%0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e58837 %T Pharmacist-Initiated Team-Based Intervention for Optimizing Guideline-Directed Lipid Therapy of Hospitalized Patients With Acute Coronary Syndrome: Pilot Study Using a Stepped-Wedge Cluster Design %A Flo,Gayle L %A Alzate Aguirre,Mateo %A Gochanour,Benjamin R %A Hynes,Kristin J %A Scott,Christopher G %A Fink,Angela L %A M Arruda-Olson,Adelaide %K coronary disease %K follow-up studies %K lipids %K myocardial infarction %K statins %D 2025 %7 28.3.2025 %9 %J JMIR Cardio %G English %X Background: Clinical guidelines recommend high-intensity statin therapy for patients with acute coronary syndrome (ACS). However, high-intensity statins have been underused in this population. Objective: The objective of this study was to evaluate the feasibility of a pharmacist-initiated, team-based intervention for the delivery of individualized, guideline-directed, lipid-lowering therapy for patients with ACS. Methods: Patients admitted with ACS to cardiology hospital services at Mayo Clinic from August 1, 2021, to June 19, 2022, were assigned to a pharmacist-initiated, team-based intervention group or control group using a stepped wedge cluster study design. For the intervention group, pharmacists reviewed electronic health records and provided recommendations for lipid lowering therapy in hospital and at follow-up. In the control group, patients received usual care. Neither care team, nor study team were blinded to study assignments. The primary outcome was the proportion of patients with ACS discharged on high-intensity statins in the intervention group compared to controls. Secondary outcomes were (1) proportion of patients in the intervention group with a specific templated pharmacist intervention note in their electronic health records, (2) frequency of low-density lipoprotein (LDL) measurements in hospital, (3) proportion of patients with information related to lipid follow-up in their discharge summary, and (4) proportion of patients that received LDL monitoring at the outpatient follow-up 4 to 12 weeks post discharge. Results: There were 410 patients included in this study (median age 68, IQR 60-78 years) of whom 285 (69.5%) were male. Of the 402 patients alive at discharge, 355 (88.3%) were discharged taking a high-intensity statin, with no significant difference (P=.89) observed between groups. Lipid levels were measured in the hospital for 176/210 (83.8%) patients in the intervention group and 155/200 (77.5%) patients in the control group (P=.14). Fifty-four of 205 (26.3%) intervention patients alive at discharge had lipid-related recommendations in their discharge summary compared to 27/197 (13.7%) controls (P=.002). Forty-seven of 81 (58%) patients with lipid management recommendations provided in the discharge summary had LDL measured in the follow-up period compared with only 119/321 (37.1%) patients without these recommendations (P=.001). Of the 402 patients who survived to discharge, 166 (41.3%) had LDL measured at follow-up; the median LDL level was 63.5 (IQR 49-79) mg/dL, and distributions were similar by group (P=.95). Only 101/166 (60.8%) patients had follow-up LDL values below the target of 70 mg/dL. Conclusions: During hospitalization, there was no group difference in the primary outcome of high-intensity statin therapy. Feasibility of an effective pharmacist-initiated intervention for improvement of lipid management was demonstrated by entry of recommendations in the discharge summary and related adjustment in outpatient statin therapy. The main opportunity for future improvement in lipid management of patients with ACS is in longitudinal patient follow-up. %R 10.2196/58837 %U https://cardio.jmir.org/2025/1/e58837 %U https://doi.org/10.2196/58837 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70247 %T Authors’ Reply: The SCeiP Model for Remote Rehabilitation in Homebound Patients With Coronary Heart Disease %A Zhang,Xinyue %+ Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China, 86 15005162289, 15005162289@163.com %K exercise rehabilitation %K coronary heart disease %K promotion strategy %K home rehabilitation %D 2025 %7 28.3.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 40152917 %R 10.2196/70247 %U https://www.jmir.org/2025/1/e70247 %U https://doi.org/10.2196/70247 %U http://www.ncbi.nlm.nih.gov/pubmed/40152917 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69927 %T The SCeiP Model for Remote Rehabilitation in Homebound Patients With Coronary Heart Disease %A Zhang,Siqi %A Chen,Tielong %+ Department of Cardiology, Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), 453 Stadium Road, Hangzhou, 310007, China, 86 13858064178, ctlktz@163.com %K remote exercise rehabilitation %K SCeiP model %K coronary heart disease %K promotion strategy %K home rehabilitation %D 2025 %7 28.3.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 40152916 %R 10.2196/69927 %U https://www.jmir.org/2025/1/e69927 %U https://doi.org/10.2196/69927 %U http://www.ncbi.nlm.nih.gov/pubmed/40152916 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53823 %T Exploring Heart Disease–Related mHealth Apps in India: Systematic Search in App Stores and Metadata Analysis %A Dubbala,Keerthi %A Prizak,Roshan %A Metzler,Ingrid %A Rubeis,Giovanni %+ Division of Biomedical and Public Health Ethics, Department of General Health Studies, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria, 43 6646194677, keerthi.dubbala@kl.ac.at %K mobile health apps %K mHealth apps %K heart disease %K data collection methods %K natural language processing %K metadata analysis %K Apple App Store %K Google Play Store %K mobile phone %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone mobile health (mHealth) apps have the potential to enhance access to health care services and address health care disparities, especially in low-resource settings. However, when developed without attention to equity and inclusivity, mHealth apps can also exacerbate health disparities. Understanding and creating solutions for the disparities caused by mHealth apps is crucial for achieving health equity. There is a noticeable gap in research that comprehensively assesses the entire spectrum of existing health apps and extensively explores apps for specific health priorities from a health care and public health perspective. In this context, with its vast and diverse population, India presents a unique context for studying the landscape of mHealth apps. Objective: This study aimed to create a comprehensive dataset of mHealth apps available in India with an initial focus on heart disease (HD)–related apps. Methods: We collected individual app data from apps in the “medical” and “health and fitness” categories from the Google Play Store and the Apple App Store in December 2022 and July 2023, respectively. Using natural language processing techniques, we selected HD apps, performed statistical analysis, and applied latent Dirichlet allocation for clustering and topic modeling to categorize the resulting HD apps. Results: We collected 118,555 health apps from the Apple App Store and 108,945 health apps from the Google Play Store. Within these datasets, we found that approximately 1.7% (1990/118,555) of apps on the Apple App Store and 0.5% (548/108,945) on the Google Play Store included support for Indian languages. Using monograms and bigrams related to HD, we identified 1681 HD apps from the Apple App Store and 588 HD apps from the Google Play Store. HD apps make up only a small fraction of the total number of health apps available in India. About 90% (1496/1681 on Apple App Store and 548/588 on Google Play Store) of the HD apps were free of cost. However, more than 70% (1329/1681, 79.1% on Apple App Store and 423/588, 71.9% on Google Play Store) of HD apps had no reviews and rating-scores, indicating low overall use. Conclusions: Our study proposed a robust method for collecting and analyzing metadata from a wide array of mHealth apps available in India through the Apple App Store and Google Play Store. We revealed the limited representation of India’s linguistic diversity within the health and medical app landscape, evident from the negligible presence of Indian-language apps. We observed a scarcity of mHealth apps dedicated to HD, along with a lower level of user engagement, as indicated by reviews and app ratings. While most HD apps are financially accessible, uptake remains a challenge. Further research should focus on app quality assessment and factors influencing user adoption. %M 40063078 %R 10.2196/53823 %U https://www.jmir.org/2025/1/e53823 %U https://doi.org/10.2196/53823 %U http://www.ncbi.nlm.nih.gov/pubmed/40063078 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68509 %T Machine Learning Models With Prognostic Implications for Predicting Gastrointestinal Bleeding After Coronary Artery Bypass Grafting and Guiding Personalized Medicine: Multicenter Cohort Study %A Dong,Jiale %A Jin,Zhechuan %A Li,Chengxiang %A Yang,Jian %A Jiang,Yi %A Li,Zeqian %A Chen,Cheng %A Zhang,Bo %A Ye,Zhaofei %A Hu,Yang %A Ma,Jianguo %A Li,Ping %A Li,Yulin %A Wang,Dongjin %A Ji,Zhili %+ Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlua, Chaoyang District, Beijing, 100020, China, 86 010 85231610, anzhenjzl@mail.ccmu.edu.cn %K machine learning %K personalized medicine %K coronary artery bypass grafting %K adverse outcome %K gastrointestinal bleeding %D 2025 %7 6.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Gastrointestinal bleeding is a serious adverse event of coronary artery bypass grafting and lacks tailored risk assessment tools for personalized prevention. Objective: This study aims to develop and validate predictive models to assess the risk of gastrointestinal bleeding after coronary artery bypass grafting (GIBCG) and to guide personalized prevention. Methods: Participants were recruited from 4 medical centers, including a prospective cohort and the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. From an initial cohort of 18,938 patients, 16,440 were included in the final analysis after applying the exclusion criteria. Thirty combinations of machine learning algorithms were compared, and the optimal model was selected based on integrated performance metrics, including the area under the receiver operating characteristic curve (AUROC) and the Brier score. This model was then developed into a web-based risk prediction calculator. The Shapley Additive Explanations method was used to provide both global and local explanations for the predictions. Results: The model was developed using data from 3 centers and a prospective cohort (n=13,399) and validated on the Drum Tower cohort (n=2745) and the MIMIC cohort (n=296). The optimal model, based on 15 easily accessible admission features, demonstrated an AUROC of 0.8482 (95% CI 0.8328-0.8618) in the derivation cohort. In external validation, the AUROC was 0.8513 (95% CI 0.8221-0.8782) for the Drum Tower cohort and 0.7811 (95% CI 0.7275-0.8343) for the MIMIC cohort. The analysis indicated that high-risk patients identified by the model had a significantly increased mortality risk (odds ratio 2.98, 95% CI 1.784-4.978; P<.001). For these high-risk populations, preoperative use of proton pump inhibitors was an independent protective factor against the occurrence of GIBCG. By contrast, dual antiplatelet therapy and oral anticoagulants were identified as independent risk factors. However, in low-risk populations, the use of proton pump inhibitors (χ21=0.13, P=.72), dual antiplatelet therapy (χ21=0.38, P=.54), and oral anticoagulants (χ21=0.15, P=.69) were not significantly associated with the occurrence of GIBCG. Conclusions: Our machine learning model accurately identified patients at high risk of GIBCG, who had a poor prognosis. This approach can aid in early risk stratification and personalized prevention. Trial Registration: Chinese Clinical Registry Center ChiCTR2400086050; http://www.chictr.org.cn/showproj.html?proj=226129 %M 40053791 %R 10.2196/68509 %U https://www.jmir.org/2025/1/e68509 %U https://doi.org/10.2196/68509 %U http://www.ncbi.nlm.nih.gov/pubmed/40053791 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56254 %T Daily Treatment Monitoring for Patients Receiving Home-Based Peritoneal Dialysis and Prediction of Heart Failure Risk: mHealth Tool Development and Modeling Study %A Wu,Jia %A Zeng,Youjia %A Yang,Jun %A Yao,Yutong %A Xu,Xiuling %A Song,Gaofeng %A Yi,Wuyong %A Wang,Taifen %A Zheng,Yihou %A Jia,Zhongwei %A Yan,Xiangyu %+ , School of Disaster and Emergency Medicine, Tianjin University, No 92 Weijin Road, Tianjin, 300072, China, 86 02287370177 ext 307, yanxiangyu1123@163.com %K peritoneal dialysis %K mHealth %K patient management %K heart failure %K prediction model %D 2025 %7 3.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Peritoneal dialysis is one of the major renal replacement modalities for patients with end-stage renal disease. Heart failure is a common adverse event among patients who undergo peritoneal dialysis treatment, especially for those who undergo continuous ambulatory peritoneal dialysis at home, because of the lack of professional input-output volume monitoring and management during treatment. Objective: This study aims to develop novel mobile health (mHealth) tools to improve the quality of home-based continuous ambulatory peritoneal dialysis treatment and to build a prediction model of heart failure based on the system’s daily treatment monitoring data. Methods: The mHealth tools with a 4-layer system were designed and developed using Spring Boot, MyBatis Plus, MySQL, and Redis as backend technology stack, and Vue, Element User Interface, and WeChat Mini Program as front-end technology stack. Patients were recruited to use the tool during daily peritoneal dialysis treatment from January 1, 2017, to April 20, 2023. Logistic regression models based on real-time treatment monitoring data were used for heart failure prediction. The sensitivity, specificity, accuracy, and Youden index were calculated to evaluate the performance of the prediction model. In the sensitivity analysis, the ratio of patients with and without heart failure was set to 1:4 and 1:10, respectively, to better evaluate the stability of the prediction model. Results: A WeChat Mini Program named Futou Bao for patients and a patient data management platform for doctors was developed. Futou Bao included an intelligent data upload function module and an auxiliary function module. The doctor’s data management platform consisted of 4 function modules, that is, patient management, data visualization and marking, data statistics, and system management. During the study period, the records of 6635 patients who received peritoneal dialysis treatment were uploaded in Futou Bao, with 0.71% (47/6635) of them experiencing heart failure. The prediction model that included sex, age, and diastolic blood pressure was considered as the optimal model, wherein the sensitivity, specificity, accuracy, and Youden index were 0.75, 0.91, 0.89, and 0.66, respectively, with an area under the curve value of 0.879 (95% CI 0.772-0.986) using the validation dataset. The sensitivity analysis showed stable results. Conclusions: This study provides a new home-based peritoneal dialysis management paradigm that enables the daily monitoring and early warning of heart failure risk. This novel paradigm is of great value for improving the efficiency, security, and personalization of peritoneal dialysis. %M 40053710 %R 10.2196/56254 %U https://formative.jmir.org/2025/1/e56254 %U https://doi.org/10.2196/56254 %U http://www.ncbi.nlm.nih.gov/pubmed/40053710 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66218 %T Establishing Syndromic Surveillance of Acute Coronary Syndrome, Myocardial Infarction, and Stroke: Registry Study Based on Routine Data From German Emergency Departments %A Schranz,Madlen %A Rupprecht,Mirjam %A Aigner,Annette %A Benning,Leo %A Schlump,Carmen %A Charfeddine,Nesrine %A Diercke,Michaela %A Grabenhenrich,Linus %A Ullrich,Alexander %A Neuhauser,Hannelore %A Maier,Birga %A , %A Hans,Felix Patricius %A Blaschke,Sabine %K emergency medicine %K routinely collected health data %K public health surveillance %K syndromic surveillance %K acute coronary syndrome %K myocardial infarction %K stroke %K routine data %K Germany %K emergency department %K accuracy %K syndrome %K diagnosis %K public health %K health surveillance %D 2025 %7 25.2.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Emergency department (ED) routine data offer a unique opportunity for syndromic surveillance of communicable and noncommunicable diseases (NCDs). In 2020, the Robert Koch Institute established a syndromic surveillance system using ED data from the AKTIN registry. The system provides daily insights into ED utilization for infectious diseases. Adding NCD indicators to the surveillance is of great public health importance, especially during acute events, where timely monitoring enables targeted public health responses and communication. Objective: This study aimed to develop and validate syndrome definitions for the NCD indicators of acute coronary syndrome (ACS), myocardial infarction (MI), and stroke (STR). Methods: First, syndrome definitions were developed with clinical experts combining ED diagnosis, chief complaints, diagnostic certainty, and discharge information. Then, using the multicenter retrospective routine ED data provided by the AKTIN registry, we conducted internal validation by linking ED cases fulfilling the syndrome definition with the hospital discharge diagnoses and calculating sensitivity, specificity, and accuracy. Lastly, external validation comprised the comparison of the ED cases fulfilling the syndrome definition with the federal German hospital diagnosis statistic. Ratios comparing the relative number of cases for all syndrome definitions were calculated and stratified by age and sex. Results: We analyzed data from 9 EDs, totaling 704,797 attendances from January 1, 2019, to March 5, 2021. Syndrome definitions were based on ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision-German Modification) diagnoses, chief complaints, and discharge information. We identified 4.3% of all cases as ACS, 0.6% as MI, and 3.2% as STR. Patients with ACS and MI were more likely to be male (58.3% and 64.7%), compared to the overall attendances (52.7%). For all syndrome definitions, the prevalence was higher in the older age groups (60‐79 years and >80 years), and the highest proportions of cases were assigned an urgency level (3=urgent or 2=very urgent). The internal validation showed accuracy and specificity levels above 96% for all syndrome definitions. The sensitivity was 85.3% for ACS, 56.6% for MI, and 80.5% for STR. The external validation showed high levels of correspondence between the ED data and the German hospital statistics, with most ratios ranging around 1, indicating congruence, particularly in older age groups. The highest differences were noted in younger age groups, with the highest ratios in women aged between 20 and 39 years (4.57 for MI and 4.17 for ACS). Conclusions: We developed NCD indicators for ACS, MI, and STR that showed high levels of internal and external validity. The integration of these indicators into the syndromic surveillance system for EDs could enable daily monitoring of NCD patterns and trends to enhance timely public health surveillance in Germany. %R 10.2196/66218 %U https://publichealth.jmir.org/2025/1/e66218 %U https://doi.org/10.2196/66218 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e59380 %T Predicting Atrial Fibrillation Relapse Using Bayesian Networks: Explainable AI Approach %A