@Article{info:doi/10.2196/58837,
author="Flo, L. Gayle
and Alzate Aguirre, Mateo
and Gochanour, R. Benjamin
and Hynes, J. Kristin
and Scott, G. Christopher
and Fink, L. Angela
and M Arruda-Olson, Adelaide",
title="Pharmacist-Initiated Team-Based Intervention for Optimizing Guideline-Directed Lipid Therapy of Hospitalized Patients With Acute Coronary Syndrome: Pilot Study Using a Stepped-Wedge Cluster Design",
journal="JMIR Cardio",
year="2025",
month="Mar",
day="28",
volume="9",
pages="e58837",
keywords="coronary disease",
keywords="follow-up studies",
keywords="lipids",
keywords="myocardial infarction",
keywords="statins",
abstract="Background: Clinical guidelines recommend high-intensity statin therapy for patients with acute coronary syndrome (ACS). However, high-intensity statins have been underused in this population. Objective: The objective of this study was to evaluate the feasibility of a pharmacist-initiated, team-based intervention for the delivery of individualized, guideline-directed, lipid-lowering therapy for patients with ACS. Methods: Patients admitted with ACS to cardiology hospital services at Mayo Clinic from August 1, 2021, to June 19, 2022, were assigned to a pharmacist-initiated, team-based intervention group or control group using a stepped wedge cluster study design. For the intervention group, pharmacists reviewed electronic health records and provided recommendations for lipid lowering therapy in hospital and at follow-up. In the control group, patients received usual care. Neither care team, nor study team were blinded to study assignments. The primary outcome was the proportion of patients with ACS discharged on high-intensity statins in the intervention group compared to controls. Secondary outcomes were (1) proportion of patients in the intervention group with a specific templated pharmacist intervention note in their electronic health records, (2) frequency of low-density lipoprotein (LDL) measurements in hospital, (3) proportion of patients with information related to lipid follow-up in their discharge summary, and (4) proportion of patients that received LDL monitoring at the outpatient follow-up 4 to 12 weeks post discharge. Results: There were 410 patients included in this study (median age 68, IQR 60-78 years) of whom 285 (69.5\%) were male. Of the 402 patients alive at discharge, 355 (88.3\%) were discharged taking a high-intensity statin, with no significant difference (P=.89) observed between groups. Lipid levels were measured in the hospital for 176/210 (83.8\%) patients in the intervention group and 155/200 (77.5\%) patients in the control group (P=.14). Fifty-four of 205 (26.3\%) intervention patients alive at discharge had lipid-related recommendations in their discharge summary compared to 27/197 (13.7\%) controls (P=.002). Forty-seven of 81 (58\%) patients with lipid management recommendations provided in the discharge summary had LDL measured in the follow-up period compared with only 119/321 (37.1\%) patients without these recommendations (P=.001). Of the 402 patients who survived to discharge, 166 (41.3\%) had LDL measured at follow-up; the median LDL level was 63.5 (IQR 49-79) mg/dL, and distributions were similar by group (P=.95). Only 101/166 (60.8\%) patients had follow-up LDL values below the target of 70 mg/dL. Conclusions: During hospitalization, there was no group difference in the primary outcome of high-intensity statin therapy. Feasibility of an effective pharmacist-initiated intervention for improvement of lipid management was demonstrated by entry of recommendations in the discharge summary and related adjustment in outpatient statin therapy. The main opportunity for future improvement in lipid management of patients with ACS is in longitudinal patient follow-up. ",
doi="10.2196/58837",
url="https://cardio.jmir.org/2025/1/e58837"
}


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


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


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


@Article{info:doi/10.2196/58124,
author="Kavanagh, E. Meaghan
and Chiavaroli, Laura
and Quibrantar, M. Selina
and Viscardi, Gabrielle
and Ramboanga, Kimberly
and Amlin, Natalie
and Paquette, Melanie
and Sahye-Pudaruth, Sandhya
and Patel, Darshna
and Grant, M. Shannan
and Glenn, J. Andrea
and Ayoub-Charette, Sabrina
and Zurbau, Andreea
and Josse, G. Robert
and Malik, S. Vasanti
and Kendall, C. Cyril W.
and Jenkins, A. David J.
and Sievenpiper, L. John",
title="Acceptability of a Web-Based Health App (PortfolioDiet.app) to Translate a Nutrition Therapy for Cardiovascular Disease in High-Risk Adults: Mixed Methods Randomized Ancillary Pilot Study",
journal="JMIR Cardio",
year="2025",
month="Mar",
day="28",
volume="9",
pages="e58124",
keywords="diet",
keywords="apps",
keywords="dietary app",
keywords="Portfolio Diet",
keywords="dietary portfolio",
keywords="cholesterol reduction",
keywords="cardiovascular disease",
keywords="eHealth",
keywords="usability",
keywords="acceptability",
abstract="Background: The Portfolio Diet is a dietary pattern for cardiovascular disease (CVD) risk reduction with 5 key categories including nuts and seeds; plant protein from specific food sources; viscous fiber sources; plant sterols; and plant-derived monounsaturated fatty acid sources. To enhance implementation of the Portfolio Diet, we developed the PortfolioDiet.app, an automated, web-based, multicomponent, patient-facing health app that was developed with psychological theory. Objective: We aimed to evaluate the effect of the PortfolioDiet.app on dietary adherence and its acceptability among adults with a high risk of CVD over 12 weeks. Methods: Potential participants with evidence of atherosclerosis and a minimum of one additional CVD risk factor in an ongoing trial were invited to participate in a remote web-based ancillary study by email. Eligible participants were randomized in a 1:1 ratio using a concealed computer-generated allocation sequence to the PortfolioDiet.app group or a control group for 12 weeks. Adherence to the Portfolio Diet was assessed by weighed 7-day diet records at baseline and 12 weeks using the clinical Portfolio Diet Score, ranging from 0 to 25. Acceptability of the app was evaluated using a multifaceted approach, including usability through the System Usability Scale ranging from 0 to 100, with a score >70 being considered acceptable, and a qualitative analysis of open-ended questions using NVivo 12. Results: In total, 41 participants were invited from the main trial to join the ancillary study by email, of which 15 agreed, and 14 were randomized (8 in the intervention group and 6 in the control group) and completed the ancillary study. At baseline, adherence to the Portfolio Diet was high in both groups with a mean clinical Portfolio Diet Score of 13.2 (SD 3.7; 13.2/25, 53\%) and 13.7 (SD 5.8; 13.7/25, 55\%) in the app and control groups, respectively. After the 12 weeks, there was a tendency for a mean increase in adherence to the Portfolio Diet by 1.25 (SD 2.8; 1.25/25, 5\%) and 0.19 (SD 4.4; 0.19/25, 0.8\%) points in the app and control group, respectively, with no difference between groups (P=.62). Participants used the app on average for 18 (SD 14) days per month and rated the app as usable (System Usability Scale of mean 80.9, SD 17.3). Qualitative analyses identified 4 main themes (user engagement, usability, external factors, and added components), which complemented the quantitative data obtained. Conclusions: Although adherence was higher for the PortfolioDiet.app group, no difference in adherence was found between the groups in this small ancillary study. However, this study demonstrates that the PortfolioDiet.app is considered usable by high-risk adults and may reinforce dietitian advice to follow the Portfolio Diet when it is a part of a trial for CVD management. Trial Registration: ClinicalTrials.gov NCT02481466; https://clinicaltrials.gov/study/NCT02481466 ",
doi="10.2196/58124",
url="https://cardio.jmir.org/2025/1/e58124"
}


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


@Article{info:doi/10.2196/67871,
author="Wei, Shengfeng
and Guo, Xiangjian
and He, Shilin
and Zhang, Chunhua
and Chen, Zhizhuan
and Chen, Jianmei
and Huang, Yanmei
and Zhang, Fan
and Liu, Qiangqiang",
title="Application of Machine Learning for Patients With Cardiac Arrest: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="10",
volume="27",
pages="e67871",
keywords="cardiac arrest",
keywords="machine learning",
keywords="prognosis",
keywords="systematic review",
keywords="artificial intelligence",
keywords="AI",
abstract="Background: Currently, there is a lack of effective early assessment tools for predicting the onset and development of cardiac arrest (CA). With the increasing attention of clinical researchers on machine learning (ML), some researchers have developed ML models for predicting the occurrence and prognosis of CA, with certain models appearing to outperform traditional scoring tools. However, these models still lack systematic evidence to substantiate their efficacy. Objective: This systematic review and meta-analysis was conducted to evaluate the prediction value of ML in CA for occurrence, good neurological prognosis, mortality, and the return of spontaneous circulation (ROSC), thereby providing evidence-based support for the development and refinement of applicable clinical tools. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were systematically searched from their establishment until May 17, 2024. The risk of bias in all prediction models was assessed using the Prediction Model Risk of Bias Assessment Tool. Results: In total, 93 studies were selected, encompassing 5,729,721 in-hospital and out-of-hospital patients. The meta-analysis revealed that, for predicting CA, the pooled C-index, sensitivity, and specificity derived from the imbalanced validation dataset were 0.90 (95\% CI 0.87-0.93), 0.83 (95\% CI 0.79-0.87), and 0.93 (95\% CI 0.88-0.96), respectively. On the basis of the balanced validation dataset, the pooled C-index, sensitivity, and specificity were 0.88 (95\% CI 0.86-0.90), 0.72 (95\% CI 0.49-0.95), and 0.79 (95\% CI 0.68-0.91), respectively. For predicting the good cerebral performance category score 1 to 2, the pooled C-index, sensitivity, and specificity based on the validation dataset were 0.86 (95\% CI 0.85-0.87), 0.72 (95\% CI 0.61-0.81), and 0.79 (95\% CI 0.66-0.88), respectively. For predicting CA mortality, the pooled C-index, sensitivity, and specificity based on the validation dataset were 0.85 (95\% CI 0.82-0.87), 0.83 (95\% CI 0.79-0.87), and 0.79 (95\% CI 0.74-0.83), respectively. For predicting ROSC, the pooled C-index, sensitivity, and specificity based on the validation dataset were 0.77 (95\% CI 0.74-0.80), 0.53 (95\% CI 0.31-0.74), and 0.88 (95\% CI 0.71-0.96), respectively. In predicting CA, the most significant modeling variables were respiratory rate, blood pressure, age, and temperature. In predicting a good cerebral performance category score 1 to 2, the most significant modeling variables in the in-hospital CA group were rhythm (shockable or nonshockable), age, medication use, and gender; the most significant modeling variables in the out-of-hospital CA group were age, rhythm (shockable or nonshockable), medication use, and ROSC. Conclusions: ML represents a currently promising approach for predicting the occurrence and outcomes of CA. Therefore, in future research on CA, we may attempt to systematically update traditional scoring tools based on the superior performance of ML in specific outcomes, achieving artificial intelligence--driven enhancements. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42024518949; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=518949 ",
doi="10.2196/67871",
url="https://www.jmir.org/2025/1/e67871",
url="http://www.ncbi.nlm.nih.gov/pubmed/40063076"
}


@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/10.2196/64349,
author="Elvas, B. Luis
and Almeida, Ana
and Ferreira, C. Joao",
title="The Role of AI in Cardiovascular Event Monitoring and Early Detection: Scoping Literature Review",
journal="JMIR Med Inform",
year="2025",
month="Mar",
day="6",
volume="13",
pages="e64349",
keywords="artificial intelligence",
keywords="machine learning",
keywords="cardiovascular diseases",
keywords="cardiovascular events",
keywords="health care",
keywords="monitoring",
keywords="early detection",
keywords="AI",
keywords="cardiovascular",
keywords="literature review",
keywords="medical data",
keywords="detect",
keywords="patient outcomes",
keywords="neural network",
keywords="ML model",
keywords="mobile phone",
abstract="Background: Artificial intelligence (AI) has shown exponential growth and advancements, revolutionizing various fields, including health care. However, domain adaptation remains a significant challenge, as machine learning (ML) models often need to be applied across different health care settings with varying patient demographics and practices. This issue is critical for ensuring effective and equitable AI deployment. Cardiovascular diseases (CVDs), the leading cause of global mortality with 17.9 million annual deaths, encompass conditions like coronary heart disease and hypertension. The increasing availability of medical data, coupled with AI advancements, offers new opportunities for early detection and intervention in cardiovascular events, leveraging AI's capacity to analyze complex datasets and uncover critical patterns. Objective: This review aims to examine AI methodologies combined with medical data to advance the intelligent monitoring and detection of CVDs, identifying areas for further research to enhance patient outcomes and support early interventions. Methods: This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology to ensure a rigorous and transparent literature review process. This structured approach facilitated a comprehensive overview of the current state of research in this field. Results: Through the methodology used, 64 documents were retrieved, of which 40 documents met the inclusion criteria. The reviewed papers demonstrate advancements in AI and ML for CVD detection, classification, prediction, diagnosis, and patient monitoring. Techniques such as ensemble learning, deep neural networks, and feature selection improve prediction accuracy over traditional methods. ML models predict cardiovascular events and risks, with applications in monitoring via wearable technology. The integration of AI in health care supports early detection, personalized treatment, and risk assessment, possibly improving the management of CVDs. Conclusions: The study concludes that AI and ML techniques can improve the accuracy of CVD classification, prediction, diagnosis, and monitoring. The integration of multiple data sources and noninvasive methods supports continuous monitoring and early detection. These advancements help enhance CVD management and patient outcomes, indicating the potential for AI to offer more precise and cost-effective solutions in health care. ",
doi="10.2196/64349",
url="https://medinform.jmir.org/2025/1/e64349"
}


@Article{info:doi/10.2196/66464,
author="Abdullayev, Kamilla
and Chico, A. Tim J.
and Canson, Jiana
and Mantelow, Matthew
and Buckley, Oli
and Condell, Joan
and Van Arkel, J. Richard
and Diaz-Zuccarini, Vanessa
and Matcham, Faith",
title="Exploring Stakeholder Perspectives on the Barriers and Facilitators of Implementing Digital Technologies for Heart Disease Diagnosis: Qualitative Study",
journal="JMIR Cardio",
year="2025",
month="Mar",
day="5",
volume="9",
pages="e66464",
keywords="heart disease",
keywords="digital technologies",
keywords="stakeholder perspectives",
keywords="qualitative research",
keywords="digital technology",
keywords="health technology",
keywords="heart",
keywords="cardio",
keywords="cardiology",
keywords="cardiovascular",
keywords="qualitative",
keywords="focused group",
keywords="quality of care",
keywords="efficiency",
keywords="digital health",
keywords="mobile phone",
keywords="artificial intelligence",
keywords="AI",
abstract="Background: Digital technologies are increasingly being implemented in health care to improve the quality and efficiency of care for patients. However, the rapid adoption of health technologies over the last 5 years has failed to adequately consider patient and clinician needs, which results in ineffective implementation. There is also a lack of consideration for the differences between patient and clinician needs, resulting in overgeneralized approaches to the implementation and use of digital health technologies. Objective: This study aimed to explore barriers and facilitators of the implementation of digital technologies in the diagnosis of heart disease for both patients and clinicians, and to provide recommendations to increase the acceptability of novel health technologies. Methods: We recruited 32 participants from across the United Kingdom, including 23 (72\%) individuals with lived experience of heart disease and 9 (28\%) clinicians involved in diagnosing heart disease. Participants with experience of living with heart disease took part in semistructured focused groups, while clinicians contributed to one-to-one semistructured interviews. Inductive thematic analysis using a phenomenological approach was conducted to analyze the resulting qualitative data and to identify themes. Results were discussed with a cardiovascular patient advisory group to enhance the rigor of our interpretation of the data. Results: Emerging themes were separated into facilitators and barriers and categorized into resource-, technology-, and user-related themes. Resource-related barriers and facilitators related to concerns around increased clinician workload, the high cost of digital technologies, and systemic limitations within health care systems such as outdated equipment and limited support. Technology-related barriers and facilitators included themes related to reliability, accuracy, safety parameters, data security, ease of use, and personalization, all of which can impact engagement and trust with digital technologies. Finally, the most prominent themes were the user-related barriers and facilitators, which encompassed user attitudes, individual-level variation in preferences and capabilities, and impact on quality of health care experiences. This theme captured a wide variety of perspectives among the sample and revealed how patient and clinician attitudes and personal experiences substantially impact engagement with digital health technologies across the cardiovascular care pathway. Conclusions: Our findings highlight the importance of considering both patient and clinician needs and preferences when investigating the barriers and facilitators to effective implementation of digital health technologies. Facilitators to technology adoption include the need for cost-effective, accurate, reliable, and easy-to-use systems as well as adequate setup support and personalization to meet individual needs. Positive user attitudes, perceived improvement in care quality, and increased involvement in the care process also enhance engagement. While both clinicians and patients acknowledge the potential benefits of digital technologies, effective implementation hinges on addressing these barriers and leveraging facilitators to ensure that the technologies are perceived as useful, safe, and supportive of health care outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-072952 ",
doi="10.2196/66464",
url="https://cardio.jmir.org/2025/1/e66464",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053721"
}


@Article{info:doi/10.2196/63186,
author="Miao, Shumei
and Ji, Pei
and Zhu, Yongqian
and Meng, Haoyu
and Jing, Mang
and Sheng, Rongrong
and Zhang, Xiaoliang
and Ding, Hailong
and Guo, Jianjun
and Gao, Wen
and Yang, Guanyu
and Liu, Yun",
title="The Construction and Application of a Clinical Decision Support System for Cardiovascular Diseases: Multimodal Data-Driven Development and Validation Study",
journal="JMIR Med Inform",
year="2025",
month="Mar",
day="3",
volume="13",
pages="e63186",
keywords="CVD",
keywords="CDSS",
keywords="multimodel data",
keywords="knowledge engine",
keywords="development",
keywords="cardiovascular disease",
keywords="clinical decision support system",
abstract="Background: Due to the acceleration of the aging population and the prevalence of unhealthy lifestyles, the incidence of cardiovascular diseases (CVDs) in China continues to grow. However, due to the uneven distribution of medical resources across regions and significant disparities in diagnostic and treatment levels, the diagnosis and management of CVDs face considerable challenges. Objective: The purpose of this study is to build a cardiovascular diagnosis and treatment knowledge base by using new technology, form an auxiliary decision support system, and integrate it into the doctor's workstation, to improve the assessment rate and treatment standardization rate. This study offers new ideas for the prevention and management of CVDs. Methods: This study designed a clinical decision support system (CDSS) with data, learning, knowledge, and application layers. It integrates multimodal data from hospital laboratory information systems, hospital information systems, electronic medical records, electrocardiography, nursing, and other systems to build a knowledge model. The unstructured data were segmented using natural language processing technology, and medical entity words and entity combination relationships were extracted using IDCNN (iterated dilated convolutional neural network) and TextCNN (text convolutional neural network). The CDSS refers to global CVD assessment indicators to design quality control strategies and an intelligent treatment plan recommendation engine map, establishing a big data analysis platform to achieve multidimensional, visualized data statistics for management decision support. Results: The CDSS system is embedded and interfaced with the physician workstation, triggering in real-time during the clinical diagnosis and treatment process. It establishes a 3-tier assessment control through pop-up windows and screen domination operations. Based on the intelligent diagnostic and treatment reminders of the CDSS, patients are given intervention treatments. The important risk assessment and diagnosis rate indicators significantly improved after the system came into use, and gradually increased within 2 years. The indicators of mandatory control, directly became 100\% after the CDSS was online. The CDSS enhanced the standardization of clinical diagnosis and treatment. Conclusions: This study establishes a specialized knowledge base for CVDs, combined with clinical multimodal information, to intelligently assess and stratify cardiovascular patients. It automatically recommends intervention treatments based on assessments and clinical characterizations, proving to be an effective exploration of using a CDSS to build a disease-specific intelligent system. ",
doi="10.2196/63186",
url="https://medinform.jmir.org/2025/1/e63186"
}


@Article{info:doi/10.2196/67576,
author="Lu, Shao-Chi
and Chen, Guang-Yuan
and Liu, An-Sheng
and Sun, Jen-Tang
and Gao, Jun-Wan
and Huang, Chien-Hua
and Tsai, Chu-Lin
and Fu, Li-Chen",
title="Deep Learning--Based Electrocardiogram Model (EIANet) to Predict Emergency Department Cardiac Arrest: Development and External Validation Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="28",
volume="27",
pages="e67576",
keywords="cardiac arrest",
keywords="emergency department",
keywords="deep learning",
keywords="computer vision",
keywords="electrocardiogram",
abstract="Background: In-hospital cardiac arrest (IHCA) is a severe and sudden medical emergency that is characterized by the abrupt cessation of circulatory function, leading to death or irreversible organ damage if not addressed immediately. Emergency department (ED)--based IHCA (EDCA) accounts for 10\% to 20\% of all IHCA cases. Early detection of EDCA is crucial, yet identifying subtle signs of cardiac deterioration is challenging. Traditional EDCA prediction methods primarily rely on structured vital signs or electrocardiogram (ECG) signals, which require additional preprocessing or specialized devices. This study introduces a novel approach using image-based 12-lead ECG data obtained at ED triage, leveraging the inherent richness of visual ECG patterns to enhance prediction and integration into clinical workflows. Objective: This study aims to address the challenge of early detection of EDCA by developing an innovative deep learning model, the ECG-Image-Aware Network (EIANet), which uses 12-lead ECG images for early prediction of EDCA. By focusing on readily available triage ECG images, this research seeks to create a practical and accessible solution that seamlessly integrates into real-world ED workflows. Methods: For adult patients with EDCA (cases), 12-lead ECG images at ED triage were obtained from 2 independent data sets: National Taiwan University Hospital (NTUH) and Far Eastern Memorial Hospital (FEMH). Control ECGs were randomly selected from adult ED patients without cardiac arrest during the same study period. In EIANet, ECG images were first converted to binary form, followed by noise reduction, connected component analysis, and morphological opening. A spatial attention module was incorporated into the ResNet50 architecture to enhance feature extraction, and a custom binary recall loss (BRLoss) was used to balance precision and recall, addressing slight data set imbalance. The model was developed and internally validated on the NTUH-ECG data set and was externally validated on an independent FEMH-ECG data set. The model performance was evaluated using the F1-score, area under the receiver operating characteristic curve (AUROC), and area under the precision-recall curve (AUPRC). Results: There were 571 case ECGs and 826 control ECGs in the NTUH data set and 378 case ECGs and 713 control ECGs in the FEMH data set. The novel EIANet model achieved an F1-score of 0.805, AUROC of 0.896, and AUPRC of 0.842 on the NTUH-ECG data set with a 40\% positive sample ratio. It achieved an F1-score of 0.650, AUROC of 0.803, and AUPRC of 0.678 on the FEMH-ECG data set with a 34.6\% positive sample ratio. The feature map showed that the region of interest in the ECG was the ST segment. Conclusions: EIANet demonstrates promising potential for accurately predicting EDCA using triage ECG images, offering an effective solution for early detection of high-risk cases in emergency settings. This approach may enhance the ability of health care professionals to make timely decisions, with the potential to improve patient outcomes by enabling earlier interventions for EDCA. ",
doi="10.2196/67576",
url="https://www.jmir.org/2025/1/e67576",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053733"
}


@Article{info:doi/10.2196/60888,
author="Luo, Aijing
and Chen, Wei
and Zhu, Hongtao
and Xie, Wenzhao
and Chen, Xi
and Liu, Zhenjiang
and Xin, Zirui",
title="Machine Learning in the Management of Patients Undergoing Catheter Ablation for Atrial Fibrillation: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="10",
volume="27",
pages="e60888",
keywords="atrial fibrillation",
keywords="catheter ablation",
keywords="deep learning",
keywords="patient management",
keywords="prognosis",
keywords="quality assessment tools",
keywords="cardiac arrhythmia",
keywords="public health",
keywords="quality of life",
keywords="severe medical condition",
keywords="electrocardiogram",
keywords="electronic health record",
keywords="morbidity",
keywords="mortality",
keywords="thromboembolism",
keywords="clinical intervention",
abstract="Background: Although catheter ablation (CA) is currently the most effective clinical treatment for atrial fibrillation, its variable therapeutic effects among different patients present numerous problems. Machine learning (ML) shows promising potential in optimizing the management and clinical outcomes of patients undergoing atrial fibrillation CA (AFCA). Objective: This scoping review aimed to evaluate the current scientific evidence on the application of ML for managing patients undergoing AFCA, compare the performance of various models across specific clinical tasks within AFCA, and summarize the strengths and limitations of ML in this field. Methods: Adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, relevant studies published up to October 7, 2023, were searched from PubMed, Web of Science, Embase, the Cochrane Library, and ScienceDirect. The final included studies were confirmed based on inclusion and exclusion criteria and manual review. The PROBAST (Prediction model Risk Of Bias Assessment Tool) and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) methodological quality assessment tools were used to review the included studies, and narrative data synthesis was performed on the modeled results provided by these studies. Results: The analysis of 23 included studies showcased the contributions of ML in identifying potential ablation targets, improving ablation strategies, and predicting patient prognosis. The patient data used in these studies comprised demographics, clinical characteristics, various types of imaging (9/23, 39\%), and electrophysiological signals (7/23, 30\%). In terms of model type, deep learning, represented by convolutional neural networks, was most frequently applied (14/23, 61\%). Compared with traditional clinical scoring models or human clinicians, the model performance reported in the included studies was generally satisfactory, but most models (14/23, 61\%) showed a high risk of bias due to lack of external validation. Conclusions: Our evidence-based findings suggest that ML is a promising tool for improving the effectiveness and efficiency of managing patients undergoing AFCA. While guiding data preparation and model selection for future studies, this review highlights the need to address prevalent limitations, including lack of external validation, and to further explore model generalization and interpretability. ",
doi="10.2196/60888",
url="https://www.jmir.org/2025/1/e60888"
}


@Article{info:doi/10.2196/60591,
author="DiCaro, Vincent Michael
and Yee, Brianna
and Lei, KaChon
and Batra, Kavita
and Dawn, Buddhadeb",
title="Mesenchymal Stem Cell Therapy for Acute Myocardial Infarction: Protocol for a Systematic Review and Meta-Analysis",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="6",
volume="14",
pages="e60591",
keywords="mesenchymal stem cells",
keywords="mesenchymal stromal cells",
keywords="progenitor cells",
keywords="acute myocardial infarction",
keywords="outcomes",
keywords="stem cell",
keywords="myocardial",
keywords="protocol",
keywords="systematic review",
keywords="meta-analysis",
keywords="medical therapy",
keywords="therapy",
keywords="cardiac",
keywords="efficacy",
abstract="Background: Medical therapy and interventional approaches have improved outcomes in patients with acute myocardial infarction (MI). However, these strategies are inadequate for replacing cells lost during tissue ischemia, thereby leaving behind noncontractile scar tissue. The anti-inflammatory and immune modulating properties of mesenchymal stem cells (MSCs) may prove useful in inducing functional cardiac regeneration following acute MI. Objective: This is a protocol for systematic review and meta-analysis that will aggregate and synthesize high-level clinical data on the effects of MSC therapy for acute MI. The findings of this study may serve as evidence for clinicians and researchers in guiding the use of MSC therapy as an adjunct to reperfusion and optimal medical therapy in patients with acute MI. Methods: The proposed systematic review is registered with PROSPERO (International Prospective Register of Systematic Reviews). A systematic search of bibliographical databases, including Embase, PubMed, and Cochrane was conducted from inception to June 2023 to identify English-language human studies with adult patients receiving MSC therapy and optimal medical therapy for acute MI in comparison with respective controls. Article screening was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data on functional cardiac outcomes and major adverse cardiac events were extracted and analyzed as primary outcomes. Results: Literature search and article screening commenced in June 2023. Data extraction and analysis will be completed by October 2024. The findings will be synthesized and reported by the end of November 2024. Conclusions: This systematic review and meta-analysis will summarize the best available updated evidence from published randomized controlled trials on the effects of MSC therapy for the treatment of acute MI. The findings of this systematic review and meta-analysis may shed light on the efficacy of MSC therapy in improving cardiac functional and structural parameters and reducing adverse cardiac events following acute MI. Trial Registration: PROSPERO CRD42024522398; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=522398 International Registered Report Identifier (IRRID): DERR1-10.2196/60591 ",
doi="10.2196/60591",
url="https://www.researchprotocols.org/2025/1/e60591"
}


@Article{info:doi/10.2196/63897,
author="Chin, Wei-Chih
and Chu, Pao-Hsien
and Wu, Lung-Sheng
and Lee, Kuang-Tso
and Lin, Chen
and Ho, Chien-Te
and Yang, Wei-Sheng
and Chung, I-Hang
and Huang, Yu-Shu",
title="The Prognostic Significance of Sleep and Circadian Rhythm for Myocardial Infarction Outcomes: Case-Control Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="4",
volume="27",
pages="e63897",
keywords="myocardial infarction",
keywords="circadian rhythm",
keywords="actigraphy",
keywords="nonparametric analysis",
keywords="prognosis",
keywords="sleep",
keywords="heart rate variability",
keywords="activity",
abstract="Background: Myocardial infarction (MI) is a medical emergency resulting from coronary artery occlusion. Patients with acute MI often experience disturbed sleep and circadian rhythm. Most previous studies assessed the premorbid sleep and circadian rhythm of patients with MI and their correlations with cardiovascular disease. However, little is known about post-MI sleep and circadian rhythm and their impacts on prognosis. The use of actigraphy with different algorithms to evaluate sleep and circadian rhythm after acute MI has the potential for predicting outcomes and preventing future disease progression. Objective: We aimed to evaluate how sleep patterns and disrupted circadian rhythm affect the prognosis of MI, using actigraphy and heart rate variability (HRV). Nonparametric analysis of actigraphy data was performed to examine the circadian rhythm of patients. Methods: Patients with MI in the intensive care unit (ICU) were enrolled alongside age- and gender-matched healthy controls. Actigraphy was used to evaluate sleep and circadian rhythm, while HRV was monitored for 24 hours to assess autonomic nerve function. Nonparametric indicators were calculated to quantify the active-rest patterns, including interdaily stability, intradaily variability, the most active 10 consecutive hours (M10), the least active 5 consecutive hours (L5), the relative amplitude, and the actigraphic dichotomy index. Follow-ups were conducted at 3 and 6 months after discharge to evaluate prognosis, including the duration of current admission, the number and duration of readmission and ICU admission, and catheterization. Independent sample t tests and analysis of covariance were used to compare group differences. Pearson correlation tests were used to explore the correlations of the parameters of actigraphy and HRV with prognosis. Results: The study included 34 patients with MI (mean age 57.65, SD 9.03 years) and 17 age- and gender-matched controls. MI patients had significantly more wake after sleep onset, an increased number of awakenings, and a lower sleep efficiency than controls. Circadian rhythm analysis revealed significantly lower daytime activity in MI patients. Moreover, these patients had a lower relative amplitude and dichotomy index and a higher intradaily variability and midpoint of M10, suggesting less sleep and wake activity changes, more fragmentation of the rest-activity patterns, and a more delayed circadian rhythm. Furthermore, significant correlations were found between the parameters of circadian rhythm analysis, including nighttime activity, time of M10 and L5, and daytime and nighttime activitySD, and patient prognosis. Conclusions: Patients with acute MI experienced significantly worse sleep and disturbed circadian rhythm compared with healthy controls. Our actigraphy-based analysis revealed a disturbed circadian rhythm, including reduced daytime activities, greater fluctuation in hourly activities, and a weak rest-activity rhythm, which were correlated with prognosis. The evaluation of sleep and circadian rhythm in patients with acute MI can serve as a valuable indicator for prognosis and should be further studied. ",
doi="10.2196/63897",
url="https://www.jmir.org/2025/1/e63897"
}


