%0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e13137 %T Validation in the General Population of the iHealth Track Blood Pressure Monitor for Self-Measurement According to the European Society of Hypertension International Protocol Revision 2010: Descriptive Investigation %A Mazoteras-Pardo,Victoria %A Becerro-De-Bengoa-Vallejo,Ricardo %A Losa-Iglesias,Marta Elena %A López-López,Daniel %A Palomo-López,Patricia %A Rodríguez-Sanz,David %A Calvo-Lobo,César %+ Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Campus Universitario de Esteiro s/n, Ferrol, 15403, Spain, 34 981337400 ext 3546, daniel.lopez.lopez@udc.es %K blood pressure determination %K heart rate determination %K validation studies %K telemedicine %D 2019 %7 19.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: High blood pressure is one of the most common reasons why patients seek assistance in daily clinical practice. Screening for hypertension is fundamental and, because hypertension is identified only when blood pressure is measured, accurate measurements are key to the diagnosis and management of this disease. The European Society of Hypertension International Protocol revision 2010 (ESH-IP2) was developed to assess the validity of automatic blood pressure measuring devices that are increasingly being used to replace mercury sphygmomanometers. Objective: We sought to determine whether the iHealth Track blood pressure monitor meets ESH-IP2 requirements for self-measurement of blood pressure and heart rate at the brachial level and is appropriate for use in the general population. Methods: This study was a descriptive investigation. ESH-IP2 requires a total number of 33 participants. For each measure, the difference between observer and device blood pressure and heart rate values is calculated. In all, 99 pairs of blood pressure differences are classified into 3 categories (≤5, ≤10, and ≤15 mm Hg), and 99 pairs of heart rate differences are classified into 3 categories (≤3, ≤5, and ≤8 beats/min). We followed these protocol procedures in a convenience sample of 33 participants. Results: iHealth Track fulfilled ESH-IP2 requirements and passed the validation process successfully. We observed an absolute difference within 5 mm Hg in 75 of 99 comparisons for systolic blood pressure, 78 of 99 comparisons for diastolic blood pressure, and 89 of 99 comparisons for heart rate. The mean differences between the test and standard readings were 4.19 (SD 4.48) mm Hg for systolic blood pressure, 3.74 (SD 4.55) mm Hg for diastolic blood pressure, and 1.95 (SD 3.27) beats/min for heart rate. With regard to part 2 of ESH-IP2, we observed a minimum of 2 of 3 measurements within a 5-mm Hg difference in 29 of 33 participants for systolic blood pressure and 26 of 33 for diastolic blood pressure, and a minimum of 2 of 3 measurements within a 3-beat/min difference in 30 of 33 participants for heart rate. Conclusions: iHealth Track readings differed from the standard by less than 5, 10, and 15 mm Hg, fulfilling ESH-IP2 requirements. Consequently, this device is suitable for use in the general population. %M 30888331 %R 10.2196/13137 %U http://mhealth.jmir.org/2019/3/e13137/ %U https://doi.org/10.2196/13137 %U http://www.ncbi.nlm.nih.gov/pubmed/30888331 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11889 %T Accuracy of Apple Watch Measurements for Heart Rate and Energy Expenditure in Patients With Cardiovascular Disease: Cross-Sectional Study %A Falter,Maarten %A Budts,Werner %A Goetschalckx,Kaatje %A Cornelissen,Véronique %A Buys,Roselien %+ Department of Rehabilitation Sciences, KU Leuven, Herestraat 49 - Bus 1501, Leuven,, Belgium, 32 48 638 81 76, roselien.buys@kuleuven.be %K mobile health %K heart rate %K energy expenditure %K validation %K Apple Watch %K wrist-worn devices %K cardiovascular rehabilitation %D 2019 %7 19.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wrist-worn tracking devices such as the Apple Watch are becoming more integrated in health care. However, validation studies of these consumer devices remain scarce. Objectives: This study aimed to assess if mobile health technology can be used for monitoring home-based exercise in future cardiac rehabilitation programs. The purpose was to determine the accuracy of the Apple Watch in measuring heart rate (HR) and estimating energy expenditure (EE) during a cardiopulmonary exercise test (CPET) in patients with cardiovascular disease. Methods: Forty patients (mean age 61.9 [SD 15.2] yrs, 80% male) with cardiovascular disease (70% ischemic, 22.5% valvular, 7.5% other) completed a graded maximal CPET on a cycle ergometer while wearing an Apple Watch. A 12-lead electrocardiogram (ECG) was used to measure HR; indirect calorimetry was used for EE. HR was analyzed at three levels of intensity (seated rest, HR1; moderate intensity, HR2; maximal performance, HR3) for 30 seconds. The EE of the entire test was used. Bias or mean difference (MD), standard deviation of difference (SDD), limits of agreement (LoA), mean absolute error (MAE), mean absolute percentage error (MAPE), and intraclass correlation coefficients (ICCs) were calculated. Bland-Altman plots and scatterplots were constructed. Results: SDD for HR1, HR2, and HR3 was 12.4, 16.2, and 12.0 bpm, respectively. Bias and LoA (lower, upper LoA) were 3.61 (–20.74, 27.96) for HR1, 0.91 (–30.82, 32.63) for HR2, and –1.82 (–25.27, 21.63) for HR3. MAE was 6.34 for HR1, 7.55 for HR2, and 6.90 for HR3. MAPE was 10.69% for HR1, 9.20% for HR2, and 6.33% for HR3. ICC was 0.729 (P<.001) for HR1, 0.828 (P<.001) for HR2, and 0.958 (P<.001) for HR3. Bland-Altman plots and scatterplots showed good correlation without systematic error when comparing Apple Watch with ECG measurements. SDD for EE was 17.5 kcal. Bias and LoA were 30.47 (–3.80, 64.74). MAE was 30.77; MAPE was 114.72%. ICC for EE was 0.797 (P<.001). The Bland-Altman plot and a scatterplot directly comparing Apple Watch and indirect calorimetry showed systematic bias with an overestimation of EE by the Apple Watch. Conclusions: In patients with cardiovascular disease, the Apple Watch measures HR with clinically acceptable accuracy during exercise. If confirmed, it might be considered safe to incorporate the Apple Watch in HR-guided training programs in the setting of cardiac rehabilitation. At this moment, however, it is too early to recommend the Apple Watch for cardiac rehabilitation. Also, the Apple Watch systematically overestimates EE in this group of patients. Caution might therefore be warranted when using the Apple Watch for measuring EE. %M 30888332 %R 10.2196/11889 %U http://mhealth.jmir.org/2019/3/e11889/ %U https://doi.org/10.2196/11889 %U http://www.ncbi.nlm.nih.gov/pubmed/30888332 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12369 %T Assessment of the Relationship Between Ambient Temperature and Home Blood Pressure in Patients From a Web-Based Synchronous Telehealth Care Program: Retrospective Study %A Huang,Ching-Chang %A Chen,Ying-Hsien %A Hung,Chi-Sheng %A Lee,Jen-Kuang %A Hsu,Tse-Pin %A Wu,Hui-Wen %A Chuang,Pao-Yu %A Chen,Ming-Fong %A Ho,Yi-Lwun %+ Graduate Institute of Clinical Medicine, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 10002, Taiwan, 886 223123456 ext 66373, ylho@ntu.edu.tw %K ambient temperature %K home blood pressure %K antihypertensive agents %K retrospective studies %D 2019 %7 04.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Decreased ambient temperature significantly increases office blood pressure, but few studies have evaluated the effect of ambient temperature on home blood pressure. Objective: We aimed to investigate the relationship between short-term ambient temperature exposure and home blood pressure. Methods: We recruited patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital. Blood pressure was measured at home by patients or their caregivers. We obtained hourly meteorological data for Taipei (temperature, relative humidity, and wind speed) for the same time period from the Central Weather Bureau, Taiwan. Results: From 2009 to 2013, we enrolled a total of 253 patients. Mean patient age was 70.28 (SD 13.79) years, and 66.0% (167/253) of patients were male. We collected a total of 110,715 home blood pressure measurements. Ambient temperature had a negative linear effect on all 3 home blood pressure parameters after adjusting for demographic and clinical factors and antihypertensive agents. A 1°C decrease was associated with a 0.5492-mm Hg increase in mean blood pressure, a 0.6841-mm Hg increase in systolic blood pressure, and a 0.2709-mm Hg increase in diastolic blood pressure. This temperature effect on home blood pressure was less prominent in patients with diabetes or hypertension. Antihypertensive agents modified this negative effect of temperature on home blood pressure to some extent, and angiotensin receptor blockers had the most favorable results. Conclusions: Short-term exposure to low ambient temperature significantly increased home blood pressure in patients with chronic cardiovascular diseases. Antihypertensive agents may modify this effect. %M 30829574 %R 10.2196/12369 %U http://www.jmir.org/2019/3/e12369/ %U https://doi.org/10.2196/12369 %U http://www.ncbi.nlm.nih.gov/pubmed/30829574 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e13259 %T Patient Adherence to a Mobile Phone–Based Heart Failure Telemonitoring Program: A Longitudinal Mixed-Methods Study %A Ware,Patrick %A Dorai,Mala %A Ross,Heather J %A Cafazzo,Joseph A %A Laporte,Audrey %A Boodoo,Chris %A Seto,Emily %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada, 1 647 227 6015, patrick.ware@mail.utoronto.ca %K telemonitoring %K mHealth %K adherence %K heart failure %D 2019 %7 26.