Alves,João Miguel %A Matos,Daniel %A Martins,Tiago %A Cavaco,Diogo %A Carmo,Pedro %A Galvão,Pedro %A Costa,Francisco Moscoso %A Morgado,Francisco %A Ferreira,António Miguel %A Freitas,Pedro %A Dias,Cláudia Camila %A Rodrigues,Pedro Pereira %A Adragão,Pedro %K artificial intelligence %K atrial fibrillation %K Bayesian networks %K clinical decision-making %K machine learning %K prognostic models %D 2025 %7 11.2.2025 %9 %J JMIR Cardio %G English %X Background: Atrial fibrillation (AF) is a prevalent arrhythmia associated with significant morbidity and mortality. Despite advancements in ablation techniques, predicting recurrence of AF remains a challenge, necessitating reliable models to identify patients at risk of relapse. Traditional scoring systems often lack applicability in diverse clinical settings and may not incorporate the latest evidence-based factors influencing AF outcomes. This study aims to develop an explainable artificial intelligence model using Bayesian networks to predict AF relapse postablation, leveraging on easily obtainable clinical variables. Objective: This study aims to investigate the effectiveness of Bayesian networks as a predictive tool for AF relapse following a percutaneous pulmonary vein isolation (PVI) procedure. The objectives include evaluating the model’s performance using various clinical predictors, assessing its adaptability to incorporate new risk factors, and determining its potential to enhance clinical decision-making in the management of AF. Methods: This study analyzed data from 480 patients with symptomatic drug-refractory AF who underwent percutaneous PVI. To predict AF relapse following the procedure, an explainable artificial intelligence model based on Bayesian networks was developed. The model used a variable number of clinical predictors, including age, sex, smoking status, preablation AF type, left atrial volume, epicardial fat, obstructive sleep apnea, and BMI. The predictive performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC-ROC) metrics across different configurations of predictors (5, 6, and 7 variables). Validation was conducted through four distinct sampling techniques to ensure robustness and reliability of the predictions. Results: The Bayesian network model demonstrated promising predictive performance for AF relapse. Using 5 predictors (age, sex, smoking, preablation AF type, and obstructive sleep apnea), the model achieved an AUC-ROC of 0.661 (95% CI 0.603‐0.718). Incorporating additional predictors improved performance, with a 6-predictor model (adding BMI) achieving an AUC-ROC of 0.703 (95% CI 0.652‐0.753) and a 7-predictor model (adding left atrial volume and epicardial fat) achieving an AUC-ROC of 0.752 (95% CI 0.701‐0.800). These results indicate that the model can effectively estimate the risk of AF relapse using readily available clinical variables. Notably, the model maintained acceptable diagnostic accuracy even in scenarios where some predictive features were missing, highlighting its adaptability and potential use in real-world clinical settings. Conclusions: The developed Bayesian network model provides a reliable and interpretable tool for predicting AF relapse in patients undergoing percutaneous PVI. By using easily accessible clinical variables, presenting acceptable diagnostic accuracy, and showing adaptability to incorporate new medical knowledge over time, the model demonstrates a flexibility and robustness that makes it suitable for real-world clinical scenarios. %R 10.2196/59380 %U https://cardio.jmir.org/2025/1/e59380 %U https://doi.org/10.2196/59380 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66179 %T Prevalence and Economic Impact of Acute Respiratory Failure in the Prehospital Emergency Medical Service of the Madrid Community: Retrospective Cohort Study %A Cintora-Sanz,Ana María %A Horrillo-García,Cristina %A Quesada-Cubo,Víctor %A Pérez-Alonso,Ana María %A Gutiérrez-Misis,Alicia %K acute respiratory failure %K COVID-19 %K chronic obstructive respiratory insufficiency %K congestive heart failure %K bronchospasm %K emergency medical services costs %K ambulances %K SARS-CoV-2 %K coronavirus %K respiratory %K pulmonary %K pandemic %K economic impact %K observational %K Madrid %K community %K medical records %K health records %K medical advanced life support %K ALS %K acute pulmonary edema %K chronic obstructive pulmonary disease %K COPD %K prevalence %D 2025 %7 16.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and acute pulmonary edema (APE) are serious illnesses that often require acute care from prehospital emergency medical services (EMSs). These respiratory diseases that cause acute respiratory failure (ARF) are one of the main reasons for hospitalization and death, generating high health care costs. The prevalence of the main respiratory diseases treated in a prehospital environment in the prepandemic period and during the COVID-19 pandemic in Spain is unknown. The Madrid Community EMS is a public service that serves all types of populations and represents an epidemiological reference for supporting a population of 6.4 million inhabitants. The high volume of patients treated by Madrid’s medical advanced life supports (ALSs) allows us to analyze this little-studied problem. Objectives: Our goal was to lay the groundwork for comprehensive data collection and surveillance of respiratory failure, with an emphasis on the most prevalent diseases that cause it, an aspect that has been largely overlooked in previous initiatives. By achieving these objectives, we hope to inform efforts to address respiratory failure and establish a standardized methodology and framework that can facilitate expansion to a continuous community-wide registry in Madrid, driving advances in emergency care and care practices in these pathologies. The aim of this retrospective observational study was to determine the pathologies that have mainly caused respiratory failure in patients and required medicalized ALS and to evaluate the cost of care for these pathologies collected through this pilot registry. Methods: A multicenter descriptive study was carried out in the Madrid Community EMS. The anonymized medical records of patients treated with medical ALS, who received any of the following medical diagnoses, were extracted: ARF not related to chronic respiratory disease, ARF in chronic respiratory failure, exacerbations of COPD, APE, CHF, and bronchospasm (not from asthma or COPD). The prevalence of each pathology, its evolution from 2014 to 2020, and the economic impact of the Medical ALSs were calculated. Results: The study included 96,221 patients. The most common pathology was exacerbation of COPD, with a prevalence of 0.07% in 2014; it decreased to 0.03% in 2020. CHF followed at 0.06% in 2014 and 0.03% in 2020. APE had a prevalence of 0.01% in 2014, decreasing to 0.005% in 2020 with the pandemic. The greatest economic impact was on exacerbation of COPD in 2015, with an annual cost of €2,726,893 (which equals to US $2,864,628). Conclusions: COPD exacerbations had the higher prevalence in the Madrid region among the respiratory diseases studied. With the COVID-19 pandemic, the prevalence and costs of almost all these diseases decreased, except for ARF not related to chronic disease. The cost of these pathologies over 5 years was €58,791,031 (US $61,832,879). %R 10.2196/66179 %U https://publichealth.jmir.org/2025/1/e66179 %U https://doi.org/10.2196/66179 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64374 %T Development and Validation of a Predictive Model Based on Serum Silent Information Regulator 6 Levels in Chinese Older Adult Patients: Cross-Sectional Descriptive Study %A You,Yuzi %A Liang,Wei %A Zhao,Yajie %K aging %K coronary artery disease %K nomogram %K SIRT6 %K TyG index %K silent information regulator 6 %K triglyceride glucose index %D 2025 %7 15.1.2025 %9 %J JMIR Aging %G English %X Background: Serum levels of silent information regulator 6 (SIRT6), a key biomarker of aging, were identified as a predictor of coronary artery disease (CAD), but whether SIRT6 can distinguish severity of coronary artery lesions in older adult patients is unknown. Objectives: This study developed a nomogram to demonstrate the functionality of SIRT6 in assessing severity of coronary artery atherosclerosis. Methods: Patients aged 60 years and older with angina pectoris were screened for this single-center clinical study between October 1, 2022, and March 31, 2023. Serum specimens of eligible patients were collected for SIRT6 detection by enzyme-linked immunosorbent assay. Clinical data and putative predictors, including 29 physiological characteristics, biochemical parameters, carotid artery ultrasonographic results, and complete coronary angiography findings, were evaluated, with CAD diagnosis as the primary outcome. The nomogram was derived from the Extreme Gradient Boosting (XGBoost) model, with logistic regression for variable selection. Model performance was assessed by examining discrimination, calibration, and clinical use separately. A 10-fold cross-validation technique was used to compare all models. The models’ performance was further evaluated on the internal validation set to ensure that the obtained results were not due to overoptimization. Results: Eligible patients (n=222) were divided into 2 cohorts: the development cohort (n=178) and the validation cohort (n=44). Serum SIRT6 levels were identified as both an independent risk factor and a predictor for CAD in older adults. The area under the receiver operating characteristic curve (AUROC) was 0.725 (95% CI 0.653‐0.797). The optimal cutoff value of SIRT6 for predicting CAD was 546.384 pg/mL. Predictors included in this nomogram were serum SIRT6 levels, triglyceride glucose (TyG) index, and apolipoprotein B. The model achieved an AUROC of 0.956 (95% CI 0.928‐0.983) in the development cohort. Similarly, in the internal validation cohort, the AUROC was 0.913 (95% CI 0.828‐0.999). All models demonstrated satisfactory calibration, with predicted outcomes closely aligning with actual results. Conclusions: SIRT6 shows promise in predicting CAD, with enhanced predictive abilities when combined with the TyG index. In clinical settings, monitoring fluctuations in SIRT6 and TyG may offer valuable insights for early CAD detection. The nomogram for CAD outcome prediction in older adult patients with angina pectoris may aid in clinical trial design and personalized clinical decision-making, particularly in institutions where SIRT6 is being explored as a biomarker for aging or cardiovascular health. %R 10.2196/64374 %U https://aging.jmir.org/2025/1/e64374 %U https://doi.org/10.2196/64374 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e55958 %T The Role of Clinician-Developed Applications in Promoting Adherence to Evidence-Based Guidelines: Pilot Study %A Prakash,Madhu Prita %A Thiagalingam,Aravinda %K computerized clinical decision support systems %K acute coronary syndrome %K clinical guidelines %K chest pain pathway %K decision support %K coronary %K heart %K cardiac %K cardiology %K chest %K pain %K web-based %K app %K applications %K computerized %K guideline %K emergency %K usability %D 2024 %7 31.12.2024 %9 %J JMIR Cardio %G English %X Background: Computerized clinical decision support systems (CDSS) are increasingly being used in clinical practice to improve health care delivery. Mobile apps are a type of CDSS that are currently being increasingly used, particularly in lifestyle interventions and disease prevention. However, the use of such apps in acute patient care, diagnosis, and management has not been studied to a great extent. The Pathway for Acute Coronary Syndrome Assessment (PACSA) is a set of guidelines developed to standardize the management of suspected acute coronary syndrome across emergency departments in New South Wales, Australia. These guidelines, which risk stratify patients and provide an appropriate management plan, are currently available as PDF documents or physical paper-based PACSA documents. The routine use of these documents and their acceptability among clinicians is uncertain. Presenting the PACSA guidelines on a mobile app in a sequential format may be a more acceptable alternative to the current paper-based PACSA documents. Objective: This study aimed to assess the utility and acceptability of a clinician-developed app modeling the PACSA guidelines as an alternative to the existing paper-based PACSA documents in assessing chest pain presentations to the emergency department. Methods: An app modeling the PACSA guidelines was created using the Research Electronic Data Capture (REDCap) platform by a cardiologist, with a total development time of <3 hours. The app utilizes a sequential design, requiring participants to input patient data in a step-wise fashion to reach the final patient risk stratification. Emergency department doctors were asked to use the app and apply it to two hypothetical patient scenarios. Participants then completed a survey to assess if the PACSA app offered any advantages over the current paper-based PACSA documents Results: Participants (n=31) ranged from junior doctors to senior physicians. Current clinician adherence to the paper-based PACSA documents was low with 55% (N=17) never using it in their daily practice. Totally, 42% of participants found the PACSA app easier to use compared to the paper-based PACSA documents and 58% reported that the PACSA app was also faster to use. The perceived usefulness of the PACSA app was similar to the perceived usefulness of the paper-based PACSA documents. Conclusions: The PACSA app offers a more efficient and user-friendly alternative to the current paper-based PACSA documents and may promote clinician adherence to evidence-based guidelines. Additional studies with a larger number of participants are required to assess the transferability of the PACSA app to everyday practice. Furthermore, apps are relatively easy to develop using existing online platforms, with the scope for clinicians to develop such apps for other evidence-based guidelines and across different specialties. %R 10.2196/55958 %U https://cardio.jmir.org/2024/1/e55958 %U https://doi.org/10.2196/55958 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57641 %T Accuracy of Machine Learning in Discriminating Kawasaki Disease and Other Febrile Illnesses: Systematic Review and Meta-Analysis %A Zhu,Jinpu %A Yang,Fushuang %A Wang,Yang %A Wang,Zhongtian %A Xiao,Yao %A Wang,Lie %A Sun,Liping %+ Center of Children's Clinic, The Affiliated Hospital to Changchun University of Chinese Medicine, No. 185, Shenzhen Street, Economic and Technological Development Zone, Jilin, P.R.C., Changchun, 130022, China, 86 15948000551, slpcczyydx@sina.com %K machine learning %K artificial intelligence %K Kawasaki disease %K febrile illness %K coronary artery lesions %K systematic review %K meta-analysis %D 2024 %7 18.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Kawasaki disease (KD) is an acute pediatric vasculitis that can lead to coronary artery aneurysms and severe cardiovascular complications, often presenting with obvious fever in the early stages. In current clinical practice, distinguishing KD from other febrile illnesses remains a significant challenge. In recent years, some researchers have explored the potential of machine learning (ML) methods for the differential diagnosis of KD versus other febrile illnesses, as well as for predicting coronary artery lesions (CALs) in people with KD. However, there is still a lack of systematic evidence to validate their effectiveness. Therefore, we have conducted the first systematic review and meta-analysis to evaluate the accuracy of ML in differentiating KD from other febrile illnesses and in predicting CALs in people with KD, so as to provide evidence-based support for the application of ML in the diagnosis and treatment of KD. Objective: This study aimed to summarize the accuracy of ML in differentiating KD from other febrile illnesses and predicting CALs in people with KD. Methods: PubMed, Cochrane Library, Embase, and Web of Science were systematically searched until September 26, 2023. The risk of bias in the included original studies was appraised using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Stata (version 15.0; StataCorp) was used for the statistical analysis. Results: A total of 29 studies were incorporated. Of them, 20 used ML to differentiate KD from other febrile illnesses. These studies involved a total of 103,882 participants, including 12,541 people with KD. In the validation set, the pooled concordance index, sensitivity, and specificity were 0.898 (95% CI 0.874-0.922), 0.91 (95% CI 0.83-0.95), and 0.86 (95% CI 0.80-0.90), respectively. Meanwhile, 9 studies used ML for early prediction of the risk of CALs in children with KD. These studies involved a total of 6503 people with KD, of whom 986 had CALs. The pooled concordance index in the validation set was 0.787 (95% CI 0.738-0.835). Conclusions: The diagnostic and predictive factors used in the studies we included were primarily derived from common clinical data. The ML models constructed based on these clinical data demonstrated promising effectiveness in differentiating KD from other febrile illnesses and in predicting coronary artery lesions. Therefore, in future research, we can explore the use of ML methods to identify more efficient predictors and develop tools that can be applied on a broader scale for the differentiation of KD and the prediction of CALs. %M 39556821 %R 10.2196/57641 %U https://www.jmir.org/2024/1/e57641 %U https://doi.org/10.2196/57641 %U http://www.ncbi.nlm.nih.gov/pubmed/39556821 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55137 %T Leveraging Implementation Science at the Early-Stage Development of a Novel Telehealth-Delivered Fear of Exercise Program to Understand Intervention Feasibility and Implementation Potential: Feasibility Behavioral Intervention Study %A Duran,Andrea T %A Cumella,Robin M %A Mendieta,Miguel %A Keener-Denoia,Adrianna %A López Veneros,David %A Farris,Samantha G %A Moise,Nathalie %A Kronish,Ian M %+ Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, United States, 1 212 342 4491, atd2127@cumc.columbia.edu %K behavioral intervention development %K implementation science %K acute coronary syndrome %K exercise sensitivity %K interoceptive exposure %K digital health %K mobile phone %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To increase real-world adoption of effective telehealth-delivered behavioral health interventions among midlife and older adults with cardiovascular disease, incorporating implementation science (IS) methods at earlier stages of intervention development may be needed. Objective: This study aims to describe how IS can be incorporated into the design and interpretation of a study assessing the feasibility and implementation potential of a technology-delivered behavioral health intervention. Methods: We assessed the feasibility and implementation potential of a 2-session, remotely delivered, home-based behavioral intervention composed of psychoeducation, interoceptive exposure through low-to-moderate intensity walking, interoceptive counseling, and homework (Reducing Exercise Sensitivity with Exposure Training; RESET) among patients with recent acute coronary syndrome (ACS) and some fear of exercise. To assess intervention feasibility, we measured patient protocol adherence, intervention delivery fidelity, and completion of intervention outcome assessments using direct observations, fidelity checklists, surveys, and device-measured physical activity. To assess implementation potential, we measured