@Article{info:doi/10.2196/64410,
author="Yu, Tianzhuo
and Parry, Monica
and Yu, Tianyue
and Xu, Linqi
and Wu, Yuejin
and Zeng, Ting
and Leng, Xin
and Tong, Qian
and Li, Feng",
title="Effectiveness of Mobile Health--Based Gamification Interventions for Improving Physical Activity in Individuals With Cardiovascular Diseases: Systematic Review and Meta-Analysis of Randomized Controlled Trials",
journal="JMIR Serious Games",
year="2025",
month="Jan",
day="24",
volume="13",
pages="e64410",
keywords="cardiovascular diseases",
keywords="digital health",
keywords="mobile health",
keywords="gamification",
keywords="exercise",
keywords="physical activity",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Gamification refers to using game design elements in nongame contexts. Promoting physical activity (PA) through gamification is a novel and promising avenue for improving lifestyles and mitigating the advancement of cardiovascular diseases (CVDs). However, evidence of its effectiveness remains mixed. Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of gamification interventions in promoting PA during short-term and follow-up periods in individuals with CVDs and to explore the most effective game design elements. Methods: A comprehensive search of 7 electronic databases was conducted for randomized controlled trials published in English from January 1, 2010, to February 3, 2024. Eligible studies used mobile health--based gamification interventions to promote PA or reduce sedentary behavior in individuals with CVDs. In total, 2 independent reviewers screened the retrieved records, extracted data, and evaluated the risk of bias using the RoB 2 tool. Discrepancies were resolved by a third reviewer. Meta-analyses were performed using a random-effects model with the Sidik-Jonkman method adjusted by the Knapp-Hartung method. Sensitivity analysis and influence analysis examined the robustness of results, while prediction intervals indicated heterogeneity. A meta-regression using a multimodel inference approach explored the most important game design elements. Statistical analyses were conducted using R (version 4.3.2; R Foundation for Statistical Computing). Results: In total, 6 randomized controlled trials were included. Meta-analysis of 5 studies revealed a small effect of gamification interventions on short-term PA (after sensitivity analysis: Hedges g=0.32, 95\% CI 0.19-0.45, 95\% prediction interval [PI] 0.02-0.62). Meta-analysis of 3 studies found the maintenance effect (measured with follow-up averaging 2.5 months after the end of the intervention) was small (Hedges g=0.20, 95\% CI 0.12-0.29, 95\% PI --0.01 to 0.41). A meta-analysis of 3 studies found participants taking 696.96 more steps per day than the control group (95\% CI 327.80 to 1066.12, 95\% PI --121.39 to 1515.31). ``Feedback'' was the most important game design element, followed by ``Avatar.'' Conclusions: This meta-analysis demonstrates that gamification interventions effectively promote PA in individuals with CVD, with effects persisting beyond the intervention period, indicating they are not merely novel effects caused by the game nature of gamification. The 95\% PI suggests that implementing gamification interventions in similar populations in the future will lead to actual effects in promoting PA in the vast majority of cases. However, the limited number of included studies underscores the urgent need for more high-quality research in this emerging field. Trial Registration: PROSPERO CRD42024518795; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=518795 ",
doi="10.2196/64410",
url="https://games.jmir.org/2025/1/e64410"
}


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


@Article{info:doi/10.2196/58812,
author="Jiang, Xiangkui
and Wang, Bingquan",
title="Enhancing Clinical Decision Making by Predicting Readmission Risk in Patients With Heart Failure Using Machine Learning: Predictive Model Development Study",
journal="JMIR Med Inform",
year="2024",
month="Dec",
day="31",
volume="12",
pages="e58812",
keywords="prediction model",
keywords="heart failure",
keywords="hospital readmission",
keywords="machine learning",
keywords="cardiology",
keywords="admissions",
keywords="hospitalization",
abstract="Background: Patients with heart failure frequently face the possibility of rehospitalization following an initial hospital stay, placing a significant burden on both patients and health care systems. Accurate predictive tools are crucial for guiding clinical decision-making and optimizing patient care. However, the effectiveness of existing models tailored specifically to the Chinese population is still limited. Objective: This study aimed to formulate a predictive model for assessing the likelihood of readmission among patients diagnosed with heart failure. Methods: In this study, we analyzed data from 1948 patients with heart failure in a hospital in Sichuan Province between 2016 and 2019. By applying 3 variable selection strategies, 29 relevant variables were identified. Subsequently, we constructed 6 predictive models using different algorithms: logistic regression, support vector machine, gradient boosting machine, Extreme Gradient Boosting, multilayer perception, and graph convolutional networks. Results: The graph convolutional network model showed the highest prediction accuracy with an area under the receiver operating characteristic curve of 0.831, accuracy of 75\%, sensitivity of 52.12\%, and specificity of 90.25\%. Conclusions: The model crafted in this study proves its effectiveness in forecasting the likelihood of readmission among patients with heart failure, thus serving as a crucial reference for clinical decision-making. ",
doi="10.2196/58812",
url="https://medinform.jmir.org/2024/1/e58812"
}


@Article{info:doi/10.2196/55958,
author="Prakash, Prita Madhu
and Thiagalingam, Aravinda",
title="The Role of Clinician-Developed Applications in Promoting Adherence to Evidence-Based Guidelines: Pilot Study",
journal="JMIR Cardio",
year="2024",
month="Dec",
day="31",
volume="8",
pages="e55958",
keywords="computerized clinical decision support systems",
keywords="acute coronary syndrome",
keywords="clinical guidelines",
keywords="chest pain pathway",
keywords="decision support",
keywords="coronary",
keywords="heart",
keywords="cardiac",
keywords="cardiology",
keywords="chest",
keywords="pain",
keywords="web-based",
keywords="app",
keywords="applications",
keywords="computerized",
keywords="guideline",
keywords="emergency",
keywords="usability",
abstract="Background: Computerized clinical decision support systems (CDSS) are increasingly being used in clinical practice to improve health care delivery. Mobile apps are a type of CDSS that are currently being increasingly used, particularly in lifestyle interventions and disease prevention. However, the use of such apps in acute patient care, diagnosis, and management has not been studied to a great extent. The Pathway for Acute Coronary Syndrome Assessment (PACSA) is a set of guidelines developed to standardize the management of suspected acute coronary syndrome across emergency departments in New South Wales, Australia. These guidelines, which risk stratify patients and provide an appropriate management plan, are currently available as PDF documents or physical paper-based PACSA documents. The routine use of these documents and their acceptability among clinicians is uncertain. Presenting the PACSA guidelines on a mobile app in a sequential format may be a more acceptable alternative to the current paper-based PACSA documents. Objective: This study aimed to assess the utility and acceptability of a clinician-developed app modeling the PACSA guidelines as an alternative to the existing paper-based PACSA documents in assessing chest pain presentations to the emergency department. Methods: An app modeling the PACSA guidelines was created using the Research Electronic Data Capture (REDCap) platform by a cardiologist, with a total development time of <3 hours. The app utilizes a sequential design, requiring participants to input patient data in a step-wise fashion to reach the final patient risk stratification. Emergency department doctors were asked to use the app and apply it to two hypothetical patient scenarios. Participants then completed a survey to assess if the PACSA app offered any advantages over the current paper-based PACSA documents Results: Participants (n=31) ranged from junior doctors to senior physicians. Current clinician adherence to the paper-based PACSA documents was low with 55\% (N=17) never using it in their daily practice. Totally, 42\% of participants found the PACSA app easier to use compared to the paper-based PACSA documents and 58\% reported that the PACSA app was also faster to use. The perceived usefulness of the PACSA app was similar to the perceived usefulness of the paper-based PACSA documents. Conclusions: The PACSA app offers a more efficient and user-friendly alternative to the current paper-based PACSA documents and may promote clinician adherence to evidence-based guidelines. Additional studies with a larger number of participants are required to assess the transferability of the PACSA app to everyday practice. Furthermore, apps are relatively easy to develop using existing online platforms, with the scope for clinicians to develop such apps for other evidence-based guidelines and across different specialties. ",
doi="10.2196/55958",
url="https://cardio.jmir.org/2024/1/e55958"
}


@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/10.2196/57960,
author="Bretschneider, Pia Maxi
and Mayer-Berger, Wolfgang
and Weine, Jens
and Roth, Lena
and Schwarz, H. Peter E.
and Petermann, Franz",
title="Results of a Digital Multimodal Motivational and Educational Program as Follow-Up Care for Former Cardiac Rehabilitation Patients: Randomized Controlled Trial",
journal="JMIR Cardio",
year="2024",
month="Dec",
day="11",
volume="8",
pages="e57960",
keywords="mHealth",
keywords="apps",
keywords="digital technology",
keywords="digital interventions",
keywords="coronary heart disease",
keywords="lifestyle intervention",
keywords="cardiac rehabilitation",
keywords="quality of life",
keywords="cardiac care",
abstract="Background: Digital interventions are promising additions for both usual care and rehabilitation. Evidence and studies for the latter, however, are still rare. Objective: The aim of the study was to examine the app/web-based patient education program called ``mebix'' (previously called ``Vision 2 -- Gesundes Herz'') regarding its effectiveness in relation to the parameters of disease-specific quality of life (HeartQoL), cardiovascular risk profile (Cardiovascular Risk Management [CARRISMA]), and prognostic estimation of early retirement (Screening instrument work and occupation [SIBAR]) in 190 participants from a cardiological rehabilitation clinic. Methods: To evaluate mebix, 354 patients from the Roderbirken Clinic of the German Pension Insurance Rhineland (Germany) with a coronary heart diesase were recruited and randomized either to the intervention group (using mebix postrehabiliation for up to 12 months) or the control group (receiving standard care). The data collection took place at the end of inpatient rehabilitation (t0), as well as 6 months (t1) and 12 months (t2) after the end of rehabilitation. Analyses of variance are used to assess the overall significance of difference in outcome parameters between groups and over time. Results: The primary endpoint of disease-related quality of life shows a significant improvement of 7.35 points over the course of the intervention that is also more pronounced in the intervention group. Similarly, the 10-year risk of cardiovascular death and myocardial infarction showed significant improvements in the cardiovascular risk profile over time and between groups, indicating better results in the intervention group (ie, a reduction of ?1.59 and ?5.03, respectively). Positive effects on secondary outcomes like body weight, blood pressure, and number of smokers only showed time effects, indicating no difference between the groups. In addition, the SIBAR was significantly lower/better at the end of the observation period than at the beginning of the observation for both groups. Conclusions: Overall, the digital training program represents an effective follow-up offer after rehabilitation that could be incorporated into standard care to further improve disease-related quality of life and cardiovascular risk profiles. Trial Registration: German Clinical Trials Register DRKS00007569; https://drks.de/search/en/trial/DRKS00007569 ",
doi="10.2196/57960",
url="https://cardio.jmir.org/2024/1/e57960"
}


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


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


@Article{info:doi/10.2196/52266,
author="Matsumura, Koichiro
and Nakagomi, Atsushi
and Yagi, Eijiro
and Yamada, Nobuhiro
and Funauchi, Yohei
and Kakehi, Kazuyoshi
and Yoshida, Ayano
and Kawamura, Takayuki
and Ueno, Masafumi
and Nakazawa, Gaku
and Tabuchi, Takahiro",
title="Impact of an mHealth App (Kencom) on Patients With Untreated Hypertension Initiating Antihypertensive Medications: Real-World Cohort Study",
journal="JMIR Cardio",
year="2024",
month="Nov",
day="26",
volume="8",
pages="e52266",
keywords="untreated hypertension",
keywords="mobile health app",
keywords="antihypertensive medication",
keywords="cardiovascular disease",
keywords="mHealth",
abstract="Background: To prevent the further development of cardiovascular diseases, it is a growing global priority to detect untreated hypertension in patients and ensure adequate blood pressure control via drug therapy. However, few effective tools that facilitate the initiation of antihypertensive medications among such patients have been identified. Objective: We aimed to determine whether a mobile health (mHealth) app facilitates the initiation of antihypertensive medications among patients with untreated hypertension. Methods: We analyzed a large longitudinal integrated database mainly comprised of data from middle-aged, employed people and their families. The database contained data from health checkups, health insurance claims, and the mHealth app kencom. kencom is used to manage daily life logs (eg, weight, number of steps) and to provide health information tailored to customers. Patients with untreated hypertension were identified using the baseline health checkup data, and follow-up health checkups were conducted to identify the rate of initiation of antihypertensive medications between mHealth app users and nonusers. Antihypertensive medication status was confirmed via a questionnaire administered during the medical checkup as well as a review of the health insurance claims database. We conducted a modified Poisson regression analysis, weighted by inverse probability of treatment weighting, to examine the effect of mHealth app usage on the initiation of antihypertensive medications. Additionally, data from four lifestyle questionnaires from the baseline and follow-up health checkups were collected to evaluate lifestyle modifications that could be attributed to the mHealth app. Results: Data were collected from 50,803 eligible patients (mean age 49, SD 9 years; men n=39,412, 77.6\%; women n=11,391, 22.4\%) with a median follow-up period of 3.0 (IQR 2.3?3.1) years. The rate of initiation of antihypertensive medications was significantly higher in the mHealth app user group than in the nonuser group: 23.4\% (3482/14,879) versus 18.5\% (6646/35,924; P<.001), respectively. The risk ratio of mHealth app usage for initiated antihypertensive medications was 1.28 (95\% CI 1.23?1.33). Among those who did not intend to improve their lifestyle habits such as exercise and diet at baseline, the rate of lifestyle improvement at follow-up was compared between mHealth app users and nonusers, using data from the questionnaires; mHealth app users demonstrated a significantly higher rate of lifestyle changes than nonusers. Conclusions: For patients with untreated hypertension, the use of the mHealth app kencom, which was not dedicated to hypertension treatment, was associated with a higher initiation of antihypertensive medications. ",
doi="10.2196/52266",
url="https://cardio.jmir.org/2024/1/e52266"
}


@Article{info:doi/10.2196/54357,
author="Cavero-Redondo, Iv{\'a}n
and Martinez-Rodrigo, Arturo
and Saz-Lara, Alicia
and Moreno-Herraiz, Nerea
and Casado-Vicente, Veronica
and Gomez-Sanchez, Leticia
and Garcia-Ortiz, Luis
and Gomez-Marcos, A. Manuel
and ",
title="Antihypertensive Drug Recommendations for Reducing Arterial Stiffness in Patients With Hypertension: Machine Learning--Based Multicohort (RIGIPREV) Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="25",
volume="26",
pages="e54357",
keywords="antihypertensive",
keywords="drugs",
keywords="models",
keywords="patients",
keywords="pulse wave velocity",
keywords="recommendations",
keywords="hypertension",
keywords="machine learning",
keywords="drug recommendations",
keywords="arterial stiffness",
keywords="RIGIPREV",
abstract="Background: High systolic blood pressure is one of the leading global risk factors for mortality, contributing significantly to cardiovascular diseases. Despite advances in treatment, a large proportion of patients with hypertension do not achieve optimal blood pressure control. Arterial stiffness (AS), measured by pulse wave velocity (PWV), is an independent predictor of cardiovascular events and overall mortality. Various antihypertensive drugs exhibit differential effects on PWV, but the extent to which these effects vary depending on individual patient characteristics is not well understood. Given the complexity of selecting the most appropriate antihypertensive medication for reducing PWV, machine learning (ML) techniques offer an opportunity to improve personalized treatment recommendations. Objective: This study aims to develop an ML model that provides personalized recommendations for antihypertensive medications aimed at reducing PWV. The model considers individual patient characteristics, such as demographic factors, clinical data, and cardiovascular measurements, to identify the most suitable antihypertensive agent for improving AS. Methods: This study, known as the RIGIPREV study, used data from the EVA, LOD-DIABETES, and EVIDENT studies involving individuals with hypertension with baseline and follow-up measurements. Antihypertensive drugs were grouped into classes such as angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), $\beta$-blockers, diuretics, and combinations of diuretics with ACEIs or ARBs. The primary outcomes were carotid-femoral and brachial-ankle PWV, while the secondary outcomes included various cardiovascular, anthropometric, and biochemical parameters. A multioutput regressor using 6 random forest models was used to predict the impact of each antihypertensive class on PWV reduction. Model performance was evaluated using the coefficient of determination (R2) and mean squared error. Results: The random forest models exhibited strong predictive capabilities, with internal validation yielding R2 values between 0.61 and 0.74, while external validation showed a range of 0.26 to 0.46. The mean squared values ranged from 0.08 to 0.22 for internal validation and from 0.29 to 0.45 for external validation. Variable importance analysis revealed that glycated hemoglobin and weight were the most critical predictors for ACEIs, while carotid-femoral PWV and total cholesterol were key variables for ARBs. The decision tree model achieved an accuracy of 84.02\% in identifying the most suitable antihypertensive drug based on individual patient characteristics. Furthermore, the system's recommendations for ARBs matched 55.3\% of patients' original prescriptions. Conclusions: This study demonstrates the utility of ML techniques in providing personalized treatment recommendations for antihypertensive therapy. By accounting for individual patient characteristics, the model improves the selection of drugs that control blood pressure and reduce AS. These findings could significantly aid clinicians in optimizing hypertension management and reducing cardiovascular risk. However, further studies with larger and more diverse populations are necessary to validate these results and extend the model's applicability. ",
doi="10.2196/54357",
url="https://www.jmir.org/2024/1/e54357",
url="http://www.ncbi.nlm.nih.gov/pubmed/39585738"
}


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


@Article{info:doi/10.2196/57328,
author="Ferguson, Caleb
and William, Scott
and Allida, M. Sabine
and Fulcher, Jordan
and Jenkins, J. Alicia
and Lattimore, Jo-Dee
and Loch, L-J
and Keech, Anthony",
title="The Development of Heart Failure Electronic-Message Driven Tips to Support Self-Management: Co-Design Case Study",
journal="JMIR Cardio",
year="2024",
month="Nov",
day="7",
volume="8",
pages="e57328",
keywords="heart failure",
keywords="co-design",
keywords="smartphone",
keywords="app design",
keywords="patient education",
keywords="e-TIPS",
keywords="electronic-message driven tips",
abstract="Background: Heart failure (HF) is a complex syndrome associated with high morbidity and mortality and increased health care use. Patient education is key to improving health outcomes, achieved by promoting self-management to optimize medical management. Newer digital tools like SMS text messaging and smartphone apps provide novel patient education approaches. Objective: This study aimed to partner with clinicians and people with lived experience of HF to identify the priority educational topic areas to inform the development and delivery of a bank of electronic-message driven tips (e-TIPS) to support HF self-management. Methods: We conducted 3 focus groups with cardiovascular clinicians, people with lived experience of HF, and their caregivers, which consisted of 2 stages: stage 1 (an exploratory qualitative study to identify the unmet educational needs of people living with HF; previously reported) and stage 2 (a co-design feedback session to identify educational topic areas and inform the delivery of e-TIPS). This paper reports the findings of the co-design feedback session. Results: We identified 5 key considerations in delivering e-TIPS and 5 relevant HF educational topics for their content. Key considerations in e-TIP delivery included (1) timing of the e-TIPS; (2) clear and concise e-TIPS; (3) embedding a feedback mechanism; (4) distinguishing actionable and nonactionable e-TIPS; and (5) frequency of e-TIP delivery. Relevant educational topic areas included the following: (1) cardiovascular risk reduction, (2) self-management, (3) food and nutrition, (4) sleep hygiene, and (5) mental health. Conclusions: The findings from this co-design case study have provided a foundation for developing a bank of e-TIPS. These will now be evaluated for usability in the BANDAIDS e-TIPS, a single-group, quasi-experimental study of a 24-week e-TIP program (personalized educational messages) delivered via SMS text messaging (ACTRN12623000644662). ",
doi="10.2196/57328",
url="https://cardio.jmir.org/2024/1/e57328"
}


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


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


@Article{info:doi/10.2196/53298,
author="Tisdale, Lauren Rebecca
and Ferguson, M. Jacqueline
and Van Campen, James
and Greene, Liberty
and Wray, M. Charlie
and Zulman, M. Donna",
title="Patient-, Provider-, and Facility-Level Contributors to the Use of Cardiology Telehealth Care in the Veterans Health Administration: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="25",
volume="26",
pages="e53298",
keywords="telehealth",
keywords="mixed models",
keywords="veteran",
keywords="patient",
keywords="virtual cardiology",
keywords="cardiology care",
keywords="cohort study",
abstract="Background: Telehealth (care delivered by phone or video) comprises a substantial proportion of cardiology care delivered in the Veterans Health Administration (VHA). Little is known about how factors specific to patients, clinicians, and facilities contribute to variation in cardiology telehealth use. Objective: The aim of this study is to estimate the relative extent to which patient-, clinician-, and facility-level factors affect cardiology telehealth use in VHA. Methods: This was a retrospective, nation-wide cohort study of veterans' use of VHA cardiology telehealth care during the first 2 years of the COVID-19 pandemic (March 11, 2020, to March 10, 2022). We constructed multilevel, multivariable, logistic regression models of patient-level cardiology telehealth use (telephone or video-based care). Models included random effects for the patient, the patient's main cardiology provider, and the patient's primary facility (ie, VHA medical center) for specialty care and fixed effects for patient sociodemographic and clinical characteristics. Results: Our analytic cohort comprised 223,809 veterans with 989,271 encounters among 2235 unique clinicians. The veterans' average age was 70.2 years, and 3.4\% (n=7616) were women. Of the 989,271 encounters, 4.2\% (n=41,480) were video based and 34.3\% (n=338,834) were phone based. Adjusted odds of telehealth use were slightly higher for women versus men (adjusted odds ratio [AOR] 1.08, 95\% CI 1.05-1.10), individuals identifying as Hispanic or Latino versus not Hispanic or Latino (AOR 1.46, 95\% CI 1.43-1.49), and those with medium and long drive times versus short drive time (AOR 1.11, 95\% CI 1.10-1.12 and AOR 1.09, 95\% CI 1.07-1.10, respectively). Further, 40.5\% of the variation in a veteran's likelihood of using cardiology telehealth care was found at the patient level, 30.8\% at the clinician level, and 7\% at the facility level. Conclusions: The largest share of the attributable variability in VHA cardiology telehealth use in this cohort was explained by the patient, followed closely by the clinician. Little variability was attributed to the primary facility through which the veteran received their cardiology care. These results suggest that policy solutions intended to improve equity of cardiology telehealth care use in VHA may be most impactful when directed at patients and clinicians. ",
doi="10.2196/53298",
url="https://www.jmir.org/2024/1/e53298"
}


@Article{info:doi/10.2196/57338,
author="Ramasawmy, Mel
and Roland Persson, Dan
and Sunkersing, David
and Gill, Paramjit
and Khunti, Kamlesh
and Poole, Lydia
and Hanif, Wasim
and Blandford, Ann
and Sajid, Madiha
and Stevenson, Fiona
and Khan, Nushrat
and Banerjee, Amitava",
title="Uptake of Digital Health Interventions for Cardiometabolic Disease in British South Asian Individuals: Think Aloud Study",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="24",
volume="11",
pages="e57338",
keywords="digital health",
keywords="cardiometabolic disease",
keywords="cardiology",
keywords="cardiovascular risk",
keywords="health inequality",
keywords="health disparity",
keywords="usability",
keywords="user experience",
keywords="think aloud",
keywords="cultural barriers",
keywords="digital divide",
keywords="digital literacy",
abstract="Background: Digital health interventions (DHIs) could support prevention and management of cardiometabolic disease. However, those who may benefit most often experience barriers to awareness and adoption of these interventions. Objective: Among South Asian individuals, we evaluated user experience of DHIs for prevention and management of cardiometabolic disease, aiming to understand barriers and facilitators to initial and ongoing use. Methods: Among South Asian individuals recruited via primary care, community organizations, and snowball methods (n=18), we conducted ``think-aloud'' interviews using a reflective and reactive approach. Participants included nonusers, as well as those that used a range of DHIs as part of monitoring and improving their health. Participants were asked to think aloud while completing a task they routinely do in a familiar DHI, as well as while setting up and completing a search task in a novel DHI; they were encouraged to behave as if unobserved. Results: Lack of cultural specificity was highlighted as reducing relevance and usability, particularly relating to dietary change. Preferred features reflected individual health beliefs and behaviors, digital skills, and trust in DHIs. For example, tracking blood glucose was considered by some to be positive, while for others it caused distress and anxiety. Similarly, some users found the novel DHI to be extremely simple to set up and use, and others grew frustrated navigating through initial interfaces. Many participants raised concerns about data privacy and needing to agree to terms and conditions that they did not understand. Participants expressed that with information and support from trusted sources, they would be interested in using DHIs as part of self-management. Conclusions: DHIs may support South Asians to prevent and manage cardiometabolic disease, but it is important to consider the needs of specific user groups in DHI development, design, and implementation. Despite motivation to make health changes, digital barriers are common. Cultural appropriateness and trusted sources (such as health care providers and community organizations) have roles in increasing awareness and enabling individuals to access and use DHIs. ",
doi="10.2196/57338",
url="https://humanfactors.jmir.org/2024/1/e57338"
}


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


@Article{info:doi/10.2196/54405,
author="Suresh Kumar, Sagar
and Connolly, Patricia
and Maier, Anja",
title="Considering User Experience and Behavioral Approaches in the Design of mHealth Interventions for Atrial Fibrillation: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="4",
volume="26",
pages="e54405",
keywords="atrial fibrillation",
keywords="wearable devices",
keywords="lifestyle modification",
keywords="user experience",
keywords="design for behavior change",
keywords="systems thinking",
keywords="cardiac disease",
keywords="stroke",
keywords="heart disease",
keywords="complication",
keywords="mobile health",
keywords="systematic review",
keywords="usability",
keywords="mHealth",
keywords="intervention",
abstract="Background: Atrial fibrillation (AF) is a leading chronic cardiac disease associated with an increased risk of stroke, cardiac complications, and general mortality. Mobile health (mHealth) interventions, including wearable devices and apps, can aid in the detection, screening, and management of AF to improve patient outcomes. The inclusion of approaches that consider user experiences and behavior in the design of health care interventions can increase the usability of mHealth interventions, and hence, hopefully, yield an increase in positive outcomes in the lives of users. Objective: This study aims to show how research has considered user experiences and behavioral approaches in designing mHealth interventions for AF detection, screening, and management; the phases of designing complex interventions from the UK Medical Research Council (MRC) were referenced: namely, identification, development, feasibility, evaluation, and implementation. Methods: Studies published until September 7, 2022, that examined user experiences and behavioral approaches associated with mHealth interventions in the context of AF were extracted from multiple databases. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were used. Results: A total of 2219 records were extracted, with only 55 records reporting on usability, user experiences, or behavioral approaches more widely for designing mHealth interventions in the context of AF. When mapping the studies onto the phases of the UK MRC's guidance for developing and evaluating complex interventions, the following was found: in the identification phase, there were significant differences between the needs of patients and health care workers. In the development phase, user perspectives guided the iterative development of apps, interfaces, and intervention protocols in 4 studies. Most studies (43/55, 78\%) assessed the usability of interventions in the feasibility phase as an outcome, although the data collection tools were not designed together with users and stakeholders. Studies that examined the evaluation and implementation phase entailed reporting on challenges in user participation, acceptance, and workflows that could not be captured by studies in the previous phases. To realize the envisaged human behavior intended through treatment, review results highlight the scant inclusion of behavior change approaches for mHealth interventions across multiple levels of sociotechnical health care systems. While interventions at the level of the individual (micro) and the level of communities (meso) were found in the studies reviewed, no studies were found intervening at societal levels (macro). Studies also failed to consider the temporal variation of user goals and feedback in the design of long-term behavioral interventions. Conclusions: In this systematic review, we proposed 2 contributions: first, mapping studies to different phases of the MRC framework for developing and evaluating complex interventions, and second, mapping behavioral approaches to different levels of health care systems. Finally, we discuss the wider implications of our results in guiding future mHealth research. ",
doi="10.2196/54405",
url="https://www.jmir.org/2024/1/e54405"
}


@Article{info:doi/10.2196/64216,
author="Taylor, Marin
and Bondi, Christina Bianca
and Andrade, F. Brendan
and Au-Young, H. Stephanie
and Chau, Vann
and Danguecan, Ashley
and D{\'e}sir{\'e}, Naddley
and Guo, Ting
and Ostojic-Aitkens, Dragana
and Wade, Shari
and Miller, Steven
and Williams, Samantha Tricia",
title="Stepped-Care Web-Based Parent Support Following Congenital Heart Disease: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Oct",
day="4",
volume="13",
pages="e64216",
keywords="congenital heart disease",
keywords="neurodevelopmental outcomes",
keywords="web-based mental health care",
keywords="stepped care",
keywords="positive parenting",
keywords="family well-being",
keywords="mental health",
keywords="I-InTERACT-North",
abstract="Background: Early neurodevelopmental risks, compounded with traumatic medical experiences, contribute to emotional and behavioral challenges in as many as 1 in 2 children with congenital heart disease (CHD). Parents report a strong need for supports; yet, there remains a lack of accessible, evidence-based behavioral interventions available for children with CHD and their families. I-InTERACT-North is a web-based stepped-care mental health program designed to support family well-being and reduce behavioral concerns through positive parenting for children with early medical complexity. In previous pilot studies, the program was effective in increasing positive parenting skills and decreasing child behavior problems, with high parent-reported acceptability. This paper presents the protocol for the first randomized study of stepped-care parent support for families of children with CHD. Objective: This study will involve a single-site, 2-arm, single-blind randomized controlled trial to evaluate (1) the feasibility and acceptability of a web-based stepped-care parent support program (I-InTERACT-North) and (2) the effectiveness of the program in enhancing positive parenting skills and reducing behavioral concerns among families of children with CHD. Methods: Families will be randomized (1:1) to either receive treatment or continue with care as usual for 12 months. Randomization will be stratified by child's sex assigned at birth and baseline parent-reported child behavior intensity. Primary outcomes include positive parenting skills and child behavior at baseline, 3 months, 6 months, and 12 months. Secondary outcomes include parental mental health, quality of life, service usage, and feasibility including program reach and adherence. A sample size of 244 families will provide >95\% power to detect an effect size of d=0.64. Based on attrition data from pilot studies, a target of 382 families will be enrolled. Parent reports of acceptability, adoption, and suggested adaptability of the program will be examined using cross-case thematic analyses. Primary efficacy analysis will be conducted using an intent-to-treat approach. Generalized estimating equations will be used to examine changes in positive parenting. Child behavior, quality of life, and parent mental health will be tested with repeated-measures analyses. Additional sensitivity and replication analyses will also be carried out. Results: Recruitment began in February 2024, and recruitment and follow-up will continue until January 2029. We anticipate results in late 2029. Conclusions: This study aims to test the effectiveness of I-InTERACT-North web-based stepped-care parent support in improving positive parenting skills and reducing child behavior problems in families of children with CHD compared with a care as usual control group. Results will inform future clinical implementation and expansion of this program among families of children with early medical conditions. Trial Registration: ClinicalTrials.gov NCT06075251; https://clinicaltrials.gov/study/NCT06075251 International Registered Report Identifier (IRRID): DERR1-10.2196/64216 ",
doi="10.2196/64216",
url="https://www.researchprotocols.org/2024/1/e64216",
url="http://www.ncbi.nlm.nih.gov/pubmed/39365658"
}


