios adjusted for the presence of other risk factors or confounding variables and relating the potential risk factor of interest to the development of SSI after lower limb revascularization surgery. We will exclude studies that did not adjust for confounding, exclusively examined certain high-risk patient cohorts, or included >20\% of patients who underwent surgery for indications other than peripheral artery disease. The primary outcomes will be early (in-hospital or ?30 days) SSI and Szilagyi grade I (cellulitis involving the wound), grade II (infection involving subcutaneous tissue), and grade III (infection involving the vascular graft) SSI. Two investigators will independently extract data and evaluate the study risk of bias using the Quality in Prognosis Studies tool. Adjusted risk factor estimates with similar definitions will be pooled using DerSimonian and Laird random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. Finally, we will use the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to determine certainty in the estimates of association between reported risk factors and the development of SSI. Results: The protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews). We will execute the peer-reviewed search strategy on June 30, 2021, and then complete the review of titles and abstracts and full-text articles by July 30, 2021, and September 15, 2021, respectively. We will complete the full-text study data extraction and risk of bias assessment by November 15, 2021. We anticipate that we will be able to submit the manuscript for peer review by January 30, 2022. Conclusions: This study will identify, synthesize, and determine the certainty in the cumulative evidence associated with risk factors for early and delayed SSI after lower limb revascularization surgery in patients with peripheral artery disease. The results will be used to inform practice, clinical practice statements and guidelines, and subsequent research. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021242557; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=242557 International Registered Report Identifier (IRRID): PRR1-10.2196/28759 ",
doi="10.2196/28759",
url="https://www.researchprotocols.org/2021/9/e28759",
url="http://www.ncbi.nlm.nih.gov/pubmed/34161251"
}


@Article{info:doi/10.2196/18834,
author="Spaulding, M. Erin
and Marvel, A. Francoise
and Piasecki, J. Rebecca
and Martin, S. Seth
and Allen, K. Jerilyn",
title="User Engagement With Smartphone Apps and Cardiovascular Disease Risk Factor Outcomes: Systematic Review",
journal="JMIR Cardio",
year="2021",
month="Feb",
day="3",
volume="5",
number="1",
pages="e18834",
keywords="mHealth",
keywords="smartphone",
keywords="mobile phone",
keywords="engagement",
keywords="cardiovascular disease",
keywords="health behaviors",
keywords="risk factors",
abstract="Background: The use of mobile health (mHealth) interventions, including smartphone apps, for the prevention of cardiovascular disease (CVD) has demonstrated mixed results for obesity, hypercholesterolemia, diabetes, and hypertension management. A major factor attributing to the variation in mHealth study results may be mHealth user engagement. Objective: This systematic review aims to determine if user engagement with smartphone apps for the prevention and management of CVD is associated with improved CVD health behavior change and risk factor outcomes. Methods: We conducted a comprehensive search of PubMed, CINAHL, and Embase databases from 2007 to 2020. Studies were eligible if they assessed whether user engagement with a smartphone app used by an individual to manage his or her CVD risk factors was associated with the CVD health behavior change or risk factor outcomes. For eligible studies, data were extracted on study and sample characteristics, intervention description, app user engagement measures, and the relationship between app user engagement and the CVD risk factor outcomes. App user engagement was operationalized as general usage (eg, number of log-ins or usage days per week) or self-monitoring within the app (eg, total number of entries made in the app). The quality of the studies was assessed. Results: Of the 24 included studies, 17 used a randomized controlled trial design, 4 used a retrospective analysis, and 3 used a single-arm pre- and posttest design. Sample sizes ranged from 55 to 324,649 adults, with 19 studies recruiting participants from a community setting. Most of the studies assessed weight loss interventions, with 6 addressing additional CVD risk factors, including diabetes, sleep, stress, and alcohol consumption. Most of the studies that assessed the relationship between user engagement and reduction in weight (9/13, 69\%), BMI (3/4, 75\%), body fat percentage (1/2, 50\%), waist circumference (2/3, 67\%), and hemoglobin A1c (3/5, 60\%) found statistically significant results, indicating that greater app user engagement was associated with better outcomes. Of 5 studies, 3 (60\%) found a statistically significant relationship between higher user engagement and an increase in objectively measured physical activity. The studies assessing the relationship between user engagement and dietary and diabetes self-care behaviors, blood pressure, and lipid panel components did not find statistically significant results. Conclusions: Increased app user engagement for prevention and management of CVD may be associated with improved weight and BMI; however, only a few studies assessed other outcomes, limiting the evidence beyond this. Additional studies are needed to assess user engagement with smartphone apps targeting other important CVD risk factors, including dietary behaviors, hypercholesterolemia, diabetes, and hypertension. Further research is needed to assess mHealth user engagement in both inpatient and outpatient settings to determine the effect of integrating mHealth interventions into the existing clinical workflow and on CVD outcomes. ",