implementation outcomes (feasibility, acceptability, and appropriateness) using 4-item measures, each rated from the patient perspective on a 1 to 5 Likert scale (1=completely disagree and 5=completely agree; criteria: ≥4=agree or completely agree), and patient-perceived implementation determinants and design feedback using survey and interview data. Interview data underwent thematic analysis to identify implementation determinant themes, which were then categorized into Consolidated Framework for Implementation Research (CFIR) domains and constructs. Results: Of 31 patients approached during recruitment, 3 (10%) were eligible, enrolled, and completed the study (mean age 46.3, SD 14.0 y; 2/3, 67% male; 1/3, 33% Black; and 1/3, 33% Asian). The intervention was delivered with fidelity for all participants, and all participants completed the entire intervention protocol and outcome assessments. On average, participants agreed that the RESET intervention was feasible and acceptable, while appropriateness ratings did not meet implementation criteria (feasibility: mean 4.2, SD 0.4; acceptability: mean 4.3, SD 0.7; and appropriateness: mean 3.7, SD 0.4). Key patient-perceived implementation determinants were related to constructs in the innovation (design, adaptability, and complexity), inner setting (available resources [physical space, funding, materials, and equipment] and access to knowledge and information), and innovation recipient characteristics (motivation, capability, opportunity, and need) domains of the CFIR, with key barriers related to innovation design. Design feedback indicated that the areas requiring the most revisions were the interoceptive exposure design and the virtual delivery modality, and reasons why included low dose and poor usability. Conclusions: The RESET intervention was feasible but not implementable in a small sample of patients with ACS. Our theory-informed, mixed methods approach aided our understanding of what, how, and why RESET was not perceived as implementable; this information will guide intervention refinement. This study demonstrated how integrating IS methods early in intervention development can guide decisions regarding readiness to advance interventions along the translational research pipeline. %M 39531636 %R 10.2196/55137 %U https://formative.jmir.org/2024/1/e55137 %U https://doi.org/10.2196/55137 %U http://www.ncbi.nlm.nih.gov/pubmed/39531636 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e54746 %T Comparison of Auscultation Quality Using Contemporary Digital Stethoscopes %A Saraya,Norah %A McBride,Jonathon %A Singh,Karandeep %A Sohail,Omar %A Das,Porag Jeet %+ Department of Learning Health Sciences, University of Michigan, North Ingalls Building, 300 N Ingalls St, Ann Arbor, MI, 48109, United States, 1 734 936 1649, karandeep@health.ucsd.edu %K auscultation %K digital stethoscopes %K valvular heart disease %D 2024 %7 8.11.2024 %9 Research Letter %J JMIR Cardio %G English %X %M 39514245 %R 10.2196/54746 %U https://cardio.jmir.org/2024/1/e54746 %U https://doi.org/10.2196/54746 %U http://www.ncbi.nlm.nih.gov/pubmed/39514245 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56552 %T The Effectiveness of Remote Exercise Rehabilitation Based on the “SCeiP” Model in Homebound Patients With Coronary Heart Disease: Randomized Controlled Trial %A Xu,Dandan %A Xu,Dongmei %A Wei,Lan %A Bao,Zhipeng %A Liao,Shengen %A Zhang,Xinyue %+ Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China, 86 15005162289, 15005162289@163.com %K coronary heart disease %K exercise rehabilitation %K promotion strategy %K home rehabilitation %D 2024 %7 5.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: While exercise rehabilitation is recognized as safe and effective, medium- to long-term compliance among patients with coronary heart disease (CHD) remains low. Therefore, promoting long-term adherence to exercise rehabilitation for these patients warrants significant attention. Objective: This study aims to investigate the impact of remote exercise rehabilitation on time investment and related cognitive levels in homebound patients with CHD. This study utilizes the SCeiP (Self-Evaluation/Condition of Exercise-Effect Perception-Internal Drive-Persistence Behavior) model, alongside WeChat and exercise bracelets. Methods: A total of 147 patients who underwent percutaneous coronary intervention in the cardiovascular department of a grade III hospital in Jiangsu Province from June 2022 to March 2023 were selected as study participants through convenience sampling. The patients were randomly divided into an experimental group and a control group. The experimental group received an exercise rehabilitation promotion strategy based on the “SCeiP” model through WeChat and exercise bracelets, while the control group followed rehabilitation training according to a standard exercise rehabilitation guide. The days and duration of exercise, levels of cardiac rehabilitation cognition, exercise planning, and exercise input were analyzed before the intervention and at 1 month and 3 months after the intervention. Results: A total of 81 men (55.1%) and 66 women (44.9%) were recruited for the study. The completion rate of exercise days was significantly higher in the experimental group compared with the control group at both 1 month (t145=5.429, P<.001) and 3 months (t145=9.113, P<.001) after the intervention. Similarly, the completion rate of exercise duration was significantly greater in the experimental group (t145=3.471, P=.001) than in the control group (t145=5.574, P<.001). The levels of autonomy, exercise planning, and exercise input in the experimental group were significantly higher than those in the control group at both 1 month and 3 months after the intervention (P<.001). Additionally, the experimental group exhibited a significant reduction in both process anxiety and outcome anxiety scores (P<.001). Repeated measures ANOVA revealed significant differences in the trends of cognitive function related to cardiac rehabilitation between the 2 patient groups over time: autonomy, F1,145(time×group)=9.055 (P<.001); process anxiety, F1,145(time×group)=30.790 (P<.001); and outcome anxiety, F1,145(time×group)=28.186 (P<.001). As expected, the scores for exercise planning (t145=2.490, P=.01 and t145=3.379, P<.001, respectively) and exercise input (t145=2.255, P=.03 and t145=3.817, P<.001, respectively) consistently demonstrated superiority in the experimental group compared with the control group at both 1 and 3 months after the intervention. Interestingly, we observed that the levels of exercise planning and exercise input in both groups initially increased and then slightly decreased over time, although both remained higher than the preintervention levels (P<.001). Conclusions: The remote health intervention based on the “SCeiP” model effectively enhances exercise compliance, exercise planning, exercise input, and cognitive levels during cardiac rehabilitation in patients with CHD. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300069463; https://www.chictr.org.cn/showproj.html?proj=192461 %M 39499548 %R 10.2196/56552 %U https://www.jmir.org/2024/1/e56552 %U https://doi.org/10.2196/56552 %U http://www.ncbi.nlm.nih.gov/pubmed/39499548 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56480 %T A Behavioral Change–Based Mobile Intervention for Promoting Regular Physical Activity in Medical Rehabilitation Maintenance of Patients With Coronary Artery Disease: Controlled Trial %A Waranski,Melina %A Garbsch,René %A Kotewitsch,Mona %A Teschler,Marc %A Schmitz,Boris %A Mooren,Frank C %+ Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany, 49 23339888156, boris.schmitz@uni-wh.de %K rehabilitation %K eHealth %K mobile health %K mHealth %K telemedicine %K cardiovascular disease %K behavioral change %K mobile phone %D 2024 %7 8.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiac rehabilitation is known to reduce coronary artery disease (CAD) severity and symptoms, but adoption of a healthy postrehabilitation lifestyle remains challenging. Innovative eHealth solutions could help, but behavioral change–based eHealth maintenance programs for patients with CAD are scarce. RehaPlus+ aims to improve postrehabilitation outcomes with a personalized eHealth intervention built on behavioral change concepts emphasizing healthy lifestyle changes, especially regular physical activity (PA). Objective: This study aims to evaluate the effectiveness of the personalized eHealth program RehaPlus+ for promoting regular PA against usual care. Methods: A total of 169 patients with CAD who had undergone stent implantation or bypass surgery were recruited after completing center-based phase II rehabilitation. They were then divided, without blinding, into 2 groups using a quasi-experimental approach: a case manager–assisted 24-week eHealth program (RehaPlus+; n=84) and a conventional physician-assisted outpatient program (usual care; n=85). The study was designed as a noninferiority trial. RehaPlus+ participants received motivational messages twice weekly for 6 months, and the usual care group engaged in a 6-month outpatient program (twenty-four 90-minute strength and endurance training sessions). The primary outcomes, evaluated using the self-assessed Bewegungs- und Sportaktivität questionnaire, were regular PA (≥150 min/wk) and weekly activities of daily living (ADLs) 6 months after rehabilitation. Secondary outcomes involved PA during work and floors climbed weekly (measured by Bewegungs- und Sportaktivität questionnaire), psychological well-being (assessed by the 5-item World Health Organization Well-Being Index), cardiac self-efficacy, health-related quality of life (measured by the 36-Item Short Form Survey), and work ability (using the Work Ability Index). Results: Data of 105 patients (RehaPlus+: n=44, 41.9%; usual care: n=61, 58.1%; male patients: n=80, 76.2%; female patients: n=25, 23.8%; mean age 56.0, SD 7.3 years) were available at the 6-month follow-up. At 6 months after discharge from phase II cardiac rehabilitation, the RehaPlus+ group exhibited 182 (SD 208) minutes per week of PA and the usual care group exhibited 119 (SD 175) minutes per week of PA (P=.15), with no interaction effect (P=.12). The RehaPlus+ group showed an ADL level of 443 (SD 538) minutes per week compared to the usual care group with 308 (SD 412) minutes per week at the 6-month follow-up, with no interaction effect (P=.84). The differences observed in PA and ADL levels between the RehaPlus+ and usual care groups were within the predefined 1-sided noninferiority margin, indicating that the RehaPlus+ intervention is not inferior to usual care based on these outcomes. There were no differences between the groups for all secondary outcomes (P>.05). Conclusions: RehaPlus+ is not inferior to the usual care program, as both groups improved PA and ADLs to a similar extent. These findings emphasize the potential of eHealth interventions to assist in maintaining healthy lifestyles after rehabilitation. Trial Registration: ClinicalTrials.gov NCT06162793; https://clinicaltrials.gov/study/NCT06162793 %M 39378432 %R 10.2196/56480 %U https://www.jmir.org/2024/1/e56480 %U https://doi.org/10.2196/56480 %U http://www.ncbi.nlm.nih.gov/pubmed/39378432 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59917 %T Multicomponent Intervention to Improve Acute Myocardial Infarction Care in Tanzania: Protocol for a Pilot Implementation Trial %A Hertz,Julian T %A Sakita,Francis M %A Rahim,Faraan O %A Mmbaga,Blandina T %A Shayo,Frida %A Kaboigora,Vivian %A Mtui,Julius %A Bloomfield,Gerald S %A Bosworth,Hayden B %A Bettger,Janet P %A Thielman,Nathan M %+ Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, United States, 1 919 684 8111, julian.hertz@duke.edu %K myocardial infarction %K Tanzania %K sub-Saharan Africa %K implementation science %K quality improvement %D 2024 %7 24.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although the incidence of acute myocardial infarction (AMI) is rising in sub-Saharan Africa, the uptake of evidence-based care for the diagnosis and treatment of AMI is limited throughout the region. In Tanzania, studies have revealed common misdiagnosis of AMI, infrequent administration of aspirin, and high short-term mortality rates following AMI. Objective: This study aims to evaluate the implementation and efficacy outcomes of an intervention, the Multicomponent Intervention to Improve Acute Myocardial Infarction Care (MIMIC), which was developed to improve the delivery of evidence-based AMI care in Tanzania. Methods: This single-arm pilot trial will be conducted in the emergency department (ED) at a referral hospital in northern Tanzania. The MIMIC intervention will be implemented by the ED staff for 1 year. Approximately 400 adults presenting to the ED with possible AMI symptoms will be enrolled, and research assistants will observe their care. Thirty days later, a follow-up survey will be administered to assess mortality and medication use. The primary outcome will be the acceptability of the MIMIC intervention, which will be measured by the Acceptability of Intervention Measurement (AIM) instrument. Acceptability will further be assessed via in-depth interviews with key stakeholders. Secondary implementation outcomes will include feasibility and fidelity. Secondary efficacy outcomes will include the following: the proportion of participants who receive electrocardiogram and cardiac biomarker testing, the proportion of participants with AMI who receive aspirin, 30-day mortality among participants with AMI, and the proportion of participants with AMI taking aspirin 30 days following enrollment. Results: Implementation of MIMIC began on September 1, 2023. Enrollment is expected to be completed by September 1, 2024, and the first results are expected to be published by December 31, 2024. Conclusions: This study will be the first to evaluate an intervention for improving AMI care in sub-Saharan Africa. If MIMIC is found to be acceptable, the findings from this study will inform a future cluster-randomized trial to assess effectiveness and scalability. Trial Registration: ClinicalTrials.gov NCT04563546; https://clinicaltrials.gov/study/NCT04563546 International Registered Report Identifier (IRRID): DERR1-10.2196/59917 %M 39316783 %R 10.2196/59917 %U https://www.researchprotocols.org/2024/1/e59917 %U https://doi.org/10.2196/59917 %U http://www.ncbi.nlm.nih.gov/pubmed/39316783 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51513 %T The Quality of Short Videos as a Source of Coronary Heart Disease Information on TikTok: Cross-Sectional Study %A Gong,Xun %A Chen,Meijuan %A Ning,Lihong %A Zeng,Lingzhong %A Dong,Bo %+ Department of Cardiology and Cardiac Rehabilitation Center, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No.61 West Jiefang Road, Furong District, Changsha, China, 86 18874832298, dt2008bj@sina.com %K coronary heart disease %K content quality %K social media %K short-video platform %K TikTok %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Coronary heart disease (CHD) is a leading cause of death worldwide and imposes a significant economic burden. TikTok has risen as a favored platform within the social media sphere for disseminating CHD-related information and stands as a pivotal resource for patients seeking knowledge about CHD. However, the quality of such content on TikTok remains largely unexplored. Objective: This study aims to assess the quality of information conveyed in TikTok CHD-related videos. Methods: A comprehensive cross-sectional study was undertaken on TikTok videos related to CHD. The sources of the videos were identified and analyzed. The comprehensiveness of content was assessed through 6 questions addressing the definition, signs and symptoms, risk factors, evaluation, management, and outcomes. The quality of the videos was assessed using 3 standardized evaluative instruments: DISCERN, the Journal of the American Medical Association (JAMA) benchmarks, and the Global Quality Scale (GQS). Furthermore, correlative analyses between video quality and characteristics of the uploaders and the videos themselves were conducted. Results: The search yielded 145 CHD-related videos from TikTok, predominantly uploaded by health professionals (n=128, 88.3%), followed by news agencies (n=6, 4.1%), nonprofit organizations (n=10, 6.9%), and for-profit organizations (n=1, 0.7%). Content comprehensiveness achieved a median score of 3 (IQR 2-4). Median values for the DISCERN, JAMA, and GQS evaluations across all videos stood at 27 (IQR 24-32), 2 (IQR 2-2), and 2 (IQR 2-3), respectively. Videos from health professionals and nonprofit organizations attained significantly superior JAMA scores in comparison to those of news agencies (P<.001 and P=.02, respectively), whereas GQS scores for videos from health professionals were also notably higher than those from news agencies (P=.048). Within health professionals, cardiologists demonstrated discernibly enhanced performance over noncardiologists in both DISCERN and GQS assessments (P=.02). Correlative analyses unveiled positive correlations between video quality and uploader metrics, encompassing the positive correlations between the number of followers; total likes; average likes per video; and established quality indices such as DISCERN, JAMA, or GQS scores. Similar investigations relating to video attributes showed correlations between user engagement factors—likes, comments, collections, shares—and the aforementioned quality indicators. In contrast, a negative correlation emerged between the number of days since upload and quality indices, while a longer video duration corresponded positively with higher DISCERN and GQS scores. Conclusions: The quality of the videos was generally poor, with significant disparities based on source category. The content comprehensiveness coverage proved insufficient, casting doubts on the reliability and quality of the information relayed through these videos. Among health professionals, video contributions from cardiologists exhibited superior quality compared to noncardiologists. As TikTok’s role in health information dissemination expands, ensuring accurate and reliable content is crucial to better meet patients’ needs for CHD information that conventional health education fails to fulfill. %M 39226540 %R 10.2196/51513 %U https://formative.jmir.org/2024/1/e51513 %U https://doi.org/10.2196/51513 %U http://www.ncbi.nlm.nih.gov/pubmed/39226540 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e52896 %T Unsupervised Feature Selection to Identify Important ICD-10 and ATC Codes for Machine Learning on a Cohort of Patients With Coronary Heart Disease: Retrospective Study %A Ghasemi,Peyman %A Lee,Joon %K unsupervised feature selection %K ICD-10 %K International Classification of Diseases %K ATC %K Anatomical Therapeutic Chemical %K concrete autoencoder %K Laplacian score %K unsupervised feature selection for multicluster data %K autoencoder-inspired unsupervised feature selection %K principal feature analysis %K machine learning %K artificial intelligence %K case study %K coronary artery disease %K artery disease %K patient cohort %K artery %K mortality prediction %K mortality %K data set %K interpretability %K International Classification of Diseases, Tenth Revision %D 2024 %7 26.7.2024 %9 %J JMIR Med Inform %G English %X Background: The application of machine learning in health care often necessitates the use of hierarchical codes such as the International Classification of Diseases (ICD) and Anatomical Therapeutic Chemical (ATC) systems. These codes classify diseases and medications, respectively, thereby