@Article{info:doi/10.2196/59392,
author="Brahma, Arindam
and Chatterjee, Samir
and Seal, Kala
and Fitzpatrick, Ben
and Tao, Youyou",
title="Development of a Cohort Analytics Tool for Monitoring Progression Patterns in Cardiovascular Diseases: Advanced Stochastic Modeling Approach",
journal="JMIR Med Inform",
year="2024",
month="Sep",
day="24",
volume="12",
pages="e59392",
keywords="healthcare analytics",
keywords="eHealth",
keywords="disease monitoring",
keywords="cardiovascular disease",
keywords="disease progression model",
keywords="myocardial",
keywords="stroke",
keywords="decision support",
keywords="continuous-time Markov chain model",
keywords="stochastic model",
keywords="stochastic",
keywords="Markov",
keywords="cardiology",
keywords="cardiovascular",
keywords="heart",
keywords="monitoring",
keywords="progression",
abstract="Background: The World Health Organization (WHO) reported that cardiovascular diseases (CVDs) are the leading cause of death worldwide. CVDs are chronic, with complex progression patterns involving episodes of comorbidities and multimorbidities. When dealing with chronic diseases, physicians often adopt a ``watchful waiting'' strategy, and actions are postponed until information is available. Population-level transition probabilities and progression patterns can be revealed by applying time-variant stochastic modeling methods to longitudinal patient data from cohort studies. Inputs from CVD practitioners indicate that tools to generate and visualize cohort transition patterns have many impactful clinical applications. The resultant computational model can be embedded in digital decision support tools for clinicians. However, to date, no study has attempted to accomplish this for CVDs. Objective: This study aims to apply advanced stochastic modeling methods to uncover the transition probabilities and progression patterns from longitudinal episodic data of patient cohorts with CVD and thereafter use the computational model to build a digital clinical cohort analytics artifact demonstrating the actionability of such models. Methods: Our data were sourced from 9 epidemiological cohort studies by the National Heart Lung and Blood Institute and comprised chronological records of 1274 patients associated with 4839 CVD episodes across 16 years. We then used the continuous-time Markov chain method to develop our model, which offers a robust approach to time-variant transitions between disease states in chronic diseases. Results: Our study presents time-variant transition probabilities of CVD state changes, revealing patterns of CVD progression against time. We found that the transition from myocardial infarction (MI) to stroke has the fastest transition rate (mean transition time 3, SD 0 days, because only 1 patient had a MI-to-stroke transition in the dataset), and the transition from MI to angina is the slowest (mean transition time 1457, SD 1449 days). Congestive heart failure is the most probable first episode (371/840, 44.2\%), followed by stroke (216/840, 25.7\%). The resultant artifact is actionable as it can act as an eHealth cohort analytics tool, helping physicians gain insights into treatment and intervention strategies. Through expert panel interviews and surveys, we found 9 application use cases of our model. Conclusions: Past research does not provide actionable cohort-level decision support tools based on a comprehensive, 10-state, continuous-time Markov chain model to unveil complex CVD progression patterns from real-world patient data and support clinical decision-making. This paper aims to address this crucial limitation. Our stochastic model--embedded artifact can help clinicians in efficient disease monitoring and intervention decisions, guided by objective data-driven insights from real patient data. Furthermore, the proposed model can unveil progression patterns of any chronic disease of interest by inputting only 3 data elements: a synthetic patient identifier, episode name, and episode time in days from a baseline date. ",
doi="10.2196/59392",
url="https://medinform.jmir.org/2024/1/e59392",
url="http://www.ncbi.nlm.nih.gov/pubmed/39316426"
}


@Article{info:doi/10.2196/63076,
author="Kumar, Mandeep
and Wilkinson, Kathryn
and Li, Ya-Huei
and Masih, Rohit
and Gandhi, Mehak
and Saadat, Haleh
and Culmone, Julie",
title="Association of a Novel Electronic Form for Preoperative Cardiac Risk Assessment With Reduction in Cardiac Consultations and Testing: Retrospective Cohort Study",
journal="JMIR Perioper Med",
year="2024",
month="Sep",
day="13",
volume="7",
pages="e63076",
keywords="preoperative",
keywords="cardiology consultations",
keywords="decrease low value care",
keywords="cardiology",
keywords="cardiac",
keywords="cohort",
keywords="surgery",
keywords="surgical",
keywords="EMR",
keywords="EMRs",
keywords="EHR",
keywords="EHRs",
keywords="electronic medical record",
keywords="electronic medical records",
keywords="electronic health record",
keywords="electronic health records",
keywords="form",
keywords="forms",
keywords="assessment",
keywords="assessments",
keywords="risk",
keywords="risks",
keywords="referral",
keywords="consultation",
keywords="consultations",
keywords="testing",
keywords="diagnosis",
keywords="diagnoses",
keywords="diagnostic",
keywords="diagnostics",
abstract="Background: Preoperative cardiac risk assessment is an integral part of preoperative evaluation; however, there is significant variation among providers, leading to inappropriate referrals for cardiology consultation or excessive low-value cardiac testing. We implemented a novel electronic medical record (EMR) form in our preoperative clinics to decrease variation. Objective: This study aimed to investigate the impact of the EMR form on the preoperative utilization of cardiology consultation and cardiac diagnostic testing (echocardiograms, stress tests, and cardiac catheterization) and evaluate postoperative outcomes. Methods: A retrospective cohort study was conducted. Patients who underwent outpatient preoperative evaluation prior to an elective surgery over 2 years were divided into 2 cohorts: from July 1, 2021, to June 30, 2022 (pre--EMR form implementation), and from July 1, 2022, to June 30, 2023 (post--EMR form implementation). Demographics, comorbidities, resource utilization, and surgical characteristics were analyzed. Propensity score matching was used to adjust for differences between the 2 cohorts. The primary outcomes were the utilization of preoperative cardiology consultation, cardiac testing, and 30-day postoperative major adverse cardiac events (MACE). Results: A total of 25,484 patients met the inclusion criteria. Propensity score matching yielded 11,645 well-matched pairs. The post--EMR form, matched cohort had lower cardiology consultation (pre--EMR form: n=2698, 23.2\% vs post--EMR form: n=2088, 17.9\%; P<.001) and echocardiogram (pre--EMR form: n=808, 6.9\% vs post--EMR form: n=591, 5.1\%; P<.001) utilization. There were no significant differences in the 30-day postoperative outcomes, including MACE (all P>.05). While patients with ``possible indications'' for cardiology consultation had higher MACE rates, the consultations did not reduce MACE risk. Most algorithm end points, except for active cardiac conditions, had MACE rates <1\%. Conclusions: In this cohort study, preoperative cardiac risk assessment using a novel EMR form was associated with a significant decrease in cardiology consultation and testing utilization, with no adverse impact on postoperative outcomes. Adopting this approach may assist perioperative medicine clinicians and anesthesiologists in efficiently decreasing unnecessary preoperative resource utilization without compromising patient safety or quality of care. ",
doi="10.2196/63076",
url="https://periop.jmir.org/2024/1/e63076"
}


@Article{info:doi/10.2196/56380,
author="Miki, Takahiro
and Yamada, Junya
and Ishida, Shinpei
and Sakui, Daisuke
and Kanai, Masashi
and Hagiwara, Yuta",
title="Exploring the Feasibility and Initial Impact of an mHealth-Based Disease Management Program for Chronic Ischemic Heart Disease: Formative Study",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="22",
volume="8",
pages="e56380",
keywords="mobile health",
keywords="chronic ischemic heart disease",
keywords="disease management program",
keywords="mobile phone",
keywords="behavior change",
abstract="Background: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide, requiring innovative management strategies. Traditional disease management programs often struggle to maintain patient engagement and ensure long-term adherence to lifestyle modifications and treatment plans. Mobile health (mHealth) technologies have emerged as a promising approach to address these challenges by providing continuous, personalized support and monitoring. However, the reported use and effectiveness of mHealth in the management of chronic diseases, such as IHD, have not been fully explored. Objective: The primary aim of this study was to evaluate the feasibility and initial impact of an mHealth-based disease management program on coronary risk factors, specifically focusing on low-density lipoprotein cholesterol (LDL-C) levels, in individuals with chronic IHD. This formative study assessed changes in LDL-C and other metabolic health indicators over a 6-month period to determine the initial impact of the program on promoting cardiovascular health and lifestyle modification. Methods: This study was conducted using data from 266 individuals enrolled in an mHealth-based disease management program between December 2018 and October 2022. Eligibility was based on a documented history of IHD, with participants undergoing a comprehensive cardiac risk assessment before enrollment. The program included biweekly telephone sessions, health tracking via a smartphone app, and regular progress reports to physicians. The study measured change in LDL-C levels as the primary outcome, with secondary outcomes including body weight, triglyceride levels, and other metabolic health indicators. Statistical analysis used paired 2-tailed t tests and stratified analyses to assess the impact of the program. Results: Participants experienced a significant reduction in LDL-C, with LDL-C levels decreasing from a mean of 98.82 (SD 40.92) mg/dL to 86.62 (SD 39.86) mg/dL (P<.001). The intervention was particularly effective in individuals with high baseline LDL-C levels. Additional improvements were seen in body weight and triglyceride levels, suggesting a broader impact on metabolic health. Program adherence and engagement metrics suggested high participant satisfaction and compliance. Conclusions: The results of this study suggest that the mHealth-based disease management program is feasible and has an initial positive impact on reducing LDL-C levels and improving metabolic health in individuals with chronic IHD. However, the study design does not allow for a definitive conclusion regarding whether mHealth-based disease management programs are more effective than traditional face-to-face care. Future studies are needed to further validate these findings and to examine the comparative effectiveness of these interventions in more detail. ",
doi="10.2196/56380",
url="https://formative.jmir.org/2024/1/e56380"
}


@Article{info:doi/10.2196/50009,
author="Melnikov, Semyon
and Klein, Stav
and Shahar, Moni
and Guy, David",
title="Using Topic Modeling to Understand Patients' and Caregivers' Perspectives About Left Ventricular Assist Device: Thematic Analysis",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="13",
volume="26",
pages="e50009",
keywords="left ventricular assist device",
keywords="LVAD",
keywords="topic modeling",
keywords="health care forum",
keywords="heart disease",
keywords="cardiovascular condition",
keywords="medical devices",
keywords="devices for heart",
keywords="latent Dirichlet allocation",
keywords="cardiovascular",
keywords="device",
keywords="visualization tool",
keywords="tool",
keywords="heart",
keywords="caregiver",
keywords="monitoring",
keywords="management",
keywords="care",
keywords="users",
keywords="communication",
keywords="heart failure",
abstract="Background: Heart failure (HF) is a significant global clinical and public health challenge, impacting 64.3 million individuals worldwide. To address the scarcity of donor organs, left ventricular assist device (LVAD) implantation has become a crucial intervention for managing end-stage HF, serving as a bridge to heart transplantation or as a destination therapy. Web-based health forums, such as MyLVAD.com, play a vital role as trusted sources of information for individuals with HF symptoms and their caregivers. Objective: We aim to uncover the latent topics within the posts shared by users on the MyLVAD.com website. Methods: Using the latent Dirichlet allocation algorithm and a visualization tool, our objective was to uncover latent topics within the posts shared on the MyLVAD.com website. Through the application of topic modeling techniques, we analyzed 459 posts authored by recipients of LVAD and their family members from 2015 to 2023. Results: This study unveiled 5 prominent themes of concern among patients with LVAD and their family members. These themes included family support (39.5\% weight value), encompassing subthemes such as family caregiving roles and emotional or practical support; clothing (23.9\% weight value), with subthemes related to comfort, normalcy, and functionality; infection (18.2\% weight value), covering driveline infections, prevention, and care; power (12\% weight value), involving challenges associated with power dependency; and self-care maintenance, monitoring, and management (6.3\% weight value), which included subthemes such as blood tests, monitoring, alarms, and device management. Conclusions: These findings contribute to a better understanding of the experiences and needs of patients implanted with LVAD, providing valuable insights for health care professionals to offer tailored support and care. By using latent Dirichlet allocation to analyze posts from the MyLVAD.com forum, this study sheds light on key topics discussed by users, facilitating improved patient care and enhanced patient-provider communication. ",
doi="10.2196/50009",
url="https://www.jmir.org/2024/1/e50009"
}


@Article{info:doi/10.2196/57058,
author="Sassone, Biagio
and Fuca', Giuseppe
and Pedaci, Mario
and Lugli, Roberta
and Bertagnin, Enrico
and Virzi', Santo
and Bovina, Manuela
and Pasanisi, Giovanni
and Mandini, Simona
and Myers, Jonathan
and Tolomeo, Paolo",
title="Analysis of Demographic and Socioeconomic Factors Influencing Adherence to a Web-Based Intervention Among Patients After Acute Coronary Syndrome: Prospective Observational Cohort Study",
journal="JMIR Cardio",
year="2024",
month="Aug",
day="2",
volume="8",
pages="e57058",
keywords="telemedicine",
keywords="digital literacy",
keywords="digital health",
keywords="acute coronary syndrome",
keywords="older age",
keywords="caregiver",
keywords="socioeconomic",
keywords="educational",
keywords="mobile phone",
abstract="Background: Although telemedicine has been proven to have significant potential for improving care for patients with cardiac problems, there remains a substantial risk of introducing disparities linked to the use of digital technology, especially for older or socially vulnerable subgroups. Objective: We investigated factors influencing adherence to a telemedicine-delivered health education intervention in patients with ischemia, emphasizing demographic and socioeconomic considerations. Methods: We conducted a descriptive, observational, prospective cohort study in consecutive patients referred to our cardiology center for acute coronary syndrome, from February 2022 to January 2023. Patients were invited to join a web-based health educational meeting (WHEM) after hospital discharge, as part of a secondary prevention program. The WHEM sessions were scheduled monthly and used a teleconference software program for remote synchronous videoconferencing, accessible through a standard computer, tablet, or smartphone based on patient preference or availability. Results: Out of the 252 patients (median age 70, IQR 61.0-77.3 years; n=189, 75\% male), 98 (38.8\%) declined the invitation to participate in the WHEM. The reasons for nonacceptance were mainly challenges in handling digital technology (70/98, 71.4\%), followed by a lack of confidence in telemedicine as an integrative tool for managing their medical condition (45/98, 45.9\%), and a lack of internet-connected devices (43/98, 43.8\%). Out of the 154 patients who agreed to participate in the WHEM, 40 (25.9\%) were unable to attend. Univariable logistic regression analysis showed that the presence of a caregiver with digital proficiency and a higher education level was associated with an increased likelihood of attendance to the WHEM, while the converse was true for increasing age and female sex. After multivariable adjustment, higher education level (odds ratio [OR] 2.26, 95\% CI 1.53-3.32; P<.001) and caregiver with digital proficiency (OR 12.83, 95\% CI 5.93-27.75; P<.001) remained independently associated with the outcome. The model discrimination was good even when corrected for optimism (optimism-corrected C-index=0.812), as was the agreement between observed and predicted probability of participation (optimism-corrected calibration intercept=0.010 and slope=0.948). Conclusions: This study identifies a notable lack of suitability for a specific cohort of patients with ischemia to participate in our telemedicine intervention, emphasizing the risk of digital marginalization for a significant portion of the population. Addressing low digital literacy rates among patients or their informal caregivers and overcoming cultural bias against remote care were identified as critical issues in our study findings to facilitate the broader adoption of telemedicine as an inclusive tool in health care. ",
doi="10.2196/57058",
url="https://cardio.jmir.org/2024/1/e57058",
url="http://www.ncbi.nlm.nih.gov/pubmed/38912920"
}


@Article{info:doi/10.2196/54994,
author="Levinson, T. Rebecca
and Paul, Cinara
and Meid, D. Andreas
and Schultz, Jobst-Hendrik
and Wild, Beate",
title="Identifying Predictors of Heart Failure Readmission in Patients From a Statutory Health Insurance Database: Retrospective Machine Learning Study",
journal="JMIR Cardio",
year="2024",
month="Jul",
day="23",
volume="8",
pages="e54994",
keywords="statutory health insurance",
keywords="readmission",
keywords="machine learning",
keywords="heart failure",
keywords="heart",
keywords="cardiology",
keywords="cardiac",
keywords="hospitalization",
keywords="insurance",
keywords="predict",
keywords="predictive",
keywords="prediction",
keywords="predictions",
keywords="predictor",
keywords="predictors",
keywords="all cause",
abstract="Background: Patients with heart failure (HF) are the most commonly readmitted group of adult patients in Germany. Most patients with HF are readmitted for noncardiovascular reasons. Understanding the relevance of HF management outside the hospital setting is critical to understanding HF and factors that lead to readmission. Application of machine learning (ML) on data from statutory health insurance (SHI) allows the evaluation of large longitudinal data sets representative of the general population to support clinical decision-making. Objective: This study aims to evaluate the ability of ML methods to predict 1-year all-cause and HF-specific readmission after initial HF-related admission of patients with HF in outpatient SHI data and identify important predictors. Methods: We identified individuals with HF using outpatient data from 2012 to 2018 from the AOK Baden-W{\"u}rttemberg SHI in Germany. We then trained and applied regression and ML algorithms to predict the first all-cause and HF-specific readmission in the year after the first admission for HF. We fitted a random forest, an elastic net, a stepwise regression, and a logistic regression to predict readmission by using diagnosis codes, drug exposures, demographics (age, sex, nationality, and type of coverage within SHI), degree of rurality for residence, and participation in disease management programs for common chronic conditions (diabetes mellitus type 1 and 2, breast cancer, chronic obstructive pulmonary disease, and coronary heart disease). We then evaluated the predictors of HF readmission according to their importance and direction to predict readmission. Results: Our final data set consisted of 97,529 individuals with HF, and 78,044 (80\%) were readmitted within the observation period. Of the tested modeling approaches, the random forest approach best predicted 1-year all-cause and HF-specific readmission with a C-statistic of 0.68 and 0.69, respectively. Important predictors for 1-year all-cause readmission included prescription of pantoprazole, chronic obstructive pulmonary disease, atherosclerosis, sex, rurality, and participation in disease management programs for type 2 diabetes mellitus and coronary heart disease. Relevant features for HF-specific readmission included a large number of canonical HF comorbidities. Conclusions: While many of the predictors we identified were known to be relevant comorbidities for HF, we also uncovered several novel associations. Disease management programs have widely been shown to be effective at managing chronic disease; however, our results indicate that in the short term they may be useful for targeting patients with HF with comorbidity at increased risk of readmission. Our results also show that living in a more rural location increases the risk of readmission. Overall, factors beyond comorbid disease were relevant for risk of HF readmission. This finding may impact how outpatient physicians identify and monitor patients at risk of HF readmission. ",
doi="10.2196/54994",
url="https://cardio.jmir.org/2024/1/e54994"
}


@Article{info:doi/10.2196/58013,
author="Miao, Yiqun
and Luo, Yuan
and Zhao, Yuhan
and Liu, Mingxuan
and Wang, Huiying
and Wu, Ying",
title="Effectiveness of eHealth Interventions in Improving Medication Adherence Among Patients With Cardiovascular Disease: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="15",
volume="26",
pages="e58013",
keywords="eHealth",
keywords="medication adherence",
keywords="heart",
keywords="cardiovascular",
keywords="adherence",
keywords="cardiology",
keywords="digital health",
keywords="cardiovascular diseases",
keywords="network meta-analysis",
keywords="synthesis",
keywords="syntheses",
keywords="review methods",
keywords="review methodology",
keywords="search",
keywords="searches",
keywords="searching",
keywords="systematic",
keywords="meta-analysis",
keywords="meta-analyses",
keywords="drug",
keywords="drugs",
keywords="pharmacy",
keywords="pharmacies",
keywords="pharmacology",
keywords="pharmacotherapy",
keywords="pharmaceutic",
keywords="pharmaceutics",
keywords="pharmaceuticals",
keywords="pharmaceutical",
keywords="medication",
keywords="medications",
abstract="Background: Nonadherence to medication among patients with cardiovascular diseases undermines the desired therapeutic outcomes. eHealth interventions emerge as promising strategies to effectively tackle this issue. Objective: The aim of this study was to conduct a network meta-analysis (NMA) to compare and rank the efficacy of various eHealth interventions in improving medication adherence among patients with cardiovascular diseases (CVDs). Methods: A systematic search strategy was conducted in PubMed, Embase, Web of Science, Cochrane, China National Knowledge Infrastructure Library (CNKI), China Science and Technology Journal Database (Weipu), and WanFang databases to search for randomized controlled trials (RCTs) published from their inception on January 15, 2024. We carried out a frequentist NMA to compare the efficacy of various eHealth interventions. The quality of the literature was assessed using the risk of bias tool from the Cochrane Handbook (version 2.0), and extracted data were analyzed using Stata16.0 (StataCorp LLC) and RevMan5.4 software (Cochrane Collaboration). The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Results: A total of 21 RCTs involving 3904 patients were enrolled. The NMA revealed that combined interventions (standardized mean difference [SMD] 0.89, 95\% CI 0.22-1.57), telephone support (SMD 0.68, 95\% CI 0.02-1.33), telemonitoring interventions (SMD 0.70, 95\% CI 0.02-1.39), and mobile phone app interventions (SMD 0.65, 95\% CI 0.01-1.30) were statistically superior to usual care. However, SMS compared to usual care showed no statistical difference. Notably, the combined intervention, with a surface under the cumulative ranking curve of 79.3\%, appeared to be the most effective option for patients with CVDs. Regarding systolic blood pressure and diastolic blood pressure outcomes, the combined intervention also had the highest probability of being the best intervention. Conclusions: The research indicates that the combined intervention (SMS text messaging and telephone support) has the greatest likelihood of being the most effective eHealth intervention to improve medication adherence in patients with CVDs, followed by telemonitoring, telephone support, and app interventions. The results of these network meta-analyses can provide crucial evidence-based support for health care providers to enhance patients' medication adherence. Given the differences in the design and implementation of eHealth interventions, further large-scale, well-designed multicenter trials are needed. Trial Registration: INPLASY 2023120063; https://inplasy.com/inplasy-2023-12-0063/ ",
doi="10.2196/58013",
url="https://www.jmir.org/2024/1/e58013"
}


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


@Article{info:doi/10.2196/52402,
author="Lee, Heekyung
and Oh, Jaehoon
and Choi, Joong Hyuk
and Shin, Hyungoo
and Cho, Yongil
and Lee, Juncheol",
title="The Incidence and Outcomes of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic in South Korea: Multicenter Registry Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="24",
volume="10",
pages="e52402",
keywords="heart arrest",
keywords="cardiopulmonary resuscitation",
keywords="SARS-CoV-2",
keywords="mortality",
keywords="outpatient",
keywords="cardiac arrest",
keywords="multicenter registry study",
keywords="out-of-hospital cardiac arrest",
keywords="heart attack",
keywords="observational study",
keywords="adult",
keywords="older adults",
keywords="analysis",
keywords="pandemic",
keywords="prepandemic",
keywords="endemic",
keywords="defibrillator",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic has profoundly affected out-of-hospital cardiac arrest (OHCA) and disrupted the chain of survival. Even after the end of the pandemic, the risk of new variants and surges persists. Analyzing the characteristics of OHCA during the pandemic is important to prepare for the next pandemic and to avoid repeated negative outcomes. However, previous studies have yielded somewhat varied results, depending on the health care system or the specific characteristics of social structures. Objective: We aimed to investigate and compare the incidence, outcomes, and characteristics of OHCA during the prepandemic and pandemic periods using data from a nationwide multicenter OHCA registry. Methods: We conducted a multicenter, retrospective, observational study using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry. This study included adult patients with OHCA in South Korea across 3 distinct 1-year periods: the prepandemic period (from January to December 2019), early phase pandemic period (from July 2020 to June 2021), and late phase pandemic period (from July 2021 to June 2022). We extracted and contrasted the characteristics of patients with OHCA, prehospital time factors, and outcomes for the patients across these 3 periods. The primary outcomes were survival to hospital admission and survival to hospital discharge. The secondary outcome was good neurological outcome. Results: From the 3 designated periods, a total of 9031 adult patients with OHCA were eligible for analysis (prepandemic: n=2728; early pandemic: n=2954; and late pandemic: n=3349). Witnessed arrest (P<.001) and arrest at home or residence (P=.001) were significantly more frequent during the pandemic period than during the prepandemic period, and automated external defibrillator use by bystanders was lower in the early phase of the pandemic than during other periods. As the pandemic advanced, the rates of the first monitored shockable rhythm (P=.10) and prehospital endotracheal intubation (P<.001) decreased significantly. Time from cardiac arrest cognition to emergency department arrival increased sequentially (prepandemic: 33 min; early pandemic: 35 min; and late pandemic: 36 min; P<.001). Both survival and neurological outcomes worsened as the pandemic progressed, with survival to discharge showing the largest statistical difference (prepandemic: 385/2728, 14.1\%; early pandemic: 355/2954, 12\%; and late pandemic: 392/3349, 11.7\%; P=.01). Additionally, none of the outcomes differed significantly between the early and late phase pandemic periods (all P>.05). Conclusions: During the pandemic, especially amid community COVID-19 surges, the incidence of OHCA increased while survival rates and good neurological outcome at discharge decreased. Prehospital OHCA factors, which are directly related to OHCA prognosis, were adversely affected by the pandemic. Ongoing discussions are needed to maintain the chain of survival in the event of a new pandemic. Trial Registration: ClinicalTrials.gov NCT03222999; https://classic.clinicaltrials.gov/ct2/show/NCT03222999 ",
doi="10.2196/52402",
url="https://publichealth.jmir.org/2024/1/e52402"
}


@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/10.2196/52341,
author="Hou, Ling Qiao
and Liu, Yang Le
and Wu, Ying",
title="The Effects of mHealth Interventions on Quality of Life, Anxiety, and Depression in Patients With Coronary Heart Disease: Meta-Analysis of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="11",
volume="26",
pages="e52341",
keywords="mobile health",
keywords="coronary heart disease",
keywords="quality of life",
keywords="anxiety",
keywords="depression",
keywords="meta-analysis",
keywords="mobile phone",
abstract="Background: Coronary heart disease (CHD) is the leading cause of death globally. In addition, 20\% to 40\% of the patients with CHD have comorbid mental health issues such as anxiety or depression, affecting the prognosis and quality of life (QoL). Mobile health (mHealth) interventions have been developed and are widely used; however, the evidence for the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD is currently ambiguous. Objective: In this study, we aimed to assess the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD. Methods: We searched the Cochrane Library, PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure, and Wanfang databases from inception to August 12, 2023. Eligible studies were randomized controlled trials that involved patients with CHD who received mHealth interventions and that reported on QoL, anxiety, or depression outcomes. We used the Cochrane risk-of-bias tool for randomized trials to evaluate the risk of bias in the studies, ensuring a rigorous and methodologically sound analysis. Review Manager (desktop version 5.4; The Cochrane Collaboration) and Stata MP (version 17.0; StataCorp LLC) were used to conduct the meta-analysis. The effect size was calculated using the standardized mean difference (SMD) and its 95\% CI. Results: The meta-analysis included 23 studies (5406 participants in total) and showed that mHealth interventions significantly improved QoL in patients with CHD (SMD 0.49, 95\% CI 0.25-0.72; Z=4.07; P<.001) as well as relieved their anxiety (SMD ?0.46, 95\% CI ?0.83 to ?0.08; Z=2.38; P=.02) and depression (SMD ?0.34, 95\% CI ?0.56 to ?0.12; Z=3.00; P=.003) compared to usual care. The subgroup analyses indicated a significant effect favoring the mHealth intervention on reducing anxiety and depressive symptoms compared to usual care, especially when (1) the intervention duration was ?6 months (P=.04 and P=.001), (2) the mHealth intervention was a simple one (only 1 mHealth intervention was used) (P=.01 and P<.001), (3) it was implemented during the COVID-19 pandemic (P=.04 and P=.01), (4) it was implemented in low- or middle-income countries (P=.01 and P=.02), (5) the intervention focused on mental health (P=.01 and P=.007), and (6) adherence rates were high (?90\%; P=.03 and P=.002). In addition, comparing mHealth interventions to usual care, there was an improvement in QoL when (1) the mHealth intervention was a simple one (P<.001), (2) it was implemented in low- or middle-income countries (P<.001), and (3) the intervention focused on mental health (P<.001). Conclusions: On the basis of the existing evidence, mHealth interventions might be effective in improving QoL and reducing anxiety and depression in patients with CHD. However, large sample, high-quality, and rigorously designed randomized controlled trials are needed to provide further evidence. Trial Registration: PROSPERO CRD42022383858; https://tinyurl.com/3ea2npxf ",
doi="10.2196/52341",
url="https://www.jmir.org/2024/1/e52341",
url="http://www.ncbi.nlm.nih.gov/pubmed/38861710"
}