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients consistently adhere to taking prescribed home readings. Objective: The objectives of this study were to (1) quantify the degree to which patients adhered to taking prescribed home readings in the context of a mobile phone–based TM program and (2) explain longitudinal adherence rates based on the duration of program enrollment, patient characteristics, and patient perceptions of the TM program. Methods: A mixed-methods explanatory sequential design was used to meet the 2 research objectives, and all explanatory methods were guided by the unified theory of acceptance and use of technology 2 (UTAUT2). Overall adherence rates were calculated as the proportion of days patients took weight, blood pressure, heart rate, and symptom readings over the total number of days they were enrolled in the program up to 1 year. Monthly adherence rates were also calculated as the proportion of days patients took the same 4 readings over each 30-day period following program enrollment. Next, simple and multivariate regressions were performed to determine the influence of time, age, sex, and disease severity on adherence rates. Additional explanatory methods included questionnaires at 6 and 12 months probing patients on the perceived benefits and ease of use of the TM program, an analysis of reasons for patients leaving the program, and semistructured interviews conducted with a purposeful sampling of patients (n=24) with a range of adherence rates and demographics. Results: Overall average adherence was 73.6% (SD 25.0) with average adherence rates declining over time at a rate of 1.4% per month (P<.001). The multivariate regressions found no significant effect of sex and disease severity on adherence rates. When grouping patients’ ages by decade, age was a significant predictor (P=.04) whereby older patients had higher adherence rates over time. Adherence rates were further explained by patients’ perceptions with regard to the themes of (1) performance expectancy (improvements in HF management and peace of mind), (2) effort expectancy (ease of use and technical issues), (3) facilitating conditions (availability of technical support and automated adherence calls), (4) social influence (support from family, friends, and trusted clinicians), and (5) habit (degree to which taking readings became automatic). Conclusions: The decline in adherence rates over time is consistent with findings from other studies. However, this study also found adherence to be the highest and most consistent over time in older age groups and progressively lower over time for younger age groups. These findings can inform the design and implementation of TM interventions that maximize patient adherence, which will enable a more accurate evaluation of impact and optimization of resources. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9911 %M 30806625 %R 10.2196/13259 %U http://mhealth.jmir.org/2019/2/e13259/ %U https://doi.org/10.2196/13259 %U http://www.ncbi.nlm.nih.gov/pubmed/30806625 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 2 %P e11332 %T Feasibility of Telemonitoring Blood Pressure in Patients With Kidney Disease (Oxford Heart and Renal Protection Study-1): Observational Study %A Warner,Bronwen E %A Velardo,Carmelo %A Salvi,Dario %A Lafferty,Kathryn %A Crosbie,Sarah %A Herrington,William G %A Haynes,Richard %+ Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, United Kingdom, 44 01865 743607, richard.haynes@ndph.ox.ac.uk %K chronic kidney disease %K blood pressure %K telemonitoring %K mobile phone %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Blood pressure (BP) is a key modifiable risk factor for patients with chronic kidney disease (CKD), with current guidelines recommending strict control to reduce the risk of progression of both CKD and cardiovascular disease. Trials involving BP lowering require multiple visits to achieve target BP, which increases the costs of such trials, and in routine care, BP measured in the clinic may not accurately reflect the usual BP. Objective: We sought to assess whether a telemonitoring system for BP (using a Bluetooth-enabled BP machine that could transmit BP measurements to a tablet device installed with a bespoke app to guide the measurement of BP and collect questionnaire data) was acceptable to patients with CKD and whether patients would provide sufficient BP readings to assess variability and guide treatment. Methods: A total of 25 participants with CKD were trained to use the telemonitoring equipment and asked to record BP daily for 30 days, attend a study visit, and then record BP on alternate days for the next 60 days. They were also offered a wrist-worn applanation tonometry device (BPro) which measures BP every 15 minutes over a 24-hour period. Participants were given questionnaires at the 1- and 3-month time points; the questionnaires were derived from the System Usability Scale and Technology Acceptance Model. All eligible participants completed the study. Results: Mean participant age was 58 (SD 11) years, and mean estimated glomerular filtration rate was 36 (SD 13) mL/min/1.73m2. 13/25 (52%) participants provided >90% of the expected data and 18/25 (72%) provided >80% of the expected data. The usability of the telemonitoring system was rated highly, with mean scores of 84.9/100 (SE 2.8) after 30 days and 84.2/100 (SE 4.1) after 90 days. The coefficient of variation for the variability of systolic BP telemonitoring was 9.4% (95% CI 7.8-10.9) compared with 7.9% (95% CI 6.4-9.5) for the BPro device, P=.05 (and was 9.0% over 1 year in a recently completed trial with identical eligibility criteria), indicating that most variation in BP was short term. Conclusions: Telemonitoring is acceptable for patients with CKD and provides sufficient data to inform titration of antihypertensive therapies in either a randomized trial setting (comparing BP among different targets) or routine clinical practice. Such methods could be employed in both scenarios and reduce costs currently associated with such activities. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN13725286; http://www.isrctn.com/ISRCTN13725286 (Archived by WebCite at http://www.webcitation.org/74PAX51Ji). %R 10.2196/11332 %U http://cardio.jmir.org/2018/2/e11332/ %U https://doi.org/10.2196/11332 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 2 %P e10319 %T A Remote Patient Monitoring Intervention for Patients With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Pre-Post Economic Analysis of the Smart Program %A Isaranuwatchai,Wanrudee %A Redwood,Olwen %A Schauer,Adrian %A Van Meer,Tim %A Vallée,Jonathan %A Clifford,Patrick %+ St. Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada, 1 416 864 6060 ext 77074, isaranuwatcw@smh.ca %K chronic heart failure %K chronic obstructive pulmonary disease %K costs %K economic analysis %K emergency department visits %K hospitalizations %K health service utilization %K remote patient monitoring %D 2018 %7 20.12.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Exacerbation of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are associated with high health care costs owing to increased emergency room (ER) visits and hospitalizations. Remote patient monitoring (RPM) interventions aim to improve the monitoring of symptoms to detect early deterioration and provide self-management strategies. As a result, RPM aims to reduce health resource utilization. To date, studies have inconsistently reported the benefits of RPM in chronic illnesses. The Smart Program is an RPM intervention that aims to provide clinical benefit to patients and economic benefit to health care payers. Objective: This study aims to economically evaluate the potential benefits of the Smart Program in terms of hospitalizations and ER visits and, thus, associated health care costs from the perspective of the public health care system. Methods: Seventy-four patients diagnosed with COPD or CHF from one hospital site were included in this one-group, pre-post study. The study involved a secondary data analysis of deidentified data collected during the study period – from 3 months before program initiation (baseline), during the program, to 3 months after program completion (follow-up). Descriptive analysis was conducted for the study population characteristics at baseline, the clinical frailty score at baseline and 3-month follow-up, client satisfaction at 3-month follow-up, and number and costs of ER visits and hospitalizations throughout the study period. Furthermore, the cost of the Smart Program over a 3-month period was calculated from the perspective of the potential implementer. Results: The baseline characteristics of the study population (N=74) showed that the majority of patients had COPD (50/74, 68%), were female (42/74, 57%), and had an average age of 72 (SD 12) years. Using the Wilcoxon signed-rank test, the number of ER visits and hospitalizations, including their associated costs, were significantly reduced between baseline and 3-month follow-up (P<.001). The intervention showed a potential 68% and 35% reduction in ER visits and hospitalizations, respectively, between the 3-month pre- and 3-month postintervention period. The average cost of ER visits reduced from Can $243 at baseline to Can $67 during the 3-month follow-up, and reduced from Can $3842 to Can $1399 for hospitalizations. Conclusions: In this study, the number and cost of ER visits and hospitalizations appeared to be markedly reduced for patients with COPD or CHF when comparing data before and after the Smart Program implementation. Recognizing the limitations of the one-group, pre-post study design, RPM requires an upfront investment, but it has the potential to reduce health care costs to the system over time. This study represents another piece of evidence to support the potential value of RPM among patients with COPD or CHF. %R 10.2196/10319 %U http://cardio.jmir.org/2018/2/e10319/ %U https://doi.org/10.2196/10319 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 2 %P e11466 %T User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study %A Ware,Patrick %A Ross,Heather J %A Cafazzo,Joseph A %A Laporte,Audrey %A Gordon,Kayleigh %A Seto,Emily %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada, 1 647 227 6015, patrick.ware@mail.utoronto.ca %K telemonitoring %K mHealth %K diffusion of innovation %K heart failure %D 2018 %7 06.12.