forming extensive data dimensions. Unsupervised feature selection tackles the “curse of dimensionality” and helps to improve the accuracy and performance of supervised learning models by reducing the number of irrelevant or redundant features and avoiding overfitting. Techniques for unsupervised feature selection, such as filter, wrapper, and embedded methods, are implemented to select the most important features with the most intrinsic information. However, they face challenges due to the sheer volume of ICD and ATC codes and the hierarchical structures of these systems. Objective: The objective of this study was to compare several unsupervised feature selection methods for ICD and ATC code databases of patients with coronary artery disease in different aspects of performance and complexity and select the best set of features representing these patients. Methods: We compared several unsupervised feature selection methods for 2 ICD and 1 ATC code databases of 51,506 patients with coronary artery disease in Alberta, Canada. Specifically, we used the Laplacian score, unsupervised feature selection for multicluster data, autoencoder-inspired unsupervised feature selection, principal feature analysis, and concrete autoencoders with and without ICD or ATC tree weight adjustment to select the 100 best features from over 9000 ICD and 2000 ATC codes. We assessed the selected features based on their ability to reconstruct the initial feature space and predict 90-day mortality following discharge. We also compared the complexity of the selected features by mean code level in the ICD or ATC tree and the interpretability of the features in the mortality prediction task using Shapley analysis. Results: In feature space reconstruction and mortality prediction, the concrete autoencoder–based methods outperformed other techniques. Particularly, a weight-adjusted concrete autoencoder variant demonstrated improved reconstruction accuracy and significant predictive performance enhancement, confirmed by DeLong and McNemar tests (P<.05). Concrete autoencoders preferred more general codes, and they consistently reconstructed all features accurately. Additionally, features selected by weight-adjusted concrete autoencoders yielded higher Shapley values in mortality prediction than most alternatives. Conclusions: This study scrutinized 5 feature selection methods in ICD and ATC code data sets in an unsupervised context. Our findings underscore the superiority of the concrete autoencoder method in selecting salient features that represent the entire data set, offering a potential asset for subsequent machine learning research. We also present a novel weight adjustment approach for the concrete autoencoders specifically tailored for ICD and ATC code data sets to enhance the generalizability and interpretability of the selected features. %R 10.2196/52896 %U https://medinform.jmir.org/2024/1/e52896 %U https://doi.org/10.2196/52896 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55421 %T Efficacy of a Mobile Health App (eMOTIVA) Regarding Compliance With Cardiac Rehabilitation Guidelines in Patients With Coronary Artery Disease: Randomized Controlled Clinical Trial %A Cruz-Cobo,Celia %A Bernal-Jiménez,María Ángeles %A Calle,Germán %A Gheorghe,Livia Luciana %A Gutiérrez-Barrios,Alejandro %A Cañadas,Dolores %A Tur,Josep A %A Vázquez-García,Rafael %A Santi-Cano,María José %+ Faculty of Nursing and Physiotherapy, University of Cádiz, Avda. Ana de Viya, 52, Cádiz, 11009, Spain, 34 956 019042, mariangeles.bernal@uca.es %K coronary event %K coronary heart disease %K eHealth %K lifestyle %K mHealth %K mobile health %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cardiac rehabilitation is fundamental among patients recovering from a coronary event, and mHealth technology may constitute a useful tool that provides guidelines based on scientific evidence in an entertaining, attractive, and user-friendly format. Objective: This study aimed to compare the efficacy of an mHealth intervention involving the eMOTIVA app and that of usual care regarding compliance with cardiac rehabilitation guidelines in terms of lifestyle, cardiovascular risk factors, and satisfaction among patients with acute coronary syndrome. Methods: A randomized controlled clinical trial with a parallel group design was conducted. It included 300 patients (mHealth group, 150; control group, 150) who underwent percutaneous coronary intervention for acute coronary syndrome. Both groups underwent evaluations initially (during hospitalization) and after 3 and 6 months (face-to-face consultations). The eMOTIVA app incorporates a virtual classroom providing audio and video information about a healthy lifestyle, a section for self-recording cardiovascular risk factors, and a section for feedback messages and gamification. The primary outcome variables were (1) adherence to the Mediterranean diet and the frequency of consumption of food; (2) physical activity level, sedentary time, and exercise capacity; (3) smoking cessation and nicotine dependence; (4) level of knowledge about cardiovascular risk factors; and (5) app satisfaction and usability. Results: The study analyzed 287 patients (mHealth group, 145; control group, 142). Most participants were male (207/300, 69.0%), and the mean age was 62.53 (SD 8.65) years. Significant improvements were observed in the mHealth group compared with the control group at 6 months in terms of (1) adherence to the Mediterranean diet (mean 11.92, SD 1.70 vs 8.92, SD 2.66 points; P<.001) and frequency of eating foods (red meat [≤1/week]: 141/143, 97.9% vs 96/141, 68.1%; industrial pastries [<2/week]: 129/143, 89.6% vs 80/141, 56.8%; oily fish [≥2/week]: 124/143, 86.1% vs 64/141, 41.4%; vegetables [≥2/day]: 130/143, 90.3% vs 78/141, 55.3%; fruit [≥2/day]: 128/143, 88.9% vs 85/141, 60.2%; all P<.001); (2) physical activity (mean 2112.66, SD 1196.67 vs 1372.60, SD 944.62 metabolic equivalents/week; P<.001) and sedentary time (mean 8.38, SD 1.88 vs 9.59, SD 2.09 hours; P<.001); (3) exercise capacity (distance: mean 473.49, SD 102.28 vs 447.25, SD 93.68 meters; P=.04); and (4) level of knowledge (mean 117.85, SD 3.83 vs 111.00, SD 7.11 points; P<.001). App satisfaction was high (mean 42.53, SD 6.38 points), and its usability was excellent (mean 95.60, SD 4.03 points). Conclusions: With the eMOTIVA app, favorable results were obtained in the intervention group in terms of adherence to the Mediterranean diet, frequency of eating certain foods, physical activity, sedentary time, exercise capacity, knowledge level, systolic blood pressure, heart rate, and blood sugar level. Furthermore, participants reported high app satisfaction and rated its usability as excellent. Thus, this innovative tool is very promising. Trial Registration: ClinicalTrials.gov NCT05247606; https://clinicaltrials.gov/study/NCT05247606 %M 39052330 %R 10.2196/55421 %U https://mhealth.jmir.org/2024/1/e55421 %U https://doi.org/10.2196/55421 %U http://www.ncbi.nlm.nih.gov/pubmed/39052330 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e49515 %T Persuasive Systems Design Trends in Coronary Heart Disease Management: Scoping Review of Randomized Controlled Trials %A Agyei,Eunice Eno Yaa Frimponmaa %A Ekpezu,Akon %A Oinas-Kukkonen,Harri %+ Oulu Advanced Research on Service and Information Systems, Faculty of Information Technology and Electrical Engineering, University of Oulu, Pentti Kaiteran katu 1, Oulu, 90570, Finland, 358 0449511559, eunice.agyei@oulu.fi %K coronary heart disease %K persuasive systems design %K behavior change %K randomized controlled trial %K RCT %K controlled trials %K heart %K CHD %K cardiovascular %D 2024 %7 19.6.2024 %9 Review %J JMIR Cardio %G English %X Background: Behavior change support systems (BCSSs) have the potential to help people maintain healthy lifestyles and aid in the self-management of coronary heart disease (CHD). The Persuasive Systems Design (PSD) model is a framework for designing and evaluating systems designed to support lifestyle modifications and health behavior change using information and communication technology. However, evidence for the underlying design principles behind BCSSs for CHD has not been extensively reported in the literature. Objective: This scoping review aims to identify existing health BCSSs for CHD, report the characteristics of these systems, and describe the persuasion context and persuasive design principles of these systems based on the PSD framework. Methods: Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, 3 digital databases (Scopus, Web of Science, and MEDLINE) were searched between 2010 to 2022. The major inclusion criteria for studies were in accordance with the PICO (Population, Intervention, Comparison, and Outcome) approach. Results: Searches conducted in the databases identified 1195 papers, among which 30 were identified as eligible for the review. The most interesting characteristics of the BCSSs were the predominant use of primary task support principles, followed by dialogue support and credibility support and the sparing use of social support principles. Theories of behavior change such as the Social Cognitive Theory and Self-Efficacy Theory were used often to underpin these systems. However, significant trends in the use of persuasive system features on par with behavior change theories could not be established from the reviewed studies. This points to the fact that there is still no theoretical consensus on how best to design interventions to promote behavior change in patients with CHD. Conclusions: Our results highlight key software features for designing BCSSs for the prevention and management of CHD. We encourage designers of behavior change interventions to evaluate the techniques that contributed to the success of the intervention. Future research should focus on evaluating the effectiveness of the interventions, persuasive design principles, and behavior change theories using research methodologies such as meta-analysis. %M 38896840 %R 10.2196/49515 %U https://cardio.jmir.org/2024/1/e49515 %U https://doi.org/10.2196/49515 %U http://www.ncbi.nlm.nih.gov/pubmed/38896840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52341 %T The Effects of mHealth Interventions on Quality of Life, Anxiety, and Depression in Patients With Coronary Heart Disease: Meta-Analysis of Randomized Controlled Trials %A Hou,Qiao Ling %A Liu,Le Yang %A Wu,Ying %+ School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069, China, 86 10 8391 1766, helenywu@vip.163.com %K mobile health %K coronary heart disease %K quality of life %K anxiety %K depression %K meta-analysis %K mobile phone %D 2024 %7 11.6.2024 %9 Review %J J Med Internet Res %G English %X Background: Coronary heart disease (CHD) is the leading cause of death globally. In addition, 20% to 40% of the patients with CHD have comorbid mental health issues such as anxiety or depression, affecting the prognosis and quality of life (QoL). Mobile health (mHealth) interventions have been developed and are widely used; however, the evidence for the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD is currently ambiguous. Objective: In this study, we aimed to assess the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD. Methods: We searched the Cochrane Library, PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure, and Wanfang databases from inception to August 12, 2023. Eligible studies were randomized controlled trials that involved patients with CHD who received mHealth interventions and that reported on QoL, anxiety, or depression outcomes. We used the Cochrane risk-of-bias tool for randomized trials to evaluate the risk of bias in the studies, ensuring a rigorous and methodologically sound analysis. Review Manager (desktop version 5.4; The Cochrane Collaboration) and Stata MP (version 17.0; StataCorp LLC) were used to conduct the meta-analysis. The effect size was calculated using the standardized mean difference (SMD) and its 95% CI. Results: The meta-analysis included 23 studies (5406 participants in total) and showed that mHealth interventions significantly improved QoL in patients with CHD (SMD 0.49, 95% CI 0.25-0.72; Z=4.07; P<.001) as well as relieved their anxiety (SMD −0.46, 95% CI −0.83 to −0.08; Z=2.38; P=.02) and depression (SMD −0.34, 95% CI −0.56 to −0.12; Z=3.00; P=.003) compared to usual care. The subgroup analyses indicated a significant effect favoring the mHealth intervention on reducing anxiety and depressive symptoms compared to usual care, especially when (1) the intervention duration was ≥6 months (P=.04 and P=.001), (2) the mHealth intervention was a simple one (only 1 mHealth intervention was used) (P=.01 and P<.001), (3) it was implemented during the COVID-19 pandemic (P=.04 and P=.01), (4) it was implemented in low- or middle-income countries (P=.01 and P=.02), (5) the intervention focused on mental health (P=.01 and P=.007), and (6) adherence rates were high (≥90%; P=.03 and P=.002). In addition, comparing mHealth interventions to usual care, there was an improvement in QoL when (1) the mHealth intervention was a simple one (P<.001), (2) it was implemented in low- or middle-income countries (P<.001), and (3) the intervention focused on mental health (P<.001). Conclusions: On the basis of the existing evidence, mHealth interventions might be effective in improving QoL and reducing anxiety and depression in patients with CHD. However, large sample, high-quality, and rigorously designed randomized controlled trials are needed to provide further evidence. Trial Registration: PROSPERO CRD42022383858; https://tinyurl.com/3ea2npxf %M 38861710 %R 10.2196/52341 %U https://www.jmir.org/2024/1/e52341 %U https://doi.org/10.2196/52341 %U http://www.ncbi.nlm.nih.gov/pubmed/38861710 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54485 %T U-Shaped Relationship Between Fibrinogen Level and 10-year Mortality in Patients With Acute Coronary Syndrome: Prospective Cohort Study %A Li,Yi ming %A Jia,Yuheng %A Bai,Lin %A Yang,Bosen %A Chen,Mao %A Peng,Yong %+ Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Street, Sichuan Province, Chengdu City, 610041, China, 86 85423169, pengyong@scu.edu.cn %K fibrinogen %K acute coronary syndrome %K 10-year mortality %K risk factor %K coronary artery disease %K myocardial %K heart disease %K inflammatory factor %K retrospective study %K Kaplan-Meier analysis %K mortality %K all-cause mortality %K cubic-spline curve %K regression model %D 2024 %7 7.6.2024 %9 Research Letter %J JMIR Public Health Surveill %G English %X This study demonstrated that fibrinogen is an independent risk factor for 10-year mortality in patients with acute coronary syndrome (ACS), with a U-shaped nonlinear relationship observed between the two. These findings underscore the importance of monitoring fibrinogen levels and the consideration of long-term anti-inflammatory treatment in the clinical management of patients with ACS. %M 38848124 %R 10.2196/54485 %U https://publichealth.jmir.org/2024/1/e54485 %U https://doi.org/10.2196/54485 %U http://www.ncbi.nlm.nih.gov/pubmed/38848124 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48756 %T Effectiveness of an Interactive mHealth App (EVITE) in Improving Lifestyle After a Coronary Event: Randomized Controlled Trial %A Bernal-Jiménez,María Ángeles %A Calle,German %A Gutiérrez Barrios,Alejandro %A Gheorghe,Livia Luciana %A Cruz-Cobo,Celia %A Trujillo-Garrido,Nuria %A Rodríguez-Martín,Amelia %A Tur,Josep A %A Vázquez-García,Rafael %A Santi-Cano,María José %+ Faculty of Nursing and Physiotherapy, University of Cádiz, Avda. Ana de Viya, 52, Cádiz, 11009, Spain, 34 956019042, mariajose.santi@uca.es %K coronary artery disease %K healthy lifestyle %K mHealth %K mobile health %K percutaneous coronary intervention %K randomized controlled trial %K secondary prevention %K therapeutic adherence %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Coronary heart disease is one of the leading causes of mortality worldwide. Secondary prevention is essential, as it reduces the risk of further coronary events. Mobile health (mHealth) technology could become a useful tool to improve lifestyles. Objective: This study aimed to evaluate the effect of an mHealth intervention on people with coronary heart disease who received percutaneous coronary intervention. Improvements in lifestyle regarding diet, physical activity, and smoking; level of knowledge of a healthy lifestyle and the control of cardiovascular risk factors (CVRFs); and therapeutic adherence and quality of life were analyzed. Methods: This was a randomized controlled trial with a parallel group design assigned 1:1 to either an intervention involving a smartphone app (mHealth group) or to standard health care (control group). The app was used for setting aims, the self-monitoring of lifestyle and CVRFs using measurements and records, educating people with access to information on their screens about healthy lifestyles and adhering to treatment, and giving motivation through feedback about achievements and aspects to improve. Both groups were assessed after 9 months. The primary outcome variables were adherence to the Mediterranean diet, frequency of food consumed, patient-reported physical activity, smoking, knowledge of healthy lifestyles and the control of CVRFs, adherence to treatment, quality of life, well-being, and satisfaction. Results: The study analyzed 128 patients, 67 in the mHealth group and 61 in the control group; most were male (92/128, 71.9%), with a mean age of 59.49 (SD 8.97) years. Significant improvements were observed in the mHealth group compared with the control group regarding adherence to the Mediterranean diet (mean 11.83, SD 1.74 points vs mean 10.14, SD 2.02 points; P<.001), frequency of food consumption, patient-reported physical activity (mean 619.14, SD 318.21 min/week vs mean 471.70, SD 261.43 min/week; P=.007), giving up smoking (25/67, 75% vs 11/61, 42%; P=.01), level of knowledge of healthy lifestyles and the control of CVRFs (mean 118.70, SD 2.65 points vs mean 111.25, SD 9.05 points; P<.001), and the physical component of the quality of life 12-item Short Form survey (SF-12; mean 45.80, SD 10.79 points vs mean 41.40, SD 10.78 points; P=.02). Overall satisfaction was higher in the mHealth group (mean 48.22, SD 3.89 vs mean 46.00, SD 4.82 points; P=.002) and app satisfaction and usability were high (mean 44.38, SD 6.18 out of 50 points and mean 95.22, SD 7.37 out of 100). Conclusions: The EVITE app was effective in improving the lifestyle of patients in terms of adherence to the Mediterranean diet, frequency of healthy food consumption, physical activity, giving up smoking, knowledge of healthy lifestyles and controlling CVRFs, quality of life, and overall satisfaction. The app satisfaction and usability were excellent. Trial Registration: Clinicaltrials.gov NCT04118504; https://clinicaltrials.gov/study/NCT04118504 %M 38648103 %R 10.2196/48756 %U https://mhealth.jmir.org/2024/1/e48756 %U https://doi.org/10.2196/48756 %U http://www.ncbi.nlm.nih.gov/pubmed/38648103 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55802 %T Clinical Decision Support Requirements for Ventricular Tachycardia Diagnosis Within the Frameworks of Knowledge and Practice: Survey Study %A Hu,Zhao %A Wang,Min %A Zheng,Si %A Xu,Xiaowei %A Zhang,Zhuxin %A Ge,Qiaoyue %A Li,Jiao %A Yao,Yan %+ Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Road 167, Beijing, 100037, China, 86 10 88322401, ianyao@263.net.cn %K clinical decision support system %K requirements analysis %K ventricular tachycardia %K knowledge %K clinical practice %K questionnaires %D 2024 %7 26.