@Article{info:doi/10.2196/51916,
author="Leitner, Jared
and Chiang, Po-Han
and Agnihotri, Parag
and Dey, Sujit",
title="The Effect of an AI-Based, Autonomous, Digital Health Intervention Using Precise Lifestyle Guidance on Blood Pressure in Adults With Hypertension: Single-Arm Nonrandomized Trial",
journal="JMIR Cardio",
year="2024",
month="May",
day="28",
volume="8",
pages="e51916",
keywords="blood pressure",
keywords="hypertension",
keywords="digital health",
keywords="lifestyle change",
keywords="lifestyle medicine",
keywords="wearables",
keywords="remote patient monitoring",
keywords="artificial intelligence",
keywords="AI",
keywords="mobile phone",
abstract="Background: Home blood pressure (BP) monitoring with lifestyle coaching is effective in managing hypertension and reducing cardiovascular risk. However, traditional manual lifestyle coaching models significantly limit availability due to high operating costs and personnel requirements. Furthermore, the lack of patient lifestyle monitoring and clinician time constraints can prevent personalized coaching on lifestyle modifications. Objective: This study assesses the effectiveness of a fully digital, autonomous, and artificial intelligence (AI)--based lifestyle coaching program on achieving BP control among adults with hypertension. Methods: Participants were enrolled in a single-arm nonrandomized trial in which they received a BP monitor and wearable activity tracker. Data were collected from these devices and a questionnaire mobile app, which were used to train personalized machine learning models that enabled precision lifestyle coaching delivered to participants via SMS text messaging and a mobile app. The primary outcomes included (1) the changes in systolic and diastolic BP from baseline to 12 and 24 weeks and (2) the percentage change of participants in the controlled, stage-1, and stage-2 hypertension categories from baseline to 12 and 24 weeks. Secondary outcomes included (1) the participant engagement rate as measured by data collection consistency and (2) the number of manual clinician outreaches. Results: In total, 141 participants were monitored over 24 weeks. At 12 weeks, systolic and diastolic BP decreased by 5.6 mm Hg (95\% CI ?7.1 to ?4.2; P<.001) and 3.8 mm Hg (95\% CI ?4.7 to ?2.8; P<.001), respectively. Particularly, for participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 9.6 mm Hg (95\% CI ?12.2 to ?6.9; P<.001) and 5.7 mm Hg (95\% CI ?7.6 to ?3.9; P<.001), respectively. At 24 weeks, systolic and diastolic BP decreased by 8.1 mm Hg (95\% CI ?10.1 to ?6.1; P<.001) and 5.1 mm Hg (95\% CI ?6.2 to ?3.9; P<.001), respectively. For participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 14.2 mm Hg (95\% CI ?17.7 to ?10.7; P<.001) and 8.1 mm Hg (95\% CI ?10.4 to ?5.7; P<.001), respectively, at 24 weeks. The percentage of participants with controlled BP increased by 17.2\% (22/128; P<.001) and 26.5\% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The percentage of participants with stage-2 hypertension decreased by 25\% (32/128; P<.001) and 26.5\% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The average weekly participant engagement rate was 92\% (SD 3.9\%), and only 5.9\% (6/102) of the participants required manual outreach over 24 weeks. Conclusions: The study demonstrates the potential of fully digital, autonomous, and AI-based lifestyle coaching to achieve meaningful BP improvements and high engagement for patients with hypertension while substantially reducing clinician workloads. Trial Registration: ClinicalTrials.gov NCT06337734; https://clinicaltrials.gov/study/NCT06337734 ",
doi="10.2196/51916",
url="https://cardio.jmir.org/2024/1/e51916",
url="http://www.ncbi.nlm.nih.gov/pubmed/38805253"
}


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


@Article{info:doi/10.2196/53905,
author="Adamu, Gati Umar
and Badianyama, Marheb
and Mpanya, Dineo
and Maseko, Muzi
and Tsabedze, Nqoba",
title="The Use of Metabolomes in Risk Stratification of Heart Failure Patients: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="23",
volume="13",
pages="e53905",
keywords="metabolomes",
keywords="metabolomics",
keywords="heart failure",
keywords="risk stratification",
keywords="morbidity",
keywords="mortality",
keywords="metabolic abnormality",
keywords="scoping review protocol",
keywords="electronic database",
abstract="Background: Heart failure (HF) is a significant health problem that is often associated with major morbidity and mortality. Metabolic abnormalities occur in HF and may be used to identify individuals at risk of developing the condition. Furthermore, these metabolic changes may play a role in the pathogenesis and progression of HF. Despite this knowledge, the utility of metabolic changes in diagnosis, management, prognosis, and therapy for patients with chronic HF has not been systematically reviewed. Objective: This scoping review aims to systematically appraise the literature on metabolic changes in patients with HF, describe the role of these changes in pathogenesis, progression, and care, and identify knowledge gaps to inform future research. Methods: This review will be conducted using a strategy based on previous reports, the JBI Manual for Evidence Synthesis, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search of electronic databases (Medline, EBSCOhost, Scopus, and Web of Science) will be conducted using keywords related to HF, myocardial failure, metabolomes, metabonomics, and analytical chemistry techniques. The search will include original peer-reviewed research papers (clinical studies conducted on humans and systematic reviews with or without a meta-analysis) published between January 2010 and September 2023. Studies that include patients with HF younger than 18 years or those not published in English will be excluded. Two authors (UGA and MB) will screen the titles and abstracts independently and perform a full-text screen of the relevant and eligible papers. Relevant data will be extracted and synthesized, and a third author or group will be consulted to resolve discrepancies. Results: This scoping review will span from January 2010 to September 2023, and the results will be published in a peer-reviewed, open-access journal as a scoping review in 2024. The presentation of the findings will use the PRISMA-ScR flow diagram and descriptive and narrative formats, including tables and graphical displays, to provide a comprehensive overview of the extracted data. Conclusions: This review aims to collect and analyze the available evidence on metabolic changes in patients with HF, aiming to enhance our current understanding of this topic. Additionally, this review will identify the most commonly used and suitable sample, analytical method, and specific metabolomes to facilitate standardization, reproducibility of results, and application in the diagnosis, treatment, and risk stratification of patients with HF. Finally, it is hoped that this review's outcomes will inspire further research into the metabolomes of patients with HF in low- and middle-income countries. Trial Registration: Open Science Framework; https://osf.io/sp6xj International Registered Report Identifier (IRRID): DERR1-10.2196/53905 ",
doi="10.2196/53905",
url="https://www.researchprotocols.org/2024/1/e53905",
url="http://www.ncbi.nlm.nih.gov/pubmed/38781584"
}


@Article{info:doi/10.2196/48756,
author="Bernal-Jim{\'e}nez, {\'A}ngeles Mar{\'i}a
and Calle, German
and Guti{\'e}rrez Barrios, Alejandro
and Gheorghe, Luciana Livia
and Cruz-Cobo, Celia
and Trujillo-Garrido, Nuria
and Rodr{\'i}guez-Mart{\'i}n, Amelia
and Tur, A. Josep
and V{\'a}zquez-Garc{\'i}a, Rafael
and Santi-Cano, Jos{\'e} Mar{\'i}a",
title="Effectiveness of an Interactive mHealth App (EVITE) in Improving Lifestyle After a Coronary Event: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Apr",
day="22",
volume="12",
pages="e48756",
keywords="coronary artery disease",
keywords="healthy lifestyle",
keywords="mHealth",
keywords="mobile health",
keywords="percutaneous coronary intervention",
keywords="randomized controlled trial",
keywords="secondary prevention",
keywords="therapeutic adherence",
abstract="Background: Coronary heart disease is one of the leading causes of mortality worldwide. Secondary prevention is essential, as it reduces the risk of further coronary events. Mobile health (mHealth) technology could become a useful tool to improve lifestyles. Objective: This study aimed to evaluate the effect of an mHealth intervention on people with coronary heart disease who received percutaneous coronary intervention. Improvements in lifestyle regarding diet, physical activity, and smoking; level of knowledge of a healthy lifestyle and the control of cardiovascular risk factors (CVRFs); and therapeutic adherence and quality of life were analyzed. Methods: This was a randomized controlled trial with a parallel group design assigned 1:1 to either an intervention involving a smartphone app (mHealth group) or to standard health care (control group). The app was used for setting aims, the self-monitoring of lifestyle and CVRFs using measurements and records, educating people with access to information on their screens about healthy lifestyles and adhering to treatment, and giving motivation through feedback about achievements and aspects to improve. Both groups were assessed after 9 months. The primary outcome variables were adherence to the Mediterranean diet, frequency of food consumed, patient-reported physical activity, smoking, knowledge of healthy lifestyles and the control of CVRFs, adherence to treatment, quality of life, well-being, and satisfaction. Results: The study analyzed 128 patients, 67 in the mHealth group and 61 in the control group; most were male (92/128, 71.9\%), with a mean age of 59.49 (SD 8.97) years. Significant improvements were observed in the mHealth group compared with the control group regarding adherence to the Mediterranean diet (mean 11.83, SD 1.74 points vs mean 10.14, SD 2.02 points; P<.001), frequency of food consumption, patient-reported physical activity (mean 619.14, SD 318.21 min/week vs mean 471.70, SD 261.43 min/week; P=.007), giving up smoking (25/67, 75\% vs 11/61, 42\%; P=.01), level of knowledge of healthy lifestyles and the control of CVRFs (mean 118.70, SD 2.65 points vs mean 111.25, SD 9.05 points; P<.001), and the physical component of the quality of life 12-item Short Form survey (SF-12; mean 45.80, SD 10.79 points vs mean 41.40, SD 10.78 points; P=.02). Overall satisfaction was higher in the mHealth group (mean 48.22, SD 3.89 vs mean 46.00, SD 4.82 points; P=.002) and app satisfaction and usability were high (mean 44.38, SD 6.18 out of 50 points and mean 95.22, SD 7.37 out of 100). Conclusions: The EVITE app was effective in improving the lifestyle of patients in terms of adherence to the Mediterranean diet, frequency of healthy food consumption, physical activity, giving up smoking, knowledge of healthy lifestyles and controlling CVRFs, quality of life, and overall satisfaction. The app satisfaction and usability were excellent. Trial Registration: Clinicaltrials.gov NCT04118504; https://clinicaltrials.gov/study/NCT04118504 ",
doi="10.2196/48756",
url="https://mhealth.jmir.org/2024/1/e48756",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648103"
}


@Article{info:doi/10.2196/55432,
author="Regan, Wherley Elizabeth
and Toto, Pamela
and Brach, Jennifer",
title="A Community Needs Assessment and Implementation Planning for a Community Exercise Program for Survivors of Stroke: Protocol for a Pilot Hybrid Type I Clinical Effectiveness and Implementation Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="11",
volume="13",
pages="e55432",
keywords="community participatory research",
keywords="need assessment",
keywords="exercise",
keywords="survivors of stroke",
keywords="community",
keywords="community need",
keywords="exercise program",
keywords="stroke",
keywords="physical activity",
keywords="PA",
keywords="mobility impairments",
keywords="impairment",
keywords="mobility",
keywords="health decline",
keywords="group activity",
keywords="group exercise",
abstract="Background: Physical activity and exercise are important aspects of maintaining health. People with mobility impairments, including survivors of stroke, are less likely to exercise and at greater risk of developing or worsening chronic health conditions. Increasing accessible, desired options for exercise may address the gap in available physical activity programs, provide an opportunity for continued services after rehabilitation, and cultivate social connections for people after stroke and others with mobility impairments. Existing evidence-based community programs for people after stroke target cardiovascular endurance, mobility, walking ability, balance, and education. While much is known about the effectiveness of these programs, it is important to understand the local environment as implementation and sustainment strategies are context-specific. Objective: This study protocol aims to evaluate community needs and resources for exercise for adults living with mobility impairments with initial emphasis on survivors of stroke in Richland County, South Carolina. Results will inform a hybrid type I effectiveness and implementation pilot of an evidence-based group exercise program for survivors of stroke. Methods: The exploration and preparation phases of the EPIS (Exploration, Preparation, Implementation, and Sustainment) implementation model guide the study. A community needs assessment will evaluate the needs and desires of survivors of stroke through qualitative semistructured interviews with survivors of stroke, rehabilitation professionals, and fitness trainers serving people with mobility impairments. Additional data will be collected from survivors of stroke through a survey. Fitness center sites will be assessed through interviews and the Accessibility Instrument Measuring Fitness and Recreation Environments inventory. Qualitative data will be evaluated using content analysis and supported by mean survey results. Data will be categorized by the community (outer context), potential participants (outer context), and fitness center (inner context) and evaluate needs, resources, barriers, and facilitators. Results will inform evidence-based exercise program selection, adaptations, and specific local implementation strategies to influence success. Pilot outcome measures for participants (clinical effectiveness), process, and program delivery levels will be identified. An implementation logic model for interventions will be created to reflect the design elements for the pilot and their complex interactions. Results: The study was reviewed by the institutional review board and exempt approved on December 19, 2023. The study data collection began in January 2024 and is projected to be completed in June 2024. A total of 17 participants have been interviewed as of manuscript submission. Results are expected to be published in early 2025. Conclusions: Performing a needs assessment before implementing it in the community allows for early identification of complex relationships and preplanning to address problems that cannot be anticipated in controlled effectiveness research. Evaluation and preparation prior to implementation of a community exercise program enhance the potential to be successful, valued, and sustained in the community. International Registered Report Identifier (IRRID): DERR1-10.2196/55432 ",
doi="10.2196/55432",
url="https://www.researchprotocols.org/2024/1/e55432",
url="http://www.ncbi.nlm.nih.gov/pubmed/38603776"
}


@Article{info:doi/10.2196/52616,
author="Awindaogo, Felix
and Acheamfour-Akowuah, Emmanuel
and Doku, Alfred
and Kokuro, Collins
and Agyekum, Francis
and Owusu, Kofi Isaac",
title="Assessing and Improving the Care of Patients With Heart Failure in Ghana: Protocol for a Prospective Observational Study and the Ghana Heart Initiative-Heart Failure Registry",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="8",
volume="13",
pages="e52616",
keywords="clinical",
keywords="cross-sectional",
keywords="epidemiology",
keywords="Ghana",
keywords="heart failure",
keywords="heart",
keywords="management",
keywords="medium-term",
keywords="monitoring",
keywords="mortality",
keywords="outcome",
keywords="patient data",
keywords="prevention",
keywords="protocol",
keywords="teaching",
keywords="treatment",
abstract="Background: Heart failure (HF) is a leading cause of morbidity and mortality globally, with a high disease burden. The prevalence of HF in Ghana is increasing rapidly, but epidemiological profiles, treatment patterns, and survival data are scarce. The national capacity to diagnose and manage HF appropriately is also limited. To address the growing epidemic of HF, it is crucial to recognize the epidemiological characteristics and medium-term outcomes of HF in Ghana and improve the capability to identify and manage HF promptly and effectively at all levels of care. Objective: This study aims to determine the epidemiological characteristics and medium-term HF outcomes in Ghana. Methods: We conducted a prospective, multicenter, multilevel cross-sectional observational study of patients with HF from January to December 2023. Approximately 5000 patients presenting with HF to 9 hospitals, including teaching, regional, and municipal hospitals, will be recruited and evaluated according to a standardized protocol, including the use of an echocardiogram and an N-terminal pro-brain natriuretic peptide (NT-proBNP) test. Guideline-directed medical treatment of HF will be initiated for 6 months, and the medium-term outcomes of interventions, including rehospitalization and mortality, will be assessed. Patient data will be collated into a HF registry for continuous assessment and monitoring. Results: This intervention will generate the necessary information on the etiology of HF, clinical presentations, the diagnostic yield of various tools, and management outcomes. In addition, it will build the necessary capacity and support for HF management in Ghana. As of July 30, 2023, the training and onboarding of all 9 centers had been completed. Preliminary analyses will be conducted by the end of the second quarter of 2024, and results are expected to be publicly available by the middle of 2024. Conclusions: This study will provide the necessary data on HF, which will inform decisions on the prevention and management of HF and form the basis for future research. Trial Registration: ISRCTN Registry (United Kingdom) ISRCTN18216214; https:www.isrctn.com/ISRCTN18216214 International Registered Report Identifier (IRRID): DERR1-10.2196/52616 ",
doi="10.2196/52616",
url="https://www.researchprotocols.org/2024/1/e52616",
url="http://www.ncbi.nlm.nih.gov/pubmed/38588528"
}


@Article{info:doi/10.2196/51848,
author="Yoon, Sungwon
and Tan, Min Chao
and Phang, Kie Jie
and Liu, Xi Venice
and Tan, Boon Wee
and Kwan, Heng Yu
and Low, Leng Lian",
title="Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="4",
volume="8",
pages="e51848",
keywords="decision-making",
keywords="diabetes",
keywords="health coach",
keywords="health coaching",
keywords="healthcare professional",
keywords="hypertension",
keywords="patient",
keywords="patient-centered care",
keywords="person-centered care",
keywords="qualitative research",
keywords="self-management",
keywords="shared decision-making",
abstract="Background: An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension. Objective: This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs. Methods: We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Participants agreed that the main responsibility of HCPs should be identifying the patient's stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach's personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority). Conclusions: The findings shed light on the appropriate roles of health coaches vis-{\`a}-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process. ",
doi="10.2196/51848",
url="https://formative.jmir.org/2024/1/e51848",
url="http://www.ncbi.nlm.nih.gov/pubmed/38573763"
}


@Article{info:doi/10.2196/55199,
author="He, Yunfan
and Zhu, Wei
and Wang, Tong
and Chen, Han
and Xin, Junyi
and Liu, Yongcheng
and Lei, Jianbo
and Liang, Jun",
title="Mining User Reviews From Hypertension Management Mobile Health Apps to Explore Factors Influencing User Satisfaction and Their Asymmetry: Comparative Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Mar",
day="28",
volume="12",
pages="e55199",
keywords="hypertension management",
keywords="mobile health",
keywords="topic modeling",
keywords="satisfaction",
keywords="2-factor model",
keywords="comparative study",
abstract="Background: Hypertension significantly impacts the well-being and health of individuals globally. Hypertension management apps (HMAs) have been shown to assist patients in controlling blood pressure (BP), with their efficacy validated in clinical trials. However, the utilization of HMAs continues to be suboptimal. Presently, there is a dearth of real-world research based on big data and exploratory mining that compares Chinese and American HMAs. Objective: This study aims to systematically gather HMAs and their user reviews from both China and the United States. Subsequently, using data mining techniques, the study aims to compare the user experience, satisfaction levels, influencing factors, and asymmetry between Chinese and American users of HMAs. In addition, the study seeks to assess the disparities in satisfaction and its determinants while delving into the asymmetry of these factors. Methods: The study sourced HMAs and user reviews from 10 prominent Chinese and American app stores globally. Using the latent Dirichlet allocation (LDA) topic model, the research identified various topics within user reviews. Subsequently, the Tobit model was used to investigate the impact and distinctions of each topic on user satisfaction. The Wald test was applied to analyze differences in effects across various factors. Results: We examined a total of 261 HMAs along with their associated user reviews, amounting to 116,686 reviews in total. In terms of quantity and overall satisfaction levels, Chinese HMAs (n=91) and corresponding reviews (n=16,561) were notably fewer compared with their American counterparts (n=220 HMAs and n=100,125 reviews). The overall satisfaction rate among HMA users was 75.22\% (87,773/116,686), with Chinese HMAs demonstrating a higher satisfaction rate (13,866/16,561, 83.73\%) compared with that for American HMAs (73,907/100,125, 73.81\%). Chinese users primarily focus on reliability (2165/16,561, 13.07\%) and measurement accuracy (2091/16,561, 12.63\%) when considering HMAs, whereas American users prioritize BP tracking (17,285/100,125, 17.26\%) and data synchronization (12,837/100,125, 12.82\%). Seven factors (easy to use: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; heart rate detection function: P=.02; blood pressure tracking function: P<.001; and interface design: P=.01) significantly influenced the positive deviation (PD) of Chinese HMA user satisfaction, while 8 factors (easy to use: P<.001; reliability: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; interface design: P<.001; real-time: P<.001; and data privacy: P=.001) affected the negative deviation (ND). Notably, BP tracking had the greatest effect on PD ($\beta$=.354, P<.001), while cost had the most significant impact on ND ($\beta$=3.703, P<.001). All 12 factors (easy to use: P<.001; blood pressure tracking function: P<.001; data synchronization: P<.001; blood pressure management effect: P<.001; heart rate detection function: P<.001; data sharing: P<.001; reliability: P<.001; compatibility: P<.001; interface design: P<.001; advertisement distribution: P<.001; measurement accuracy: P<.001; and cost: P<.001) significantly influenced the PD and ND of American HMA user satisfaction. Notably, BP tracking had the greatest effect on PD ($\beta$=0.312, P<.001), while data synchronization had the most significant impact on ND ($\beta$=2.662, P<.001). In addition, the influencing factors of PD and ND in user satisfaction of HMA in China and the United States are different. Conclusions: User satisfaction factors varied significantly between different countries, showing considerable asymmetry. For Chinese HMA users, ease of use and interface design emerged as motivational factors, while factors such as cost, measurement accuracy, and compatibility primarily contributed to user dissatisfaction. For American HMA users, motivational factors were ease of use, BP tracking, BP management effect, interface design, measurement accuracy, and cost. Moreover, users expect features such as data sharing, synchronization, software reliability, compatibility, heart rate detection, and nonintrusive advertisement distribution. Tailored experience plans should be devised for different user groups in various countries to address these diverse preferences and requirements. ",
doi="10.2196/55199",
url="https://mhealth.jmir.org/2024/1/e55199",
url="http://www.ncbi.nlm.nih.gov/pubmed/38547475"
}


@Article{info:doi/10.2196/53991,
author="Schmitz, Boris
and Wirtz, Svenja
and Sestayo-Fern{\'a}ndez, Manuela
and Sch{\"a}fer, Hendrik
and Douma, R. Emma
and Alonso Vazquez, Marta
and Gonz{\'a}lez-Salvado, Violeta
and Habibovic, Mirela
and Gatsios, Dimitris
and Kop, Johan Willem
and Pe{\~n}a-Gil, Carlos
and Mooren, Frank",
title="Living Lab Data of Patient Needs and Expectations for eHealth-Based Cardiac Rehabilitation in Germany and Spain From the TIMELY Study: Cross-Sectional Analysis",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="22",
volume="26",
pages="e53991",
keywords="eHealth",
keywords="coronary artery disease",
keywords="rehabilitation",
keywords="mHealth",
keywords="mobile health",
keywords="mobile phone",
keywords="app",
keywords="apps",
keywords="applications",
keywords="personalized medicine",
keywords="patient empowerment",
keywords="living lab",
keywords="coronary",
keywords="cardiac",
keywords="cardiology",
keywords="heart",
keywords="telehealth",
keywords="telemedicine",
keywords="monitoring",
keywords="survey",
keywords="surveys",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="acceptance",
keywords="technology use",
keywords="usage",
abstract="Background: The use of eHealth technology in cardiac rehabilitation (CR) is a promising approach to enhance patient outcomes since adherence to healthy lifestyles and risk factor management during phase III CR maintenance is often poorly supported. However, patients' needs and expectations have not been extensively analyzed to inform the design of such eHealth solutions. Objective: The goal of this study was to provide a detailed patient perspective on the most important functionalities to include in an eHealth solution to assist them in phase III CR maintenance. Methods: A guided survey as part of a Living Lab approach was conducted in Germany (n=49) and Spain (n=30) involving women (16/79, 20\%) and men (63/79, 80\%) with coronary artery disease (mean age 57 years, SD 9 years) participating in a structured center-based CR program. The survey covered patients' perceived importance of different CR components in general, current usage of technology/technical devices, and helpfulness of the potential features of eHealth in CR. Questionnaires were used to identify personality traits (psychological flexibility, optimism/pessimism, positive/negative affect), potentially predisposing patients to acceptance of an app/monitoring devices. Results: All the patients in this study owned a smartphone, while 30\%-40\% used smartwatches and fitness trackers. Patients expressed the need for an eHealth platform that is user-friendly, personalized, and easily accessible, and 71\% (56/79) of the patients believed that technology could help them to maintain health goals after CR. Among the offered components, support for regular physical exercise, including updated schedules and progress documentation, was rated the highest. In addition, patients rated the availability of information on diagnosis, current medication, test results, and risk scores as (very) useful. Of note, for each item, except smoking cessation, 35\%-50\% of the patients indicated a high need for support to achieve their long-term health goals, suggesting the need for individualized care. No major differences were detected between Spanish and German patients (all P>.05) and only younger age (P=.03) but not sex, education level, or personality traits (all P>.05) were associated with the acceptance of eHealth components. Conclusions: The patient perspectives collected in this study indicate high acceptance of personalized user-friendly eHealth platforms with remote monitoring to improve adherence to healthy lifestyles among patients with coronary artery disease during phase III CR maintenance. The identified patient needs comprise support in physical exercise, including regular updates on personalized training recommendations. Availability of diagnoses, laboratory results, and medications, as part of a mobile electronic health record were also rated as very useful. Trial Registration: ClinicalTrials.gov NCT05461729; https://clinicaltrials.gov/study/NCT05461729 ",
doi="10.2196/53991",
url="https://www.jmir.org/2024/1/e53991",
url="http://www.ncbi.nlm.nih.gov/pubmed/38386376"
}


@Article{info:doi/10.2196/49178,
author="Trivedi, Rupal
and Elshafie, Shaimaa
and Tackett, Randall
and Young, Henry
and Sattler, Pia Elisabeth Lilian",
title="Effectiveness and Feasibility of Telehealth-Based Dietary Interventions Targeting Cardiovascular Disease Risk Factors: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="16",
volume="26",
pages="e49178",
keywords="telehealth",
keywords="dietary interventions",
keywords="cardiovascular diseases",
keywords="risk factors",
keywords="self-management",
keywords="systematic review and meta-analysis",
abstract="Background: Telehealth-based dietary interventions were recommended for cardiovascular disease (CVD) management during the COVID-19 pandemic; however, data regarding their effectiveness and feasibility are limited. Objective: We aimed to examine (1) the effectiveness of telehealth-based dietary interventions in improving clinical CVD risk factors and (2) the feasibility of these interventions among individuals with CVD. Methods: To conduct this systematic review and meta-analysis of randomized controlled trials (RCTs), 2 investigators searched PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov databases based on predetermined search terms and included English-language RCTs published between January 2000 and July 2022. The Cochrane Risk of Bias tool was used to assess RCT quality. To evaluate intervention effectiveness, weight, BMI, systolic and diastolic blood pressure, and levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, or blood glucose were compared postintervention in telehealth and usual care (UC) groups. Feasibility was determined through the number of participants retained in intervention and UC groups. Pooled data for each CVD outcome were analyzed using a random effects model. Mean difference (MD), standardized MD, or risk ratio were calculated using R software. Results: A total of 13 RCTs with 3013 participants were included in the analysis to assess the effectiveness and feasibility of telehealth-based dietary interventions among individuals with CVD. Participants had a mean age of 61.0 (SD 3.7) years, and 18.5\% (n=559) were women. Approximately one-third of RCTs were conducted in the United States (n=4, 31\%). Included studies used telephone, app, text, audio-visual media, or website-based interventions. Of the 13 included studies, 3 were of high quality, 9 were of moderate quality, and only 1 was of low quality. Pooled estimates showed systolic blood pressure (MD --2.74, 95\% CI --4.93 to --0.56) and low-density lipoprotein cholesterol (standardized MD --0.11, 95\% CI --0.19 to --0.03) to be significantly improved among individuals with CVD as a result of telehealth-based dietary interventions compared to UC. No significant difference in effectiveness was detected for weight, BMI, and levels of diastolic blood pressure, total cholesterol, high-density lipoprotein, and triglycerides between telehealth-based dietary interventions and UC among those with CVD. There was no significant difference between the feasibility of telehealth-based dietary interventions versus UC. Significant I2 indicated moderate to considerable heterogeneity. Conclusions: Telehealth-based dietary interventions show promise in addressing CVD risk factors. ",
doi="10.2196/49178",
url="https://www.jmir.org/2024/1/e49178",
url="http://www.ncbi.nlm.nih.gov/pubmed/38363635"
}


@Article{info:doi/10.2196/51399,
author="Texiwala, Z. Sikander
and de Souza, J. Russell
and Turner, Suzette
and Singh, M. Sheldon",
title="Physical Activity, Heart Rate Variability, and Ventricular Arrhythmia During the COVID-19 Lockdown: Retrospective Cohort Study",
journal="JMIR Cardio",
year="2024",
month="Feb",
day="5",
volume="8",
pages="e51399",
keywords="implantable cardioverter defibrillator",
keywords="heart rate variability",
keywords="physical activity",
keywords="lockdown",
keywords="ICD",
keywords="ventricular arrhythmias",
keywords="defibrillator",
keywords="implementation",
abstract="Background: Ventricular arrhythmias (VAs) increase with stress and national disasters. Prior research has reported that VA did not increase during the onset of the COVID-19 lockdown in March 2020, and the mechanism for this is unknown. Objective: This study aimed to report the presence of VA and changes in 2 factors associated with VA (physical activity and heart rate variability [HRV]) at the onset of COVID-19 lockdown measures in Ontario, Canada. Methods: Patients with implantable cardioverter defibrillator (ICD) followed at a regional cardiac center in Ontario, Canada with data available for both HRV and physical activity between March 1 and 31, 2020, were included. HRV, physical activity, and the presence of VA were determined during the pre- (March 1-10, 2020) and immediate postlockdown (March 11-31) period. When available, these data were determined for the same period in 2019. Results: In total, 68 patients had complete data for 2020, and 40 patients had complete data for 2019. Three (7.5\%) patients had VA in March 2019, whereas none had VA in March 2020 (P=.048). Physical activity was reduced during the postlockdown period (mean 2.3, SD 1.6 hours vs mean 2.1, SD 1.6 hours; P=.003). HRV was unchanged during the pre- and postlockdown period (mean 91, SD 30 ms vs mean 92, SD 28 ms; P=.84). Conclusions: VA was infrequent during the COVID-19 pandemic. A reduction in physical activity with lockdown maneuvers may explain this observation. ",
doi="10.2196/51399",
url="https://cardio.jmir.org/2024/1/e51399",
url="http://www.ncbi.nlm.nih.gov/pubmed/38315512"
}