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Telemonitoring interventions for the management of heart failure have seen limited adoption in Canadian health systems, but isolated examples of telemonitoring programs do exist. An example of such a program was launched in a specialty heart failure clinic in Toronto, Canada, and a recent implementation evaluation concluded that reducing the cost of delivering the program is necessary to ensure its sustainability and scalability. Objective: The objectives of this study were to (1) understand which components of the telemonitoring program could be modified to reduce costs and adapted to other contexts while maintaining program fidelity and (2) describe the changes made to the telemonitoring program to enable its sustainability within the initial implementation site and scalability to other health organizations. Methods: Semistructured interviews probed the experiences of patients (n=23) and clinicians (n=8) involved in the telemonitoring program to identify opportunities for cost reduction and resource optimization. Ideas for adapting the program were informed by the interview results and prioritized based on (1) potential impact for sustainability and scalability, (2) feasibility, and (3) perceived risks to negatively impacting the program’s ability to yield desired health outcomes. Results: A total of 5 themes representing opportunities for cost reduction were discussed, including (1) Bring Your Own Device (BYOD), (2) technical support, (3) clinician role, (4) duration of enrollment, and (5) intensity of monitoring. The hardware used for the telemonitoring system and the modalities of providing technical support were found to be highly adaptable, which supported the decision to implement a BYOD model, whereby patients used their own smartphone, weight scale, and blood pressure cuff. Changes also included the development of a website aimed at reducing the burden on a technical support telehealth analyst. In addition, the interviews suggested that although it is important to have a clinician who is part of a patient’s circle of care monitoring telemonitoring alerts, the skill level and experience were moderately adaptable. Thus, a registered nurse was determined to be more cost-effective and was hired to replace the existing nurse practitioners in the frontline management of telemonitoring alerts and take over the technical support role from a telehealth analyst. Conclusions: This study provides a user-centered example of how necessary cost-reduction actions can be taken to ensure the sustainability and scalability of telemonitoring programs. In addition, the findings offer insights into what components of a telemonitoring program can be safely adapted to ensure its integration in various clinical settings. %R 10.2196/11466 %U http://cardio.jmir.org/2018/2/e11466/ %U https://doi.org/10.2196/11466 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e12048 %T A Cardiopulmonary Monitoring System for Patient Transport Within Hospitals Using Mobile Internet of Things Technology: Observational Validation Study %A Lee,Jang Ho %A Park,Yu Rang %A Kweon,Solbi %A Kim,Seulgi %A Ji,Wonjun %A Choi,Chang-Min %+ Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 2 3010 5902, ccm@amc.seoul.kr %K wearable device %K patient safety %K intrahospital transport %K oxygen saturation %K heart rate %K mobile application %K real-time monitoring %D 2018 %7 14.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During intrahospital transport, adverse events are inevitable. Real-time monitoring can be helpful for preventing these events during intrahospital transport. Objective: We attempted to determine the viability of risk signal detection using wearable devices and mobile apps during intrahospital transport. An alarm was sent to clinicians in the event of oxygen saturation below 90%, heart rate above 140 or below 60 beats per minute (bpm), and network errors. We validated the reliability of the risk signal transmitted over the network. Methods: We used two wearable devices to monitor oxygen saturation and heart rate for 23 patients during intrahospital transport for diagnostic workup or rehabilitation. To determine the agreement between the devices, records collected every 4 seconds were matched and imputation was performed if no records were collected at the same time by both devices. We used intraclass correlation coefficients (ICC) to evaluate the relationships between the two devices. Results: Data for 21 patients were delivered to the cloud over LTE, and data for two patients were delivered over Wi-Fi. Monitoring devices were used for 20 patients during intrahospital transport for diagnostic work up and for three patients during rehabilitation. Three patients using supplemental oxygen before the study were included. In our study, the ICC for the heart rate between the two devices was 0.940 (95% CI 0.939-0.942) and that of oxygen saturation was 0.719 (95% CI 0.711-0.727). Systemic error analyzed with Bland-Altman analysis was 0.428 for heart rate and –1.404 for oxygen saturation. During the study, 14 patients had 20 risk signals: nine signals for eight patients with less than 90% oxygen saturation, four for four patients with a heart rate of 60 bpm or less, and seven for five patients due to network error. Conclusions: We developed a system that notifies the health care provider of the risk level of a patient during transportation using a wearable device and a mobile app. Although there were some problems such as missing values and network errors, this paper is meaningful in that the previously mentioned risk detection system was validated with actual patients. %M 30429115 %R 10.2196/12048 %U http://mhealth.jmir.org/2018/11/e12048/ %U https://doi.org/10.2196/12048 %U http://www.ncbi.nlm.nih.gov/pubmed/30429115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e163 %T Electronic Health Physical Activity Behavior Change Intervention to Self-Manage Cardiovascular Disease: Qualitative Exploration of Patient and Health Professional Requirements %A Walsh,Deirdre MJ %A Moran,Kieran %A Cornelissen,Véronique %A Buys,Roselien %A Cornelis,Nils %A Woods,Catherine %+ MedEx Wellness, School of Health and Human Performance, Dublin City Unviersity, Room A246, Albert College, Dublin, Dublin 9, Ireland, 353 1 7008011, kieran.moran@dcu.ie %K telemedicine %K exercise %K cardiovascular diseases %K rehabilitation %D 2018 %7 08.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiovascular diseases are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation. Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based cardiac rehabilitation programs is low, with community-based cardiac rehabilitation rates and individual long-term exercise maintenance even lower. Home-based cardiac rehabilitation programs have been shown to be equally effective in clinical and health-related quality of life outcomes and yet are not readily available. Objective: Given the potential that home-based cardiac rehabilitation programs have, it is important to explore how to appropriately design any such intervention in conjunction with key stakeholders. The aim of this study was to engage with individuals with cardiovascular disease and other professionals within the health ecosystem to (1) understand the personal, social, and physical factors that inhibit or promote their capacity to engage with physical activity and (2) explore their technology competencies, needs, and wants in relation to an eHealth intervention. Methods: Fifty-four semistructured interviews were conducted across two countries. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Barriers to the implementation of PATHway were also explored specifically in relation to physical capability and safety as well as technology readiness and further mapped onto the COM-B model for future intervention design. Results: Key recommendations included collection of patient data and use of measurements, harnessing hospital based social connections, and advice to utilize a patient-centered approach with personalization and tailoring to facilitate optimal engagement. Conclusions: In summary, a multifaceted, personalizable intervention with an inclusively designed interface was deemed desirable for use among cardiovascular disease patients both by end users and key stakeholders. In-depth understanding of core needs of the population can aid intervention development and acceptability. %M 29739740 %R 10.2196/jmir.9181 %U http://www.jmir.org/2018/5/e163/ %U https://doi.org/10.2196/jmir.9181 %U http://www.ncbi.nlm.nih.gov/pubmed/29739740 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e11 %T HerzMobil, an Integrated and Collaborative Telemonitoring-Based Disease Management Program for Patients With Heart Failure: A Feasibility Study Paving the Way to Routine Care %A Ammenwerth,Elske %A Modre-Osprian,Robert %A Fetz,Bettina %A Gstrein,Susanne %A Krestan,Susanne %A Dörler,Jakob %A Kastner,Peter %A Welte,Stefan %A Rissbacher,Clemens %A Pölzl,Gerhard %+ Institute of Medical Informatics, UMIT – University for Health Sciences, Medical Informatics and Technology, Eduard Wallnöfer Zentrum 1, Hall in Tirol, 6060, Austria, 43 508648 ext 3809, elske.ammenwerth@umit.at %K heart failure %K telemedicine %K delivery of health care, integrated %K program evaluation %D 2018 %7 30.04.