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Ventricular tachycardia (VT) diagnosis is challenging due to the similarity between VT and some forms of supraventricular tachycardia, complexity of clinical manifestations, heterogeneity of underlying diseases, and potential for life-threatening hemodynamic instability. Clinical decision support systems (CDSSs) have emerged as promising tools to augment the diagnostic capabilities of cardiologists. However, a requirements analysis is acknowledged to be vital for the success of a CDSS, especially for complex clinical tasks such as VT diagnosis. Objective: The aims of this study were to analyze the requirements for a VT diagnosis CDSS within the frameworks of knowledge and practice and to determine the clinical decision support (CDS) needs. Methods: Our multidisciplinary team first conducted semistructured interviews with seven cardiologists related to the clinical challenges of VT and expected decision support. A questionnaire was designed by the multidisciplinary team based on the results of interviews. The questionnaire was divided into four sections: demographic information, knowledge assessment, practice assessment, and CDS needs. The practice section consisted of two simulated cases for a total score of 10 marks. Online questionnaires were disseminated to registered cardiologists across China from December 2022 to February 2023. The scores for the practice section were summarized as continuous variables, using the mean, median, and range. The knowledge and CDS needs sections were assessed using a 4-point Likert scale without a neutral option. Kruskal-Wallis tests were performed to investigate the relationship between scores and practice years or specialty. Results: Of the 687 cardiologists who completed the questionnaire, 567 responses were eligible for further analysis. The results of the knowledge assessment showed that 383 cardiologists (68%) lacked knowledge in diagnostic evaluation. The overall average score of the practice assessment was 6.11 (SD 0.55); the etiological diagnosis section had the highest overall scores (mean 6.74, SD 1.75), whereas the diagnostic evaluation section had the lowest scores (mean 5.78, SD 1.19). A majority of cardiologists (344/567, 60.7%) reported the need for a CDSS. There was a significant difference in practice competency scores between general cardiologists and arrhythmia specialists (P=.02). Conclusions: There was a notable deficiency in the knowledge and practice of VT among Chinese cardiologists. Specific knowledge and practice support requirements were identified, which provide a foundation for further development and optimization of a CDSS. Moreover, it is important to consider clinicians’ specialization levels and years of practice for effective and personalized support. %M 38530337 %R 10.2196/55802 %U https://humanfactors.jmir.org/2024/1/e55802 %U https://doi.org/10.2196/55802 %U http://www.ncbi.nlm.nih.gov/pubmed/38530337 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48557 %T A Social Media–Based Mindfulness Psycho-Behavioral Intervention (MCARE) for Patients With Acute Coronary Syndrome: Randomized Controlled Trial %A Zou,Huijing %A Chair,Sek Ying %A Feng,Bilong %A Liu,Qian %A Liu,Yu Jia %A Cheng,Yu Xin %A Luo,Dan %A Wang,Xiao Qin %A Chen,Wei %A Huang,Leiqing %A Xianyu,Yunyan %A Yang,Bing Xiang %+ School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, China, 86 02768788685, yangbx@whu.edu.cn %K acute coronary syndrome %K psychological distress %K depression %K anxiety %K mindfulness %K mindfulness-based intervention %K quality of life %K risk factors %K cardiac rehabilitation %K social media %D 2024 %7 20.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychological distress is common among patients with acute coronary syndrome (ACS) and has considerable adverse impacts on disease progression and health outcomes. Mindfulness-based intervention is a promising complementary approach to address patients’ psychological needs and promote holistic well-being. Objective: This study aims to examine the effects of a social media–based mindfulness psycho-behavioral intervention (MCARE) on psychological distress, psychological stress, health-related quality of life (HRQoL), and cardiovascular risk factors among patients with ACS. Methods: This study was a 2-arm, parallel-group randomized controlled trial. We recruited 178 patients (mean age 58.7, SD 8.9 years; 122/178, 68.5% male) with ACS at 2 tertiary hospitals in Jinan, China. Participants were randomly assigned to the MCARE group (n=89) or control group (n=89). The 6-week intervention consisted of 1 face-to-face session (phase I) and 5 weekly WeChat (Tencent Holdings Ltd)–delivered sessions (phase II) on mindfulness training and health education and lifestyle modification. The primary outcomes were depression and anxiety. Secondary outcomes included psychological stress, HRQoL, and cardiovascular risk factors (ie, smoking status, physical activity, dietary behavior, BMI, blood pressure, blood lipids, and blood glucose). Outcomes were measured at baseline (T0), immediately after the intervention (T1), and 12 weeks after the commencement of the intervention (T2). Results: The MCARE group showed significantly greater reductions in depression (T1: β=–2.016, 95% CI –2.584 to –1.449, Cohen d=–1.28, P<.001; T2: β=–2.089, 95% CI –2.777 to –1.402, Cohen d=–1.12, P<.001) and anxiety (T1: β=–1.024, 95% CI –1.551 to –0.497, Cohen d=–0.83, P<.001; T2: β=–0.932, 95% CI –1.519 to –0.346, Cohen d=–0.70, P=.002). Significantly greater improvements were also observed in psychological stress (β=–1.186, 95% CI –1.678 to –0.694, Cohen d=–1.41, P<.001), physical HRQoL (β=0.088, 95% CI 0.008-0.167, Cohen d=0.72, P=.03), emotional HRQoL (β=0.294, 95% CI 0.169-0.419, Cohen d=0.81, P<.001), and general HRQoL (β=0.147, 95% CI 0.070-0.224, Cohen d=1.07) at T1, as well as dietary behavior (β=0.069, 95% CI 0.003-0.136, Cohen d=0.75, P=.04), physical activity level (β=177.542, 95% CI –39.073 to 316.011, Cohen d=0.51, P=.01), and systolic blood pressure (β=–3.326, 95% CI –5.928 to –0.725, Cohen d=–1.32, P=.01) at T2. The overall completion rate of the intervention (completing ≥5 sessions) was 76% (68/89). Positive responses to the questions of the acceptability questionnaire ranged from 93% (76/82) to 100% (82/82). Conclusions: The MCARE program generated favorable effects on psychological distress, psychological stress, HRQoL, and several aspects of cardiovascular risk factors in patients with ACS. This study provides clues for guiding clinical practice in the recognition and management of psychological distress and integrating the intervention into routine rehabilitation practice. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000033526; https://www.chictr.org.cn/showprojEN.html?proj=54693 %M 38376899 %R 10.2196/48557 %U https://www.jmir.org/2024/1/e48557 %U https://doi.org/10.2196/48557 %U http://www.ncbi.nlm.nih.gov/pubmed/38376899 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48487 %T Machine Learning for Early Prediction of Major Adverse Cardiovascular Events After First Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction: Retrospective Cohort Study %A Zhang,Pin %A Wu,Lei %A Zou,Ting-Ting %A Zou,ZiXuan %A Tu,JiaXin %A Gong,Ren %A Kuang,Jie %+ Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461 BaYi Road, Nanchang, 330006, China, 86 0791 8636228, kuangjie@ncu.edu.cn %K acute myocardial infarction %K percutaneous coronary intervention %K machine learning %K early prediction %K cardiovascular event %D 2024 %7 3.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The incidence of major adverse cardiovascular events (MACEs) remains high in patients with acute myocardial infarction (AMI) who undergo percutaneous coronary intervention (PCI), and early prediction models to guide their clinical management are lacking. Objective: This study aimed to develop machine learning–based early prediction models for MACEs in patients with newly diagnosed AMI who underwent PCI. Methods: A total of 1531 patients with AMI who underwent PCI from January 2018 to December 2019 were enrolled in this consecutive cohort. The data comprised demographic characteristics, clinical investigations, laboratory tests, and disease-related events. Four machine learning models—artificial neural network (ANN), k-nearest neighbors, support vector machine, and random forest—were developed and compared with the logistic regression model. Our primary outcome was the model performance that predicted the MACEs, which was determined by accuracy, area under the receiver operating characteristic curve, and F1-score. Results: In total, 1362 patients were successfully followed up. With a median follow-up of 25.9 months, the incidence of MACEs was 18.5% (252/1362). The area under the receiver operating characteristic curve of the ANN, random forest, k-nearest neighbors, support vector machine, and logistic regression models were 80.49%, 72.67%, 79.80%, 77.20%, and 71.77%, respectively. The top 5 predictors in the ANN model were left ventricular ejection fraction, the number of implanted stents, age, diabetes, and the number of vessels with coronary artery disease. Conclusions: The ANN model showed good MACE prediction after PCI for patients with AMI. The use of machine learning–based prediction models may improve patient management and outcomes in clinical practice. %M 38170581 %R 10.2196/48487 %U https://formative.jmir.org/2024/1/e48487 %U https://doi.org/10.2196/48487 %U http://www.ncbi.nlm.nih.gov/pubmed/38170581 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e52697 %T Efficacy of eHealth Technologies on Medication Adherence in Patients With Acute Coronary Syndrome: Systematic Review and Meta-Analysis %A Bhagavathula,Akshaya Srikanth %A Aldhaleei,Wafa Ali %A Atey,Tesfay Mehari %A Assefa,Solomon %A Tesfaye,Wubshet %+ Department of Public Health, College of Health and Human Services, North Dakota State University, 640 Aldevron Tower, Fargo, ND, 58102, United States, 1 7012316549, akshaya.bhagavathula@ndsu.edu %K medication adherence %K eHealth %K secondary prevention %K acute coronary syndrome %K heart disease %K text messaging %K mobile app %K cardiology %K cardioprotective %K prevention %K efficacy %K statins %D 2023 %7 19.12.2023 %9 Review %J JMIR Cardio %G English %X Background: Suboptimal adherence to cardiac pharmacotherapy, recommended by the guidelines after acute coronary syndrome (ACS) has been recognized and is associated with adverse outcomes. Several randomized controlled trials (RCTs) have shown that eHealth technologies are useful in reducing cardiovascular risk factors. However, little is known about the effect of eHealth interventions on medication adherence in patients following ACS. Objective: The aim of this study is to examine the efficacy of the eHealth interventions on medication adherence to selected 5 cardioprotective medication classes in patients with ACS. Methods: A systematic literature search of PubMed, Embase, Scopus, and Web of Science was conducted between May and October 2022, with an update in October 2023 to identify RCTs that evaluated the effectiveness of eHealth technologies, including texting, smartphone apps, or web-based apps, to improve medication adherence in patients after ACS. The risk of bias was evaluated using the modified Cochrane risk-of-bias tool for RCTs. A pooled meta-analysis was performed using a fixed-effect Mantel-Haenszel model and assessed the medication adherence to the medications of statins, aspirin, P2Y12 inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and β-blockers. Results: We identified 5 RCTs, applicable to 4100 participants (2093 intervention vs 2007 control), for inclusion in the meta-analysis. In patients who recently had an ACS, compared to the control group, the use of eHealth intervention was not associated with improved adherence to statins at different time points (risk difference [RD] –0.01, 95% CI –0.03 to 0.03 at 6 months and RD –0.02, 95% CI –0.05 to 0.02 at 12 months), P2Y12 inhibitors (RD –0.01, 95% CI –0.04 to 0.02 and RD –0.01, 95% CI –0.03 to 0.02), aspirin (RD 0.00, 95% CI –0.06 to 0.07 and RD –0.00, 95% CI –0.07 to 0.06), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RD –0.01, 95% CI –0.04 to 0.02 and RD 0.01, 95% CI –0.04 to 0.05), and β-blockers (RD 0.00, 95% CI –0.03 to 0.03 and RD –0.01, 95% CI –0.05 to 0.03). The intervention was also not associated with improved adherence irrespective of the adherence assessment method used (self-report or objective). Conclusions: This review identified limited evidence on the effectiveness of eHealth interventions on adherence to guideline-recommended medications after ACS. While the pooled analyses suggested a lack of effectiveness of such interventions on adherence improvement, further studies are warranted to better understand the role of different eHealth approaches in the post-ACS context. %M 38113072 %R 10.2196/52697 %U https://cardio.jmir.org/2023/1/e52697 %U https://doi.org/10.2196/52697 %U http://www.ncbi.nlm.nih.gov/pubmed/38113072 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50091 %T Intravenous Ascorbic Acid for the Prevention of Postreperfusion Syndrome in Orthotopic Liver Transplantation: Protocol for a Randomized Controlled Trial %A Gajate,Luis %A de la Hoz,Inés %A Espiño,Mercedes %A Martin Gonzalez,Maria del Carmen %A Fernandez Martin,Cristina %A Martín-Grande,Ascensión %A Parise Roux,Diego %A Pastor,Oscar %A Villahoz,Judith %A Rodriguez-Gandía,Miguel Ángel %A Nuño Vazquez,Javier %+ Department of Anesthesiology and Critical Care, Instituto Ramon y Cajal de Investigacion Sanitaria, Hospital Universitario Ramon y Cajal, Ctra de Colmenar Viejo Km 9,100, Madrid, 28034, Spain, 34 913368269, gajate.luis@gmail.com %K antioxidant therapy %K antioxidant %K ascorbic acid %K blood %K controlled trials %K hepatic %K ischemia %K ischemic %K liver transplantation %K liver %K postreperfusion syndrome %K randomization %K randomized controlled trial %K RCT %K reperfusion injury %K reperfusion %K surgery %K surgical %K transplant %K transplantation %K vascular %K vitamin C %K vitamin %K vitamins %D 2023 %7 15.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Liver transplantation is the last therapeutic option for patients with end-stage liver disease. Postreperfusion syndrome (PRS), defined as a fall in mean arterial pressure of more than 30% within the first 5 minutes after reperfusion of at least 1 minute, can occur in liver transplantation as a deep hemodynamic instability with associated hyperfibrinolysis immediately after reperfusion of the new graft. Its incidence has remained unchanged since it was first described in 1987. PRS is related to ischemia-reperfusion (I/R) injury, whose pathophysiology involves the release of several mediators from both the donor and the recipient. The antioxidant effect of ascorbic acid has been studied in resuscitating patients with septic shock and burns. Even today, there are publications with conflicting results, and there is a need for further studies to confirm or rule out the usefulness of this drug in this group of patients. The addition of ascorbic acid to preservation solutions used in solid organ transplantation is under investigation to harness its antioxidant effect and mitigate I/R injury. Since PRS could be considered a manifestation of I/R injury, we believe that the possible beneficial effect of ascorbic acid on the occurrence of PRS should be investigated. Objective: The aim of this randomized controlled trial is to assess the benefits of ascorbic acid over saline in the development of PRS in adult liver transplantation. Methods: We plan to conduct a single-center randomized controlled trial at the Hospital Universitario Ramón y Cajal in Spain. A total of 70 participants aged 18 years or older undergoing liver transplantation will be randomized to receive either ascorbic acid or saline. The primary outcome will be the difference between groups in the incidence of PRS. The randomized controlled trial will be conducted under conditions of respect for fundamental human rights and ethical principles governing biomedical research involving human participants and in accordance with the international recommendations contained in the Declaration of Helsinki and its subsequent revisions. Results: The enrollment process began in 2020. A total of 35 patients have been recruited so far. Data cleaning and analysis are expected to occur in the first months of 2024. Results are expected around the middle of 2024. Conclusions: We believe that this study could be particularly relevant because it will be the first to analyze the clinical effect of ascorbic acid in liver transplantation. Moreover, we believe that this study fills an important gap in the knowledge of the potential benefits of ascorbic acid in the field of liver transplantation, particularly in relation to PRS. Trial Registration: European Union Drug Regulating Authorities Clinical Trials Database 2020-000123-39; https://tinyurl.com/2cfzddw8; ClinicalTrials.gov NCT05754242; https://tinyurl.com/346vw7sm International Registered Report Identifier (IRRID): DERR1-10.2196/50091 %M 38100226 %R 10.2196/50091 %U https://www.researchprotocols.org/2023/1/e50091 %U https://doi.org/10.2196/50091 %U http://www.ncbi.nlm.nih.gov/pubmed/38100226 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e51375 %T AI Algorithm to Predict Acute Coronary Syndrome in Prehospital Cardiac Care: Retrospective Cohort Study %A de Koning,Enrico %A van der Haas,Yvette %A Saguna,Saguna %A Stoop,Esmee %A Bosch,Jan %A Beeres,Saskia %A Schalij,Martin %A Boogers,Mark %+ Cardiology Department, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 715269111, j.m.j.boogers@lumc.nl %K cardiology %K acute coronary syndrome %K Hollands Midden Acute Regional Triage–cardiology %K prehospital %K triage %K artificial intelligence %K natural language processing %K angina %K algorithm %K overcrowding %K emergency department %K clinical decision-making %K emergency medical service %K paramedics %D 2023 %7 31.10.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Overcrowding of hospitals and emergency departments (EDs) is a growing problem. However, not all ED consultations are necessary. For example, 80% of patients in the ED with chest pain do not have an acute coronary syndrome (ACS). Artificial intelligence (AI) is useful in analyzing (medical) data, and might aid health care workers in prehospital clinical decision-making before patients are presented to the hospital. Objective: The aim of this study was to develop an AI model which would be able to predict ACS before patients visit the ED. The model retrospectively analyzed prehospital data acquired by emergency medical services' nurse paramedics. Methods: Patients presenting to the emergency medical services with symptoms suggestive of ACS between September 2018 and September 2020 were included. An AI model using a supervised text classification algorithm was developed to analyze data. Data were analyzed for all 7458 patients (mean 68, SD 15 years, 54% men). Specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for control and intervention groups. At first, a machine learning (ML) algorithm (or model) was chosen; afterward, the features needed were selected and then the model was tested and improved using iterative evaluation and in a further step through hyperparameter tuning. Finally, a method was selected to explain the final AI model. Results: The AI model had a specificity of 11% and a sensitivity of 99.5% whereas usual care had a specificity of 1% and a sensitivity of 99.5%. The PPV of the AI model was 15% and the NPV was 99%. The PPV of usual care was 13% and the NPV was 94%. Conclusions: The AI model was able to predict ACS based on retrospective data from the prehospital setting. It led to an increase in specificity (from 1% to 11%) and NPV (from 94% to 99%) when compared to usual care, with a similar sensitivity. Due to the retrospective nature of this study and the singular focus on ACS it should be seen as a proof-of-concept. Other (possibly life-threatening) diagnoses were not analyzed. Future prospective validation is necessary before implementation. %M 37906226 %R 10.2196/51375 %U https://cardio.jmir.org/2023/1/e51375 %U https://doi.org/10.2196/51375 %U http://www.ncbi.nlm.nih.gov/pubmed/37906226 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e48795 %T Effective Prediction of Mortality by Heart Disease Among Women in Jordan Using the Chi-Squared Automatic Interaction Detection Model: Retrospective Validation Study %A Bani Hani,Salam %A Ahmad,Muayyad %+ Clinical Nursing Department, School of Nursing, The University of Jordan, Queen Rania St, Amman, 11942, Jordan, 962 785577701, banihani.salam@yahoo.com %K coronary heart disease %K mortality %K artificial intelligence %K machine learning %K algorithms %K algorithm %K women %K death %K predict %K prediction %K predictive %K heart %K cardiology %K coronary %K CHD %K cardiovascular disease %K CVD %K cardiovascular %D 2023 %7 20.7.