@Article{info:doi/10.2196/45946,
author="Antoniou, Panagiotis
and Dafli, Eleni
and Giannakoulas, George
and Igimbayeva, Gaukhar
and Visternichan, Olga
and Kyselov, Serhii
and Lykhasenko, Ivetta
and Lashkul, Dmytro
and Nadareishvili, Ilia
and Tabagari, Sergo
and Bamidis, D. Panagiotis",
title="Education of Patients With Atrial Fibrillation and Evaluation of the Efficacy of a Mobile Virtual Patient Environment: Protocol for a Multicenter Pseudorandomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jan",
day="23",
volume="13",
pages="e45946",
keywords="atrial fibrillation",
keywords="virtual patient",
keywords="scenario based learning",
keywords="technology enhanced learning",
keywords="mHealth",
keywords="mobile health",
keywords="patient engagement",
keywords="patient education",
keywords="cardiac arrhythmia",
keywords="mortality",
keywords="mobile application",
keywords="mobile app",
keywords="health education",
keywords="randomized control trial",
keywords="cardiology",
keywords="cardiac",
keywords="heart",
keywords="Greece",
keywords="Ukraine",
keywords="Kazakhstan",
keywords="clinical decision support systems",
keywords="CDSS",
keywords="virtual patient scenario",
keywords="myocardial infarction",
keywords="arrhythmia",
keywords="stroke",
abstract="Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is a leading cause of mortality and morbidity. Patient knowledge about AF and its management is paramount but often limited. Patients need to be appropriately informed about treatment options, medicinal adherence, and potential consequences of nonadherence, while also understanding treatment goals and expectations from it. Mobile health apps have experienced an explosion both in their availability and acceptance as ``soft interventions'' for patient engagement and education; however, the prolific nature of such solutions revealed a gap in the evidence base regarding their efficacy and impact. Virtual patients (VPs), interactive computer simulations, have been used as learning activities in modern health care education. VPs demonstrably improved cognitive and behavioral skills; hence, they have been effectively implemented across undergraduate and postgraduate curricula. However, their application in patient education has been rather limited so far. Objective: This work aims to implement and evaluate the efficacy of a mobile-deployed VP regimen for the education and engagement of patients with AF on crucial topics regarding their condition. A mobile VP app is being developed with the goal of each VP being a simple scenario with a set goal and very specific messages and will be subsequently attempted and evaluated. Methods: A mobile VP player app is being developed so as to be used for the design of 3 educational scenarios for AF management. A pseudorandomized controlled trial for the efficacy of VPs is planned to be executed at 3 sites in Greece, Ukraine, and Kazakhstan for patients with AF. The Welch t test will be used to demonstrate the performance of patients' evaluation of the VP experience. Results: Our study is at the development stage. A preliminary study regarding the system's development and feasibility was initiated in December 2022. The results of our study are expected to be available in 2024 or when the needed sample size is achieved. Conclusions: This study aims to evaluate and demonstrate the first significant evidence for the value of VP resources in outreach and training endeavors for empowering and patients with AF and fostering healthy habits among them. International Registered Report Identifier (IRRID): PRR1-10.2196/45946 ",
doi="10.2196/45946",
url="https://www.researchprotocols.org/2024/1/e45946",
url="http://www.ncbi.nlm.nih.gov/pubmed/38261376"
}


@Article{info:doi/10.2196/48748,
author="Chang, Hao-Yun
and Wu, Hui-Wen
and Hung, Chi-Sheng
and Chen, Ying-Hsien
and Huang, Ching-Chang
and Yang, Li-Tan
and Hwang, Shin-Tsyr
and Yu, Jiun-Yu
and Lee, Jen-Kuang
and Ho, Yi-Lwun",
title="Costs and Cardiovascular Benefits of a Fourth-Generation Synchronous Telehealth Program on Mortality and Cardiovascular Outcomes for Patients With Atrial Fibrillation: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Jan",
day="8",
volume="26",
pages="e48748",
keywords="atrial fibrillation",
keywords="cardiovascular death",
keywords="fourth-generation synchronous program",
keywords="ischemic stroke",
keywords="telehealth",
abstract="Background: The prevalence of atrial fibrillation (AF) continues to increase in modern aging society. Patients with AF are at high risk for multiple adverse cardiovascular events, including heart failure, stroke, and mortality. Improved medical care is needed for patients with AF to enhance their quality of life and limit their medical resource utilization. With advances in the internet and technology, telehealth programs are now widely used in medical care. A fourth-generation telehealth program offers synchronous and continuous medical attention in response to physiological parameters measured at home. Although we have previously shown the benefits of this telehealth program for some patients with a high risk of cardiovascular disease, its benefits for patients with AF remains uncertain. Objective: This study aims to investigate the benefits of participating in a fourth-generation telehealth program for patients with AF in relation to cardiovascular outcomes. Methods: This was a retrospective cohort study. We retrospectively searched the medical records database of a tertiary medical center in Northern Taiwan between January 2007 and December 2017. We screened 5062 patients with cardiovascular disease and enrolled 537 patients with AF, of which 279 participated in the telehealth program and 258 did not. Bias was reduced using the inverse probability of treatment weighting adjustment based on the propensity score. Outcomes were collected and analyzed, including all-cause readmission, admission for heart failure, acute coronary syndrome, ischemic stroke, systemic embolism, bleeding events, all-cause mortality, and cardiovascular death within the follow-up period. Total medical expenses and medical costs in different departments were also compared. Subgroup analyses were conducted on ischemic stroke stratified by several subgroup variables. Results: The mean follow-up period was 3.0 (SD 1.7) years for the telehealth group and 3.4 (SD 1.9) years for the control group. After inverse probability of treatment weighting adjustment, the patients in the telehealth program had significantly fewer ischemic strokes (2.0 vs 4.5 events per 100 person-years; subdistribution hazard ratio [SHR] 0.45, 95\% CI 0.22-0.92) and cardiovascular deaths (2.5 vs 5.9 events per 100 person-years; SHR 0.43, 95\% CI 0.18-0.99) at the follow-up. The telehealth program particularly benefited patients comorbid with vascular disease (SHR 0.11, 95\% CI 0.02-0.53 vs SHR 1.16, 95\% CI 0.44-3.09; P=.01 for interaction). The total medical expenses during follow-up were similar in the telehealth and control groups. Conclusions: This study demonstrated the benefits of participating in the fourth-generation telehealth program for patients with AF by significantly reducing their ischemic stroke risk while spending the same amount on medical expenses. ",
doi="10.2196/48748",
url="https://www.jmir.org/2024/1/e48748",
url="http://www.ncbi.nlm.nih.gov/pubmed/38190237"
}


@Article{info:doi/10.2196/48487,
author="Zhang, Pin
and Wu, Lei
and Zou, Ting-Ting
and Zou, ZiXuan
and Tu, JiaXin
and Gong, Ren
and Kuang, Jie",
title="Machine Learning for Early Prediction of Major Adverse Cardiovascular Events After First Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction: Retrospective Cohort Study",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="3",
volume="8",
pages="e48487",
keywords="acute myocardial infarction",
keywords="percutaneous coronary intervention",
keywords="machine learning",
keywords="early prediction",
keywords="cardiovascular event",
abstract="Background: The incidence of major adverse cardiovascular events (MACEs) remains high in patients with acute myocardial infarction (AMI) who undergo percutaneous coronary intervention (PCI), and early prediction models to guide their clinical management are lacking. Objective: This study aimed to develop machine learning--based early prediction models for MACEs in patients with newly diagnosed AMI who underwent PCI. Methods: A total of 1531 patients with AMI who underwent PCI from January 2018 to December 2019 were enrolled in this consecutive cohort. The data comprised demographic characteristics, clinical investigations, laboratory tests, and disease-related events. Four machine learning models---artificial neural network (ANN), k-nearest neighbors, support vector machine, and random forest---were developed and compared with the logistic regression model. Our primary outcome was the model performance that predicted the MACEs, which was determined by accuracy, area under the receiver operating characteristic curve, and F1-score. Results: In total, 1362 patients were successfully followed up. With a median follow-up of 25.9 months, the incidence of MACEs was 18.5\% (252/1362). The area under the receiver operating characteristic curve of the ANN, random forest, k-nearest neighbors, support vector machine, and logistic regression models were 80.49\%, 72.67\%, 79.80\%, 77.20\%, and 71.77\%, respectively. The top 5 predictors in the ANN model were left ventricular ejection fraction, the number of implanted stents, age, diabetes, and the number of vessels with coronary artery disease. Conclusions: The ANN model showed good MACE prediction after PCI for patients with AMI. The use of machine learning--based prediction models may improve patient management and outcomes in clinical practice. ",
doi="10.2196/48487",
url="https://formative.jmir.org/2024/1/e48487",
url="http://www.ncbi.nlm.nih.gov/pubmed/38170581"
}


@Article{info:doi/10.2196/52035,
author="Schulze Lammers, Sophia
and Lawrenz, Thorsten
and Lawin, Dennis
and Hoyer, Annika
and Stellbrink, Christoph
and Albrecht, Urs-Vito",
title="Prolonged mHealth-Based Arrhythmia Monitoring in Patients With Hypertrophic Cardiomyopathy (HCM-PATCH): Protocol for a Single-Center Cohort Study",
journal="JMIR Res Protoc",
year="2023",
month="Dec",
day="29",
volume="12",
pages="e52035",
keywords="hypertrophic cardiomyopathy",
keywords="nonsustained ventricular arrhythmia",
keywords="sudden cardiac death",
keywords="implantable cardioverter-defibrillator",
keywords="long-term ECG",
keywords="digital medicine",
keywords="long-term electrocardiography",
abstract="Background: Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of sudden cardiac death (SCD) due to ventricular arrhythmias and other arrhythmias. Screening for arrhythmias is mandatory to assess the individual SCD risk, but long-term electrocardiography (ECG) is rarely performed in routine clinical practice. Intensified monitoring may increase the detection rate of ventricular arrhythmias and identify more patients with an increased SCD risk who are potential candidates for the primary prophylactic implantation of an implantable cardioverter-defibrillator. To date, reliable data on the clinical benefit of prolonged arrhythmia monitoring in patients with HCM are rare. Objective: This prospective study aims to measure the prevalence of ventricular arrhythmias in patients with HCM observed by mobile health (mHealth)--based continuous rhythm monitoring over 14 days compared to standard practice (a 24- and 48-h long-term ECG). The frequency of ventricular arrhythmias in this 14-day period is compared with the frequency in the first 24 or 48 hours for the same patient (intraindividual comparison). Methods: Following the sample size calculation, 34 patients with a low or intermediate risk for SCD, assessed by the HCM Risk--SCD calculator, will need to be recruited in this single-center cohort study between June 2023 and February 2024. All patients will receive an ECG patch that records their heart activity over 14 days. In addition, cardiac magnetic resonance imaging and genetic testing data will be integrated into risk stratification. All patients will be asked to complete questionnaires about their symptoms; previous therapy; family history; and, at the end of the study, their experience with the ECG patch-based monitoring. Results: The Hypertrophic Cardiomyopathy: Clinical Impact of a Prolonged mHealth-Based Arrhythmia Monitoring by Single-Channel ECG (HCM-PATCH) study investigates the prevalence of nonsustained ventricular tachycardia (ie, ?3 consecutive ventricular beats at a rate of 120 beats per minute, lasting for <30 seconds) in low- to intermediate-risk patients with HCM (according to the HCM Risk--SCD calculator) with additional mHealth-based prolonged rhythm monitoring. The study was funded by third-party funding from the Department of Cardiology and Intensive Care Medicine, University Hospital Ostwestfalen-Lippe of Bielefeld University in June 2023 and approved by the institutional review board in May 2023. Data collection began in June 2023, and we plan to end the study in February 2024. Of the 34 patients, 26 have been recruited. Data analysis has not yet taken place. Publication of the results is planned for the fall of 2024. Conclusions: Prolonged mHealth-based rhythm monitoring could lead to differences in the prevalence of arrhythmias compared to 24- and 48-hour long-term ECGs. This may lead to improved identification of patients at high risk and trigger therapeutic interventions that may provide better protection from SCD or atrial fibrillation--related complications such as embolic stroke. Trial Registration: Deutsches Register Klinischer Studien DRKS00032144; https://tinyurl.com/498bkrx8 International Registered Report Identifier (IRRID): DERR1-10.2196/52035 ",
doi="10.2196/52035",
url="https://www.researchprotocols.org/2023/1/e52035",
url="http://www.ncbi.nlm.nih.gov/pubmed/38157231"
}


@Article{info:doi/10.2196/48244,
author="Kim, Kwan Yun
and Koo, Hyung Ja
and Lee, Jung Sun
and Song, Seok Hee
and Lee, Minji",
title="Explainable Artificial Intelligence Warning Model Using an Ensemble Approach for In-Hospital Cardiac Arrest Prediction: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="22",
volume="25",
pages="e48244",
keywords="cardiac arrest prediction",
keywords="ensemble learning",
keywords="temporal pattern changes",
keywords="cost-sensitive learning",
keywords="electronic medical records",
abstract="Background: Cardiac arrest (CA) is the leading cause of death in critically ill patients. Clinical research has shown that early identification of CA reduces mortality. Algorithms capable of predicting CA with high sensitivity have been developed using multivariate time series data. However, these algorithms suffer from a high rate of false alarms, and their results are not clinically interpretable. Objective: We propose an ensemble approach using multiresolution statistical features and cosine similarity--based features for the timely prediction of CA. Furthermore, this approach provides clinically interpretable results that can be adopted by clinicians. Methods: Patients were retrospectively analyzed using data from the Medical Information Mart for Intensive Care-IV database and the eICU Collaborative Research Database. Based on the multivariate vital signs of a 24-hour time window for adults diagnosed with heart failure, we extracted multiresolution statistical and cosine similarity--based features. These features were used to construct and develop gradient boosting decision trees. Therefore, we adopted cost-sensitive learning as a solution. Then, 10-fold cross-validation was performed to check the consistency of the model performance, and the Shapley additive explanation algorithm was used to capture the overall interpretability of the proposed model. Next, external validation using the eICU Collaborative Research Database was performed to check the generalization ability. Results: The proposed method yielded an overall area under the receiver operating characteristic curve (AUROC) of 0.86 and area under the precision-recall curve (AUPRC) of 0.58. In terms of the timely prediction of CA, the proposed model achieved an AUROC above 0.80 for predicting CA events up to 6 hours in advance. The proposed method simultaneously improved precision and sensitivity to increase the AUPRC, which reduced the number of false alarms while maintaining high sensitivity. This result indicates that the predictive performance of the proposed model is superior to the performances of the models reported in previous studies. Next, we demonstrated the effect of feature importance on the clinical interpretability of the proposed method and inferred the effect between the non-CA and CA groups. Finally, external validation was performed using the eICU Collaborative Research Database, and an AUROC of 0.74 and AUPRC of 0.44 were obtained in a general intensive care unit population. Conclusions: The proposed framework can provide clinicians with more accurate CA prediction results and reduce false alarm rates through internal and external validation. In addition, clinically interpretable prediction results can facilitate clinician understanding. Furthermore, the similarity of vital sign changes can provide insights into temporal pattern changes in CA prediction in patients with heart failure--related diagnoses. Therefore, our system is sufficiently feasible for routine clinical use. In addition, regarding the proposed CA prediction system, a clinically mature application has been developed and verified in the future digital health field. ",
doi="10.2196/48244",
url="https://www.jmir.org/2023/1/e48244",
url="http://www.ncbi.nlm.nih.gov/pubmed/38133922"
}


@Article{info:doi/10.2196/49345,
author="Misra, Satish
and Niazi, Karen
and Swayampakala, Kamala
and Blackmon, Amanda
and Lang, Melissa
and Davenport, Elizabeth
and Saxonhouse, Sherry
and Fedor, John
and Powell, Brian
and Thompson, Joseph
and Holshouser, John
and Mehta, Rohit",
title="Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study",
journal="JMIR Cardio",
year="2023",
month="Dec",
day="14",
volume="7",
pages="e49345",
keywords="atrial fibrillation",
keywords="behavior modification",
keywords="cardiac rehabilitation",
keywords="catheter ablation",
keywords="exercise",
keywords="remote exercise supervision",
keywords="weight loss",
abstract="Background: Risk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities, insurance coverage, work or home responsibilities, and transportation. Digital health technology offers an opportunity to address this gap and offer scalable interventions for risk factor modification. Objective: This study aims to assess the feasibility and effectiveness of a 12-week asynchronous remotely supervised exercise and patient education program, modeled on cardiac rehabilitation programs, in patients with AF. Methods: A total of 12 patients undergoing catheter ablation of AF were enrolled in this pilot study. Participants met with an exercise physiologist for a supervised exercise session to generate a personalized exercise plan to be implemented over the subsequent 12-week program. Disease-specific education was also provided as well as instruction in areas such as blood pressure and weight measurement. A digital health toolkit for self-tracking was provided to facilitate monitoring of exercise time, blood pressure, weight, and cardiac rhythm. The exercise physiologist remotely monitored participants and completed weekly check-ins to titrate exercise targets and provide further education. The primary end point was program completion. Secondary end points included change in self-tracking adherence, weight, 6-minute walk test (6MWT), waist circumference, AF symptom score, and program satisfaction. Results: The median participant age was 67.5 years, with a mean BMI of 33.8 kg/m2 and CHADs2VASC (Congestive Heart Failure, Hypertension, Age [?75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]) of 1.5. A total of 11/12 (92\%) participants completed the program, with 94\% of expected check-ins completed and 2.9 exercise sessions per week. Adherence to electrocardiogram and blood pressure tracking was fair at 81\% and 47\%, respectively. Significant reductions in weight, waist circumference, and BMI were observed with improvements in 6MWT and AF symptom scores (P<.05) at the completion of the program. For program management, a mean of 2 hours per week or 0.5 hours per patient per week was required, inclusive of time for follow-up and intake visits. Participants rated the program highly (>8 on a 10-point Likert scale) in terms of the impact on health and wellness, educational value, and sustainability of the personal exercise program. Conclusions: An asynchronous remotely supervised exercise program augmented with AF-specific educational components for patients with AF was feasible and well received in this pilot study. While improvements in patient metrics like BMI and 6MWT are encouraging, they should be viewed as hypothesis generating. Based on insights gained, future program iterations will include particular attention to improved technology for data aggregation, adjustment of self-monitoring targets based on observed adherence, and protocol-driven exercise titration. The study design will need to incorporate strategies to facilitate the recruitment of a diverse and representative participant cohort. ",
doi="10.2196/49345",
url="https://cardio.jmir.org/2023/1/e49345",
url="http://www.ncbi.nlm.nih.gov/pubmed/38096021"
}


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


@Article{info:doi/10.2196/49892,
author="Pelly, Louise Melissa
and Fatehi, Farhad
and Liew, Danny
and Verdejo-Garcia, Antonio",
title="Digital Health Secondary Prevention Using Co-Design Procedures: Focus Group Study With Health Care Providers and Patients With Myocardial Infarction",
journal="JMIR Cardio",
year="2023",
month="Oct",
day="30",
volume="7",
pages="e49892",
keywords="co-design",
keywords="digital health",
keywords="myocardial infarction",
keywords="qualitative",
keywords="participatory",
keywords="mobile health",
abstract="Background: Myocardial infarction (MI) is a debilitating condition and a leading cause of morbidity and mortality worldwide. Digital health is a promising approach for delivering secondary prevention to support patients with a history of MI and for reducing risk factors that can lead to a future event. However, its potential can only be fulfilled when the technology meets the needs of the end users who will be interacting with this secondary prevention. Objective: We aimed to gauge the opinions of patients with a history of MI and health professionals concerning the functions, features, and characteristics of a digital health solution to support post-MI care. Methods: Our approach aligned with the gold standard participatory co-design procedures enabling progressive refinement of feedback via exploratory, confirmatory, and prototype-assisted feedback from participants. Patients with a history of MI and health professionals from Australia attended focus groups over a videoconference system. We engaged with 38 participants across 3 rounds of focus groups using an iterative co-design approach. Round 1 included 8 participants (4 patients and 4 health professionals), round 2 included 24 participants (11 patients and 13 health professionals), and round 3 included 22 participants (14 patients and 8 health professionals). Results: Participants highlighted the potential of digital health in addressing the unmet needs of post-MI care. Both patients with a history of MI and health professionals agreed that mental health is a key concern in post-MI care that requires further support. Participants agreed that family members can be used to support postdischarge care and require support from the health care team. Participants agreed that incorporating simple games with a points system can increase long-term engagement. However, patients with a history of MI emphasized a lack of support from their health care team, family, and community more strongly than health professionals. They also expressed some openness to using artificial intelligence, whereas health professionals expressed that users should not be aware of artificial intelligence use. Conclusions: These results provide valuable insights into the development of digital health secondary preventions aimed at supporting patients with a history of MI. Future research can implement a pilot study in the population with MI to trial these recommendations in a real-world setting. ",
doi="10.2196/49892",
url="https://cardio.jmir.org/2023/1/e49892",
url="http://www.ncbi.nlm.nih.gov/pubmed/37902821"
}


@Article{info:doi/10.2196/47876,
author="Pamart, Nicolas
and Drigny, Joffrey
and Azambourg, H{\'e}l{\`e}ne
and Remilly, Marion
and Macquart, Maxime
and Lef{\`e}vre, Alexandre
and Lahjaily, Kamal
and Parienti, Jacques Jean
and Rocamora, Am{\'e}lia
and Guermont, Henri
and Desverg{\'e}e, Antoine
and Ollitrault, Pierre
and Tournoux, Francois
and Saloux, Eric
and Normand, Herv{\'e}
and Reboursi{\`e}re, Emmanuel
and Gauthier, Antoine
and Hodzic, Amir",
title="Effects of a 20-Week High-Intensity Strength Training Program on Muscle Strength Gain and Cardiac Adaptation in Untrained Men: Preliminary Results of a Prospective Longitudinal Study",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="24",
volume="7",
pages="e47876",
keywords="actimetry",
keywords="athlete's heart",
keywords="athletes",
keywords="echocardiography",
keywords="exercise",
keywords="isokinetic dynamometry",
keywords="muscle strength gain",
keywords="sports physiology",
keywords="strength training",
keywords="strengthening exercise",
keywords="untrained population",
keywords="weightlifting",
abstract="Background: As strength sports gain popularity, there is a growing need to explore the impact of sustained strength training on cardiac biventricular structure and function, an area that has received less attention compared to the well-established physiological cardiac adaptation to endurance training. Objective: This study aims to implement a 20-week high-intensity strength training program to enhance maximal muscle strength and evaluate its impact on cardiac biventricular adaptation in healthy, untrained men. Methods: A total of 27 healthy and untrained young men (mean age 22.8, SD 3.2 years) participated in a strength training program designed to increase muscle strength. The training program involved concentric, eccentric, and isometric exercise phases, conducted over a consecutive 20-week time frame with a frequency of 3 weekly training sessions. Participants were evaluated before and after 12 and 20 weeks of training through body composition analysis (bioelectrical impedance), a 12-lead resting electrocardiogram, 3D transthoracic echocardiography, cardiopulmonary exercise testing, and muscle isokinetic dynamometry. The progression of strength training loads was guided by 1-repetition maximum (RM) testing during the training program. Results: Of the initial cohort, 22 participants completed the study protocol. No injuries were reported. The BMI (mean 69.8, SD 10.8 kg/m{\texttwosuperior} vs mean 72, SD 11 kg/m{\texttwosuperior}; P=.72) and the fat mass (mean 15.3\%, SD 7.5\% vs mean 16.5\%, SD 7\%; P=.87) remained unchanged after training. The strength training program led to significant gains in 1-RM exercise testing as early as 4 weeks into training for leg extension (mean 69.6, SD 17.7 kg vs mean 96.5, SD 31 kg; P<.001), leg curl (mean 43.2, SD 9.7 kg vs mean 52.8, SD 13.4 kg; P<.001), inclined press (mean 174.1, SD 41.1 kg vs mean 229.2, SD 50.4 kg; P<.001), butterfly (mean 26.3, SD 6.2 kg vs mean 32.5, SD 6.6 kg; P<.001), and curl biceps on desk (mean 22.9, SD 5.2 kg vs mean 29.6, SD 5.2 kg; P<.001). After 20 weeks, the 1-RM leg curl, bench press, pullover, butterfly, leg extension, curl biceps on desk, and inclined press showed significant mean percentage gains of +40\%, +41.1\%, +50.3\%, +63.5\%, +80.1\%, +105\%, and +106\%, respectively (P<.001). Additionally, the isokinetic evaluation confirmed increases in maximal strength for the biceps (+9.2 Nm), triceps (+11.6 Nm), quadriceps (+46.8 Nm), and hamstrings (+25.3 Nm). In this paper, only the training and muscular aspects are presented; the cardiac analysis will be addressed separately. Conclusions: This study demonstrated that a short-term high-intensity strength training program was successful in achieving significant gains in muscle strength among previously untrained young men. We intend to use this protocol to gain a better understanding of the impact of high-intensity strength training on cardiac physiological remodeling, thereby providing new insights into the cardiac global response in strength athletes. Trial Registration: ClinicalTrials.gov NCT04187170; https://clinicaltrials.gov/study/NCT04187170 ",
doi="10.2196/47876",
url="https://formative.jmir.org/2023/1/e47876",
url="http://www.ncbi.nlm.nih.gov/pubmed/37874630"
}


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


@Article{info:doi/10.2196/43889,
author="Kazi, Samia
and Truesdale, Chloe
and Ryan, Pauline
and Wiesner, Glen
and Jennings, Garry
and Chow, Clara",
title="Initial Implementation of the My Heart, My Life Program by the National Heart Foundation of Australia: Pilot Mixed Methods Evaluation Study",
journal="JMIR Cardio",
year="2023",
month="Oct",
day="5",
volume="7",
pages="e43889",
keywords="cardiology",
keywords="prevention",
keywords="digital health",
keywords="heart",
keywords="text message",
keywords="text messaging",
keywords="SMS",
keywords="health communication",
keywords="demographic",
keywords="preventative",
keywords="cardio",
abstract="Background: Coronary heart disease (CHD) remains the leading cause of death in Australia, with a high residual risk of repeat events in survivors. Secondary prevention therapy is crucial for reducing the risk of both death and other major adverse cardiac events. The National Heart Foundation of Australia has developed a consumer-facing support program called My Heart, My Life (MHML) to address the gap in the secondary prevention of CHD in Australia. The MHML pilot program supplies advice and support for both patients and their caregivers, and it was conducted over 8 months from November 2019 to June 2020. Objective: This study aims to describe and examine the implementation of a novel multimodality secondary CHD prevention pilot program called MHML, which was delivered through booklets, text messages, emails, and telephone calls. Methods: This pilot study consists of a mixed methods evaluation involving surveys of participants (patients and caregivers) and health professionals, in-depth interviews, and digital communication (SMS text message, electronic direct mail, and call record analytics). This study was performed in people older than 18 years with acute coronary syndrome or angina and their caregivers in 38 Australian hospitals from November 2019 to June 2020 through the National Heart Foundation of Australia web page. The main outcome measures were reach, accessibility, feasibility, barriers, and enablers to implementation of this program. Results: Of the 1004 participants (838 patients and 164 caregivers; 2 missing), 60.9\% (608/1001) were males, 50.7\% (491/967) were aged between 45 and 64 years, 27.4\% (276/1004) were from disadvantaged areas, 2.5\% (24/946) were from Aboriginal or Torres Strait Islander background, and 16.9\% (170/1004) reported English as their second language. The participants (patients and their caregivers) and health professionals reported high satisfaction with the MHML program (55/62, 88.7\% and 33/38, 87\%, respectively). Of the 62 participants who took the survey, 88\% (55/62) used the text messaging service and reported a very high level of satisfaction. Approximately 94\% (58/62) and 89\% (55/62) of the participants were satisfied with the quick guide booklets 1 and 2, respectively; 79\% (49/62) were satisfied with the monthly email journey and 71\% (44/62) were satisfied with the helpline calls. Most participants reported that the MHML program improved preventive behaviors, that is, 73\% (45/62) of them reported that they maintained increased physical activity and 84\% (52/62) reported that they maintained a healthy diet even after the MHML program. Conclusions: The findings of our pilot study suggest that a multimodal support program, including digital, print, phone, and web-based media, for the secondary prevention of CHD is useful and could be a potential means of providing customized at-scale secondary prevention support for survivors of acute coronary syndrome. ",
doi="10.2196/43889",
url="https://cardio.jmir.org/2023/1/e43889",
url="http://www.ncbi.nlm.nih.gov/pubmed/37796544"
}


@Article{info:doi/10.2196/43489,
author="Wu, Justin
and Napoleone, Jenna
and Linke, Sarah
and Noble, Madison
and Turken, Michael
and Rakotz, Michael
and Kirley, Kate
and Folk Akers, Jennie
and Juusola, Jessie
and Jasik, Bradner Carolyn",
title="Long-Term Results of a Digital Hypertension Self-Management Program: Retrospective Cohort Study",
journal="JMIR Cardio",
year="2023",
month="Aug",
day="24",
volume="7",
pages="e43489",
keywords="hypertension",
keywords="digital health program",
keywords="home measurement",
keywords="self-management",
keywords="behavior change",
abstract="Background: Digital health programs that incorporate frequent blood pressure (BP) self-monitoring and support for behavior change offer a scalable solution for hypertension management. Objective: We examined the impact of a digital hypertension self-management and lifestyle change support program on BP over 12 months. Methods: Data were analyzed from a retrospective observational cohort of commercially insured members (n=1117) that started the Omada for Hypertension program between January 1, 2019, and September 30, 2021. Paired t tests and linear regression were used to measure the changes in systolic blood pressure (SBP) over 12 months overall and by SBP control status at baseline (?130 mm Hg vs <130 mm Hg). Results: Members were on average 50.9 years old, 50.8\% (n=567) of them were female, 60.5\% (n=675) of them were White, and 70.5\% (n=788) of them had uncontrolled SBP at baseline (?130 mm Hg). At 12 months, all members (including members with controlled and uncontrolled BP at baseline) and those with uncontrolled SBP at baseline experienced significant mean reductions in SBP (mean --4.8 mm Hg, 95\% CI --5.6 to --4.0; --8.1 mm Hg, 95\% CI --9.0 to --7.1, respectively; both P<.001). Members with uncontrolled SBP at baseline also had significant reductions in diastolic blood pressure (--4.7 mm Hg; 95\% CI --5.3 to --4.1), weight (--6.5 lbs, 95\% CI --7.7 to --5.3; 2.7\% weight loss), and BMI (--1.1 kg/m2; 95\% CI --1.3 to --0.9; all P<.001). Those with controlled SBP at baseline maintained within BP goal range. Additionally, 48\% (418/860) of members with uncontrolled BP at baseline experienced enough change in BP to improve their BP category. Conclusions: This study provides real-world evidence that a comprehensive digital health program involving hypertension education, at-home BP monitoring, and behavior change coaching support was effective for self-managing hypertension over 12 months. ",
doi="10.2196/43489",
url="https://cardio.jmir.org/2023/1/e43489",
url="http://www.ncbi.nlm.nih.gov/pubmed/37463311"
}