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Heart failure is a major health problem associated with frequent hospital admissions. HerzMobil Tirol is a multidisciplinary postdischarge disease management program for heart failure patients to improve quality of life, prevent readmission, and reduce mortality and health care costs. It uses a telemonitoring system that is incorporated into a network of specialized heart failure nurses, physicians, and hospitals. Patients are equipped with a mobile phone, a weighing scale, and a blood pressure and heart rate monitor for daily acquisition and transmission of data on blood pressure, heart rate, weight, well-being, and drug intake. These data are transmitted daily and regularly reviewed by the network team. In addition, patients are scheduled for 3 visits with the network physician and 2 visits with the heart failure nurse within 3 months after hospitalization for acute heart failure. Objective: The objectives of this study were to evaluate the feasibility of HerzMobil Tirol by analyzing changes in health status as well as patients’ self-care behavior and satisfaction and to derive recommendations for implementing a telemonitoring-based interdisciplinary disease management program for heart failure in everyday clinical practice. Methods: In this prospective, pilot, single-arm study including 35 elderly patients, the feasibility of HerzMobil Tirol was assessed by analyzing changes in health status (via Kansas City Cardiomyopathy Questionnaire, KCCQ), patients’ self-care behavior (via European Heart Failure Self-Care Behavior Scale, revised into a 9-item scale, EHFScB-9), and user satisfaction (via Delone and McLean System Success Model). Results: A total of 43 patients joined the HerzMobil Tirol program, and of these, 35 patients completed it. The mean age of participants was 67 years (range: 43-86 years). Health status (KCCQ, range: 0-100) improved from 46.2 to 69.8 after 3 months. Self-care behavior (EHFScB-9, possible range: 9-22) after 3 months was 13.2. Patient satisfaction in all dimensions was 86% or higher. Lessons learned for the rollout of HerzMobil Tirol comprise a definite time schedule for interventions, solid network structures with clear process definition, a network coordinator, and specially trained heart failure nurses. Conclusions: On the basis of the positive evaluation results, HerzMobil Tirol has been officially introduced in the province of Tyrol in July 2017. It is, therefore, the first regular financed telehealth care program in Austria. %R 10.2196/cardio.9936 %U http://cardio.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/cardio.9936 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e9 %T Remote Monitoring of Patients Undergoing Transcatheter Aortic Valve Replacement: A Framework for Postprocedural Telemonitoring %A Hermans,Mathilde C %A Van Mourik,Martijn S %A Hermens,Hermie J %A Baan Jr,Jan %A Vis,Marije M %+ Heart Centre, Academic Medical Centre, University of Amsterdam, PO Box 22660, Amsterdam, 1100 DD, Netherlands, 31 5666555, m.m.vis@amc.uva.nl %K transcatheter aortic valve replacement %K postoperative care %K electrocardiography %K telemonitoring %K telemedicine %D 2018 %7 16.03.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: The postprocedural trajectory of patients undergoing transcatheter aortic valve replacement (TAVR) involves in-hospital monitoring of potential cardiac rhythm or conduction disorders and other complications. Recent advances in telemonitoring technologies create opportunities to monitor electrocardiogram (ECG) and vital signs remotely, facilitating redesign of follow-up trajectories. Objective: This study aimed to outline a potential set-up of telemonitoring after TAVR. Methods: A multidisciplinary team systematically framed the envisioned telemonitoring scenario according to the intentions, People, Activities, Context, Technology (iPACT) and Functionality, Interaction, Content, Services (FICS) methods and identified corresponding technical requirements. Results: In this scenario, a wearable sensor system is used to continuously transmit ECG and contextual data to a central monitoring unit, allowing remote follow-up of ECG abnormalities and physical deteriorations. Telemonitoring is suggested as an alternative or supplement to current in-hospital monitoring after TAVR, enabling early hospital dismissal in eligible patients and accessible follow-up prolongation. Together, this approach aims to improve rehabilitation, enhance patient comfort, optimize hospital capacity usage, and reduce overall costs. Required technical components include continuous data acquisition, real-time data transfer, privacy-ensured storage, automatic event detection, and user-friendly interfaces. Conclusions: The suggested telemonitoring set-up involves a new approach to patient follow-up that could bring durable solutions for the growing scarcities in health care and for improving health care quality. To further explore the potential and feasibility of post-TAVR telemonitoring, we recommend evaluation of the overall impact on patient outcomes and of the safety, social, ethical, legal, organizational, and financial factors. %R 10.2196/cardio.9075 %U http://cardio.jmir.org/2018/1/e9/ %U https://doi.org/10.2196/cardio.9075 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e5 %T Monitoring Patients With Implantable Cardioverter Defibrillators Using Mobile Phone Electrocardiogram: Case Study %A Kropp,Caley %A Ellis,Jordan %A Nekkanti,Rajasekhar %A Sears,Samuel %+ Department of Psychology, East Carolina University, 104 Rawl Building, East 5th Street, Greenville, NC, 27858, United States, 1 252 328 1828, kroppc15@students.ecu.edu %K atrial fibrillation %K ICD %K ECG %K mobile phone monitoring %K mobile health %K electrophysiology %D 2018 %7 21.02.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Preventable poor health outcomes associated with atrial fibrillation continue to make early detection a priority. A one-lead mobile electrocardiogram (mECG) device given to patients with an implantable cardioverter defibrillator (ICD) allowed users to receive real-time ECG readings in 30 seconds. Objective: Three cases were selected from an institutional review board-approved clinical trial aimed at assessing mECG device usage and satisfaction, patient engagement, quality of life (QoL), and cardiac anxiety. These three specific cases were selected to examine a variety of possible patient presentations and user experiences. Methods: Three ICD patients with mobile phones who were being seen in an adult device clinic were asked to participate. The participants chosen represented individuals with varying degrees of reported education and patient engagement. Participants were instructed to use the mECG device at least once per day for 30 days. Positive ECGs for atrial fibrillation were evaluated in clinic. At follow-up, information was collected regarding their frequency of use of the mECG device and three psychological outcomes in the domains of patient engagement, QoL, and cardiac anxiety. Results: Each patient used the technology approximately daily or every other day as prescribed. At the 30-day follow-up, usage reports indicated an average of 32 readings per month per participant. At 90-day follow-up, usage reports indicated an average of 34 readings per month per participant. Two of the three participants self-reported a significant improvement in their physical QoL from baseline to completion, while simultaneously self-reporting a significant decrease in their mental QoL. All three participants reported high levels of device acceptance and technology satisfaction. Conclusions: This case study demonstrates that ICD patients with varying degrees of education and patient engagement were relatively active in their use of mECGs. All three participants using the mECG technology reported high technology satisfaction and device acceptance. High sensitivity, specificity, and accuracy of mECG technology may allow routine atrial fibrillation screening at lower costs, in addition to improving patient outcomes. %R 10.2196/cardio.8710 %U http://cardio.jmir.org/2018/1/e5/ %U https://doi.org/10.2196/cardio.8710 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e16 %T Evaluation Criteria of Noninvasive Telemonitoring for Patients With Heart Failure: Systematic Review %A Farnia,Troskah %A Jaulent,Marie-Christine %A Steichen,Olivier %+ Department of Internal Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4 Rue de la Chine, Paris,, France, 33 1 56 01 78 31, olivier.steichen@aphp.fr %K telemedicine %K outcome and process assessment (health care) %K program evaluation %K heart failure %D 2018 %7 16.01.2018 %9 Review %J J Med Internet Res %G English %X Background: Telemonitoring can improve heart failure (HF) management, but there is no standardized evaluation framework to comprehensively evaluate its impact. Objective: Our objectives were to list the criteria used in published evaluations of noninvasive HF telemonitoring projects, describe how they are used in the evaluation studies, and organize them into a consistent scheme. Methods: Articles published from January 1990 to August 2015 were obtained through MEDLINE, Web of Science, and EMBASE. Articles were eligible if they were original reports of a noninvasive HF telemonitoring evaluation study in the English language. Studies of implantable telemonitoring devices were excluded. Each selected article was screened to extract the description of the telemonitoring project and the evaluation process and criteria. A qualitative synthesis was performed. Results: We identified and reviewed 128 articles leading to 52 evaluation criteria classified into 6 dimensions: clinical, economic, user perspective, educational, organizational, and technical. The clinical and economic impacts were evaluated in more than 70% of studies, whereas the educational, organizational, and technical impacts were studied in fewer than 15%. User perspective was the most frequently covered dimension in the development phase of telemonitoring projects, whereas clinical and economic impacts were the focus of later phases. Conclusions: Telemonitoring evaluation frameworks should cover all 6 dimensions appropriately distributed along the telemonitoring project lifecycle. Our next goal is to build such a comprehensive evaluation framework for telemonitoring and test it on an ongoing noninvasive HF telemonitoring project. %M 29339348 %R 10.2196/jmir.7873 %U http://www.jmir.org/2018/1/e16/ %U https://doi.org/10.2196/jmir.7873 %U http://www.ncbi.nlm.nih.gov/pubmed/29339348 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e127 %T Impact of a Telehealth Program With Voice Recognition Technology in Patients With Chronic Heart Failure: Feasibility Study %A Lee,Heesun %A Park,Jun-Bean %A Choi,Sae Won %A Yoon,Yeonyee E %A Park,Hyo Eun %A Lee,Sang Eun %A Lee,Seung-Pyo %A Kim,Hyung-Kwan %A Cho,Hyun-Jai %A Choi,Su-Yeon %A Lee,Hae-Young %A Choi,Jonghyuk %A Lee,Young-Joon %A Kim,Yong-Jin %A Cho,Goo-Yeong %A Choi,Jinwook %A Sohn,Dae-Won %+ Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Republic Of Korea, 82 2 2072 2252, nanumy1@gmail.com %K heart failure %K telemedicine %K selfcare %K compliance %D 2017 %7 02.