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Many current studies have claimed that the actual risk of heart disease among women is equal to that in men. Using a large machine learning algorithm (MLA) data set to predict mortality in women, data mining techniques have been used to identify significant aspects of variables that help in identifying the primary causes of mortality within this target category of the population. Objective: This study aims to predict mortality caused by heart disease among women, using an artificial intelligence technique–based MLA. Methods: A retrospective design was used to retrieve big data from the electronic health records of 2028 women with heart disease. Data were collected for Jordanian women who were admitted to public health hospitals from 2015 to the end of 2021. We checked the extracted data for noise, consistency issues, and missing values. After categorizing, organizing, and cleaning the extracted data, the redundant data were eliminated. Results: Out of 9 artificial intelligence models, the Chi-squared Automatic Interaction Detection model had the highest accuracy (93.25%) and area under the curve (0.825) among the build models. The participants were 62.6 (SD 15.4) years old on average. Angina pectoris was the most frequent diagnosis in the women's extracted files (n=1,264,000, 62.3%), followed by congestive heart failure (n=764,000, 37.7%). Age, systolic blood pressure readings with a cutoff value of >187 mm Hg, medical diagnosis (women diagnosed with congestive heart failure were at a higher risk of death [n=31, 16.58%]), pulse pressure with a cutoff value of 98 mm Hg, and oxygen saturation (measured using pulse oximetry) with a cutoff value of 93% were the main predictors for death among women. Conclusions: To predict the outcomes in this study, we used big data that were extracted from the clinical variables from the electronic health records. The Chi-squared Automatic Interaction Detection model—an MLA—confirmed the precise identification of the key predictors of cardiovascular mortality among women and can be used as a practical tool for clinical prediction. %M 37471126 %R 10.2196/48795 %U https://cardio.jmir.org/2023/1/e48795 %U https://doi.org/10.2196/48795 %U http://www.ncbi.nlm.nih.gov/pubmed/37471126 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e44791 %T Feasibility of Artificial Intelligence–Based Electrocardiography Analysis for the Prediction of Obstructive Coronary Artery Disease in Patients With Stable Angina: Validation Study %A Park,Jiesuck %A Yoon,Yeonyee %A Cho,Youngjin %A Kim,Joonghee %+ Department of Cardiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea, 82 31 787 7072, yeonyeeyoon@gmail.com %K artificial intelligence %K AI %K coronary artery disease %K coronary stenosis %K electrocardiography %K stable angina %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Despite accumulating research on artificial intelligence–based electrocardiography (ECG) algorithms for predicting acute coronary syndrome (ACS), their application in stable angina is not well evaluated. Objective: We evaluated the utility of an existing artificial intelligence–based quantitative electrocardiography (QCG) analyzer in stable angina and developed a new ECG biomarker more suitable for stable angina. Methods: This single-center study comprised consecutive patients with stable angina. The independent and incremental value of QCG scores for coronary artery disease (CAD)–related conditions (ACS, myocardial injury, critical status, ST-elevation myocardial infarction, and left ventricular dysfunction) for predicting obstructive CAD confirmed by invasive angiography was examined. Additionally, ECG signals extracted by the QCG analyzer were used as input to develop a new QCG score. Results: Among 723 patients with stable angina (median age 68 years; male: 470/723, 65%), 497 (69%) had obstructive CAD. QCG scores for ACS and myocardial injury were independently associated with obstructive CAD (odds ratio [OR] 1.09, 95% CI 1.03-1.17 and OR 1.08, 95% CI 1.02-1.16 per 10-point increase, respectively) but did not significantly improve prediction performance compared to clinical features. However, our new QCG score demonstrated better prediction performance for obstructive CAD (area under the receiver operating characteristic curve 0.802) than the original QCG scores, with incremental predictive value in combination with clinical features (area under the receiver operating characteristic curve 0.827 vs 0.730; P<.001). Conclusions: QCG scores developed for acute conditions show limited performance in identifying obstructive CAD in stable angina. However, improvement in the QCG analyzer, through training on comprehensive ECG signals in patients with stable angina, is feasible. %M 37129937 %R 10.2196/44791 %U https://cardio.jmir.org/2023/1/e44791 %U https://doi.org/10.2196/44791 %U http://www.ncbi.nlm.nih.gov/pubmed/37129937 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e45299 %T Accuracy of Artificial Intelligence–Based Automated Quantitative Coronary Angiography Compared to Intravascular Ultrasound: Retrospective Cohort Study %A Moon,In Tae %A Kim,Sun-Hwa %A Chin,Jung Yeon %A Park,Sung Hun %A Yoon,Chang-Hwan %A Youn,Tae-Jin %A Chae,In-Ho %A Kang,Si-Hyuck %+ Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Seongnam, 13620, Republic of Korea, 82 31 787 7027, eandp303@gmail.com %K artificial intelligence %K AI %K coronary angiography %K coronary stenosis %K interventional ultrasonography %K coronary %K machine learning %K angiography %K stenosis %K automated analysis %K computer vision %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: An accurate quantitative analysis of coronary artery stenotic lesions is essential to make optimal clinical decisions. Recent advances in computer vision and machine learning technology have enabled the automated analysis of coronary angiography. Objective: The aim of this paper is to validate the performance of artificial intelligence–based quantitative coronary angiography (AI-QCA) in comparison with that of intravascular ultrasound (IVUS). Methods: This retrospective study included patients who underwent IVUS-guided coronary intervention at a single tertiary center in Korea. Proximal and distal reference areas, minimal luminal area, percent plaque burden, and lesion length were measured by AI-QCA and human experts using IVUS. First, fully automated QCA analysis was compared with IVUS analysis. Next, we adjusted the proximal and distal margins of AI-QCA to avoid geographic mismatch. Scatter plots, Pearson correlation coefficients, and Bland-Altman were used to analyze the data. Results: A total of 54 significant lesions were analyzed in 47 patients. The proximal and distal reference areas, as well as the minimal luminal area, showed moderate to strong correlation between the 2 modalities (correlation coefficients of 0.57, 0.80, and 0.52, respectively; P<.001). The correlation was weaker for percent area stenosis and lesion length, although statistically significant (correlation coefficients of 0.29 and 0.33, respectively). AI-QCA tended to measure reference vessel areas smaller and lesion lengths shorter than IVUS did. Systemic proportional bias was not observed in Bland-Altman plots. The biggest cause of bias originated from the geographic mismatch of AI-QCA with IVUS. Discrepancies in the proximal or distal lesion margins were observed between the 2 modalities, which were more frequent at the distal margins. After the adjustment of proximal or distal margins, there was a stronger correlation of proximal and distal reference areas between AI-QCA and IVUS (correlation coefficients of 0.70 and 0.83, respectively). Conclusions: AI-QCA showed a moderate to strong correlation compared with IVUS in analyzing coronary lesions with significant stenosis. The main discrepancy was in the perception of the distal margins by AI-QCA, and the correction of margins improved the correlation coefficients. We believe that this novel tool could provide confidence to treating physicians and help in making optimal clinical decisions. %M 37099368 %R 10.2196/45299 %U https://cardio.jmir.org/2023/1/e45299 %U https://doi.org/10.2196/45299 %U http://www.ncbi.nlm.nih.gov/pubmed/37099368 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e40283 %T Remotely Delivered Cardiac Rehabilitation Exercise for Coronary Heart Disease: Nonrandomized Feasibility Study %A Giggins,Oonagh M %A Doyle,Julie %A Smith,Suzanne %A Vavasour,Grainne %A Moran,Orla %A Gavin,Shane %A Sojan,Nisanth %A Boyle,Gordon %+ NetwellCASALA, Dundalk Institute of Technology, Dublin Road, Dundalk, A91K584, Ireland, 353 429370200 ext 2114, oonagh.giggins@dkit.ie %K cardiac rehabilitation %K exercise %K coronary heart disease %K CHD %K coronary %K cardiovascular %K virtual rehabilitation %K remote rehabilitation %K digital health %K heart %K rehabilitation %K cardiac %K digital platform %K digital %K intervention %K program %K physical activity %K fitness %D 2023 %7 10.2.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Exercise-based cardiac rehabilitation (CR) is recommended for coronary heart disease (CHD). However, poor uptake of and poor adherence to CR exercise programs have been reported globally. Delivering CR exercise classes remotely may remove some of the barriers associated with traditional hospital- or center-based CR. Objective: We have developed a bespoke platform, Eastern Corridor Medical Engineering Centre–Cardiac Rehabilitation (ECME-CR), to support remotely delivered CR exercise. This pilot trial sought to test the ECME-CR platform and examine the efficacy and feasibility of a remote CR exercise program compared to a traditional center-based program. Methods: In all, 21 participants with CHD were recruited and assigned to either the intervention or control group. Both groups performed the same 8-week exercise program. Participants in the intervention group took part in web-based exercise classes and used the ECME-CR platform during the intervention period, whereas participants in the control group attended in-person classes. Outcomes were assessed at baseline and following the 8-week intervention period. The primary outcome measure was exercise capacity, assessed using a 6-minute walk test (6MWT). Secondary outcomes included measurement of grip strength, self-reported quality of life, heart rate, blood pressure, and body composition. A series of mixed between-within subjects ANOVA were conducted to examine the mean differences in study outcomes between and within groups. Participant adherence to the exercise program was also analyzed. Results: In all, 8 participants (male: n=5; age: mean 69.7, SD 7.2 years; height: mean 163.9, SD 5.4 cm; weight: mean 81.6, SD 14.1 kg) in the intervention group and 9 participants (male: n=9; age: mean 69.8, SD 8.2 years; height: mean 173.8, SD 5.2 cm; weight: mean 94.4, SD 18.0 kg) in the control group completed the exercise program. Although improvements in 6MWT distance were observed from baseline to follow-up in both the intervention (mean 490.1, SD 80.2 m to mean 504.5, SD 93.7 m) and control (mean 510.2, SD 48.3 m to mean 520.6, SD 49.4 m) group, no significant interaction effect (F1,14=.026; P=.87) nor effect for time (F1,14=2.51; P=.14) were observed. No significant effects emerged for any of the other secondary end points (all P>.0275). Adherence to the exercise program was high in both the intervention (14.25/16, 89.1%) and control (14.33/16, 89.6%) group. No adverse events or safety issues were reported in either group during the study. Conclusions: This pilot trial did not show evidence of significant positive effect for either the remotely delivered or center-based program. The 6MWT may not have been sufficiently sensitive to identify a change in this cohort of participants with stable CHD. This trial does provide evidence that remote CR exercise, supported with digital self-monitoring, is feasible and may be considered for individuals less likely to participate in traditional center-based programs. International Registered Report Identifier (IRRID): RR2-10.2196/31855 %M 36763453 %R 10.2196/40283 %U https://cardio.jmir.org/2023/1/e40283 %U https://doi.org/10.2196/40283 %U http://www.ncbi.nlm.nih.gov/pubmed/36763453 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e39593 %T Effectiveness of mHealth Interventions in the Control of Lifestyle and Cardiovascular Risk Factors in Patients After a Coronary Event: Systematic Review and Meta-analysis %A Cruz-Cobo,Celia %A Bernal-Jiménez,María Ángeles %A Vázquez-García,Rafael %A Santi-Cano,María José %+ Faculty of Nursing and Physiotherapy, University of Cádiz, Av. Ana de Viya, 52, Cádiz, 11009, Spain, 34 956 019042 ext 9042, mariajose.santi@uca.es %K coronary disease %K acute coronary syndrome %K mobile health %K smartphone %K mobile apps %K mobile phone %D 2022 %7 2.12.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Coronary artery disease is the main cause of death and loss of disability-adjusted life years worldwide. Information and communication technology has become an important part of health care systems, including the innovative cardiac rehabilitation services through mobile phone and mobile health (mHealth) interventions. Objective: In this study, we aimed to determine the effectiveness of different kinds of mHealth programs in changing lifestyle behavior, promoting adherence to treatment, and controlling modifiable cardiovascular risk factors and psychosocial outcomes in patients who have experienced a coronary event. Methods: A systematic review of the literature was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A thorough search of the following biomedical databases was conducted: PubMed, Embase, Web of Science, SciELO, CINAHL, Scopus, The Clinical Trial, and Cochrane. Articles that were randomized clinical trials that involved an intervention consisting of an mHealth program using a mobile app in patients after a coronary event were included. The articles analyzed some of the following variables as outcome variables: changes in lifestyle behavior, cardiovascular risk factors, and anthropometric and psychosocial variables. A meta-analysis of the variables studied was performed with the Cochrane tool. The risk of bias was assessed using the Cochrane Collaboration tool; the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation tool; and heterogeneity was measured using the I2 test. Results: A total of 23 articles were included in the review, and 20 (87%) were included in the meta-analysis, with a total sample size of 4535 patients. Exercise capacity measured using the 6-minute walk test (mean difference=21.64, 95% CI 12.72-30.55; P<.001), physical activity (standardized mean difference [SMD]=0.42, 95% CI 0.04-0.81; P=.03), and adherence to treatment (risk difference=0.19, 95% CI 0.11-0.28; P<.001) were significantly superior in the mHealth group. Furthermore, both the physical and mental dimensions of quality of life were better in the mHealth group (SMD=0.26, 95% CI 0.09-0.44; P=.004 and SMD=0.27, 95% CI 0.06-0.47; P=.01, respectively). In addition, hospital readmissions for all causes and cardiovascular causes were statistically higher in the control group than in the mHealth group (SMD=–0.03, 95% CI –0.05 to –0.00; P=.04 vs SMD=–0.04, 95% CI –0.07 to –0.00; P=.05). Conclusions: mHealth technology has a positive effect on patients who have experienced a coronary event in terms of their exercise capacity, physical activity, adherence to medication, and physical and mental quality of life, as well as readmissions for all causes and cardiovascular causes. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42022299931; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299931 %M 36459396 %R 10.2196/39593 %U https://mhealth.jmir.org/2022/12/e39593 %U https://doi.org/10.2196/39593 %U http://www.ncbi.nlm.nih.gov/pubmed/36459396 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 2 %P e38040 %T The Impact of Time Horizon on Classification Accuracy: Application of Machine Learning to Prediction of Incident Coronary Heart Disease %A Simon,Steven %A Mandair,Divneet %A Albakri,Abdel %A Fohner,Alison %A Simon,Noah %A Lange,Leslie %A Biggs,Mary %A Mukamal,Kenneth %A Psaty,Bruce %A Rosenberg,Michael %+ Division of Cardiology, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, United States, 1 303 724 6946, steven.simon@cuanschutz.edu %K coronary heart disease %K risk prediction %K machine learning %K heart %K heart disease %K clinical %K risk %K myocardial %K gender %D 2022 %7 2.11.