@Article{info:doi/10.2196/14332, author="Sohn, Albert and Speier, William and Lan, Esther and Aoki, Kymberly and Fonarow, Gregg and Ong, Michael and Arnold, Corey", title="Assessment of Heart Failure Patients' Interest in Mobile Health Apps for Self-Care: Survey Study", journal="JMIR Cardio", year="2019", month="Oct", day="29", volume="3", number="2", pages="e14332", keywords="mHealth", keywords="patient-reported outcome", keywords="heart failure", keywords="self-care", keywords="patient monitoring", abstract="Background: Heart failure is a serious public health concern that afflicts millions of individuals in the United States. Development of behaviors that promote heart failure self-care may be imperative to reduce complications and avoid hospital re-admissions. Mobile health solutions, such as activity trackers and smartphone apps, could potentially help to promote self-care through remote tracking and issuing reminders. Objective: The objective of this study was to ascertain heart failure patients' interest in a smartphone app to assist them in managing their treatment and symptoms and to determine factors that influence their interest in such an app. Methods: In the clinic waiting room on the day of their outpatient clinic appointments, 50 heart failure patients participated in a self-administered survey. The survey comprised 139 questions from previously published, institutional review board--approved questionnaires. The survey measured patients' interest in and experience using technology as well as their function, heart failure symptoms, and heart failure self-care behaviors. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was among the 11 questionnaires and was used to measure the heart failure patients' health-related quality of life through patient-reported outcomes. Results: Participants were aged 64.5 years on average, 32\% (16/50) of the participants were women, and 91\% (41/45) of the participants were determined to be New York Heart Association Class II or higher. More than 60\% (30/50) of the survey participants expressed interest in several potential features of a smartphone app designed for heart failure patients. Participant age correlated negatively with interest in tracking, tips, and reminders in multivariate regression analysis (P<.05). In contrast, MLHFQ scores (worse health status) produced positive correlations with these interests (P<.05). Conclusions: The majority of heart failure patients showed interest in activity tracking, heart failure symptom management tips, and reminder features of a smartphone app. Desirable features and an understanding of factors that influence patient interest in a smartphone app for heart failure self-care may allow researchers to address common concerns and to develop apps that demonstrate the potential benefits of mobile technology. ", doi="10.2196/14332", url="https://cardio.jmir.org/2019/2/e14332", url="http://www.ncbi.nlm.nih.gov/pubmed/31758788" } @Article{info:doi/10.2196/cardio.9815, author="Giannola, Gabriele and Torcivia, Riccardo and Air{\`o} Farulla, Riccardo and Cipolla, Tommaso", title="Outsourcing the Remote Management of Cardiac Implantable Electronic Devices: Medical Care Quality Improvement Project", journal="JMIR Cardio", year="2019", month="Dec", day="18", volume="3", number="2", pages="e9815", keywords="remote monitoring", keywords="telemonitoring", keywords="cardiac implantable electronic devices", keywords="implantable defibrillators", keywords="pacemaker", keywords="implantable cardioverter defibrillator", keywords="triage outsourcing", keywords="follow-up", abstract="Background: Remote management is partially replacing routine follow-up in patients implanted with cardiac implantable electronic devices (CIEDs). Although it reduces clinical staff time compared with standard in-office follow-up, a new definition of roles and responsibilities may be needed to review remote transmissions in an effective, efficient, and timely manner. Whether remote triage may be outsourced to an external remote monitoring center (ERMC) is still unclear. Objective: The aim of this health care quality improvement project was to evaluate the feasibility of outsourcing remote triage to an ERMC to improve patient care and health care resource utilization. Methods: Patients (N=153) with implanted CIEDs were followed up for 8 months. An ERMC composed of nurses and physicians reviewed remote transmissions daily following a specific remote monitoring (RM) protocol. A 6-month benchmarking phase where patients' transmissions were managed directly by hospital staff was evaluated as a term of comparison. Results: A total of 654 transmissions were recorded in the RM system and managed by the ERMC team within 2 working days, showing a significant time reduction compared with standard RM management (100\% vs 11\%, respectively, within 2 days; P<.001). A total of 84.3\% (551/654) of the transmissions did not include a prioritized event and did not require escalation to the hospital clinician. High priority was assigned to 2.3\% (15/654) of transmissions, which were communicated to the hospital team by email within 1 working day. Nonurgent device status events occurred in 88 cases and were communicated to the hospital within 2 working days. Of these, 11\% (10/88) were followed by a hospitalization. Conclusions: The outsourcing of RM management to an ERMC safely provides efficacy and efficiency gains in patients' care compared with a standard in-hospital management. Moreover, the externalization of RM management could be a key tool for saving dedicated staff and facility time with possible positive economic impact. Trial Registration: ClinicalTrials.gov NCT01007474; http://clinicaltrials.gov/ct2/show/NCT01007474 ", doi="10.2196/cardio.9815", url="https://cardio.jmir.org/2019/2/e9815", url="http://www.ncbi.nlm.nih.gov/pubmed/31845898" } @Article{info:doi/10.2196/15320, 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" }