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the advances in the diagnosis and treatment of heart failure (HF), the current hospital-oriented framework for HF management does not appear to be sufficient to maintain the stability of HF patients in the long term. The importance of self-care management is increasingly being emphasized as a promising long-term treatment strategy for patients with chronic HF. Objective: The objective of this study was to evaluate whether a new information communication technology (ICT)–based telehealth program with voice recognition technology could improve clinical or laboratory outcomes in HF patients. Methods: In this prospective single-arm pilot study, we recruited 31 consecutive patients with chronic HF who were referred to our institute. An ICT-based telehealth program with voice recognition technology was developed and used by patients with HF for 12 weeks. Patients were educated on the use of this program via mobile phone, landline, or the Internet for the purpose of improving communication and data collection. Using these systems, we collected comprehensive data elements related to the risk of HF self-care management such as weight, diet, exercise, medication adherence, overall symptom change, and home blood pressure. The study endpoints were the changes observed in urine sodium concentration (uNa), Minnesota Living with Heart Failure (MLHFQ) scores, 6-min walk test, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) as surrogate markers for appropriate HF management. Results: Among the 31 enrolled patients, 27 (87%) patients completed the study, and 10 (10/27, 37%) showed good adherence to ICT-based telehealth program with voice recognition technology, which was defined as the use of the program for 100 times or more during the study period. Nearly three-fourths of the patients had been hospitalized at least once because of HF before the enrollment (20/27, 74%); 14 patients had 1, 2 patients had 2, and 4 patients had 3 or more previous HF hospitalizations. In the total study population, there was no significant interval change in laboratory and functional outcome variables after 12 weeks of ICT-based telehealth program. In patients with good adherence to ICT-based telehealth program, there was a significant improvement in the mean uNa (103.1 to 78.1; P=.01) but not in those without (85.4 to 96.9; P=.49). Similarly, a marginal improvement in MLHFQ scores was only observed in patients with good adherence (27.5 to 21.4; P=.08) but not in their counterparts (19.0 to 19.7; P=.73). The mean 6-min walk distance and NT-proBNP were not significantly increased in patients regardless of their adherence. Conclusions: Short-term application of ICT-based telehealth program with voice recognition technology showed the potential to improve uNa values and MLHFQ scores in HF patients, suggesting that better control of sodium intake and greater quality of life can be achieved by this program. %M 28970189 %R 10.2196/mhealth.7058 %U https://mhealth.jmir.org/2017/10/e127/ %U https://doi.org/10.2196/mhealth.7058 %U http://www.ncbi.nlm.nih.gov/pubmed/28970189 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 9 %P e135 %T Atrial Fibrillation Screening in Nonmetropolitan Areas Using a Telehealth Surveillance System With an Embedded Cloud-Computing Algorithm: Prospective Pilot Study %A Chen,Ying-Hsien %A Hung,Chi-Sheng %A Huang,Ching-Chang %A Hung,Yu-Chien %A Hwang,Juey-Jen %A Ho,Yi-Lwun %+ Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei, 10002, Taiwan, 886 2 2312 3456 ext 63651, ylho@ntu.edu.tw %K atrial fibrillation %K screen %K cloud-computing algorithm %K electrocardiography %D 2017 %7 26.09.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. Objective: The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. Methods: We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Results: Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4%, 22/922) residents with AF were identified by the physician’s ECG interpretation, and only 0.2% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5% (95% CI 77.2%-99.9%) and specificity of 97.7% (95% CI 96.5%-98.5%). The overall satisfaction score for the process of AF screening was 92.1%. Conclusions: AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. %M 28951384 %R 10.2196/mhealth.8290 %U https://mhealth.jmir.org/2017/9/e135/ %U https://doi.org/10.2196/mhealth.8290 %U http://www.ncbi.nlm.nih.gov/pubmed/28951384 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e231 %T Informing the Design of “Lifestyle Monitoring” Technology for the Detection of Health Deterioration in Long-Term Conditions: A Qualitative Study of People Living With Heart Failure %A Hargreaves,Sarah %A Hawley,Mark S %A Haywood,Annette %A Enderby,Pamela M %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Innovation Centre, 217 Portobello, Sheffield, S1 4DP, United Kingdom, 44 114 2220682, mark.hawley@sheffield.ac.uk %K independent living %K human activities %K heart failure %K biomedical technology %D 2017 %7 28.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Health technologies are being developed to help people living at home manage long-term conditions. One such technology is “lifestyle monitoring” (LM), a telecare technology based on the idea that home activities may be monitored unobtrusively via sensors to give an indication of changes in health-state. However, questions remain about LM technology: how home activities change when participants experience differing health-states; and how sensors might capture clinically important changes to inform timely interventions. Objective: The objective of this paper was to report the findings of a study aimed at identifying changes in activity indicative of important changes in health in people with long-term conditions, particularly changes indicative of exacerbation, by exploring the relationship between home activities and health among people with heart failure (HF). We aimed to add to the knowledge base informing the development of home monitoring technologies designed to detect health deterioration in order to facilitate early intervention and avoid hospital admissions. Methods: This qualitative study utilized semistructured interviews to explore everyday activities undertaken during the three health-states of HF: normal days, bad days, and exacerbations. Potential recruits were identified by specialist nurses and attendees at an HF support group. The sample was purposively selected to include a range of experience of living with HF. Results: The sample comprised a total of 20 people with HF aged 50 years and above, and 11 spouses or partners of the individuals with HF. All resided in Northern England. Participant accounts revealed that home activities are in part shaped by the degree of intrusion from HF symptoms. During an exacerbation, participants undertook activities specifically to ease symptoms, and detailed activity changes were identified. Everyday activity was also influenced by a range of factors other than health. Conclusions: The study highlights the importance of careful development of LM technology to identify changes in activities that occur during clinically important changes in health. These detailed activity changes need to be considered by developers of LM sensors, platforms, and algorithms intended to detect early signs of deterioration. Results suggest that for LM to move forward, sensor set-up should be personalized to individual circumstances and targeted at individual health conditions. LM needs to take account of the uncertainties that arise from placing technology within the home, in order to inform sensor set-up and data interpretation. This targeted approach is likely to yield more clinically meaningful data and address some of the ethical issues of remote monitoring. %M 28659253 %R 10.2196/jmir.6931 %U http://www.jmir.org/2017/6/e231/ %U https://doi.org/10.2196/jmir.6931 %U http://www.ncbi.nlm.nih.gov/pubmed/28659253 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e172 %T Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer %A Hanlon,Peter %A Daines,Luke %A Campbell,Christine %A McKinstry,Brian %A Weller,David %A Pinnock,Hilary %+ Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 131 650 9474, hilary.pinnock@ed.ac.uk %K telehealth %K telemonitoring %K self-management %K chronic disease %K diabetes %K heart failure %K asthma %K COPD %K pulmonary disease, chronic obstructive %K cancer %D 2017 %7 17.05.2017 %9 Review %J J Med Internet Res %G English %X Background: Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. Objective: The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. Methods: We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. Results: We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma. Conclusions: While telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established. %M 28526671 %R 10.2196/jmir.6688 %U http://www.jmir.org/2017/5/e172/ %U