doi="10.2196/18834",
url="http://cardio.jmir.org/2021/1/e18834/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33533730"
}


@Article{info:doi/10.2196/18229,
author="Fundikira, Said Lulu
and Chillo, Pilly
and van Laake, W. Linda
and Mutagaywa, Kato Reuben
and Schmidt, Floriaan Amand
and Kamuhabwa, Appolinary
and Kwesigabo, Gideon
and Asselbergs, W. Folkert",
title="Risk Factors and Prevalence of Dilated Cardiomyopathy in Sub-Saharan Africa: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="21",
volume="10",
number="1",
pages="e18229",
keywords="dilated cardiomyopathy",
keywords="cardiomyopathy",
keywords="heart failure",
keywords="cardiovascular risk factors",
keywords="sub-Saharan Africa",
abstract="Background: Cardiomyopathies, defined as diseases involving mainly the heart muscles, are linked to an estimated 5.9 of 100,000 deaths globally. In sub-Saharan Africa, cardiomyopathies constitute 21.4\% of heart failure cases, with dilated cardiomyopathy (DCM) being the most common form. The etiology of DCM is heterogeneous and is broadly categorized as genetic or nongenetic, as well as a mixed disease in which genetics interact with intrinsic and environmental factors. Factors such as age, gender, family history, and ethnicity are nonmodifiable, whereas modifiable risk factors include poor nutrition, physical inactivity, and excessive alcohol consumption, among others. However, the relative contribution of the different risk factors to the etiology of DCM is not known in sub-Saharan Africa, and the prevalence of DCM among heart failure patients has not been systematically studied in the region. Objective: The aim of this review is to synthesize available literature from sub-Saharan Africa on the prevalence of DCM among patients with heart failure, as well as the literature on factors associated with DCM. This paper outlines the protocol that will be followed to conduct the systematic review. Methods: A limited search of the PubMed database will be performed to identify relevant keywords contained in the title, abstract, and subject descriptors using initial search terms ``heart failure,'' ``cardiomyopathy,'' and ``sub-Saharan Africa.'' These search terms and their synonyms will then be used in an extensive search in PubMed, and will address the first research question on prevalence. To address the second research question on risk factors, the terms ``heart failure,'' ``cardiomyopathy,'' and ``cardiovascular risk factors'' in ``Sub-Saharan Africa'' will be used, listing them one by one. Articles published from 2000 and in the English language will be included. Indexed articles in PubMed and Embase will be included, as well as the first 300 articles retrieved from a Google Scholar search. Collected data will be organized in Endnote and then uploaded to the Rayyan web app for systematic reviews. Two reviewers will independently select articles against the inclusion criteria. Discrepancies in reviewer selections will be resolved by an arbitrator. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting systematic reviews will be applied. A map of sub-Saharan Africa with colors to show disease prevalence in each country will be included. For quantitative data, where possible, odds ratios (for categorical outcome data) or standardized mean differences (for continuous data) and their 95\% CIs will be calculated. Results: The primary outcomes will be the prevalence of DCM among patients with heart failure and cardiovascular risk factors associated with DCM in sub-Saharan Africa. The literature search will begin on January 1, 2021, and data analysis is expected to be completed by April 30, 2021. Conclusions: This review will provide information on the current status of the prevalence and associated factors of DCM, and possibly identify gaps, including paucity of data or conflicting results that need to be addressed to improve our understanding of DCM in sub-Saharan Africa. International Registered Report Identifier (IRRID): PRR1-10.2196/18229 ",
doi="10.2196/18229",
url="http://www.researchprotocols.org/2021/1/e18229/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33475522"
}


@Article{info:doi/10.2196/11951,
author="Palacholla, Sita Ramya
and Fischer, Nils
and Coleman, Amanda
and Agboola, Stephen
and Kirley, Katherine
and Felsted, Jennifer
and Katz, Chelsea
and Lloyd, Stacy
and Jethwani, Kamal",
title="Provider- and Patient-Related Barriers to and Facilitators of Digital Health Technology Adoption for Hypertension Management: Scoping Review",
journal="JMIR Cardio",
year="2019",
month="Mar",
day="26",
volume="3",
number="1",
pages="e11951",
keywords="medical informatics",
keywords="culturally appropriate technology",
keywords="hypertension",