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Many machine learning approaches are limited to classification of outcomes rather than longitudinal prediction. One strategy to use machine learning in clinical risk prediction is to classify outcomes over a given time horizon. However, it is not well-known how to identify the optimal time horizon for risk prediction. Objective: In this study, we aim to identify an optimal time horizon for classification of incident myocardial infarction (MI) using machine learning approaches looped over outcomes with increasing time horizons. Additionally, we sought to compare the performance of these models with the traditional Framingham Heart Study (FHS) coronary heart disease gender-specific Cox proportional hazards regression model. Methods: We analyzed data from a single clinic visit of 5201 participants of a cardiovascular health study. We examined 61 variables collected from this baseline exam, including demographic and biologic data, medical history, medications, serum biomarkers, electrocardiographic, and echocardiographic data. We compared several machine learning methods (eg, random forest, L1 regression, gradient boosted decision tree, support vector machine, and k-nearest neighbor) trained to predict incident MI that occurred within time horizons ranging from 500-10,000 days of follow-up. Models were compared on a 20% held-out testing set using area under the receiver operating characteristic curve (AUROC). Variable importance was performed for random forest and L1 regression models across time points. We compared results with the FHS coronary heart disease gender-specific Cox proportional hazards regression functions. Results: There were 4190 participants included in the analysis, with 2522 (60.2%) female participants and an average age of 72.6 years. Over 10,000 days of follow-up, there were 813 incident MI events. The machine learning models were most predictive over moderate follow-up time horizons (ie, 1500-2500 days). Overall, the L1 (Lasso) logistic regression demonstrated the strongest classification accuracy across all time horizons. This model was most predictive at 1500 days follow-up, with an AUROC of 0.71. The most influential variables differed by follow-up time and model, with gender being the most important feature for the L1 regression and weight for the random forest model across all time frames. Compared with the Framingham Cox function, the L1 and random forest models performed better across all time frames beyond 1500 days. Conclusions: In a population free of coronary heart disease, machine learning techniques can be used to predict incident MI at varying time horizons with reasonable accuracy, with the strongest prediction accuracy in moderate follow-up periods. Validation across additional populations is needed to confirm the validity of this approach in risk prediction. %M 36322114 %R 10.2196/38040 %U https://cardio.jmir.org/2022/2/e38040 %U https://doi.org/10.2196/38040 %U http://www.ncbi.nlm.nih.gov/pubmed/36322114 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37728 %T Effects of Video-Based Patient Education and Consultation on Unplanned Health Care Utilization and Early Recovery After Coronary Artery Bypass Surgery (IMPROV-ED): Randomized Controlled Trial %A van Steenbergen,Gijs %A van Veghel,Dennis %A van Lieshout,Dideke %A Sperwer,Merel %A ter Woorst,Joost %A Dekker,Lukas %+ Cardiothoracic Surgery Department, Catharina Heart Centre, Catharina Hospital, Michaelangelolaan 3, PO Box 1350, Eindhoven, 5602, Netherlands, 31 040 239 9111, gijs.v.steenbergen@catharinaziekenhuis.nl %K e-Health %K eHealth %K digital health %K patient education %K coronary artery bypass surgery %K cardiac surgery %K health care utilization %K costs %K cost %K economic %K coronary %K cardiology %K heart %K surgery %K bypass %K RCT %K randomized controlled trial %K video consultation %K telehealth %K telemedicine %K patient-reported %K recovery %K expense %D 2022 %7 26.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care utilization after coronary artery bypass graft (CABG) surgery is high and is partly of an unplanned nature. eHealth applications have been proposed to reduce care consumption, which involve and assist patients in their recovery. In this way, health care expenses could be reduced and quality of care could be improved. Objective: The aim of this study was to evaluate if an eHealth program can reduce unplanned health care utilization and improve mental and physical health in the first 6 weeks after CABG surgery. Methods: A single-blind randomized controlled trial was performed, in which patients scheduled for nonacute CABG surgery were included from a single center in the Netherlands between February 2020 and October 2021. Participants in the intervention group had, alongside standard care, access to an eHealth program consisting of online education videos and video consultations developed in conjunction with the Dutch Heart Foundation. The control group received standard care. The primary outcome was the volume and costs of a composite of unplanned health care utilization, including emergency department visits, outpatient clinic visits, rehospitalization, patient-initiated telephone consultations, and visits to a general practitioner, measured using the Medical Technology Assessment Medical Consumption Questionnaire. Patient-reported anxiety and recovery were also assessed. Intention-to-treat and “users-only” analyses were used. Results: During the study period, 280 patients were enrolled and randomly allocated at a 1:1 ratio to the intervention or control group. The intention-to-treat analysis consisted of 136 and 135 patients in the intervention and control group, respectively. At 6 weeks, the primary endpoint had occurred in 43 of 136 (31.6%) patients in the intervention group and in 61 of 135 (45.2%) patients in the control group (hazard ratio 0.56, 95% CI 0.34-0.92). Recovery was faster in the intervention group, whereas anxiety was similar between study groups. “Users-only” analysis yielded similar results. Conclusions: An eHealth strategy comprising educational videos and video consultations can reduce unplanned health care utilization and can aid in faster patient-reported recovery in patients following CABG surgery. Trial Registration: Netherlands Trial Registry NL8510; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8510 International Registered Report Identifier (IRRID): RR2-10.1007/s12471-020-01508-9 %M 36018625 %R 10.2196/37728 %U https://www.jmir.org/2022/8/e37728 %U https://doi.org/10.2196/37728 %U http://www.ncbi.nlm.nih.gov/pubmed/36018625 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e24595 %T Design and Rationale of the National Tunisian Registry of Percutaneous Coronary Intervention: Protocol for a Prospective Multicenter Observational Study %A Hammami,Rania %A Boudiche,Selim %A Rami,Tlili %A Ben Halima,Nejeh %A Jamel,Ahmed %A Rekik,Bassem %A Gribaa,Rym %A Imtinene,Ben Mrad %A Charfeddine,Salma %A Ellouze,Tarek %A Bahloul,Amine %A Hédi,Ben Slima %A Langar,Jamel %A Ben Ahmed,Habib %A Ibn Elhadj,Zied %A Hmam,Mohamed %A Ben Abdessalem,Mohamed Aymen %A Maaoui,Sabri %A Fennira,Sana %A Lobna,Laroussi %A Hassine,Majed %A Ouanes,Sami %A Mohamed Faouzi,Drissi %A Mallek,Souad %A Mahdhaoui,Abdallah %A Meriem,Dghim %A Jomaa,Walid %A Zayed,Sofien %A Kateb,Tawfik %A Bouchahda,Nidhal %A Azaiez,Fares %A Ben Salem,Helmi %A Marouen,Morched %A Noamen,Aymen %A Abdesselem,Salem %A Hichem,Denguir %A Ibn Hadj Amor,Hassen %A Abdeljelil,Farhati %A Amara,Amine %A Bejar,Karim %A Khaldoun,Ben Hamda %A Hamza,Chiheb %A Ben Jamaa,Mohsen %A Fourati,Sami %A Elleuch,Faycal %A Grati,Zeineb %A Chtourou,Slim %A Marouene,Sami %A Sahnoun,Mohamed %A Hadrich,Morched %A Mohamed Abdelkader,Maalej %A Bouraoui,Hatem %A Kamoun,Kamel %A Hadrich,Moufid %A Ben Chedli,Tarek %A Drissa,Mohamed Akrem %A Charfeddine,Hanene %A Saadaoui,Nizar %A Achraf,Gargouri %A Ahmed,Siala %A Ayari,Mokdad %A Nabil,Marsit %A Mnif,Sabeur %A Sahnoun,Maher %A Kammoun,Helmi %A Ben Jemaa,Khaled %A Mostari,Gharbi %A Hamrouni,Nebil %A Yamen,Maazoun %A Ellouz,Yassine %A Smiri,Zahreddine %A Hdiji,Amine %A Bassem,Jerbi %A Ayadi,Wacef %A Zouari,Amir %A Abbassi,Chedly %A Fatma,Boujelben Masmoudi %A Battikh,Kais %A Kharrat,Elyes %A Gtif,Imen %A Sami,Milouchi %A Bezdah,Leila %A Kachboura,Salem %A Maatouk,Mohamed Faouzi %A Kraiem,Sondes %A Jeridi,Gouider %A Neffati,Elyes %A Kammoun,Samir %A Ben Ameur,Youssef %A Fehri,Wafa %A Gamra,Habib %A Zakhama,Lilia %A Addad,Faouzi %A Mohamed Sami,Mourali %A Abid,Leila %+ Department of Cardiology, Hédi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, 3029 Al Ain Road, Sfax, 3029, Tunisia, 216 24056985, raniahammami@yahoo.fr %K percutaneous coronary intervention %K 1-year outcome %K Tunisia %K national %K multicentric %K registry %K percutaneous %K coronary %K artery disease %D 2022 %7 5.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Coronary artery diseases remain the leading cause of death in the world. The management of this condition has improved remarkably in the recent years owing to the development of new technical tools and multicentric registries. Objective: The aim of this study is to investigate the in-hospital and 1-year clinical outcomes of patients treated with percutaneous coronary intervention (PCI) in Tunisia. Methods: We will conduct a prospective multicentric observational study with patients older than 18 years who underwent PCI between January 31, 2020 and June 30, 2020. The primary end point is the occurrence of a major adverse cardiovascular event, defined as cardiovascular death, myocardial infarction, cerebrovascular accident, or target vessel revascularization with either repeat PCI or coronary artery bypass grafting (CABG). The secondary end points are procedural success rate, stent thrombosis, and the rate of redo PCI/CABG for in-stent restenosis. Results: In this study, the demographic profile and the general risk profile of Tunisian patients who underwent PCI and their end points will be analyzed. The complexity level of the procedures and the left main occlusion, bifurcation occlusion, and chronic total occlusion PCI will be analyzed, and immediate as well as long-term results will be determined. The National Tunisian Registry of PCI (NATURE-PCI) will be the first national multicentric registry of angioplasty in Africa. For this study, the institutional ethical committee approval was obtained (0223/2020). This trial consists of 97 cardiologists and 2498 patients who have undergone PCI with a 1-year follow-up period. Twenty-eight catheterization laboratories from both public (15 laboratories) and private (13 laboratories) sectors will enroll patients after receiving informed consent. Of the 2498 patients, 1897 (75.9%) are managed in the public sector and 601 (24.1%) are managed in the private sector. The COVID-19 pandemic started in Tunisia in March 2020; 719 patients (31.9%) were included before the COVID-19 pandemic and 1779 (60.1%) during the pandemic. The inclusion of patients has been finished, and we expect to publish the results by the end of 2022. Conclusions: This study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of PCI in this limited-income region. Trial Registration: Clinicaltrials.gov NCT04219761; https://clinicaltrials.gov/ct2/show/NCT04219761 International Registered Report Identifier (IRRID): RR1-10.2196/24595 %M 35930353 %R 10.2196/24595 %U https://www.researchprotocols.org/2022/8/e24595 %U https://doi.org/10.2196/24595 %U http://www.ncbi.nlm.nih.gov/pubmed/35930353 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37486 %T Improving the Performance of Outcome Prediction for Inpatients With Acute Myocardial Infarction Based on Embedding Representation Learned From Electronic Medical Records: Development and Validation Study %A Huang,Yanqun %A Zheng,Zhimin %A Ma,Moxuan %A Xin,Xin %A Liu,Honglei %A Fei,Xiaolu %A Wei,Lan %A Chen,Hui %+ School of Biomedical Engineering, Capital Medical University, No. 10, Xitoutiao, You An Men, Fengtai District, Beijing, 100069, China, 86 01083911545, chenhui@ccmu.edu.cn %K representation learning %K skip-gram %K feature association strengths %K feature importance %K mortality risk prediction %K acute myocardial infarction %D 2022 %7 3.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The widespread secondary use of electronic medical records (EMRs) promotes health care quality improvement. Representation learning that can automatically extract hidden information from EMR data has gained increasing attention. Objective: We aimed to propose a patient representation with more feature associations and task-specific feature importance to improve the outcome prediction performance for inpatients with acute myocardial infarction (AMI). Methods: Medical concepts, including patients’ age, gender, disease diagnoses, laboratory tests, structured radiological features, procedures, and medications, were first embedded into real-value vectors using the improved skip-gram algorithm, where concepts in the context windows were selected by feature association strengths measured by association rule confidence. Then, each patient was represented as the sum of the feature embeddings weighted by the task-specific feature importance, which was applied to facilitate predictive model prediction from global and local perspectives. We finally applied the proposed patient representation into mortality risk prediction for 3010 and 1671 AMI inpatients from a public data set and a private data set, respectively, and compared it with several reference representation methods in terms of the area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), and F1-score. Results: Compared with the reference methods, the proposed embedding-based representation showed consistently superior predictive performance on the 2 data sets, achieving mean AUROCs of 0.878 and 0.973, AUPRCs of 0.220 and 0.505, and F1-scores of 0.376 and 0.674 for the public and private data sets, respectively, while the greatest AUROCs, AUPRCs, and F1-scores among the reference methods were 0.847 and 0.939, 0.196 and 0.283, and 0.344 and 0.361 for the public and private data sets, respectively. Feature importance integrated in patient representation reflected features that were also critical in prediction tasks and clinical practice. Conclusions: The introduction of feature associations and feature importance facilitated an effective patient representation and contributed to prediction performance improvement and model interpretation. %M 35921141 %R 10.2196/37486 %U https://www.jmir.org/2022/8/e37486 %U https://doi.org/10.2196/37486 %U http://www.ncbi.nlm.nih.gov/pubmed/35921141 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e34974 %T Design of a Remote Coaching Program to Bridge the Gap From Hospital Discharge to Cardiac Rehabilitation: Intervention Mapping Study %A Keessen,Paul %A van Duijvenbode,Ingrid CD %A Latour,Corine HM %A Kraaijenhagen,Roderik A %A Janssen,Veronica R %A Jørstad,Harald T %A Scholte op Reimer,Wilma JM %A Visser,Bart %+ Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, Amsterdam, 1105 BD, Netherlands, 31 6 16389451, p.keessen@hva.nl %K coronary artery disease %K intervention mapping approach %K information needs %K support needs %K eHealth %K cardiac rehabilitation %K remote coaching %K e-coaching %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Remote coaching might be suited for providing information and support to patients with coronary artery disease (CAD) in the vulnerable phase between hospital discharge and the start of cardiac rehabilitation (CR). Objective: The goal of the research was to explore and summarize information and support needs of patients with CAD and develop an early remote coaching program providing tailored information and support. Methods: We used the intervention mapping approach to develop a remote coaching program. Three steps were completed in this study: (1) identification of information and support needs in patients with CAD, using an exploratory literature study and semistructured interviews, (2) definition of program objectives, and (3) selection of theory-based methods and practical intervention strategies. Results: Our exploratory literature study (n=38) and semistructured interviews (n=17) identified that after hospital discharge, patients with CAD report a need for tailored information and support about CAD itself and the specific treatment procedures, medication and side effects, physical activity, and psychological distress. Based on the preceding steps, we defined the following program objectives: (1) patients gain knowledge on how CAD and revascularization affect their bodies and health, (2) patients gain knowledge about medication and side effects and adhere to their treatment plan, (3) patients know which daily physical activities they can and can’t do safely after hospital discharge and are physically active, and (4) patients know the psychosocial consequences of CAD and know how to discriminate between harmful and harmless body signals. Based on the preceding steps, a remote coaching program was developed with the theory of health behavior change as a theoretical framework with behavioral counseling and video modeling as practical strategies for the program. Conclusions: This study shows that after (acute) cardiac hospitalization, patients are in need of information and support about CAD and revascularization, medication and side effects, physical activity, and psychological distress. In this study, we present the design of an early remote coaching program based on the needs of patients with CAD. The development of this program constitutes a step in the process of bridging the gap from hospital discharge to start of CR. %M 35612879 %R 10.2196/34974 %U https://cardio.jmir.org/2022/1/e34974 %U https://doi.org/10.2196/34974 %U http://www.ncbi.nlm.nih.gov/pubmed/35612879 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e30236 %T The Box—eHealth in the Outpatient Clinic Follow-up of Patients With Acute Myocardial Infarction: Cost-Utility Analysis %A Treskes,Roderick Willem %A van den Akker-van Marle,M Elske %A van Winden,Louise %A van Keulen,Nicole %A van der Velde,Enno Tjeerd %A Beeres,Saskia %A Atsma,Douwe %A Schalij,Martin Jan %+ Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 715262020, m.j.schalij@lumc.nl %K smart technology %K myocardial infarction %K cost-utility %K outpatients %K cost-effectiveness %K eHealth %K remote monitoring %K cost of care %K quality of life %D 2022 %7 25.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone compatible wearables have been released on the consumers market, enabling remote monitoring. Remote monitoring is often named as a tool to reduce the cost of care. Objective: The primary purpose of this paper is to describe a cost-utility analysis of an eHealth intervention compared to regular follow-up in patients with acute myocardial infarction (AMI). Methods: In this trial, of which clinical results have been published previously, patients with an AMI were randomized in a 1:1 fashion between an eHealth intervention and regular follow-up. The remote monitoring intervention consisted of a blood pressure monitor, weight scale, electrocardiogram device, and step counter. Furthermore, two in-office outpatient clinic visits were replaced by e-visits. The control group received regular care. The differences in mean costs and quality of life per patient between both groups during one-year follow-up were calculated. Results: Mean costs per patient were €2417±2043 (US $2657±2246) for the intervention and €2888±2961 (US $3175±3255) for the control group. This yielded a cost reduction of €471 (US $518) per patient. This difference was not statistically significant (95% CI –€275 to €1217; P=.22, US $–302 to $1338). The average quality-adjusted life years in the first year of follow-up was 0.74 for the intervention group and 0.69 for the control (difference –0.05, 95% CI –0.09 to –0.01; P=.01). Conclusions: eHealth in the outpatient clinic setting for patients who suffered from AMI is likely to be cost-effective compared to regular follow-up. Further research should be done to corroborate these findings in other patient populations and different care settings. Trial Registration: ClinicalTrials.gov NCT02976376; https://clinicaltrials.gov/ct2/show/NCT02976376 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8038 %M 35468091 %R 10.2196/30236 %U https://www.jmir.org/2022/4/e30236 %U https://doi.org/10.2196/30236 %U http://www.ncbi.nlm.nih.gov/pubmed/35468091 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e36801 %T Authors’ Reply to: Using Caution When Interpreting Gender-Based Relative Risk. Comment on “The Effect of Cardiovascular Comorbidities on Women Compared to Men: Longitudinal Retrospective Analysis” %A Dervic,Elma %A Deischinger,Carola %A Haug,Nina %A Leutner,Michael %A Kautzky-Willer,Alexandra %A Klimek,Peter %+ Section for Science of Complex Systems, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria, 43 1 40160 362, peter.klimek@meduniwien.ac.at %K gender gap %K sex differences %K cardiovascular diseases %K acute myocardial infarction %K chronic ischemic heart disease %K gender %K diabetes %K smoking %K risk factors %K comorbidities %K relative risk %K interaction %D 2022 %7 25.3.2022 %9 Letter to the Editor %J JMIR Cardio %G English %X   %M 35333178 %R 10.2196/36801 %U https://cardio.jmir.org/2022/1/e36801 %U https://doi.org/10.2196/36801 %U http://www.ncbi.nlm.nih.gov/pubmed/35333178 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e34647 %T Using Caution When Interpreting Gender-Based Relative Risk. Comment on “The Effect of Cardiovascular Comorbidities on Women Compared to Men: Longitudinal Retrospective Analysis” %A Janszky,Imre %+ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls Gate 11, Trondheim, N-7491, Norway, 47 73597575, imre.janszky@ntnu.no %K gender gap %K sex differences %K cardiovascular diseases %K acute myocardial infarction %K chronic ischemic heart disease %K gender %K diabetes %K smoking %K risk factors %K comorbidities %K relative risk %K interaction %D 2022 %7 25.3.2022 %9 Letter to the Editor %J JMIR Cardio %G English %X   %M 35333181 %R 10.2196/34647 %U https://cardio.jmir.org/2022/1/e34647 %U https://doi.org/10.2196/34647 %U http://www.ncbi.nlm.nih.gov/pubmed/35333181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27202 %T An mHealth Intervention to Improve Medication Adherence and Health Outcomes Among Patients With Coronary Heart Disease: Randomized Controlled Trial %A Ni,Zhao %A Wu,Bei %A Yang,Qing %A Yan,Lijing L %A Liu,Changqing %A Shaw,Ryan J %+ School of Medicine, Yale University, 135 College Street, New Haven, CT, 06510, United States, 1 646 617 2232, zhao.ni@yale.edu %K mHealth %K medication adherence %K coronary disease %K blood pressure %K China %K randomized controlled trial %D 2022 %7 9.