https://doi.org/10.2196/jmir.6688 %U http://www.ncbi.nlm.nih.gov/pubmed/28526671 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e18 %T Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews %A Bashi,Nazli %A Karunanithi,Mohanraj %A Fatehi,Farhad %A Ding,Hang %A Walters,Darren %+ Australian eHealth Research Centre, CSIRO, Level 5 - UQ Health Sciences Building 901/16, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Brisbane,, Australia, 61 7 3253 3611, nazli.bashi@csiro.au %K systematic review %K patient monitoring %K mobile phone %K telemedicine %K heart failure %D 2017 %7 20.01.2017 %9 Review %J J Med Internet Res %G English %X Background: Many systematic reviews exist on the use of remote patient monitoring (RPM) interventions to improve clinical outcomes and psychological well-being of patients with heart failure. However, research is broadly distributed from simple telephone-based to complex technology-based interventions. The scope and focus of such evidence also vary widely, creating challenges for clinicians who seek information on the effect of RPM interventions. Objective: The aim of this study was to investigate the effects of RPM interventions on the health outcomes of patients with heart failure by synthesizing review-level evidence. Methods: We searched PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from 2005 to 2015. We screened reviews based on relevance to RPM interventions using criteria developed for this overview. Independent authors screened, selected, and extracted information from systematic reviews. AMSTAR (Assessment of Multiple Systematic Reviews) was used to assess the methodological quality of individual reviews. We used standardized language to summarize results across reviews and to provide final statements about intervention effectiveness. Results: A total of 19 systematic reviews met our inclusion criteria. Reviews consisted of RPM with diverse interventions such as telemonitoring, home telehealth, mobile phone–based monitoring, and videoconferencing. All-cause mortality and heart failure mortality were the most frequently reported outcomes, but others such as quality of life, rehospitalization, emergency department visits, and length of stay were also reported. Self-care and knowledge were less commonly identified. Conclusions: Telemonitoring and home telehealth appear generally effective in reducing heart failure rehospitalization and mortality. Other interventions, including the use of mobile phone–based monitoring and videoconferencing, require further investigation. %M 28108430 %R 10.2196/jmir.6571 %U http://www.jmir.org/2017/1/e18/ %U https://doi.org/10.2196/jmir.6571 %U http://www.ncbi.nlm.nih.gov/pubmed/28108430 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e198 %T Supporting Heart Failure Patient Transitions From Acute to Community Care With Home Telemonitoring Technology: A Protocol for a Provincial Randomized Controlled Trial (TEC4Home) %A , %+ C/o Kendall Ho, MD, FRCPC, Digital Emergency Medicine, Department of Emergency Medicine, University of British Columbia, 105-2194 Health Sciences Mall, Vancouver, BC, Canada, 1 604 822 8389, kendall.ho@ubc.ca %K heart failure %K telemedicine %K remote sensing technology %K emergency service, hospital %K hospitalization %K quality of life %D 2016 %7 18.12.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Seniors with chronic diseases such as heart failure have complex care needs. They are vulnerable to their condition deteriorating and, without timely intervention, may require multiple emergency department visits and/or repeated hospitalizations. Upon discharge, the transition from the emergency department to home can be a vulnerable time for recovering patients with disruptions in the continuity of care. Remote monitoring of heart failure patients using home telemonitoring, coupled with clear communication protocols between health care professionals, can be effective in increasing the safety and quality of care for seniors with heart failure discharged from the emergency department. Objective: The aim of the Telehealth for Emergency-Community Continuity of Care Connectivity via Home Telemonitoring (TEC4Home) study is to generate evidence through a programmatic evaluation and a clinical trial to determine how home telemonitoring may improve care and increase patient safety during the transition of care and determine how it is best implemented to support patients with heart failure within this context. Methods: This 4-year project consists of 3 studies to comprehensively evaluate the outcomes and effectiveness of TEC4Home. Study 1 is a feasibility study with 90 patients recruited from 2 emergency department sites to test implementation and evaluation procedures. Findings from the feasibility study will be used to refine protocols for the larger trial. Study 2 is a cluster randomized controlled trial that will include 30 emergency department sites and 900 patients across British Columbia. The primary outcome of the randomized controlled trial will be emergency department revisits and hospital readmission rates. Secondary outcomes include health care resource utilization/costs, communication between members of the care team, and patient quality of life. Study 3 will run concurrently to study 2 and test the effectiveness of predictive analytic software to detect patient deterioration sooner. Results: It is hypothesized that TEC4Home will be a cost-effective strategy to decrease 90-day emergency department revisits and hospital admission rates and improve comfort and quality of life for seniors with heart failure. The results from this project will also help establish an innovation pathway for rapid and rigorous introduction of innovation into the health system. Conclusions: While there is some evidence about the effectiveness of home telemonitoring for some patients and conditions, the TEC4Home project will be one of the first protocols that implements and evaluates the technology for patients with heart failure as they transition from the emergency department to home care. The results from this research are expected to inform the full scale and spread of the home monitoring approach throughout British Columbia and Canada and to other chronic diseases. ClinicalTrial: ClinicalTrials.gov NCT02821065; https://clinicaltrials.gov/ct2/show/NCT02821065 (Archived by WebCite at http://www.webcitation.org/6ml2iwKax) %M 27977002 %R 10.2196/resprot.5856 %U http://www.researchprotocols.org/2016/4/e198/ %U https://doi.org/10.2196/resprot.5856 %U http://www.ncbi.nlm.nih.gov/pubmed/27977002 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e74 %T Review and Analysis of Existing Mobile Phone Apps to Support Heart Failure Symptom Monitoring and Self-Care Management Using the Mobile Application Rating Scale (MARS) %A Masterson Creber,Ruth M %A Maurer,Mathew S %A Reading,Meghan %A Hiraldo,Grenny %A Hickey,Kathleen T %A Iribarren,Sarah %+ Columbia University, School of Nursing, 617 W 168th St, New York, NY, 10032, United States, 1 2123050391, rm3284@cumc.columbia.edu %K mobile apps %K mobile health %K heart failure %K self-care %K self-management %K review %K symptom assessment %K nursing informatics %D 2016 %7 14.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heart failure is the most common cause of hospital readmissions among Medicare beneficiaries and these hospitalizations are often driven by exacerbations in common heart failure symptoms. Patient collaboration with health care providers and decision making is a core component of increasing symptom monitoring and decreasing hospital use. Mobile phone apps offer a potentially cost-effective solution for symptom monitoring and self-care management at the point of need. Objective: The purpose of this review of commercially available apps was to identify and assess the functionalities of patient-facing mobile health apps targeted toward supporting heart failure symptom monitoring and self-care management. Methods: We searched 3 Web-based mobile app stores using multiple terms and combinations (eg, “heart failure,” “cardiology,” “heart failure and self-management”). Apps meeting inclusion criteria were evaluated using the Mobile Application Rating Scale (MARS), IMS Institute for Healthcare Informatics functionality scores, and Heart Failure Society of America (HFSA) guidelines for nonpharmacologic management. Apps were downloaded and assessed independently by 2-4 reviewers, interclass correlations between reviewers were calculated, and consensus was met by discussion. Results: Of 3636 potentially relevant apps searched, 34 met inclusion criteria. Most apps were excluded because they were unrelated to heart failure, not in English or Spanish, or were games. Interrater reliability between reviewers was high. AskMD app had the highest average MARS total (4.9/5). More than half of the apps (23/34, 68%) had acceptable MARS scores (>3.0). Heart Failure Health Storylines (4.6) and AskMD (4.5) had the highest scores for behavior change. Factoring MARS, functionality, and HFSA guideline scores, the highest performing apps included Heart Failure Health Storylines, Symple, ContinuousCare Health App, WebMD, and AskMD. Peer-reviewed publications were identified for only 3 of the 34 apps. Conclusions: This review suggests that few apps meet prespecified criteria for quality, content, or functionality, highlighting the need for further refinement and mapping to evidence-based guidelines and room for overall quality improvement in heart failure symptom monitoring and self-care related apps. %M 27302310 %R 10.2196/mhealth.5882 %U http://mhealth.jmir.org/2016/2/e74/ %U https://doi.org/10.2196/mhealth.5882 %U http://www.ncbi.nlm.nih.gov/pubmed/27302310 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e101 %T Heart Failure Remote Monitoring: Evidence From the Retrospective Evaluation of a Real-World Remote Monitoring Program %A Agboola,Stephen %A Jethwani,Kamal %A Khateeb,Kholoud %A Moore,Stephanie %A Kvedar,Joseph %+ Partners Healthcare Center for Connected Health, Connected Health Innovation, 25 New Chardon St., Suite 300, Boston, MA, 02128, United States, 1 617 643 0291, sagboola@mgh.harvard.edu %K heart failure %K telemonitoring %K remote monitoring %K self-management %K hospitalizations %K mortality %D 2015 %7 22.04.