@Article{info:doi/10.2196/48332,
author="Park, Sangil
and Woo, Geol Ho
and Kim, Soeun
and Kim, Sunyoung
and Lim, Hyunjung
and Yon, Keon Dong
and Rhee, Youl Sang",
title="Real-World Evidence of a Hospital-Linked Digital Health App for the Control of Hypertension and Diabetes Mellitus in South Korea: Nationwide Multicenter Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="21",
volume="7",
pages="e48332",
keywords="hypertension",
keywords="blood pressure",
keywords="diabetes",
keywords="glucose",
keywords="digital health technology",
keywords="effectiveness",
keywords="application",
keywords="blood glucose",
keywords="systolic",
keywords="diastolic",
keywords="management",
keywords="consumer",
keywords="cost",
keywords="monitoring",
abstract="Background: Digital health care apps have been widely used for managing chronic conditions such as diabetes mellitus and hypertension, providing promising prospects for enhanced health care delivery, increased patient engagement, and improved self-management. However, the impact of integrating these apps within hospital systems for managing such conditions still lacks conclusive evidence. Objective: We aimed to investigate the real-world effectiveness of using hospital-linked digital health care apps in lowering blood pressure (BP) and blood glucose levels in patients with hypertension and diabetes mellitus. Methods: Nationwide multicenter data on demographic characteristics and the use of a digital health care app from 233 hospitals were collected for participants aged 20 to 80 years in South Korea between August 2021 and June 2022. We divided the participants into 2 groups: 1 group consisted of individuals who exclusively used the digital health app (control) and the other group used the hospital-linked digital health app. All the patients participated in a 12-week digital health care intervention. We conducted a comparative analysis to assess the real-world effectiveness of the hospital-linked digital health app. The primary outcome was the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) level, and postprandial glucose (PPG) level between baseline and 12 weeks. Results: A total of 1029 participants were analyzed for the FBG level, 527 participants were analyzed for the PPG level, and 2029 participants for the SBP and DBP were enrolled. After 12 weeks, a hospital-linked digital health app was found to reduce SBP (?5.4 mm Hg, 95\% CI ?7.0 to ?3.9) and DBP (?2.4 mm Hg, 95\% CI ?3.4 to ?1.4) in participants without hypertension and FBG level in all participants (those without diabetes, ?4.4 mg/dL, 95\% CI ?7.9 to ?1.0 and those with diabetes, ?3.2 mg/dL, 95\% CI ?5.4 to ?1.0); however, there was no statistically significant difference compared to the control group (using only digital health app). Specifically, participants with diabetes using a hospital-linked digital health app demonstrated a significant decrease in PPG after 12 weeks (?10.9 mg/dL, 95\% CI ?31.1 to ?5.3) compared to those using only a digital health app (P=.006). Conclusions: Hospital-linked digital interventions have greatly improved glucose control for diabetes compared with using digital health technology only. These hospital-linked digital health apps have the potential to offer consumers and health care professionals cost-effective support in decreasing glucose levels when used in conjunction with self-monitoring. ",
doi="10.2196/48332",
url="https://formative.jmir.org/2023/1/e48332",
url="http://www.ncbi.nlm.nih.gov/pubmed/37603401"
}


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


@Article{info:doi/10.2196/40557,
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/10.2196/45611,
author="Zaman, Sameer
and Padayachee, Yorissa
and Shah, Moulesh
and Samways, Jack
and Auton, Alice
and Quaife, M. Nicholas
and Sweeney, Mark
and Howard, P. James
and Tenorio, Indira
and Bachtiger, Patrik
and Kamalati, Tahereh
and Pabari, A. Punam
and Linton, F. Nick W.
and Mayet, Jamil
and Peters, S. Nicholas
and Barton, Carys
and Cole, D. Graham
and Plymen, M. Carla",
title="Smartphone-Based Remote Monitoring in Heart Failure With Reduced Ejection Fraction: Retrospective Cohort Study of Secondary Care Use and Costs",
journal="JMIR Cardio",
year="2023",
month="Jun",
day="23",
volume="7",
pages="e45611",
keywords="heart failure",
keywords="remote monitoring",
keywords="smartphone care",
keywords="telemonitoring",
keywords="self-management",
keywords="admission prevention",
keywords="cohort study",
keywords="hospitalization",
keywords="noninvasive",
keywords="smartphone",
keywords="vital signs",
keywords="diagnosis",
abstract="Background: Despite effective therapies, the economic burden of heart failure with reduced ejection fraction (HFrEF) is driven by frequent hospitalizations. Treatment optimization and admission avoidance rely on frequent symptom reviews and monitoring of vital signs. Remote monitoring (RM) aims to prevent admissions by facilitating early intervention, but the impact of noninvasive, smartphone-based RM of vital signs on secondary health care use and costs in the months after a new diagnosis of HFrEF is unknown. Objective: The purpose of this study is to conduct a secondary care health use and health-economic evaluation for patients with HFrEF using smartphone-based noninvasive RM and compare it with matched controls receiving usual care without RM. Methods: We conducted a retrospective study of 2 cohorts of newly diagnosed HFrEF patients, matched 1:1 for demographics, socioeconomic status, comorbidities, and HFrEF severity. They are (1) the RM group, with patients using the RM platform for >3 months and (2) the control group, with patients referred before RM was available who received usual heart failure care without RM. Emergency department (ED) attendance, hospital admissions, outpatient use, and the associated costs of this secondary care activity were extracted from the Discover data set for a 3-month period after diagnosis. Platform costs were added for the RM group. Secondary health care use and costs were analyzed using Kaplan-Meier event analysis and Cox proportional hazards modeling. Results: A total of 146 patients (mean age 63 years; 42/146, 29\% female) were included (73 in each group). The groups were well-matched for all baseline characteristics except hypertension (P=.03). RM was associated with a lower hazard of ED attendance (hazard ratio [HR] 0.43; P=.02) and unplanned admissions (HR 0.26; P=.02). There were no differences in elective admissions (HR 1.03, P=.96) or outpatient use (HR 1.40; P=.18) between the 2 groups. These differences were sustained by a univariate model controlling for hypertension. Over a 3-month period, secondary health care costs were approximately 4-fold lower in the RM group than the control group, despite the additional cost of RM itself (mean cost per patient GBP {\textsterling}465, US \$581 vs GBP {\textsterling}1850, US \$2313, respectively; P=.04). Conclusions: This retrospective cohort study shows that smartphone-based RM of vital signs is feasible for HFrEF. This type of RM was associated with an approximately 2-fold reduction in ED attendance and a 4-fold reduction in emergency admissions over just 3 months after a new diagnosis with HFrEF. Costs were significantly lower in the RM group without increasing outpatient demand. This type of RM could be adjunctive to standard care to reduce admissions, enabling other resources to help patients unable to use RM. ",
doi="10.2196/45611",
url="https://cardio.jmir.org/2023/1/e45611",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351921"
}


@Article{info:doi/10.2196/45352,
author="Killian, O. Michael
and Tian, Shubo
and Xing, Aiwen
and Hughes, Dana
and Gupta, Dipankar
and Wang, Xiaoyu
and He, Zhe",
title="Prediction of Outcomes After Heart Transplantation in Pediatric Patients Using National Registry Data: Evaluation of Machine Learning Approaches",
journal="JMIR Cardio",
year="2023",
month="Jun",
day="20",
volume="7",
pages="e45352",
keywords="explainable artificial intelligence",
keywords="machine learning",
keywords="mortality",
keywords="outcome prediction",
keywords="organ rejection",
keywords="organ transplantation",
keywords="pediatrics",
keywords="United Network for Organ Sharing",
abstract="Background: The prediction of posttransplant health outcomes for pediatric heart transplantation is critical for risk stratification and high-quality posttransplant care. Objective: The purpose of this study was to examine the use of machine learning (ML) models to predict rejection and mortality for pediatric heart transplant recipients. Methods: Various ML models were used to predict rejection and mortality at 1, 3, and 5 years after transplantation in pediatric heart transplant recipients using United Network for Organ Sharing data from 1987 to 2019. The variables used for predicting posttransplant outcomes included donor and recipient as well as medical and social factors. We evaluated 7 ML models---extreme gradient boosting (XGBoost), logistic regression, support vector machine, random forest (RF), stochastic gradient descent, multilayer perceptron, and adaptive boosting (AdaBoost)---as well as a deep learning model with 2 hidden layers with 100 neurons and a rectified linear unit (ReLU) activation function followed by batch normalization for each and a classification head with a softmax activation function. We used 10-fold cross-validation to evaluate model performance. Shapley additive explanations (SHAP) values were calculated to estimate the importance of each variable for prediction. Results: RF and AdaBoost models were the best-performing algorithms for different prediction windows across outcomes. RF outperformed other ML algorithms in predicting 5 of the 6 outcomes (area under the receiver operating characteristic curve [AUROC] 0.664 and 0.706 for 1-year and 3-year rejection, respectively, and AUROC 0.697, 0.758, and 0.763 for 1-year, 3-year, and 5-year mortality, respectively). AdaBoost achieved the best performance for prediction of 5-year rejection (AUROC 0.705). Conclusions: This study demonstrates the comparative utility of ML approaches for modeling posttransplant health outcomes using registry data. ML approaches can identify unique risk factors and their complex relationship with outcomes, thereby identifying patients considered to be at risk and informing the transplant community about the potential of these innovative approaches to improve pediatric care after heart transplantation. Future studies are required to translate the information derived from prediction models to optimize counseling, clinical care, and decision-making within pediatric organ transplant centers. ",
doi="10.2196/45352",
url="https://cardio.jmir.org/2023/1/e45352",
url="http://www.ncbi.nlm.nih.gov/pubmed/37338974"
}


@Article{info:doi/10.2196/46828,
author="Siegmund, Anne Lee
and Bena, F. James
and Morrison, L. Shannon",
title="Cardiac Rehabilitation Facebook Intervention: Feasibility Randomized Controlled Trial",
journal="JMIR Cardio",
year="2023",
month="Jun",
day="15",
volume="7",
pages="e46828",
keywords="cardiac rehabilitation",
keywords="motivation",
keywords="exercise",
keywords="social media",
keywords="cardiology",
keywords="adherence",
keywords="physical activity",
keywords="satisfaction",
keywords="rehabilitation",
keywords="Facebook",
keywords="peer support",
abstract="Background: The adherence to cardiac rehabilitation is low. Social media has been used to improve motivation and cardiac rehabilitation completion, but the authors did not find Facebook interventions for these purposes in the literature. Objective: The purpose of this study was to determine the feasibility of the Cardiac Rehabilitation Facebook Intervention (Chat) for affecting changes in exercise motivation and need satisfaction and adherence to cardiac rehabilitation. Methods: The Behavioral Regulation in Exercise Questionnaire-3 and Psychological Need Satisfaction for Exercise were used to measure motivation and need satisfaction (competence, autonomy, and relatedness) before and after the Chat intervention. To support need satisfaction, the intervention included educational posts, supportive posts, and interaction with peers. The feasibility measures included recruitment, engagement, and acceptability. Groups were compared using analysis of variance and Kruskal-Wallis tests. Paired t tests were used to assess motivation and need satisfaction change, and Pearson or Spearman correlations were used for continuous variables. Results: A total of 32 participants were lost to follow-up and 22 were included in the analysis. Higher motivation at intake (relative autonomy index 0.53, 95\% CI 0.14-0.78; P=.01) and change in need satisfaction-autonomy (relative autonomy index 0.61, 95\% CI 0.09-0.87; P=.02) were associated with more completed sessions. No between-group differences were found. Engagement included ``likes'' (n=210) and ``hits'' (n=157). For acceptability, mean scores on a 1 (not at all) to 5 (quite a bit) Likert scale for feeling supported and in touch with providers were 4.6 and 4.4, respectively. Conclusions: Acceptability of the Chat group was high; however, intervention feasibility could not be determined due to the small sample size. Those with greater motivation at intake completed more sessions, indicating its importance in cardiac rehabilitation completion. Despite challenges with recruitment and engagement, important lessons were learned. Trial Registration: ClinicalTrials.gov NCT02971813; https://clinicaltrials.gov/ct2/show/NCT02971813 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.7554 ",
doi="10.2196/46828",
url="https://cardio.jmir.org/2023/1/e46828",
url="http://www.ncbi.nlm.nih.gov/pubmed/37318865"
}


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


@Article{info:doi/10.2196/45801,
author="Radhakrishnan, Kavita
and Julien, Christine
and O'Hair, Matthew
and Tunis, Rachel
and Lee, Grace
and Rangel, Angelica
and Custer, James
and Baranowski, Tom
and Rathouz, J. Paul
and Kim, T. Miyong",
title="Sensor-Controlled Digital Game for Heart Failure Self-management: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="10",
volume="12",
pages="e45801",
keywords="heart failure",
keywords="digital game",
keywords="self-management",
keywords="mobile phone",
keywords="older adults",
abstract="Background: Heart failure (HF) is the leading cause of hospitalization among older adults in the United States. There are substantial racial and geographic disparities in HF outcomes, with patients living in southern US states having a mortality rate 69\% higher than the national average. Self-management behaviors, particularly daily weight monitoring and physical activity, are extremely important in improving HF outcomes; however, patients typically have particularly low adherence to these behaviors. With the rise of digital technologies to improve health outcomes and motivate health behaviors, sensor-controlled digital games (SCDGs) have become a promising approach. SCDGs, which leverage sensor-connected technologies, offer the benefits of being portable and scalable and allowing for continuous observation and motivation of health behaviors in their real-world contexts. They are also becoming increasingly popular among older adults and offer an immersive and accessible way to measure self-management behaviors and improve adherence. No SCDGs have been designed for older adults or evaluated to test their outcomes. Objective: This randomized clinical trial aims to assess the efficacy of a SCDG in integrating the behavioral data of participants with HF from weight scale and activity tracker sensors to activate game progress, rewards, and feedback and, ultimately, to improve adherence to important self-management behaviors. Methods: A total of 200 participants with HF, aged ?45 years, will be recruited and randomized into 2 groups: the SCDG playing group (intervention group) and sensor-only group (control group). Both groups will receive a weight scale, physical activity tracker, and accompanying app, whereas only the intervention group will play the SCDG. This design, thereby, assesses the contributions of the game. All participants will complete a baseline survey as well as posttests at 6 and 12 weeks to assess the immediate effect of the intervention. They will also complete a third posttest at 24 weeks to assess the maintenance of behavioral changes. Efficacy and benefits will be assessed by measuring improvements in HF-related proximal outcomes (self-management behaviors of daily weight monitoring and physical activity) and distal outcomes (HF hospitalization, quality of life, and functional status) between baseline and weeks 6, 12, and 24. The primary outcome measured will be days with weight monitoring, for which this design provides at least 80\% power to detect differences between the 2 groups. Results: Recruitment began in the fall of 2022, and the first patient was enrolled in the study on November 7, 2022. Recruitment of the last participant is expected in quarter 1 of 2025. Publication of complete results and data from this study is expected in 2026. Conclusions: This project will generate insight and guidance for scalable and easy-to-use digital gaming solutions to motivate persistent adherence to HF self-management behaviors and improve health outcomes among individuals with HF. Trial Registration: ClinicalTrials.gov NCT05056129; https://clinicaltrials.gov/ct2/show/NCT05056129 International Registered Report Identifier (IRRID): DERR1-10.2196/45801 ",
doi="10.2196/45801",
url="https://www.researchprotocols.org/2023/1/e45801",
url="http://www.ncbi.nlm.nih.gov/pubmed/37163342"
}


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


@Article{info:doi/10.2196/43781,
author="Bente, E. Britt
and Wentzel, Jobke
and Schepers, Celina
and Breeman, D. Linda
and Janssen, R. Veronica
and Pieterse, E. Marcel
and Evers, M. Andrea W.
and van Gemert-Pijnen, Lisette",
title="Implementation and User Evaluation of an eHealth Technology Platform Supporting Patients With Cardiovascular Disease in Managing Their Health After a Cardiac Event: Mixed Methods Study",
journal="JMIR Cardio",
year="2023",
month="Mar",
day="24",
volume="7",
pages="e43781",
keywords="patient needs",
keywords="health behavior",
keywords="lifestyle support",
keywords="user-centered design",
keywords="implementation",
keywords="evaluation",
keywords="cardiovascular disease",
keywords="app",
keywords="web-based platform",
keywords="intervention",
abstract="Background: eHealth technology can help patients with cardiovascular disease adopt and maintain a healthy lifestyle by supporting self-management and offering guidance, coaching, and tailored information. However, to support patients over time, eHealth needs to blend in with their needs, treatment, and daily lives. Just as needs can differ between patients, needs can change within patients over time. To better adapt technology features to patients' needs, it is necessary to account for these changes in needs and contexts of use. Objective: This study aimed to identify and monitor patients' needs for support from a web-based health management platform and how these needs change over time. It aimed to answer the following research questions: ``How do novice and more advanced users experience an online health management platform?'' ``What user expectations support or hinder the adoption of an online health management platform, from a user perspective?'' and ``How does actual usage relate to user experiences and adoption?'' Methods: A mixed methods design was adopted. The first method involved 2 rounds of usability testing, followed by interviews, with 10 patients at 0 months (round 1) and 12 patients at 6 months (round 2). In the second method, log data were collected to describe the actual platform use. Results: After starting cardiac rehabilitation, the platform was used frequently. The patients mentioned that they need to have an incentive, set goals, self-monitor their health data, and feel empowered by the platform. However, soon after the rehabilitation program stopped, use of the platform declined or patients even quit because of the lack of continued tailored or personalized advice. The reward system motivated them to log data, but most participants indicated that being healthy should be the main focus, not receiving gifts. A web-based platform is flexible, accessible, and does not have any obligations; however, it should be implemented as an addition to regular care. Conclusions: Although use of the platform declined in the longer term, patients quitting the technology did not directly indicate that the technology was not functioning well or that patients no longer focused on achieving their values. The key to success should not be user adherence to a platform but adherence to healthy lifestyle habits. Therefore, the implementation of eHealth should include the transition to a stage where patients might no longer need support from a technology platform to be independently and sustainably adherent to their healthy lifestyle habits. This emphasizes the importance of conducting multi-iterative evaluations to continuously monitor whether and how patients' needs and contexts of use change over time. Future research should focus on how this transition can be identified and monitored and how these insights can inform the design and implementation of the technology. ",
doi="10.2196/43781",
url="https://cardio.jmir.org/2023/1/e43781",
url="http://www.ncbi.nlm.nih.gov/pubmed/36961491"
}


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


@Article{info:doi/10.2196/40764,
author="Xue, Haoning
and Zhang, Jingwen
and Sagae, Kenji
and Nishimine, Brian
and Fukuoka, Yoshimi",
title="Analyzing Public Conversations About Heart Disease and Heart Health on Facebook From 2016 to 2021: Retrospective Observational Study Applying Latent Dirichlet Allocation Topic Modeling",
journal="JMIR Cardio",
year="2022",
month="Nov",
day="22",
volume="6",
number="2",
pages="e40764",
keywords="heart health",
keywords="heart disease",
keywords="topic modeling",
keywords="sentiment analysis",
keywords="social media",
keywords="Facebook",
keywords="COVID-19",
keywords="women's heart health",
abstract="Background: Heart disease continues to be the leading cause of death in men and women in the United States. The COVID-19 pandemic has further led to increases in various long-term cardiovascular complications. Objective: This study analyzed public conversations related to heart disease and heart health on Facebook in terms of their thematic topics and sentiments. In addition, it provided in-depth analyses of 2 subtopics with important practical implications: heart health for women and heart health during the COVID-19 pandemic. Methods: We collected 34,885 posts and 51,835 comments spanning from June 2016 to June 2021 that were related to heart disease and health from public Facebook pages and groups. We used latent Dirichlet allocation topic modeling to extract discussion topics illuminating the public's interests and concerns regarding heart disease and heart health. We also used Linguistic Inquiry and Word Count (Pennebaker Conglomerates, Inc) to identify public sentiments regarding heart health. Results: We observed an increase in discussions related to heart health on Facebook. Posts and comments increased from 3102 and 3632 in 2016 to 8550 (176\% increase) and 14,617 (302\% increase) in 2021, respectively. Overall, 35.37\% (12,340/34,885) of the posts were created after January 2020, the start of the COVID-19 pandemic. In total, 39.21\% (13,677/34,885) of the posts were by nonprofit health organizations. We identified 6 topics in the posts (heart health promotion, personal experiences, risk-reduction education, heart health promotion for women, educational information, and physicians' live discussion sessions). We identified 6 topics in the comments (personal experiences, survivor stories, risk reduction, religion, medical questions, and appreciation of physicians and information on heart health). During the pandemic (from January 2020 to June 2021), risk reduction was a major topic in both posts and comments. Unverified information on alternative treatments and promotional content was also prevalent. Among all posts, 14.91\% (5200/34,885) were specifically about heart health for women centering on local event promotion and distinctive symptoms of heart diseases for women. Conclusions: Our results tracked the public's ongoing discussions on heart disease and heart health on one prominent social media platform, Facebook. The public's discussions and information sharing on heart health increased over time, especially since the start of the COVID-19 pandemic. Various levels of health organizations on Facebook actively promoted heart health information and engaged a large number of users. Facebook presents opportunities for more targeted heart health interventions that can reach and engage diverse populations. ",
doi="10.2196/40764",
url="https://cardio.jmir.org/2022/2/e40764",
url="http://www.ncbi.nlm.nih.gov/pubmed/36318640"
}


@Article{info:doi/10.2196/35796,
author="Rissanen, E. Antti-Pekka
and Rottensteiner, Mirva
and Kujala, M. Urho
and Kurkela, O. Jari L.
and Wikgren, Jan
and Laukkanen, A. Jari",
title="Cardiorespiratory Fitness Estimation Based on Heart Rate and Body Acceleration in Adults With Cardiovascular Risk Factors: Validation Study",
journal="JMIR Cardio",
year="2022",
month="Oct",
day="25",
volume="6",
number="2",
pages="e35796",
keywords="cardiopulmonary exercise test",
keywords="cardiorespiratory fitness",
keywords="heart rate variability",
keywords="hypertension",
keywords="type 2 diabetes",
keywords="wearable technology",
abstract="Background: Cardiorespiratory fitness (CRF) is an independent risk factor for cardiovascular morbidity and mortality. Adding CRF to conventional risk factors (eg, smoking, hypertension, impaired glucose metabolism, and dyslipidemia) improves the prediction of an individual's risk for adverse health outcomes such as those related to cardiovascular disease. Consequently, it is recommended to determine CRF as part of individualized risk prediction. However, CRF is not determined routinely in everyday clinical practice. Wearable technologies provide a potential strategy to estimate CRF on a daily basis, and such technologies, which provide CRF estimates based on heart rate and body acceleration, have been developed. However, the validity of such technologies in estimating individual CRF in clinically relevant populations is poorly known. Objective: The objective of this study is to evaluate the validity of a wearable technology, which provides estimated CRF based on heart rate and body acceleration, in working-aged adults with cardiovascular risk factors. Methods: In total, 74 adults (age range 35-64 years; n=56, 76\% were women; mean BMI 28.7, SD 4.6 kg/m2) with frequent cardiovascular risk factors (eg, n=64, 86\% hypertension; n=18, 24\% prediabetes; n=14, 19\% type 2 diabetes; and n=51, 69\% metabolic syndrome) performed a 30-minute self-paced walk on an indoor track and a cardiopulmonary exercise test on a treadmill. CRF, quantified as peak O2 uptake, was both estimated (self-paced walk: a wearable single-lead electrocardiogram device worn to record continuous beat-to-beat R-R intervals and triaxial body acceleration) and measured (cardiopulmonary exercise test: ventilatory gas analysis). The accuracy of the estimated CRF was evaluated against that of the measured CRF. Results: Measured CRF averaged 30.6 (SD 6.3; range 20.1-49.6) mL/kg/min. In all participants (74/74, 100\%), mean difference between estimated and measured CRF was ?0.1 mL/kg/min (P=.90), mean absolute error was 3.1 mL/kg/min (95\% CI 2.6-3.7), mean absolute percentage error was 10.4\% (95\% CI 8.5-12.5), and intraclass correlation coefficient was 0.88 (95\% CI 0.80-0.92). Similar accuracy was observed in various subgroups (sexes, age, BMI categories, hypertension, prediabetes, and metabolic syndrome). However, mean absolute error was 4.2 mL/kg/min (95\% CI 2.6-6.1) and mean absolute percentage error was 16.5\% (95\% CI 8.6-24.4) in the subgroup of patients with type 2 diabetes (14/74, 19\%). Conclusions: The error of the CRF estimate, provided by the wearable technology, was likely below or at least very close to the clinically significant level of 3.5 mL/kg/min in working-aged adults with cardiovascular risk factors, but not in the relatively small subgroup of patients with type 2 diabetes. From a large-scale clinical perspective, the findings suggest that wearable technologies have the potential to estimate individual CRF with acceptable accuracy in clinically relevant populations. ",
doi="10.2196/35796",
url="https://cardio.jmir.org/2022/2/e35796",
url="http://www.ncbi.nlm.nih.gov/pubmed/36282560"
}


@Article{info:doi/10.2196/35599,
author="Matthews, Stacey
and Atkins, Brooke
and Walton, Natalie
and Mitchell, Julie-Anne
and Jennings, Garry
and Buttery, K. Amanda",
title="Development and Use of a Cardiac Clinical Guideline Mobile App in Australia: Acceptability and Multi-Methods Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="5",
volume="6",
number="8",
pages="e35599",
keywords="mHealth",
keywords="mobile heath",
keywords="apps",
keywords="app",
keywords="guideline",
keywords="cardiovascular disease",
keywords="atrial fibrillation",
keywords="heart failure",
keywords="heart",
keywords="cardiac",
keywords="cardiovascular",
keywords="acute coronary syndrome",
keywords="smartphone",
keywords="implementation",
keywords="digital health",
keywords="develop",
keywords="evaluate",
keywords="evaluation",
keywords="Australia",
abstract="Background: Implementation of clinical guidelines into routine practice remains highly variable. Strategies to increase guideline uptake include developing digital tools and mobile apps for use in clinical practice. The National Heart Foundation of Australia in collaboration with the Cardiac Society of Australia and New Zealand published 3 key cardiac clinical guidelines, including the Australian clinical guidelines for the (1) prevention and detection of atrial fibrillation, (2) detection and management of heart failure, and (3) management of acute coronary syndromes. To improve access and uptake for health care providers, we developed the Smart Heart Guideline App. Objective: This study aims to evaluate the acceptability, implementation, and usability of an Australian-specific cardiac guidelines mobile app. Methods: We used an iterative multiple methods development and implementation approach. First, we conducted a cross-sectional web-based survey with end users (n=504 health professionals) in 2017 to determine the acceptability of an Australian-specific cardiac clinical guidelines mobile app. Second, the Smart Heart Guidelines app was created using a design, user testing, and revision process. The app includes interactive algorithms and flowcharts to inform diagnosis and management at the point of care. The freely available app was launched in October 2019 on iOS and Android operating systems and promoted and implemented using multiple methods. Third, data from 2 annual national cross-sectional general practitioner (GP) surveys in 2019 and 2020 were evaluated to understand the awareness and use of the clinical guidelines and the app. Fourth, data from the app stores were analyzed between October 1, 2019, and June 30, 2021, to evaluate usage. Results: Most health professionals surveyed (447/504, 89\%) reported accessing resources electronically, and most (318/504, 63\%) reported that they would use an Australian-specific cardiac guidelines app. GPs surveyed in 2019 were aware of the heart failure (159/312, 51\%) and atrial fibrillation (140/312, 45\%) guidelines, and in 2020, a total of 34 of 189 (18\%) reported that they were aware of the app. The app was downloaded 11,313 times (7483, 66\% from the Apple App Store; 3830, 34\% from Google Play) during the first 20-month period. Most downloads (6300/7483, 84\%) were a result of searching for the app in the stores. Monthly download rates varied. App Store data showed that people used the app twice (on average 2.06 times) during the 20 months. Many (3256/3830, 85\%) Android users deleted the app. Conclusions: Health professionals supported the development of the Smart Heart Guidelines app. Although initial downloads were promising, the frequency of using the app was low and deletion rates were high. Further evaluation of users' experience of the most and least useful components of the app is needed. ",
doi="10.2196/35599",
url="https://formative.jmir.org/2022/8/e35599",
url="http://www.ncbi.nlm.nih.gov/pubmed/35930350"
}


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


@Article{info:doi/10.2196/29926,
author="Johansson, Peter
and Lundgren, Johan
and Andersson, Gerhard
and Svensson, Erland
and Mourad, Ghassan",
title="Internet-Based Cognitive Behavioral Therapy and its Association With Self-efficacy, Depressive Symptoms, and Physical Activity: Secondary Analysis of a Randomized Controlled Trial in Patients With Cardiovascular Disease",
journal="JMIR Cardio",
year="2022",
month="Jun",
day="3",
volume="6",
number="1",
pages="e29926",
keywords="internet-based cognitive behavioral therapy",
keywords="cardiovascular disease",
keywords="depression",
keywords="self-efficacy",
keywords="physical activity",
keywords="mental health",
keywords="digital health",
keywords="online health",
keywords="digital therapy",
keywords="cognition",
keywords="self-care",
keywords="CVD",
keywords="internet-based",
keywords="cardiology",
keywords="heart disease",
keywords="cardiac health",
keywords="cognitive behavioral therapy",
abstract="Background: In patients with cardiovascular disease (CVD), knowledge about the associations among changes in depressive symptoms, self-efficacy, and self-care activities has been requested. This is because such knowledge can be helpful in the design of behavioral interventions aimed to improve self-efficacy, reduce depressive symptoms, and improve performance of self-care activities in CVD patients. Objective: We aim to evaluate if internet-based cognitive behavioral therapy (iCBT) improves self-efficacy and explore the relationships among changes in depressive symptoms, self-efficacy, and physical activity, as well as the influence of iCBT on these relationships. Methods: This study received funding in January 2015. Participant recruitment took place between January 2017 and February 2018, and the main findings were published in 2019. This study is a secondary analysis of data collected in a randomized controlled study evaluating the effects of a 9-week iCBT program compared to an online discussion forum (ODF) on depressive symptoms in patients with CVD (N=144). Data were collected at baseline and at the 9-week follow-up. Analysis of covariance was used to evaluate the differences in self-efficacy between the iCBT and ODF groups. Structural equation modeling explored the relationships among changes in depressive symptoms, self-efficacy, and physical activity, as well as the influence of iCBT on these relationships. Results: At follow-up, a significant difference in the increase in self-efficacy favoring iCBT was found (P=.04, Cohen d=0.27). We found an indirect association between changes in depressive symptoms and physical activity ($\beta$=--.24, P<.01), with the change in self-efficacy acting as a mediator. iCBT had a direct effect on the changes in depressive symptoms, which in turn influenced the changes in self-efficacy ($\beta$=.23, P<.001) and physical activity ($\beta$=.12, P<.001). Conclusions: Self-efficacy was improved by iCBT. However, the influence of iCBT on self-efficacy and physical activity was mostly mediated by improvements in depressive symptoms. Trial Registration: ClinicalTrials.gov NCT02778074; https://clinicaltrials.gov/ct2/show/NCT02778074 ",
doi="10.2196/29926",
url="https://cardio.jmir.org/2022/1/e29926",
url="http://www.ncbi.nlm.nih.gov/pubmed/35657674"
}