abstract="Background: The uptake of digital health technology (DHT) has been surprisingly low in clinical practice. Despite showing great promise to improve patient outcomes and disease management, there is limited information on the factors that contribute to the limited adoption of DHT, particularly for hypertension management. Objective: This scoping review provides a comprehensive summary of barriers to and facilitators of DHT adoption for hypertension management reported in the published literature with a focus on provider- and patient-related barriers and facilitators. Methods: This review followed the methodological framework developed by Arskey and O'Malley. Systematic literature searches were conducted on PubMed or Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica database. Articles that reported on barriers to and/or facilitators of digital health adoption for hypertension management published in English between 2008 and 2017 were eligible. Studies not reporting on barriers or facilitators to DHT adoption for management of hypertension were excluded. A total of 2299 articles were identified based on the above criteria after removing duplicates, and they were assessed for eligibility. Of these, 2165 references did not meet the inclusion criteria. After assessing 134 studies in full text, 98 studies were excluded (full texts were either unavailable or studies did not fulfill the inclusion criteria), resulting in a final set of 32 articles. In addition, 4 handpicked articles were also included in the review, making it a total of 36 studies. Results: A total of 36 studies were selected for data extraction after abstract and full-text screening by 2 independent reviewers. All conflicts were resolved by a third reviewer. Thematic analysis was conducted to identify major themes pertaining to barriers and facilitators of DHT from both provider and patient perspectives. The key facilitators of DHT adoption by physicians that were identified include ease of integration with clinical workflow, improvement in patient outcomes, and technology usability and technical support. Technology usability and timely technical support improved self-management and patient experience, and positive impact on patient-provider communication were most frequently reported facilitators for patients. Barriers to use of DHTs reported by physicians include lack of integration with clinical workflow, lack of validation of technology, and lack of technology usability and technical support. Finally, lack of technology usability and technical support, interference with patient-provider relationship, and lack of validation of technology were the most commonly reported barriers by patients. Conclusions: Findings suggest the settings and context in which DHTs are implemented and individuals involved in implementation influence adoption. Finally, to fully realize the potential of digitally enabled hypertension management, there is a greater need to validate these technologies to provide patients and providers with reliable and accurate information on both clinical outcomes and cost effectiveness. ",
doi="10.2196/11951",
url="http://cardio.jmir.org/2019/1/e11951/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758771"
}


@Article{info:doi/10.2196/10057,
author="Athilingam, Ponrathi
and Jenkins, Bradlee",
title="Mobile Phone Apps to Support Heart Failure Self-Care Management: Integrative Review",
journal="JMIR Cardio",
year="2018",
month="May",
day="02",
volume="2",
number="1",
pages="e10057",
keywords="heart failure",
keywords="self-care management",
keywords="mobile health",
abstract="Background: With an explosive growth in mobile health, an estimated 500 million patients are potentially using mHealth apps for supporting health and self-care of chronic diseases. Therefore, this review focused on mHealth apps for use among patients with heart failure. Objective: The aim of this integrative review was to identify and assess the functionalities of mHealth apps that provided usability and efficacy data and apps that are commercially available without supporting data, all of which are to support heart failure self-care management and thus impact heart failure outcomes. Methods: A search of published, peer-reviewed literature was conducted for studies of technology-based interventions that used mHealth apps specific for heart failure. The initial database search yielded 8597 citations. After filters for English language and heart failure, the final 487 abstracts was reviewed. After removing duplicates, a total of 18 articles that tested usability and efficacy of mobile apps for heart failure self-management were included for review. Google Play and Apple App Store were searched with specified criteria to identify mHealth apps for heart failure. A total of 26 commercially available apps specific for heart failure were identified and rated using the validated Mobile Application Rating Scale. Results: The review included studies with low-quality design and sample sizes ranging from 7 to 165 with a total sample size of 847 participants from all 18 studies. Nine studies assessed usability of the newly developed mobile health system. Six of the studies included are randomized controlled trials, and 4 studies are pilot randomized controlled trials with sample sizes of fewer than 40. There were inconsistencies in the self-care components tested, increasing bias. Thus, risk of bias was assessed using the Cochrane Collaboration's tool for risk of selection, performance, detection, attrition, and reporting biases. Most studies included in this review are underpowered and had high risk of bias across all categories. Three studies failed to provide enough information to allow for a complete assessment of bias, and thus had unknown or unclear risk of bias. This review on the commercially available apps demonstrated many incomplete apps, many apps with bugs, and several apps with low quality. Conclusions: The heterogeneity of study design, sample size, intervention components, and outcomes measured precluded the performance of a systematic review or meta-analysis, thus introducing bias of this review. Although the heart failure--related outcomes reported in this review vary, they demonstrated trends toward making an impact and offer a potentially cost-effective solution with 24/7 access to symptom monitoring as a point of care solution, promoting patient engagement in their own home care. ",
doi="10.2196/10057",
url="http://cardio.jmir.org/2018/1/e10057/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758762"
}