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the magnitude of increasing heart failure mortality, multidisciplinary approaches, in the form of disease management programs and other integrative models of care, are recommended to optimize treatment outcomes. Remote monitoring, either as structured telephone support or telemonitoring or a combination of both, is fast becoming an integral part of many disease management programs. However, studies reporting on the evaluation of real-world heart failure remote monitoring programs are scarce. Objective: This study aims to evaluate the effect of a heart failure telemonitoring program, Connected Cardiac Care Program (CCCP), on hospitalization and mortality in a retrospective database review of medical records of patients with heart failure receiving care at the Massachusetts General Hospital. Methods: Patients enrolled in the CCCP heart failure monitoring program at the Massachusetts General Hospital were matched 1:1 with usual care patients. Control patients received care from similar clinical settings as CCCP patients and were identified from a large clinical data registry. The primary endpoint was all-cause mortality and hospitalizations assessed during the 4-month program duration. Secondary outcomes included hospitalization and mortality rates (obtained by following up on patients over an additional 8 months after program completion for a total duration of 1 year), risk for multiple hospitalizations and length of stay. The Cox proportional hazard model, stratified on the matched pairs, was used to assess primary outcomes. Results: A total of 348 patients were included in the time-to-event analyses. The baseline rates of hospitalizations prior to program enrollment did not differ significantly by group. Compared with controls, hospitalization rates decreased within the first 30 days of program enrollment: hazard ratio (HR)=0.52, 95% CI 0.31-0.86, P=.01). The differential effect on hospitalization rates remained consistent until the end of the 4-month program (HR=0.74, 95% CI 0.54-1.02, P=.06). The program was also associated with lower mortality rates at the end of the 4-month program: relative risk (RR)=0.33, 95% 0.11-0.97, P=.04). Additional 8-months follow-up following program completion did not show residual beneficial effects of the CCCP program on mortality (HR=0.64, 95% 0.34-1.21, P=.17) or hospitalizations (HR=1.12, 95% 0.90-1.41, P=.31). Conclusions: CCCP was associated with significantly lower hospitalization rates up to 90 days and significantly lower mortality rates over 120 days of the program. However, these effects did not persist beyond the 120-day program duration. %M 25903278 %R 10.2196/jmir.4417 %U http://www.jmir.org/2015/4/e101/ %U https://doi.org/10.2196/jmir.4417 %U http://www.ncbi.nlm.nih.gov/pubmed/25903278 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e33 %T Patient Engagement With a Mobile Web-Based Telemonitoring System for Heart Failure Self-Management: A Pilot Study %A Zan,Shiyi %A Agboola,Stephen %A Moore,Stephanie A %A Parks,Kimberly A %A Kvedar,Joseph C %A Jethwani,Kamal %+ Center for Connected Health, Partners HealthCare, 25 New Chardon Street, Suite 300, Boston, MA, , United States, 1 617 724 3410, kjethwani@partners.org %K heart failure %K disease self-management %K remote monitoring %K telemonitoring %K interactive voice response system %K mobile health %K Web portal %K patient engagement %K quality of life %D 2015 %7 01.04.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Intensive remote monitoring programs for congestive heart failure have been successful in reducing costly readmissions, but may not be appropriate for all patients. There is an opportunity to leverage the increasing accessibility of mobile technologies and consumer-facing digital devices to empower patients in monitoring their own health outside of the hospital setting. The iGetBetter system, a secure Web- and telephone-based heart failure remote monitoring program, which leverages mobile technology and portable digital devices, offers a creative solution at lower cost. Objective: The objective of this pilot study was to evaluate the feasibility of using the iGetBetter system for disease self-management in patients with heart failure. Methods: This was a single-arm prospective study in which 21 ambulatory, adult heart failure patients used the intervention for heart failure self-management over a 90-day study period. Patients were instructed to take their weight, blood pressure, and heart rate measurements each morning using a WS-30 bluetooth weight scale, a self-inflating blood pressure cuff (Withings LLC, Issy les Moulineaux, France), and an iPad Mini tablet computer (Apple Inc, Cupertino, CA, USA) equipped with cellular Internet connectivity to view their measurements on the Internet. Outcomes assessed included usability and satisfaction, engagement with the intervention, hospital resource utilization, and heart failure-related quality of life. Descriptive statistics were used to summarize data, and matched controls identified from the electronic medical record were used as comparison for evaluating hospitalizations. Results: There were 20 participants (mean age 53 years) that completed the study. Almost all participants (19/20, 95%) reported feeling more connected to their health care team and more confident in performing care plan activities, and 18/20 (90%) felt better prepared to start discussions about their health with their doctor. Although heart failure-related quality of life improved from baseline, it was not statistically significant (P=.55). Over half of the participants had greater than 80% (72/90 days) weekly and overall engagement with the program, and 15% (3/20) used the interactive voice response telephone system exclusively for managing their care plan. Hospital utilization did not differ in the intervention group compared to the control group (planned hospitalizations P=.23, and unplanned hospitalizations P=.99). Intervention participants recorded shorter average length of hospital stay, but no significant differences were observed between intervention and control groups (P=.30). Conclusions: This pilot study demonstrated the feasibility of a low-intensive remote monitoring program leveraging commonly used mobile and portable consumer devices in augmenting care for a fairly young population of ambulatory patients with heart failure. Further prospective studies with a larger sample size and within more diverse patient populations is necessary to determine the effect of mobile-based remote monitoring programs such as the iGetBetter system on clinical outcomes in heart failure. %M 25842282 %R 10.2196/mhealth.3789 %U http://mhealth.jmir.org/2015/2/e33/ %U https://doi.org/10.2196/mhealth.3789 %U http://www.ncbi.nlm.nih.gov/pubmed/25842282 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e282 %T Use of Home Telemonitoring to Support Multidisciplinary Care of Heart Failure Patients in Finland: Randomized Controlled Trial %A Vuorinen,Anna-Leena %A Leppänen,Juha %A Kaijanranta,Hannu %A Kulju,Minna %A Heliö,Tiina %A van Gils,Mark %A Lähteenmäki,Jaakko %+ VTT Technical Research Centre of Finland, PO Box 1300, Tampere, FIN-33101, Finland, 358 40 848 5966, anna-leena.vuorinen@vtt.fi %K heart failure %K telemonitoring %K hospitalization %K user experience %K clinical outcomes %K EHFSBS %K health care resources %D 2014 %7 11.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Heart failure (HF) patients suffer from frequent and repeated hospitalizations, causing a substantial economic burden on society. Hospitalizations can be reduced considerably by better compliance with self-care. Home telemonitoring has the potential to boost patients’ compliance with self-care, although the results are still contradictory. Objective: A randomized controlled trial was conducted in order to study whether the multidisciplinary care of heart failure patients promoted with telemonitoring leads to decreased HF-related hospitalization. Methods: HF patients were eligible whose left ventricular ejection fraction was lower than 35%, NYHA functional class ≥2, and who needed regular follow-up. Patients in the telemonitoring group (n=47) measured their body weight, blood pressure, and pulse and answered symptom-related questions on a weekly basis, reporting their values to the heart failure nurse using a mobile phone app. The heart failure nurse followed the status of patients weekly and if necessary contacted the patient. The primary outcome was the number of HF-related hospital days. Control patients (n=47) received multidisciplinary treatment according to standard practices. Patients’ clinical status, use of health care resources, adherence, and user experience from the patients’ and the health care professionals’ perspective were studied. Results: Adherence, calculated as a proportion of weekly submitted self-measurements, was close to 90%. No difference was found in the number of HF-related hospital days (incidence rate ratio [IRR]=0.812, P=.351), which was the primary outcome. The intervention group used more health care resources: they paid an increased number of visits to the nurse (IRR=1.73, P<.001), spent more time at the nurse reception (mean difference of 48.7 minutes, P<.001), and there was a greater number of telephone contacts between the nurse and intervention patients (IRR=3.82, P<.001 for nurse-induced contacts and IRR=1.63, P=.049 for patient-induced contacts). There were no statistically significant differences in patients’ clinical health status or in their self-care