@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/10.2196/33893,
author="Pinczak, Witold
and Trzci?ska, Sylwia
and Kami?ski, Miko?aj",
title="Characteristics and Outcomes of Clinical Trials on Gene Therapy in Noncongenital Cardiovascular Diseases: Cross-sectional Study of Three Clinical Trial Registries",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="21",
volume="6",
number="4",
pages="e33893",
keywords="gene therapy",
keywords="cardiovascular disease",
keywords="clinical trials",
keywords="trial design",
keywords="heart disease",
keywords="clinical trial",
keywords="therapy",
keywords="cardiac risk factor",
keywords="health intervention",
abstract="Background: Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide. Gene therapies (GTs) may become a novel therapeutic option for cardiovascular diseases. Objective: We aimed to characterize all trials involving human subjects utilizing GT to treat noncongenital cardiovascular diseases. Methods: In March 2021, we searched for clinical trials on the ClinicalTrials.gov (CT), International Clinical Trials Registry Platform (ICTRP), and International Standard Randomised Controlled Trials Number (ISRCTN) databases. Two authors screened the titles and registry notes of all the searched studies. We collected details of the included studies regarding their design, location funding source, treated conditions, completion, publication statuses, and final outcomes. Results: We generated a total of 3508 records, and 50 unique clinical trials met our eligibility criteria. Of these, 20 (40\%) concerned peripheral artery disease, and 18 (36\%) concerned coronary artery disease. Most studies were randomized (34/50, 68\%) and were performed in multiple locations (30/50, 60\%), and around half of the trials compared GT with a placebo (27/50, 54\%), while one in four were single-arm (14/50, 28\%), and the rest concerned dose-finding (22\%). More than half of the trials (29/50, 58\%) were funded by industry. Of the 50 clinical trials, 28 (56\%) published their results by the data collection date (March 2021), and 22 of 31 (71\%) were slated to be completed before 2021. Overall, 12 of 28 (42.9\%) clinical trials showed favorable outcomes of the intervention. Conclusions: Among noncongenital cardiovascular diseases, GTs are mostly investigated in peripheral artery disease and coronary artery disease. Many clinical trials on GT use in noncongenital cardiovascular diseases did not disclose their results. Regardless of the trial phase, less than half of published studies on GT in noncongenital cardiovascular diseases showed promising results. ",
doi="10.2196/33893",
url="https://formative.jmir.org/2022/4/e33893",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451992"
}


@Article{info:doi/10.2196/30661,
author="Brasca, Angelo Francesco Maria
and Casale, Carla Maria
and Canevese, Lorenzo Fabio
and Tortora, Giovanni
and Pagano, Giulia
and Botto, Luca Giovanni",
title="Physical Activity in Patients With Heart Failure During and After COVID-19 Lockdown: Single-Center Observational Retrospective Study",
journal="JMIR Cardio",
year="2022",
month="Apr",
day="19",
volume="6",
number="1",
pages="e30661",
keywords="heart failure",
keywords="physical activity",
keywords="COVID-19",
keywords="remote monitoring",
keywords="implantable cardiac device",
keywords="monitoring",
keywords="exercise",
keywords="surveillance",
keywords="lockdown",
keywords="cardiovascular",
keywords="heart",
keywords="retrospective",
keywords="burden",
abstract="Background: The COVID-19 pandemic forced several European governments to impose severe lockdown measures. The reduction of physical activity during the lockdown could have been deleterious. Objective: The aim of this observational, retrospective study was to investigate the effect of the lockdown strategy on the physical activity burden and subsequent reassessment in a group of patients with heart failure who were followed by means of remote monitoring. Methods: We analyzed remote monitoring transmissions during the 3-month period immediately preceding the lockdown, 69 days of lockdown, and 3-month period after the first lockdown in a cohort of patients with heart failure from a general hospital in Lombardy, Italy. We compared variation of daily physical activity measured by cardiac implantable electrical devices with clinical variables collected in a hospital database. Results: We enrolled 41 patients with heart failure that sent 176 transmissions. Physical activity decreased during the lockdown period (mean 3.4, SD 1.9 vs mean 2.9, SD 1.8 hours/day; P<.001) but no significant difference was found when comparing the period preceding and following the lockdown (--0.0007 hours/day; P=.99). We found a significant correlation between physical activity reduction during and after the lockdown (R2=0.45, P<.001). The only significant predictor of exercise variation in the postlockdown period was the lockdown to prelockdown physical activity ratio. Conclusions: An excessive reduction of exercise in patients with heart failure decreased the tolerance to exercise, especially in patients with more comorbidities. Remote monitoring demonstrated exercise reduction, suggesting its potential utility to encourage patients to maintain their usual physical activity levels. ",
doi="10.2196/30661",
url="https://cardio.jmir.org/2022/1/e30661",
url="http://www.ncbi.nlm.nih.gov/pubmed/35103602"
}


@Article{info:doi/10.2196/33783,
author="Moran, Orla
and Doyle, Julie
and Giggins, Oonagh
and McHugh, Louise
and Gould, Evelyn
and Smith, Suzanne
and Gavin, Shane
and Sojan, Nisanth
and Boyle, Gordon",
title="Efficacy of a Digital Acceptance and Commitment Therapy Intervention for the Improvement of Self-management Behaviors and Psychological Flexibility in Adults With Cardiac Disease: Protocol for a Single Case Experimental Design",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="1",
volume="11",
number="4",
pages="e33783",
keywords="cardiac disease",
keywords="acceptance and commitment therapy",
keywords="distress management",
keywords="self-management",
keywords="single case experimental design",
keywords="digital health",
abstract="Background: Research indicates that the management of distress levels in those with cardiac disease is not only important for improving quality of life and functioning but also critical for condition management; adherence to treatment; and, ultimately, disease prognosis and progression. Acceptance and commitment therapy (ACT) has consistently demonstrated positive long-term outcomes across a wide array of conditions, including chronic illness. However, most empirical investigations conducted to date have also involved in-person therapy, which can be difficult to access, particularly for those dealing with the demands of chronic disease. Objective: The objective of our research is to evaluate a digital ACT intervention for improving self-management behaviors and distress levels in those with cardiac conditions. Methods: The digital ACT intervention will be delivered via a digital health self-management platform over 6 sessions. This will involve a randomized, multiple baseline, single case experimental design with approximately 3 to 15 adults with cardiac disease. The independent variable for each participant will be the pre-post intervention phase. The dependent variables will be a daily self-report measure of psychological flexibility as well as objective measures of condition self-management (eg, blood pressure readings) and engagement with the app (eg, completing guided mindfulness). One-to-one qualitative interviews will also be conducted to further examine participants' experiences with using the intervention and what factors contribute to or impede successful outcomes. Results: Participant recruitment and data collection began in October 2021, and it is projected that the study findings will be available for dissemination by spring 2022. Conclusions: The findings will be discussed in terms of how a digital ACT intervention can best meet the needs of cardiac patients. International Registered Report Identifier (IRRID): PRR1-10.2196/33783 ",
doi="10.2196/33783",
url="https://www.researchprotocols.org/2022/4/e33783",
url="http://www.ncbi.nlm.nih.gov/pubmed/35363156"
}


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


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


@Article{info:doi/10.2196/27202,
author="Ni, Zhao
and Wu, Bei
and Yang, Qing
and Yan, L. Lijing
and Liu, Changqing
and Shaw, J. Ryan",
title="An mHealth Intervention to Improve Medication Adherence and Health Outcomes Among Patients With Coronary Heart Disease: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="9",
volume="24",
number="3",
pages="e27202",
keywords="mHealth",
keywords="medication adherence",
keywords="coronary disease",
keywords="blood pressure",
keywords="China",
keywords="randomized controlled trial",
abstract="Background: The treatment of many chronic illnesses involves long-term pharmaceutical therapy, but it is an ongoing challenge to find effective ways to improve medication adherence to promote good health outcomes. Cardioprotective medications can prevent the enlargement of harmful clots, cardiovascular symptoms, and poor therapeutic outcomes, such as uncontrolled high blood pressure and hyperlipidemia, for patients with coronary heart disease. Poor adherence to cardioprotective medications, however, has been reported as a global health concern among patients with coronary heart disease, and it is particularly a concern in China. Objective: This study aimed to evaluate the efficacy of a mobile health (mHealth) intervention using 2 mobile apps to improve medication adherence and health outcomes. Methods: A randomized, placebo-controlled, 2-arm parallel study was conducted in a major university-affiliated medical center located in Chengdu, China. Participants were recruited by flyers and health care provider referrals. Each participant was observed for 90 days, including a 60-day period of mHealth intervention and a 30-day period of nonintervention follow-up. The study coordinator used WeChat and Message Express to send educational materials and reminders to take medication, respectively. Participants used WeChat to receive both the educational materials and reminders. Participants in the control group only received educational materials. This study received ethics approval from the Duke Health Institutional Review Board (Pro00073395) on May 5, 2018, and was approved by West China Hospital (20170331180037). Recruitment began on May 20, 2018. The pilot phase of this study was registered on June 8, 2016, and the current, larger-scale study was retrospectively registered on January 11, 2021 (ClinicalTrials.gov). Results: We recruited 230 patients with coronary heart disease. Of these patients, 196 completed the baseline survey and received the intervention. The majority of participants were married (181/196, 92.4\%), male (157/196, 80.1\%), and lived in urban China (161/196, 82.1\%). Participants' average age was 61 years, and half were retired (103/191, 53.9\%). More than half the participants (121/196, 61.7\%) were prescribed at least 5 medications. The mean decrease in medication nonadherence score was statistically significant at both 60 days (t179=2.04, P=.04) and 90 days (t155=3.48, P<.001). Systolic blood pressure and diastolic blood pressure decreased in the experimental group but increased in the control group. The mean decrease in diastolic blood pressure was statistically significant at both 60 days (t160=2.07, P=.04) and 90 days (t164=2.21, P=.03). The mean decrease in systolic blood pressure was significantly different in the groups at 90 days (t165=3.12, P=.002). Conclusions: The proposed mHealth intervention can improve medication adherence and health outcomes, including systolic blood pressure and diastolic blood pressure. Trial Registration: ClinicalTrials.gov NCT02793830; https://clinicaltrials.gov/ct2/show/NCT02793830 and ClinicalTrials.gov NCT04703439; https://clinicaltrials.gov/ct2/show/NCT04703439 ",
doi="10.2196/27202",
url="https://www.jmir.org/2022/3/e27202",
url="http://www.ncbi.nlm.nih.gov/pubmed/35262490"
}


@Article{info:doi/10.2196/34452,
author="Chen, Jinying
and Wijesundara, G. Jessica
and Enyim, E. Gabrielle
and Lombardini, M. Lisa
and Gerber, S. Ben
and Houston, K. Thomas
and Sadasivam, S. Rajani",
title="Understanding Patients' Intention to Use Digital Health Apps That Support Postdischarge Symptom Monitoring by Providers Among Patients With Acute Coronary Syndrome: Survey Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="7",
volume="9",
number="1",
pages="e34452",
keywords="coronary",
keywords="monitor",
keywords="elder",
keywords="health app",
keywords="symptom",
keywords="eHealth",
keywords="mobile health",
keywords="intention",
keywords="barrier",
keywords="facilitator",
abstract="Background: After hospital discharge, patients with acute coronary syndrome (ACS) often experience symptoms that prompt them to seek acute medical attention. Early evaluation of postdischarge symptoms by health care providers may reduce unnecessary acute care utilization. However, hospital-initiated follow-up encounters are insufficient for timely detection and assessment of symptoms. While digital health tools can help address this issue, little is known about the intention to use such tools in ACS patients. Objective: This study aimed to assess ACS patients' intention to use digital health apps that support postdischarge symptom monitoring by health care providers and identify patient-perceived facilitators and barriers to app use. Methods: Using email invitations or phone calls, we recruited ACS patients discharged from a central Massachusetts health care system between December 2020 and April 2021, to participate in the study. Surveys were delivered online or via phone to individual participants. Demographics and access to technology were assessed. The intention to use a symptom monitoring app was assessed using 5-point Likert-type (from strongly agree to strongly disagree) items, such as ``If this app were available to me, I would use it.'' Responses were compared across demographic subgroups and survey delivery methods. Two open-ended questions assessed perceived facilitators and barriers to app use, with responses analyzed using qualitative content analysis. Results: Among 100 respondents (response rate 8.1\%), 45 (45\%) completed the survey by phone. The respondents were on average 68 years old (SD 13 years), with 90\% (90/100) White, 39\% (39/100) women, and 88\% (88/100) having access to the internet or a mobile phone. Most participants (65/100, 65\%) agreed or strongly agreed that they would use the app, among which 53 (82\%) would use the app as often as possible. The percentage of participants with the intention to use the app was 75\% among those aged 65-74 years and dropped to 44\% among those older than 75 years. The intention to use was higher in online survey respondents (vs phone survey respondents; odds ratio 3.07, 95\% CI 1.20-7.88) after adjusting for age and access to technology. The analysis of open-ended questions identified the following 4 main facilitators (motivations): (1) easily reaching providers, (2) accessing or providing information, (3) quickly reaching providers, and (4) consulting providers for symptoms, and the following 4 main barriers: (1) privacy/security concerns, (2) uncomfortable using technology, (3) user-unfriendly app interface, and (4) preference for in-person/phone care. Conclusions: There was a strong intention to use a symptom monitoring app postdischarge among ACS patients. However, this intent decreased in patients older than 75 years. The survey identified barriers related to technology use, privacy/security, and the care delivery mode. Further research is warranted to determine if such intent translates into app use, and better symptom management and health care quality. ",
doi="10.2196/34452",
url="https://humanfactors.jmir.org/2022/1/e34452",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254269"
}


@Article{info:doi/10.2196/33579,
author="de Freitas Gon{\c{c}}alves, Shelry Kamila
and Queiroz Godoy Daniel, Carolina Ana
and Tatagiba Lamas, Luiz Jos{\'e}
and Ceretta Oliveira, Henrique
and Silveira, P. Renata C. C.
and Cloutier, Lyne
and Velludo Veiga, Eugenia",
title="Device- and Nondevice-Guided Slow Breathing to Reduce Blood Pressure in Patients with Hypertension: Protocol for a Systematic Review and Meta-analysis",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="4",
volume="11",
number="3",
pages="e33579",
keywords="hypertension",
keywords="breathing exercises",
keywords="device-guided breathing",
keywords="respirate",
keywords="systematic review",
keywords="physical therapy",
keywords="blood pressure",
keywords="clinical decision making",
keywords="health care professional",
keywords="physiotherapy",
abstract="Background: Physiotherapy can include both device-guided slow breathing (DGSB) and nondevice-guided slow breathing (NDGSB) in the treatment of systemic arterial hypertension. Objective: The aim of this study is to summarize the effects of DGSB on blood pressure levels of patients with hypertension based on the published literature to date. Methods: A systematic search of all published randomized controlled trials (RCTs) on the effects of device-guided and nondevice-guided slow breathing in patients with hypertension, without language restriction, was carried out up to a publication date of January 2020 in nine databases: PubMed/MEDLINE, Latin American and Caribbean Health Sciences Literature (LILACS), EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Physiotherapy Evidence Database (PEDro), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, Web of Science, and Livivo. Clinical trial records databases (ClinicalTrials.gov), and bases for the open gray literature, including Gray Literature Report and ProQuest Central (Citation, Abstract or Indexing, and Dissertations and Theses), were also searched for potentially eligible RCTs. The quality assessment of the included studies will be performed using the Cochrane Risk of Bias Tool for Randomized Trials. The overall quality of the evidence for each outcome will be assessed using the GRADE (Grading of Recommendations, Development and Evaluation) system. Results: As of December 2021, the review was completed and all data from continuous variables referring to blood pressure values (mmHg) were synthesized. Conclusions: This systematic review will provide a summary of the current evidence on the effects of both DGSB and NDGSB on blood pressure levels. This information can contribute to decision-making by health professionals related to the use of these interventions in patients with hypertension. Trial Registration: PROSPERO (Prospective International Register of Systematic Reviews) CRD42020147554; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=147554 International Registered Report Identifier (IRRID): RR1-10.2196/33579 ",
doi="10.2196/33579",
url="https://www.researchprotocols.org/2022/3/e33579",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254284"
}


@Article{info:doi/10.2196/26184,
author="Ben Hafaiedh, Sonia
and Ben Daya, Yosra
and Radoui, Hadjer Amina
and Bouchoucha, Mohamed
and Razgallah, Rabie
and Nouira, Semir",
title="Home Telemonitoring of Arterial Hypertension With Antihypertensive Treatment Titration: Protocol for a Randomized Controlled Prospective Trial (HOROSCOPE Study)",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="1",
volume="11",
number="3",
pages="e26184",
keywords="telemonitoring",
keywords="arterial hypertension",
keywords="primary care",
keywords="ambulatory blood pressure monitoring",
keywords="randomized controlled trial",
abstract="Background: Despite the availability of effective treatment, the control of hypertension remains insufficient. Telemonitoring in the management of hypertension would be an effective way to improve blood pressure control. Objective: The aim of our study will be to evaluate the effects of telemonitoring with antihypertensive treatment titration on blood pressure control in Tunisian patients with hypertension. Methods: Our trial will be a prospective, rater-blinded randomized controlled trial carried out with primary care physicians in the Sahel region of Tunisia. Patients will be eligible for enrollment if they are aged over 35 years, are newly diagnosed with hypertension, or are known to be poorly controlled on antihypertensive therapy. Participants will be randomly assigned in a 1:1 ratio to the telemonitoring arm or usual care arm. The telemonitoring arm will involve a weekly telephone call for the collection of the home blood pressure measurements, therapeutic education, and treatment compliance assessment as well as a monthly call for treatment titration and a side effect check. Randomization will be done via the use of an interactive web responsive system, and patients will be stratified by investigation center. Neither participants nor investigators will be masked to the group assignments. The primary outcome will be the change in mean 24-hour systolic blood pressure from baseline to the 6-month follow-up in the 2 groups. All randomized patients who attend the follow-up visit at 6 months and have no missing data for the primary outcome will be included in the analysis. Results: Recruitment to the trial started in July 2020. The study was initiated with 17 primary care physicians. We expect the inclusion period to last for approximately 6 months. We expect to complete data collection by the end of 2021 and plan to disseminate the results subsequently. Conclusions: The HOROSCOPE (Home Telemonitoring of Arterial Hypertension With Antihypertensive Treatment Titration: Randomized Controlled Prospective Trial) study will provide important new evidence that could shed some light on the feasibility and impact of telemonitoring and self-monitoring in a Tunisian population of patients with hypertension who consult primary care physicians. Trial Registration: ClinicalTrials.gov NCT04607239; https://clinicaltrials.gov/ct2/show/NCT04607239 International Registered Report Identifier (IRRID): DERR1-10.2196/26184 ",
doi="10.2196/26184",
url="https://www.researchprotocols.org/2022/3/e26184",
url="http://www.ncbi.nlm.nih.gov/pubmed/35230254"
}


@Article{info:doi/10.2196/31885,
author="Chowdhury, Rajiv
and Noh, Md Mohd Fairulnizal
and Ismail, Rasheeqa Sophia
and van Daalen, Robin Kim
and Kamaruddin, Megat Puteri Sofia Nadira
and Zulkiply, Hafizah Siti
and Azizul, Hayati Nur
and Khalid, Mustafa Norhayati
and Ali, Azizan
and Idris, Mohd Izyan
and Mei, Shih Yong
and Abdullah, Rifham Shazana
and Faridus, Norfashihah
and Yusof, Md Nur Azirah
and Yusoff, M. Nur Najwa Farahin
and Jamal, Rahman
and Rahim, Abdul Aizai Azan
and Ghapar, Abdul Abdul Kahar
and Radhakrishnan, Kutty Ammu
and Fong, Yip Alan Yean
and Ismail, Omar
and Krishinan, Saravanan
and Lee, Yan Chuey
and Bang, Houng Liew
and Mageswaren, Eashwary
and Mahendran, Kauthaman
and Amin, Mohd Nor Hanim
and Muthusamy, Gunavathy
and Jin, Hean Aaron Ong
and Ramli, Wazi Ahmad
and Ross, Thomas Noel
and Ruhani, Irawan Anwar
and Yahya, Mansor
and Yusoff, Yusniza
and Abidin, Zainal Siti Khairani
and Amado, Laryssa
and Bolton, Thomas
and Weston, Sophie
and Crawte, Jason
and Ovenden, Niko
and Michielsen, Ank
and Monower, Mostafa Md
and Mahiyuddin, Wan Wan Rozita
and Wood, Angela
and Di Angelantonio, Emanuele
and Sulaiman, Suffia Nur
and Danesh, John
and Butterworth, S. Adam",
title="Investigating Genetic and Other Determinants of First-Onset Myocardial Infarction in Malaysia: Protocol for the Malaysian Acute Vascular Events Risk Study",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="10",
volume="11",
number="2",
pages="e31885",
keywords="myocardial infarction",
keywords="cardiovascular disease",
keywords="case-control study",
keywords="Malaysia",
abstract="Background: Although the burden of premature myocardial infarction (MI) is high in Malaysia, direct evidence on the determinants of MI in this multi-ethnic population remains sparse. Objective: The Malaysian Acute Vascular Events Risk (MAVERIK) study is a retrospective case-control study established to investigate the genomic, lipid-related, and other determinants of acute MI in Malaysia. In this paper, we report the study protocol and early results. Methods: By June 2019, we had enrolled approximately 2500 patients with their first MI and 2500 controls without cardiovascular disease, who were frequency-matched by age, sex, and ethnicity, from 17 hospitals in Malaysia. For each participant, serum and whole blood have been collected and stored. Clinical, demographic, and behavioral information has been obtained using a 200-item questionnaire. Results: Tobacco consumption, a history of diabetes, hypertension, markers of visceral adiposity, indicators of lower socioeconomic status, and a family history of coronary disease were more prevalent in cases than in controls. Adjusted (age and sex) logistic regression models for traditional risk factors indicated that current smoking (odds ratio [OR] 4.11, 95\% CI 3.56-4.75; P<.001), previous smoking (OR 1.34, 95\% CI 1.12-1.60; P=.001), a history of high blood pressure (OR 2.13, 95\% CI 1.86-2.44; P<.001), a history of diabetes mellitus (OR 2.72, 95\% CI 2.34-3.17; P<.001), a family history of coronary heart disease (OR 1.28, 95\% CI 1.07-1.55; P=.009), and obesity (BMI >30 kg/m2; OR 1.19, 95\% CI 1.05-1.34; P=.009) were associated with MI in age- and sex-adjusted models. Conclusions: The MAVERIK study can serve as a useful platform to investigate genetic and other risk factors for MI in an understudied Southeast Asian population. It should help to hasten the discovery of disease-causing pathways and inform regionally appropriate strategies that optimize public health action. International Registered Report Identifier (IRRID): RR1-10.2196/31885 ",
doi="10.2196/31885",
url="https://www.researchprotocols.org/2022/2/e31885",
url="http://www.ncbi.nlm.nih.gov/pubmed/35142634"
}


@Article{info:doi/10.2196/24174,
author="Rivers, T. John
and Smith, Carla
and Smith, Ian
and Cameron, James",
title="The Impact of a Mobile App on Participation in Cardiac Rehabilitation and Understanding Barriers to Success: Comparative Cohort Study",
journal="JMIR Cardio",
year="2022",
month="Jan",
day="17",
volume="6",
number="1",
pages="e24174",
keywords="cardiac rehabilitation",
keywords="digital health",
keywords="smartphone app",
keywords="Cardihab",
keywords="participation rates",
keywords="rehabilitation",
keywords="cardiology",
keywords="heart",
keywords="app",
keywords="barrier",
abstract="Background: Poor patient uptake of cardiac rehabilitation (CR) remains a challenge for multiple reasons including geographic, time, cultural, cost, and psychological constraints. Objective: We evaluated the impact on CR participation rates associated with the addition of the option of mobile app--based CR (Cardihab) for patients declining conventional CR. Methods: A total of 204 consecutive patients were offered CR following angioplasty; of these, 99 were in cohort 1 (offered conventional CR only) and 105 were in cohort 2 (app-based CR offered to those declining conventional CR). Patients in each cohort were followed throughout a 6-week CR program and participation rates were compared for both groups. Patients in cohort 2 declining both forms of CR were interviewed to assess reasons for nonparticipation. Results: CR participation improved from 21\% (95\% CI 14\%-30\%) to 63\% (95\% CI 53\%-71\%) with the addition of the app (P<.001). Approximately 25\% (9/39) of the group declining the app-based program identified technology issues as the reason for nonparticipation. The remainder declined both CR programs or were ineligible due to frailty or comorbidities. Conclusions: Providing patients with the additional option of an app-based CR program substantially improved CR participation. Technology and psychological barriers can limit CR participation. Further innovation in CR delivery systems is required to improve uptake. ",
doi="10.2196/24174",
url="https://cardio.jmir.org/2022/1/e24174",
url="http://www.ncbi.nlm.nih.gov/pubmed/35037891"
}


@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/10.2196/31617,
author="Breil, Bernhard
and Salewski, Christel
and Apolin{\'a}rio-Hagen, Jennifer",
title="Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey",
journal="JMIR Cardio",
year="2022",
month="Jan",
day="6",
volume="6",
number="1",
pages="e31617",
keywords="patient acceptance of health care",
keywords="mobile apps",
keywords="blood pressure",
keywords="mobile health",
keywords="health applications",
keywords="technology acceptance",
keywords="patients",
keywords="physicians",
keywords="digital health",
abstract="Background: High blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison. Objective: The present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients' preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc). Methods: Based on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses. Results: As expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians. Conclusions: In summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research. ",
doi="10.2196/31617",
url="https://cardio.jmir.org/2022/1/e31617",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989683"
}


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


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


@Article{info:doi/10.2196/23285,
author="Choi, Yeon Jah
and Kim, Bak Ji
and Lee, Sunki
and Lee, Seo-Joon
and Shin, Eon Seung
and Park, Hyun Se
and Park, Jin Eun
and Kim, Woohyeun
and Na, Oh Jin
and Choi, Ung Cheol
and Rha, Seung-Woon
and Park, Gyu Chang
and Seo, Seog Hong
and Ahn, Jeonghoon
and Jeong, Hyun-Ghang
and Kim, Ju Eung",
title="A Smartphone App (AnSim) With Various Types and Forms of Messages Using the Transtheoretical Model for Cardiac Rehabilitation in Patients With Coronary Artery Disease: Development and Usability Study",
journal="JMIR Med Inform",
year="2021",
month="Dec",
day="7",
volume="9",
number="12",
pages="e23285",
keywords="cardiac rehabilitation",
keywords="smartphone app",
keywords="coronary heart disease",
abstract="Background: Despite strong evidence of clinical benefit, cardiac rehabilitation (CR) programs are currently underutilized and smartphone-based CR strategies are thought to address this unmet need. However, data regarding the detailed process of development are scarce. Objective: This study focused on the development of a smartphone-based, patient-specific, messaging app for patients who have undergone percutaneous coronary intervention (PCI). Methods: The AnSim app was developed in collaboration with a multidisciplinary team that included cardiologists, psychiatrists, nurses, pharmacists, nutritionists, and rehabilitation doctors and therapists. First, a focus group interview was conducted, and the narratives of the patients were analyzed to identify their needs and preferences. Based on the results, health care experts and clinicians drafted messages into 5 categories: (1) general information regarding cardiovascular health and medications, (2) nutrition, (3) physical activity, (4) destressing, and (5) smoking cessation. In each category, 90 messages were developed according to 3 simplified steps of the transtheoretical model of behavioral change: (1) precontemplation, (2) contemplation and preparation, and (3) action and maintenance. After an internal review and feedback from potential users, a bank of 450 messages was developed. Results: The focus interview was conducted with 8 patients with PCI within 1 year, and 450 messages, including various forms of multimedia, were developed based on the transtheoretical model of behavioral change in each category. Positive feedback was obtained from the potential users (n=458). The mean Likert scale score was 3.95 (SD 0.39) and 3.91 (SD 0.39) for readability and usefulness, respectively, and several messages were refined based on the feedback. Finally, the patient-specific message delivery system was developed according to the baseline characteristics and stages of behavioral change in each participant. Conclusions: We developed an app (AnSim), which includes a bank of 450 patient-specific messages, that provides various medical information and CR programs regarding coronary heart disease. The detailed process of multidisciplinary collaboration over the course of the study provides a scientific basis for various medical professionals planning smartphone-based clinical research. ",
doi="10.2196/23285",
url="https://medinform.jmir.org/2021/12/e23285",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878987"
}


@Article{info:doi/10.2196/31985,
author="Cruz-Mart{\'i}nez, Rafael Roberto
and Wentzel, Jobke
and Bente, Elise Britt
and Sanderman, Robbert
and van Gemert-Pijnen, EWC Julia",
title="Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis",
journal="JMIR Cardio",
year="2021",
month="Dec",
day="1",
volume="5",
number="2",
pages="e31985",
keywords="eHealth",
keywords="self-management",
keywords="self-care",
keywords="cardiovascular diseases",
keywords="value sensitive design",
keywords="values",
keywords="content analysis",
abstract="Background: eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients' fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. Objective: This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. Methods: Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. Results: In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients' values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. Conclusions: Positively, existing eHealth technologies could be connected with CVD patients' values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions. ",
doi="10.2196/31985",
url="https://cardio.jmir.org/2021/2/e31985",
url="http://www.ncbi.nlm.nih.gov/pubmed/34855608"
}


@Article{info:doi/10.2196/32351,
author="Montgomery, M. Robert
and Boucher, M. Eliane
and Honomichl, D. Ryan
and Powell, A. Tyler
and Guyton, L. Sharelle
and Bernecker, L. Samantha
and Stoeckl, Elizabeth Sarah
and Parks, C. Acacia",
title="The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data",
journal="JMIR Cardio",
year="2021",
month="Nov",
day="19",
volume="5",
number="2",
pages="e32351",
keywords="digital mental health",
keywords="digital health",
keywords="mobile apps",
keywords="mobile health",
keywords="internet-based intervention",
keywords="happiness",
keywords="subjective well-being",
keywords="anxiety",
keywords="cardiovascular health",
keywords="high blood pressure",
keywords="high cholesterol",
keywords="diabetes",
keywords="cardiovascular disease risk",
keywords="real-world data",
abstract="Background: The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions. Objective: The objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2). Methods: Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks' exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time. Results: Both hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well. Conclusions: This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD. ",
doi="10.2196/32351",
url="https://cardio.jmir.org/2021/2/e32351",
url="http://www.ncbi.nlm.nih.gov/pubmed/34806986"
}