behavior. The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study. Conclusions: Home telemonitoring did not reduce the number of patients’ HF-related hospital days and did not improve the patients’ clinical condition. Patients in the telemonitoring group contacted the Cardiology Outpatient Clinic more frequently, and on this way increased the use of health care resources. Trial Registration: Clinicaltrials.gov NCT01759368; http://clinicaltrials.gov/show/NCT01759368 (Archived by WebCite at http://www.webcitation.org/6UFxiCk8Z). %M 25498992 %R 10.2196/jmir.3651 %U http://www.jmir.org/2014/12/e282/ %U https://doi.org/10.2196/jmir.3651 %U http://www.ncbi.nlm.nih.gov/pubmed/25498992 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 2 %N 2 %P e27 %T Remote Monitoring for Implantable Defibrillators: A Nationwide Survey in Italy %A Luzi,Mario %A De Simone,Antonio %A Leoni,Loira %A Amellone,Claudia %A Pisanò,Ennio %A Favale,Stefano %A Iacoviello,Massimo %A Luise,Raffaele %A Bongiorni,Maria Grazia %A Stabile,Giuseppe %A La Rocca,Vincenzo %A Folino,Franco %A Capucci,Alessandro %A D'Onofrio,Antonio %A Accardi,Francesco %A Valsecchi,Sergio %A Buia,Gianfranco %+ Azienda Ospedaliero Universitaria Ospedali Riuniti, Cardiology Clinic, Via Conca, 71, Ancona, 60126, Italy, 39 338 7893860, marioluzi@virgilio.it %K implantable defibrillator %K remote monitoring %K follow-up %D 2013 %7 20.09.2013 %9 Original Paper %J Interact J Med Res %G English %X Background: Remote monitoring (RM) permits home interrogation of implantable cardioverter defibrillator (ICD) and provides an alternative option to frequent in-person visits. Objective: The Italia-RM survey aimed to investigate the current practice of ICD follow-up in Italy and to evaluate the adoption and routine use of RM. Methods: An ad hoc questionnaire on RM adoption and resource use during in-clinic and remote follow-up sessions was completed in 206 Italian implanting centers. Results: The frequency of routine in-clinic ICD visits was 2 per year in 158/206 (76.7%) centers, 3 per year in 37/206 (18.0%) centers, and 4 per year in 10/206 (4.9%) centers. Follow-up examinations were performed by a cardiologist in 203/206 (98.5%) centers, and by more than one health care worker in 184/206 (89.3%) centers. There were 137/206 (66.5%) responding centers that had already adopted an RM system, the proportion of ICD patients remotely monitored being 15% for single- and dual-chamber ICD and 20% for cardiac resynchronization therapy ICD. Remote ICD interrogations were scheduled every 3 months, and were performed by a cardiologist in 124/137 (90.5%) centers. After the adoption of RM, the mean time between in-clinic visits increased from 5 (SD 1) to 8 (SD 3) months (P<.001). Conclusions: In current clinical practice, in-clinic ICD follow-up visits consume a large amount of health care resources. The results of this survey show that RM has only partially been adopted in Italy and, although many centers have begun to implement RM in their clinical practice, the majority of their patients continue to be routinely followed-up by means of in-clinic visits. %M 24055720 %R 10.2196/ijmr.2824 %U http://www.i-jmr.org/2013/2/e27/ %U https://doi.org/10.2196/ijmr.2824 %U http://www.ncbi.nlm.nih.gov/pubmed/24055720 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 5 %P e106 %T Cost-Utility Analysis of the EVOLVO Study on Remote Monitoring for Heart Failure Patients With Implantable Defibrillators: Randomized Controlled Trial %A Zanaboni,Paolo %A Landolina,Maurizio %A Marzegalli,Maurizio %A Lunati,Maurizio %A Perego,Giovanni B %A Guenzati,Giuseppe %A Curnis,Antonio %A Valsecchi,Sergio %A Borghetti,Francesca %A Borghi,Gabriella %A Masella,Cristina %+ Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, PO Box 35, Tromsø, N-9038, Norway, 47 41409600, paolo.zanaboni@telemed.no %K telemedicine %K heart failure %K implantable defibrillators %K cost-effectiveness %D 2013 %7 30.05.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. Objective: We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators. Methods: Two hundred patients implanted with a wireless transmission–enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained. Results: Overall, remote monitoring did not show significant annual cost savings for the health care system (€1962.78 versus €2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (€291.36 versus €381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of €888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution. Conclusions: Remote management of heart failure patients with implantable defibrillators appears to be cost-effective compared to the conventional method of in-person evaluations. Trial Registration: ClinicalTrials.gov NCT00873899; http://clinicaltrials.gov/show/NCT00873899 (Archived by WebCite at http://www.webcitation.org/6H0BOA29f). %M 23722666 %R 10.2196/jmir.2587 %U http://www.jmir.org/2013/5/e106/ %U https://doi.org/10.2196/jmir.2587 %U http://www.ncbi.nlm.nih.gov/pubmed/23722666 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 1 %P e31 %T Mobile Phone-Based Telemonitoring for Heart Failure Management: A Randomized Controlled Trial %A Seto,Emily %A Leonard,Kevin J %A Cafazzo,Joseph A %A Barnsley,Jan %A Masino,Caterina %A Ross,Heather J %+ Centre for Global eHealth Innovation, University Health Network, TGH/RFE Bldg, 4th Fl., 190 Elizabeth St., Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 6409, emily.seto@uhn.on.ca %K heart failure %K telemedicine %K mobile phone %K patient monitoring %K randomized controlled trial %D 2012 %7 16.02.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous trials of telemonitoring for heart failure management have reported inconsistent results, largely due to diverse intervention and study designs. Mobile phones are becoming ubiquitous and economical, but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined. Objective: The objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes. Methods: One hundred patients were recruited from a heart function clinic and randomized into telemonitoring and control groups. The telemonitoring group (N = 50) took daily weight and blood pressure readings and weekly single-lead ECGs, and answered daily symptom questions on a mobile phone over 6 months. Readings were automatically transmitted wirelessly to the mobile phone and then to data servers. Instructions were sent to the patients’ mobile phones and alerts to a cardiologist’s mobile phone as required. Results: Baseline questionnaires were completed and returned by 94 patients, and 84 patients returned post-study questionnaires. About 70% of telemonitoring patients completed at least 80% of their possible daily readings. The change in quality of life from baseline to post-study, as measured with the Minnesota Living with Heart Failure Questionnaire, was significantly greater for the telemonitoring group compared to the control group (P = .05). A between-group analysis also found greater post-study self-care maintenance (measured with the Self-Care of Heart Failure Index) for the telemonitoring group (P = .03). Brain natriuretic peptide (BNP) levels, self-care management, and left ventricular ejection fraction (LVEF) improved significantly for both groups from baseline to post-study, but did not show a between-group difference. However, a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the telemonitoring group had significant improvements from baseline to post-study in BNP (decreased by 150 pg/mL, P = .02), LVEF (increased by 7.4%, P = .005) and self-care maintenance (increased by 7 points, P = .05) and management (increased by 14 points, P = .03), while the control group did not. No differences were found between the telemonitoring and control groups in terms of hospitalization, mortality, or emergency department visits, but the trial was underpowered to detect differences in these metrics. Conclusions: Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based telemonitoring system. The use of the mobile phone-based system had high adherence and was feasible for patients, including the elderly and those with no experience with mobile phones. Trial Registration: ClinicalTrials.gov NCT00778986 %M 22356799 %R 10.2196/jmir.1909 %U http://www.jmir.org/2012/1/e31/ %U https://doi.org/10.2196/jmir.1909 %U http://www.ncbi.nlm.nih.gov/pubmed/22356799 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 1 %P e25 %T Perceptions and Experiences of Heart Failure Patients and Clinicians on the Use of Mobile Phone-Based Telemonitoring %A Seto,Emily %A Leonard,Kevin J %A Cafazzo,Joseph A %A Barnsley,Jan %A Masino,Caterina %A Ross,Heather J %+ Centre for Global eHealth Innovation, University Health Network, TGH/RFE Bldg, 4th Fl., 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 6409, emily.seto@uhn.on.ca %K heart failure %K telemonitoring %K mobile phone %K patient monitoring %K self-care %K qualitative research %D 2012 %7 10.02.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs. Objectives: The objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring. Methods: Semi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based telemonitoring system for 6 months. The telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient’s mobile phone based on their physiological values. Alerts were also sent to a cardiologist’s mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach. Results: The telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients’ heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from telemonitoring. Some clinical concerns included ongoing costs of the telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system. Conclusions: The success of a telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing telemonitoring solutions. Key Words: %M 22328237 %R 10.2196/jmir.1912 %U http://www.jmir.org/2012/1/e25/ %U https://doi.org/10.2196/jmir.1912 %U http://www.ncbi.nlm.nih.gov/pubmed/22328237