@Article{info:doi/10.2196/25646,
author="Cohen Rodrigues, R. Talia
and de Buisonj{\'e}, R. David
and Keesman, Mike
and Reijnders, Thomas
and van der Geer, E. Jessica
and Janssen, R. Veronica
and Kraaijenhagen, A. Roderik
and Atsma, E. Douwe
and Evers, M. Andrea W.",
title="Facilitators of and Barriers to Lifestyle Support and eHealth Solutions: Interview Study Among Health Care Professionals Working in Cardiac Care",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="15",
volume="23",
number="10",
pages="e25646",
keywords="eHealth",
keywords="digital health",
keywords="cardiovascular disease",
keywords="cardiac care",
keywords="lifestyle change",
keywords="lifestyle support",
keywords="intervention",
keywords="health care professionals",
keywords="implementation",
keywords="interview",
keywords="facilitators",
keywords="barriers",
abstract="Background: Cardiovascular diseases (CVDs) pose a significant health threat and reduce both people's life expectancy and quality of life. Healthy living is a key component in the effective prevention and treatment of CVD. However, health care professionals (HCPs) experience difficulties in supporting lifestyle changes among their patients. eHealth can provide a solution to these barriers. Objective: This study aims to provide insights into the factors HCPs find important in the support of patients with CVD in the uptake of and adherence to a healthy lifestyle and the perceived facilitators of and barriers to using eHealth to provide lifestyle support to patients with CVD. Methods: In-depth interviews were conducted with 16 Dutch HCPs specializing in lifestyle support in cardiac care. Results: We identified 13 themes, of which the first 12 concerned lifestyle support in general and were related to intervention, patient, or health care. Throughout these themes, the use of eHealth reoccurred as a potential facilitator of or solution to barriers to lifestyle support. Our final theme specifically concerned barriers to the adoption and usability of eHealth. Conclusions: HCPs do recognize the potential advantages of eHealth while experiencing barriers to using digital tools. Incorporating their needs and values in the development of lifestyle support programs, especially eHealth, could increase their use and lead to a more widespread adoption of eHealth into health care. ",
doi="10.2196/25646",
url="https://www.jmir.org/2021/10/e25646",
url="http://www.ncbi.nlm.nih.gov/pubmed/34652280"
}


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


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


@Article{info:doi/10.2196/28974,
author="Nazarian, Scarlet
and Lam, Kyle
and Darzi, Ara
and Ashrafian, Hutan",
title="Diagnostic Accuracy of Smartwatches for the Detection of Cardiac Arrhythmia: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e28974",
keywords="wearables",
keywords="smartwatch",
keywords="cardiac arrhythmia",
keywords="atrial fibrillation",
keywords="cardiology",
keywords="mHealth",
keywords="wearable devices",
keywords="screening",
keywords="diagnostics",
keywords="accuracy",
abstract="Background: Significant morbidity, mortality, and financial burden are associated with cardiac rhythm abnormalities. Conventional investigative tools are often unsuccessful in detecting cardiac arrhythmias because of their episodic nature. Smartwatches have gained popularity in recent years as a health tool for the detection of cardiac rhythms. Objective: This study aims to systematically review and meta-analyze the diagnostic accuracy of smartwatches in the detection of cardiac arrhythmias. Methods: A systematic literature search of the Embase, MEDLINE, and Cochrane Library databases was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies reporting the use of a smartwatch for the detection of cardiac arrhythmia. Summary estimates of sensitivity, specificity, and area under the curve were attempted using a bivariate model for the diagnostic meta-analysis. Studies were examined for quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: A total of 18 studies examining atrial fibrillation detection, bradyarrhythmias and tachyarrhythmias, and premature contractions were analyzed, measuring diagnostic accuracy in 424,371 subjects in total. The signals analyzed by smartwatches were based on photoplethysmography. The overall sensitivity, specificity, and accuracy of smartwatches for detecting cardiac arrhythmias were 100\% (95\% CI 0.99-1.00), 95\% (95\% CI 0.93-0.97), and 97\% (95\% CI 0.96-0.99), respectively. The pooled positive predictive value and negative predictive value for detecting cardiac arrhythmias were 85\% (95\% CI 0.79-0.90) and 100\% (95\% CI 1.0-1.0), respectively. Conclusions: This review demonstrates the evolving field of digital disease detection. The current diagnostic accuracy of smartwatch technology for the detection of cardiac arrhythmias is high. Although the innovative drive of digital devices in health care will continue to gain momentum toward screening, the process of accurate evidence accrual and regulatory standards ready to accept their introduction is strongly needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020213237; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=213237. ",
doi="10.2196/28974",
url="https://www.jmir.org/2021/8/e28974",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448706"
}


@Article{info:doi/10.2196/18130,
author="Ding, Y. Eric
and Erskine, Nathaniel
and Stut, Wim
and McManus, D. David
and Peterson, Amy
and Wang, Ziyue
and Escobar Valle, Jorge
and Albuquerque, Daniella
and Alonso, Alvaro
and Botkin, F. Naomi
and Pack, R. Quinn",
title="MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study",
journal="JMIR Hum Factors",
year="2021",
month="Jul",
day="8",
volume="8",
number="3",
pages="e18130",
keywords="cardiac rehabilitation",
keywords="telerehabilitation",
keywords="health watch",
keywords="mHealth",
keywords="exercise",
abstract="Background: Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. Objective: In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch--informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. Methods: We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. Results: Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33\%) were women, and 6 (33\%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86\% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). Conclusions: This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch--based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation. ",
doi="10.2196/18130",
url="https://humanfactors.jmir.org/2021/3/e18130",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255660"
}


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


@Article{info:doi/10.2196/22533,
author="Dabner, Lucy
and Pieles, E. Guido
and Steward, G. Colin
and Hamilton-Shield, P. Julian
and Ness, R. Andrew
and Rogers, A. Chris
and Bucciarelli-Ducci, Chiara
and Greenwood, Rosemary
and Ellis, Lucy
and Sheehan, Karen
and Reeves, C. Barnaby",
title="Treatment of Barth Syndrome by Cardiolipin Manipulation (CARDIOMAN) With Bezafibrate: Protocol for a Randomized Placebo-Controlled Pilot Trial Conducted in the Nationally Commissioned Barth Syndrome Service",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="31",
volume="10",
number="5",
pages="e22533",
keywords="randomized controlled trial",
keywords="Barth syndrome",
keywords="cardiomyopathies",
keywords="inherited cardiomyopathy",
keywords="bezafibrate",
keywords="placebo controlled",
keywords="rare disease",
keywords="resveratrol",
keywords="cardiomyopathy",
keywords="metabolism",
keywords="lipid",
keywords="genetic diseases",
keywords="x-linked",
keywords="genes",
keywords="mitochondrial",
keywords="controlled clinical trial",
keywords="placebos",
keywords="mitochondrial diseases",
keywords="metabolic diseases",
keywords="lipid metabolism",
keywords="lipid metabolism disorders",
keywords="cross-over studies",
abstract="Background: Barth syndrome is a rare, life-threatening, X-linked recessive genetic disease that predominantly affects young males and is caused by abnormal mitochondrial lipid metabolism. Currently, there is no definitive treatment for Barth syndrome other than interventions to ameliorate acute symptoms, such as heart failure, cardiac arrhythmias, neutropenia, and severe muscle fatigue. Previous mechanistic studies have identified the lipid-lowering drug bezafibrate as a promising potential treatment; however, to date, no human trials have been performed in this population. Objective: The aim of this study is to determine whether bezafibrate (and resveratrol in vitro) will increase mitochondrial biogenesis and potentially modify the cellular ratio of monolysocardiolipin (MLCL) to tetralinoleoyl-cardiolipin (L4-CL), ameliorating the disease phenotype in those living with the disease. Methods: The CARDIOMAN (Cardiolipin Manipulation) study is a UK single-center, double-blinded, randomized, placebo-controlled crossover study investigating the efficacy of bezafibrate in participants with Barth syndrome. Treatment was administered in two 15-week phases with a minimum washout period of 1 month between the phases where no treatment was administered. The primary outcome is peak oxygen consumption (VO2 peak). Secondary outcomes include MLCL/L4-CL ratio and CL profile in blood cells, amino acid expression, phosphocreatine to adenosine triphosphate ratio in cardiac muscle and skeletal muscle oxidative function on phosphorus-31 magnetic resonance spectroscopy, quality of life using the Pediatric Quality of Life Inventory questionnaire, absolute neutrophil count, cardiac function and rhythm profiles at rest and during exercise, and mitochondrial organization and function assessments. Outcomes were assessed at baseline and during the final week of each treatment phase. Results: A total of 12 patients were scheduled to participate across three consecutive research clinics between March and April 2019. In total, 11 participants were recruited, and the follow-up was completed in January 2020. Data analysis is ongoing, with publication expected in 2021. Conclusions: This trial was approved by the United Kingdom National Research Ethics Service Committee and the Medicines and Healthcare products Regulatory Agency. The feasibility of the CARDIOMAN study will help to inform the future conduct of randomized controlled trials in rare disease populations as well as testing the efficacy of bezafibrate as a potential treatment for the disease and advancing the mechanistic understanding of Barth syndrome. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 58006579; https://www.isrctn.com/ISRCTN58006579 International Registered Report Identifier (IRRID): DERR1-10.2196/22533 ",
doi="10.2196/22533",
url="https://www.researchprotocols.org/2021/5/e22533",
url="http://www.ncbi.nlm.nih.gov/pubmed/34057417"
}


@Article{info:doi/10.2196/25397,
author="Kerr, M. Kim
and Elliott, Greg C.
and Benza, L. Raymond
and Channick, N. Richard
and Chin, M. Kelly
and Davis, Duane R.
and Jain, Sonia
and LaCroix, Z. Andrea
and Madani, M. Michael
and McLaughlin, V. Vallerie
and Park, H. Myung
and Tapson, F. Victor
and Auger, R. William",
title="The United States Chronic Thromboembolic Pulmonary Hypertension Registry: Protocol for a Prospective, Longitudinal Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="25",
volume="10",
number="5",
pages="e25397",
keywords="CTEPH",
keywords="pulmonary hypertension",
keywords="pulmonary embolism",
keywords="registry",
keywords="surgical",
keywords="nonsurgical",
keywords="therapy",
keywords="treatment",
abstract="Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare sequela of acute pulmonary embolism that is treatable when recognized. Awareness of this disease has increased with recent advancements in therapeutic options, but delays in diagnosis remain common, and diagnostic and treatment guidelines are often not followed. Data gathered from international registries have improved our understanding of CTEPH, but these data may not be applicable to the US population owing to differences in demographics and medical practice patterns. Objective: The US CTEPH Registry (US-CTEPH-R) was developed to provide essential information to better understand the demographics, risk factors, evaluation, and treatment of CTEPH in the United States, as well as the short- and long-term outcomes of surgical and nonsurgical therapies in the modern treatment era. Methods: Thirty sites throughout the United States enrolled 750 subjects in this prospective, longitudinal, observational registry of patients newly diagnosed with CTEPH. Enrollment criteria included a mean pulmonary artery pressure ?25 mmHg by right heart catheterization and radiologic confirmation of CTEPH by a multidisciplinary adjudication committee. Following enrollment, subjects were followed biannually until the conclusion of the study. Quality of life surveys were administered at enrollment and biannually, and all other testing was at the discretion of the treating clinician. Details regarding surgical therapy, balloon pulmonary angioplasty, and medical therapy were collected at enrollment and at follow-up, as well as information related to health care utilization and survival. Results: Data from this registry will improve understanding of the demographics, risk factors, and treatment patterns of patients with CTEPH, and the longitudinal impact of therapies on quality of life, health care utilization, and survival. Conclusions: This manuscript details the methodology and design of the first large, prospective, longitudinal registry of patients with CTEPH in the United States. Trial Registration: ClinicalTrials.gov NCT02429284; https://www.clinicaltrials.gov/ct2/show/NCT02429284 International Registered Report Identifier (IRRID): DERR1-10.2196/25397 ",
doi="10.2196/25397",
url="https://www.researchprotocols.org/2021/5/e25397",
url="http://www.ncbi.nlm.nih.gov/pubmed/33848258"
}


@Article{info:doi/10.2196/17957,
author="Subedi, Narayan
and Rawstorn, C. Jonathan
and Gao, Lan
and Koorts, Harriet
and Maddison, Ralph",
title="Implementation of Telerehabilitation Interventions for the Self-Management of Cardiovascular Disease: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="27",
volume="8",
number="11",
pages="e17957",
keywords="heart diseases",
keywords="cardiac rehabilitation",
keywords="telerehabilitation",
keywords="implementation science",
keywords="smartphone",
keywords="systematic review",
abstract="Background: Coronary heart disease (CHD) is a leading cause of disability and deaths worldwide. Secondary prevention, including cardiac rehabilitation (CR), is crucial to improve risk factors and to reduce disease burden and disability. Accessibility barriers contribute to underutilization of traditional center-based CR programs; therefore, alternative delivery models, including cardiac telerehabilitation (ie, delivery via mobile, smartphone, and/or web-based apps), have been tested. Experimental studies have shown cardiac telerehabilitation to be effective and cost-effective, but there is inadequate evidence about how to translate this research into routine clinical practice. Objective: This systematic review aimed to synthesize research evaluating the effectiveness of implementing cardiac telerehabilitation interventions at scale in routine clinical practice, including factors underlying successful implementation processes, and experimental research evaluating implementation-related outcomes. Methods: MEDLINE, Embase, PsycINFO, and Global Health databases were searched from 1990 through November 9, 2018, for studies evaluating the implementation of telerehabilitation for the self-management of CHD. Reference lists of included studies and relevant systematic reviews were hand searched to identify additional studies. Implementation outcomes of interest included acceptability, appropriateness, adoption, feasibility, fidelity, implementation cost, penetration, and sustainability. A narrative synthesis of results was carried out. Results: No included studies evaluated the implementation of cardiac telerehabilitation in routine clinical practice. A total of 10 studies of 2250 participants evaluated implementation outcomes, including acceptability (8/10, 80\%), appropriateness (9/10, 90\%), adoption (6/10, 60\%), feasibility (6/10, 60\%), fidelity (7/10, 70\%), and implementation cost (4/10, 40\%), predominantly from the participant perspective. Cardiac telerehabilitation interventions had high acceptance among the majority of participants, but technical challenges such as reliable broadband internet connectivity can impact acceptability and feasibility. Many participants considered telerehabilitation to be an appropriate alternative CR delivery model, as it was convenient, flexible, and easy to access. Participants valued interactive intervention components, such as real-time exercise monitoring and feedback as well as individualized support. The penetration and sustainability of cardiac telerehabilitation, as well as the perspectives of CR practitioners and health care organizations, have received little attention in existing cardiac telerehabilitation research. Conclusions: Experimental trials suggest that participants perceive cardiac telerehabilitation to be an acceptable and appropriate approach to improve the reach and utilization of CR, but pragmatic implementation studies are needed to understand how interventions can be sustainably translated from research into clinical practice. Addressing this gap could help realize the potential impact of telerehabilitation on CR accessibility and participation as well as person-centered, health, and economic outcomes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019124254; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=124254 ",
doi="10.2196/17957",
url="http://mhealth.jmir.org/2020/11/e17957/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33245286"
}


@Article{info:doi/10.2196/15320,
author="Waring, E. Molly
and Hills, T. Mellanie
and Lessard, M. Darleen
and Saczynski, S. Jane
and Libby, A. Brooke
and Holovatska, M. Marta
and Kapoor, Alok
and Kiefe, I. Catarina
and McManus, D. David",
title="Characteristics Associated With Facebook Use and Interest in Digital Disease Support Among Older Adults With Atrial Fibrillation: Cross-Sectional Analysis of Baseline Data From the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) Cohort",
journal="JMIR Cardio",
year="2019",
month="Nov",
day="14",
volume="3",
number="2",
pages="e15320",
keywords="atrial fibrillation",
keywords="social media",
keywords="information seeking behavior",
abstract="Background: Online support groups for atrial fibrillation (AF) and apps to detect and manage AF exist, but the scientific literature does not describe which patients are interested in digital disease support. Objective: The objective of this study was to describe characteristics associated with Facebook use and interest in digital disease support among older patients with AF who used the internet. Methods: We used baseline data from the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF), a prospective cohort of older adults (?65 years) with AF at high stroke risk. Participants self-reported demographics, clinical characteristics, and Facebook and technology use. Online patients (internet use in the past 4 weeks) were asked whether they would be interested in participating in an online support AF community. Mobile users (owns smartphone and/or tablet) were asked about interest in communicating with their health care team about their AF-related health using a secure app. Logistic regression models identified crude and multivariable predictors of Facebook use and interest in digital disease support. Results: Online patients (N=816) were aged 74.2 (SD 6.6) years, 47.8\% (390/816) were female, and 91.1\% (743/816) were non-Hispanic white. Roughly half (52.5\%; 428/816) used Facebook. Facebook use was more common among women (adjusted odds ratio [aOR] 2.21, 95\% CI 1.66-2.95) and patients with mild to severe depressive symptoms (aOR 1.50, 95\% CI 1.08-2.10) and less common among patients aged ?85 years (aOR 0.27, 95\% CI 0.15-0.48). Forty percent (40.4\%; 330/816) reported interest in an online AF patient community. Interest in an online AF patient community was more common among online patients with some college/trade school or Bachelors/graduate school (aOR 1.70, 95\% CI 1.10-2.61 and aOR 1.82, 95\% CI 1.13-2.92, respectively), obesity (aOR 1.65, 95\% CI 1.08-2.52), online health information seeking at most weekly or multiple times per week (aOR 1.84, 95\% CI 1.32-2.56 and aOR 2.78, 95\% CI 1.86-4.16, respectively), and daily Facebook use (aOR 1.76, 95\% CI 1.26-2.46). Among mobile users, 51.8\% (324/626) reported interest in communicating with their health care team via a mobile app. Interest in app-mediated communication was less likely among women (aOR 0.48, 95\% CI 0.34-0.68) and more common among online patients who had completed trade school/some college versus high school/General Educational Development (aOR 1.95, 95\% CI 1.17-3.22), sought online health information at most weekly or multiple times per week (aOR 1.86, 95\% CI 1.27-2.74 and aOR 2.24, 95\% CI 1.39-3.62, respectively), and had health-related apps (aOR 3.92, 95\% CI 2.62-5.86). Conclusions: Among older adults with AF who use the internet, technology use and demographics are associated with interest in digital disease support. Clinics and health care providers may wish to encourage patients to join an existing online support community for AF and explore opportunities for app-mediated patient-provider communication. ",
doi="10.2196/15320",
url="http://cardio.jmir.org/2019/2/e15320/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758791"
}


@Article{info:doi/10.2196/humanfactors.8820,
author="Tanaka, Rika
and Banerjee, Anita
and Surikova, Jelena
and Tracey, Jacqueline
and Payne, Ada
and Ross, Heather
and Nolan, Robert",
title="A Moderated e-Forum for Adults With Cardiovascular Disease: Usability Study",
journal="JMIR Hum Factors",
year="2018",
month="May",
day="18",
volume="5",
number="2",
pages="e20",
keywords="support groups",
keywords="cardiovascular disease",
keywords="qualitative research",
abstract="Background: Self-care behaviors are commonly prescribed to manage both cardiovascular disease and hypertension to reduce modifiable risk factors and improve quality of life. Nevertheless, long-term adherence to self-care recommendations for cardiac patients has been problematic. In cardiac patients, moderated online forums have been found to be particularly useful in supporting maintenance of heart-healthy diet and fewer hospital visits. As such, we developed the e-Forum, a Web-based moderated forum designed to promote continued user engagement and long-term self-care adherence. Objective: The objective of this study was to assess the usability of the user interface for the newly designed e-Forum. In addition to overall user satisfaction, we obtained feedback from our target users on the key features of this newly developed interface. Methods: An iterative design tested the usability of the e-Forum. On the basis of the user feedback, adjustments were made to the design of our e-Forum, and these changes were then tested in the succeeding group. Participants were recruited from the Heart Function Clinic at the Peter Munk Cardiac Center, University Health Network. After consenting to participate in our study, patients were asked to complete a set of goal-oriented tasks and a feedback interview for the e-Forum. A content analysis of the transcripts from the set of goal-oriented tasks and feedback interviews identified several themes, including general feedback and comments regarding 3 key areas of the e-Forum: layout, navigation, and content. Results: Overall, 13 cardiac patients (aged 32-81 years) participated in 3 rounds of testing. Participants across all 3 rounds were highly satisfied with our e-Forum and indicated that they would find such a forum useful in managing their health. Expressions of overall satisfaction with the e-Forum and positive comments regarding layout increased between the initial and the final round. As improvements were made to the e-Forum based on participant feedback, potential barriers, negative comments related to the content, and the number of navigation errors decreased between rounds 1 and 3. Conclusions: We found evidence to support the usability of the user interface for our e-Forum. These results indicate that the e-Forum will likely be a successful tool to support an online community of cardiac patients in their efforts to sustain long-term lifestyle behavior change. ",
doi="10.2196/humanfactors.8820",
url="http://humanfactors.jmir.org/2018/2/e20/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29776901"
}


@Article{info:doi/10.2196/cardio.9000,
author="Baek, Hyunyoung
and Suh, Jung-Won
and Kang, Si-Hyuck
and Kang, Seungjin
and Lim, Ho Tae
and Hwang, Hee
and Yoo, Sooyoung",
title="Enhancing User Experience Through User Study: Design of an mHealth Tool for Self-Management and Care Engagement of Cardiovascular Disease Patients",
journal="JMIR Cardio",
year="2018",
month="Feb",
day="09",
volume="2",
number="1",
pages="e3",
keywords="cardiovascular disease",
keywords="mHealth",
keywords="mobile application",
keywords="app",
keywords="user-centered design",
abstract="Background: As patient communication, engagement, personal health data tracking, and up-to-date information became more efficient through mobile health (mHealth), cardiovascular diseases (CVD) and other diseases that require behavioral improvements in daily life are now capable of being managed and prevented more effectively. However, to increase patient engagement through mHealth, it is important for the initial design to consider functionality and usability factors and accurately assess user demands during the developmental process so that the app can be used continuously. Objective: The purpose of the study was to provide insightful information for developing mHealth service for patients with CVD based on user research to help enhance communication between patients and doctors. Methods: To drive the mobile functions and services needed to manage diseases in CVD patients, user research was conducted on patients and doctors at a tertiary general university hospital located in the Seoul metropolitan area of South Korea. Interviews and a survey were performed on patients (35 participants) and a focus group interview was conducted with doctors (5 participants). A mock-up mobile app was developed based on the user survey results, and a usability test was then conducted (8 participants) to identify factors that should be considered to improve usability. Results: The majority of patients showed a positive response in terms of their interest or intent to use an app for managing CVD. Functional features, such as communication with doctors, self-risk assessment, exercise, tailored education, blood pressure management, and health status recording had a score of 4.0 or higher on a 5-point Likert scale, showing that these functions were perceived to be useful to patients. The results of the mock-up usability test showed that inputting and visualizing blood pressure and other health conditions was required to be easier. The doctors requested a function that offered a comprehensive view of the patient's daily health status by linking the mHealth app data with the hospital's electronic health record system. Conclusions: Insights derived from a user study for developing an mHealth tool for CVD management, such as self-assessment and a communication channel between patients and doctors, may be helpful to improve patient engagement in care. ",
doi="10.2196/cardio.9000",
url="http://cardio.jmir.org/2018/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758783"
}


@Article{info:doi/10.2196/cardio.8543,
author="Magnani, W. Jared
and Schlusser, L. Courtney
and Kimani, Everlyne
and Rollman, L. Bruce
and Paasche-Orlow, K. Michael
and Bickmore, W. Timothy",
title="The Atrial Fibrillation Health Literacy Information Technology System: Pilot Assessment",
journal="JMIR Cardio",
year="2017",
month="Dec",
day="12",
volume="1",
number="2",
pages="e7",
keywords="atrial fibrillation",
keywords="mHealth",
keywords="health-related quality of life",
keywords="medication adherence",
abstract="Background: Atrial fibrillation (AF) is a highly prevalent heart rhythm condition that has significant associated morbidity and requires chronic treatment. Mobile health (mHealth) technologies have the potential to enhance multiple aspects of AF care, including education, monitoring of symptoms, and encouraging and tracking medication adherence. We have previously implemented and tested relational agents to improve outcomes in chronic disease and sought to develop a smartphone-based relational agent for improving patient-centered outcomes in AF. Objective: The objective of this study was to pilot a smartphone-based relational agent as preparation for a randomized clinical trial, the Atrial Fibrillation Health Literacy Information Technology Trial (AF-LITT). Methods: We developed the relational agent for use by a smartphone consistent with our prior approaches. We programmed the relational agent as a computer-animated agent to simulate a face-to-face conversation and to serve as a health counselor or coach specific to AF. Relational agent's dialogue content, informed by a review of literature, focused on patient-centered domains and qualitative interviews with patients with AF, encompassed AF education, common symptoms, adherence challenges, and patient activation. We established that the content was accessible to individuals with limited health or computer literacy. Relational agent content coordinated with use of the smartphone AliveCor Kardia heart rate and rhythm monitor. Participants (N=31) were recruited as a convenience cohort from ambulatory clinical sites and instructed to use the relational agent and Kardia for 30 days. We collected demographic, social, and clinical characteristics and conducted baseline and 30-day assessments of health-related quality of life (HRQoL) with the Atrial Fibrillation Effect on Quality of life (AFEQT) measure; self-reported medication adherence with the Morisky 8-item Medication Adherence Scale (MMAS-8); and patient activation with the Patient Activation Measure (PAM). Results: Participants (mean age 68 [SD 11]; 39\% [12/31] women) used the relational agent for an average 17.8 (SD 10.0) days. The mean number of independent log-ins was 19.6 (SD 10.7), with a median of 20 times over 30 days. The mean number of Kardia uses was 26.5 (SD 5.9), and participants using Kardia were in AF for 14.3 (SD 11.0) days. AFEQT scores improved significantly from 64.5 (SD 22.9) at baseline to 76.3 (SD 19.4) units at 30 days (P<.01). We observed marginal but statistically significant improvement in self-reported medication adherence (baseline: 7.3 [SD 0.9], 30 days: 7.7 [SD 0.5]; P=.01). Assessments of acceptability identified that most of the participants found the relational agent useful, informative, and trustworthy. Conclusions: We piloted a 30-day smartphone-based intervention that combined a relational agent with dedicated content for AF alongside Kardia heart rate and rhythm monitoring. Pilot participants had favorable improvements in HRQoL and self-reported medication adherence, as well as positive responses to the intervention. These data will guide a larger, enhanced randomized trial implementing the smartphone relational agent and the Kardia monitor system. ",
doi="10.2196/cardio.8543",
url="http://cardio.jmir.org/2017/2/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29473644"
}


@Article{info:doi/10.2196/cardio.7342,
author="Cossette, Sylvie
and C{\^o}t{\'e}, Jos{\'e}
and Rouleau, Genevi{\`e}ve
and Robitaille, Marie
and Heppell, Sonia
and Mailhot, Tanya
and Fontaine, Guillaume
and Cournoyer, Catherine
and Gagnon, Marie-Pierre
and Gallani, Maria-Cecilia
and Tanguay, Jean-Francois
and Dupuis, Jocelyn
and Nigam, Anil
and Guertin, Marie-Claude",
title="A Web-Based Tailored Intervention to Support Illness Management in Patients With an Acute Coronary Syndrome: Pilot Study",
journal="JMIR Cardio",
year="2017",
month="Sep",
day="06",
volume="1",
number="2",
pages="e4",
keywords="nursing informatics",
keywords="health behavior",
keywords="self-care",
keywords="acute coronary syndrome",
keywords="pilot study",
abstract="Background: Illness management after an acute coronary syndrome (ACS) is crucial to prevent cardiac complications, to foster participation in a cardiac rehabilitation (CR) program, and to optimize recovery. Web-based tailored interventions have the potential to provide individualized information and counseling to optimize patient's illness management after hospital discharge. Objective: We aimed to assess the feasibility and acceptability of a Web-based tailored intervention (TAVIE@COEUR) designed to improve illness management in patients hospitalized for an ACS. Illness management outcomes were operationalized by self-care, medication adherence, anxiety management, cardiac risk factors reduction, and enrollment in a CR program. Methods: This posttest pilot study was conducted with one group (N=30) of patients hospitalized for an ACS on the coronary care unit of a tertiary cardiology center. TAVIE@COEUR comprises three Web-based sessions, with a duration ranging from 10 to 45 min and is structured around an algorithm to allow the tailoring of the intervention to different pathways according to patients' responses to questions. TAVIE@COEUR includes 90 pages, 85 videos, and 47 PDF documents divided across session 1 (S1), session 2 (S2), and session 3 (S3). These sessions concern self-care and self-observation skills related to medication-taking (S1), emotional control and problem-solving skills (S2), and social skills and interacting with health professionals (S3). Throughout the videos, a virtual nurse (providing the intervention virtually) guides the participants in the acquisition of self-care skills. Patients completed S1 of TAVIE@COEUR before hospital discharge and were asked to complete S2 and S3 within 2 weeks after discharge. Feasibility indicators were extracted from the TAVIE@COEUR system. Data regarding acceptability (satisfaction and appreciation of the platform) and preliminary effect (self-care, medication adherence, anxiety management, risk factor reduction, and CR enrollment) were assessed through questionnaires at 1 month following discharge. Preliminary effect was assessed by comparing baseline and 1-month illness management variables. Results: Of the 30 participants, 20 completed S1, 10 completed S2, and 5 completed S3. Good acceptability scores were observed for ease of navigation (mean=3.58, standard deviation [SD]=0.70; scale=0-4), ease of understanding (mean=3.46, SD=0.63; scale=0-4), and applicability (mean=3.55, SD=0.74; scale=0-4). The lowest acceptability scores were observed for information tailoring (mean=2.93, SD=0.68; scale=0-4) and individual relevance (mean=2.56, SD=0.96; scale=0-4). With regard to preliminary effect, we observed an overall self-care at 1 month following discharge score higher than at baseline (mean at 1 month=54.07, SD=3.99 vs mean at baseline=49.09, SD=6.92; scale-0-60). Conclusions: Although participants reported general satisfaction and appreciation of TAVIE@COEUR, acceptability and feasibility results show the need for further development of the Web-based intervention to enhance its tailoring before undertaking a full-fledged randomized controlled trial. This may be accomplished by optimizing the adaptability of TAVIE@COEUR to patients' knowledge, needs, interests, individual capabilities, and emotional and cognitive responses during session completion. ",
doi="10.2196/cardio.7342",
url="http://cardio.jmir.org/2017/2/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758758"
}


@Article{info:doi/10.5210/ojphi.v4i2.4005,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2012",
volume="4",
number="2",
pages="e4005",
doi="10.5210/ojphi.v4i2.4005",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/23569637"
}