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The treatment of many chronic illnesses involves long-term pharmaceutical therapy, but it is an ongoing challenge to find effective ways to improve medication adherence to promote good health outcomes. Cardioprotective medications can prevent the enlargement of harmful clots, cardiovascular symptoms, and poor therapeutic outcomes, such as uncontrolled high blood pressure and hyperlipidemia, for patients with coronary heart disease. Poor adherence to cardioprotective medications, however, has been reported as a global health concern among patients with coronary heart disease, and it is particularly a concern in China. Objective: This study aimed to evaluate the efficacy of a mobile health (mHealth) intervention using 2 mobile apps to improve medication adherence and health outcomes. Methods: A randomized, placebo-controlled, 2-arm parallel study was conducted in a major university-affiliated medical center located in Chengdu, China. Participants were recruited by flyers and health care provider referrals. Each participant was observed for 90 days, including a 60-day period of mHealth intervention and a 30-day period of nonintervention follow-up. The study coordinator used WeChat and Message Express to send educational materials and reminders to take medication, respectively. Participants used WeChat to receive both the educational materials and reminders. Participants in the control group only received educational materials. This study received ethics approval from the Duke Health Institutional Review Board (Pro00073395) on May 5, 2018, and was approved by West China Hospital (20170331180037). Recruitment began on May 20, 2018. The pilot phase of this study was registered on June 8, 2016, and the current, larger-scale study was retrospectively registered on January 11, 2021 (ClinicalTrials.gov). Results: We recruited 230 patients with coronary heart disease. Of these patients, 196 completed the baseline survey and received the intervention. The majority of participants were married (181/196, 92.4%), male (157/196, 80.1%), and lived in urban China (161/196, 82.1%). Participants’ average age was 61 years, and half were retired (103/191, 53.9%). More than half the participants (121/196, 61.7%) were prescribed at least 5 medications. The mean decrease in medication nonadherence score was statistically significant at both 60 days (t179=2.04, P=.04) and 90 days (t155=3.48, P<.001). Systolic blood pressure and diastolic blood pressure decreased in the experimental group but increased in the control group. The mean decrease in diastolic blood pressure was statistically significant at both 60 days (t160=2.07, P=.04) and 90 days (t164=2.21, P=.03). The mean decrease in systolic blood pressure was significantly different in the groups at 90 days (t165=3.12, P=.002). Conclusions: The proposed mHealth intervention can improve medication adherence and health outcomes, including systolic blood pressure and diastolic blood pressure. Trial Registration: ClinicalTrials.gov NCT02793830; https://clinicaltrials.gov/ct2/show/NCT02793830 and ClinicalTrials.gov NCT04703439; https://clinicaltrials.gov/ct2/show/NCT04703439 %M 35262490 %R 10.2196/27202 %U https://www.jmir.org/2022/3/e27202 %U https://doi.org/10.2196/27202 %U http://www.ncbi.nlm.nih.gov/pubmed/35262490 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e34452 %T Understanding Patients’ Intention to Use Digital Health Apps That Support Postdischarge Symptom Monitoring by Providers Among Patients With Acute Coronary Syndrome: Survey Study %A Chen,Jinying %A Wijesundara,Jessica G %A Enyim,Gabrielle E %A Lombardini,Lisa M %A Gerber,Ben S %A Houston,Thomas K %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, United States, 1 508 856 6063, jinying.chen@umassmed.edu %K coronary %K monitor %K elder %K health app %K symptom %K eHealth %K mobile health %K intention %K barrier %K facilitator %D 2022 %7 7.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: After hospital discharge, patients with acute coronary syndrome (ACS) often experience symptoms that prompt them to seek acute medical attention. Early evaluation of postdischarge symptoms by health care providers may reduce unnecessary acute care utilization. However, hospital-initiated follow-up encounters are insufficient for timely detection and assessment of symptoms. While digital health tools can help address this issue, little is known about the intention to use such tools in ACS patients. Objective: This study aimed to assess ACS patients’ intention to use digital health apps that support postdischarge symptom monitoring by health care providers and identify patient-perceived facilitators and barriers to app use. Methods: Using email invitations or phone calls, we recruited ACS patients discharged from a central Massachusetts health care system between December 2020 and April 2021, to participate in the study. Surveys were delivered online or via phone to individual participants. Demographics and access to technology were assessed. The intention to use a symptom monitoring app was assessed using 5-point Likert-type (from strongly agree to strongly disagree) items, such as “If this app were available to me, I would use it.” Responses were compared across demographic subgroups and survey delivery methods. Two open-ended questions assessed perceived facilitators and barriers to app use, with responses analyzed using qualitative content analysis. Results: Among 100 respondents (response rate 8.1%), 45 (45%) completed the survey by phone. The respondents were on average 68 years old (SD 13 years), with 90% (90/100) White, 39% (39/100) women, and 88% (88/100) having access to the internet or a mobile phone. Most participants (65/100, 65%) agreed or strongly agreed that they would use the app, among which 53 (82%) would use the app as often as possible. The percentage of participants with the intention to use the app was 75% among those aged 65-74 years and dropped to 44% among those older than 75 years. The intention to use was higher in online survey respondents (vs phone survey respondents; odds ratio 3.07, 95% CI 1.20-7.88) after adjusting for age and access to technology. The analysis of open-ended questions identified the following 4 main facilitators (motivations): (1) easily reaching providers, (2) accessing or providing information, (3) quickly reaching providers, and (4) consulting providers for symptoms, and the following 4 main barriers: (1) privacy/security concerns, (2) uncomfortable using technology, (3) user-unfriendly app interface, and (4) preference for in-person/phone care. Conclusions: There was a strong intention to use a symptom monitoring app postdischarge among ACS patients. However, this intent decreased in patients older than 75 years. The survey identified barriers related to technology use, privacy/security, and the care delivery mode. Further research is warranted to determine if such intent translates into app use, and better symptom management and health care quality. %M 35254269 %R 10.2196/34452 %U https://humanfactors.jmir.org/2022/1/e34452 %U https://doi.org/10.2196/34452 %U http://www.ncbi.nlm.nih.gov/pubmed/35254269 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e29473 %T A Preoperative Virtual Reality App for Patients Scheduled for Cardiac Catheterization: Pre–Post Questionnaire Study Examining Feasibility, Usability, and Acceptability %A Aardoom,Jiska J %A Hilt,Alexander D %A Woudenberg,Tamar %A Chavannes,Niels H %A Atsma,Douwe E %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2300 RC, Netherlands, 31 7152668605, j.j.aardoom@lumc.nl %K virtual reality %K cardiac catheterization %K stress inoculation training %K preoperative anxiety %K acceptability %K feasibility %K presence %K immersive tendencies %K presence %K patient education %K mobile phone %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Pre- and postoperative anxiety is a common phenomenon associated with negative postoperative outcomes. Symptoms of posttraumatic stress disorder, such as fear, nightmares, and sleep deprivation, are prevalent in approximately 30% to 50% of patients following discharge from intensive care units after cardiac surgery. Preliminary evidence suggests a promising role of virtual reality (VR) in preventing stress-related reactions using stress inoculation training. Such training enables cognitive preparation of individuals for stressful situations, thereby becoming more tolerant and resistant to stress, subsequently reducing the risk of potential negative psychological consequences. This study investigated a preoperative VR app—Pre-View—aimed at better informing and preparing patients for cardiac catheterization. Objective: This study aims to assess the feasibility, usability, and acceptability of Pre-View in patients undergoing cardiac catheterization. Methods: Eligible participants were adults scheduled for elective cardiac catheterization. Pre-View comprised an interactive virtual representation of the whole care process related to cardiac catheterization, from entering the hospital for admission to postprocedural stay and discharge. These processes were represented through 360° videos and interactive photos. Self-report questionnaires were completed at baseline (ie, before catheterization and after undergoing the VR experience) and after cardiac catheterization. Outcome measures included user experience and satisfaction, VR presence and immersive tendencies, and user friendliness. The perceived effectiveness was assessed exploratively. Results: A total of 8 individuals, with a mean age of 67 (SD 7.5) years, participated in this study. Half of them underwent the VR experience at the hospital and the other half at home. Participants reported high levels of presence in the virtual environment (Presence Questionnaire score: mean 129.1, SD 13.4). The usability of Pre-View was well evaluated (System Usability Scale score: mean 89.1, SD 12.0), and patient satisfaction was high (Client Satisfaction Questionnaire score: mean 27.1, SD 3.2). Usability and satisfaction scores were higher for participants who underwent Pre-View at home versus those who underwent Pre-View at the hospital, although the latter group was significantly older; 72.8 versus 61.3, respectively. All participants reported Pre-View to be effective in terms of feeling better informed about the care process of cardiac catheterization. Most participants (7/8, 88%) reported Pre-View to be effective in terms of feeling better prepared for cardiac catheterization, acknowledging the potential of Pre-View in reducing negative psychological consequences after catheterization. Conclusions: The results provide initial support for the feasibility and acceptability of a preoperative VR app, creating a virtual environment that supports patient education and preparation for upcoming cardiac catheterization. More studies are needed to further investigate the effects of VR as a tool to better prepare patients for medical procedures, its effectiveness in reducing negative patient outcomes (eg, anxiety, stress, and postoperative recovery outcomes), and the generalizability of effects across different settings and patient populations. %M 35191839 %R 10.2196/29473 %U https://cardio.jmir.org/2022/1/e29473 %U https://doi.org/10.2196/29473 %U http://www.ncbi.nlm.nih.gov/pubmed/35191839 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e32251 %T Effects on Adherence to a Mobile App–Based Self-management Digital Therapeutics Among Patients With Coronary Heart Disease: Pilot Randomized Controlled Trial %A Li,Yuxi %A Gong,Yanjun %A Zheng,Bo %A Fan,Fangfang %A Yi,Tieci %A Zheng,Yimei %A He,Pengkang %A Fang,Jin %A Jia,Jia %A Zhu,Qin %A Jiang,Jie %A Huo,Yong %+ Department of Cardiology, Peking University First Hospital, Xishiku No. 8, Xicheng District, Beijing, 100034, China, 86 83572283, huoyong@263.net.cn %K coronary heart disease %K secondary prevention %K self-management %K mobile app %K adherence %K digital therapeutics %K mobile phone %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The adherence to secondary prevention treatment in patients with coronary heart disease (CHD) is low. Digital therapeutics (DTx) refers to an emerging branch of medicine that delivers medical interventions directly to patients using evidence-based, clinically evaluated, technology-based software algorithms or apps to facilitate disease management, which may be an efficient tool to optimize adherence. Objective: This paper aims to investigate the effect of mobile app–based self-management DTx on long-term use of secondary prevention medications in patients with CHD in China. Methods: This pilot study was a parallel-designed, open-labeled, single-center, randomized controlled trial. Hospitalized patients with CHD admitted to Peking University First Hospital between April 2016 and June 2017 were randomized before discharge on a 1:1 ratio. The intervention group received regular follow-up combined with DTx, which is a self-management mobile app already installed on an Android 5 (Mi Pad 1, Xiaomi Corporation) tablet. Structured data from the hospital informatics system were integrated automatically, and medication, lifestyle intervention plan, follow-up protocol, and patient education materials were also provided according to the diagnosis. Participants could use DTx for self-management at home. The control group was under conventional hospital–based follow-up care. Patients were followed up for 1 year, and the primary end point was the percentage of all guideline-recommended medications at 12 months. The secondary end points included the percentage adhered to standard secondary prevention medications at 6 months, the control rate of lipid profile, and blood pressure at 6 months and 1 year. Results: Among 300 randomized patients with CHD, 290 (96.7%) were included in the final analysis, including 49.3% (143/290) and 50.7% (147/290) of patients from the intervention and control groups, respectively. Baseline characteristics were similar between the 2 groups. There was a statistically significant improvement in the percentage of all guideline-recommended medications at 12 months in the intervention group compared with the control group (relative risk [RR] 1.34, 95% CI 1.12-1.61; P=.001), and there was no interaction with baseline characteristics. The intervention group had a significantly higher proportion of patients achieving blood pressure under control (systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) and low-density lipoprotein cholesterol <1.8 mmol/L (RR 1.45, 95% CI 1.22-1.72; P<.001 and RR 1.40, 95% CI 1.11-1.75; P=.004, respectively) at 12 months. Furthermore, on logistic regression, the intervention group had a lower risk of withdrawing from guideline-recommended medications (odds ratio 0.46, 95% CI 0.27-0.78; P=.004). Conclusions: Among patients with CHD, using a mobile app–based self-management DTx in addition to traditional care resulted in a significant improvement in guideline-recommended medication adherence at 12 months. The results of the trial will be applicable to primary care centers, especially in rural areas with less medical resources. Trial Registration: ClinicalTrials.gov NCT03565978; https://clinicaltrials.gov/ct2/show/NCT03565978 %M 34906924 %R 10.2196/32251 %U https://mhealth.jmir.org/2022/2/e32251 %U https://doi.org/10.2196/32251 %U http://www.ncbi.nlm.nih.gov/pubmed/34906924 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e31885 %T Investigating Genetic and Other Determinants of First-Onset Myocardial Infarction in Malaysia: Protocol for the Malaysian Acute Vascular Events Risk Study %A Chowdhury,Rajiv %A Noh,Mohd Fairulnizal Md %A Ismail,Sophia Rasheeqa %A van Daalen,Kim Robin %A Kamaruddin,Puteri Sofia Nadira Megat %A Zulkiply,Siti Hafizah %A Azizul,Nur Hayati %A Khalid,Norhayati Mustafa %A Ali,Azizan %A Idris,Izyan Mohd %A Mei,Yong Shih %A Abdullah,Shazana Rifham %A Faridus,Norfashihah %A Yusof,Nur Azirah Md %A Yusoff,Nur Najwa Farahin M %A Jamal,Rahman %A Rahim,Aizai Azan Abdul %A Ghapar,Abdul Kahar Abdul %A Radhakrishnan,Ammu Kutty %A Fong,Alan Yean Yip %A Ismail,Omar %A Krishinan,Saravanan %A Lee,Chuey Yan %A Bang,Liew Houng %A Mageswaren,Eashwary %A Mahendran,Kauthaman %A Amin,Nor Hanim Mohd %A Muthusamy,Gunavathy %A Jin,Aaron Ong Hean %A Ramli,Ahmad Wazi %A Ross,Noel Thomas %A Ruhani,Anwar Irawan %A Yahya,Mansor %A Yusoff,Yusniza %A Abidin,Siti Khairani Zainal %A Amado,Laryssa %A Bolton,Thomas %A Weston,Sophie %A Crawte,Jason %A Ovenden,Niko %A Michielsen,Ank %A Monower,Md Mostafa %A Mahiyuddin,Wan Rozita Wan %A Wood,Angela %A Di Angelantonio,Emanuele %A Sulaiman,Nur Suffia %A Danesh,John %A Butterworth,Adam S %+ British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom, 44 01223 748600, asb38@medschl.cam.ac.uk %K myocardial infarction %K cardiovascular disease %K case-control study %K Malaysia %D 2022 %7 10.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although the burden of premature myocardial infarction (MI) is high in Malaysia, direct evidence on the determinants of MI in this multi-ethnic population remains sparse. Objective: The Malaysian Acute Vascular Events Risk (MAVERIK) study is a retrospective case-control study established to investigate the genomic, lipid-related, and other determinants of acute MI in Malaysia. In this paper, we report the study protocol and early results. Methods: By June 2019, we had enrolled approximately 2500 patients with their first MI and 2500 controls without cardiovascular disease, who were frequency-matched by age, sex, and ethnicity, from 17 hospitals in Malaysia. For each participant, serum and whole blood have been collected and stored. Clinical, demographic, and behavioral information has been obtained using a 200-item questionnaire. Results: Tobacco consumption, a history of diabetes, hypertension, markers of visceral adiposity, indicators of lower socioeconomic status, and a family history of coronary disease were more prevalent in cases than in controls. Adjusted (age and sex) logistic regression models for traditional risk factors indicated that current smoking (odds ratio [OR] 4.11, 95% CI 3.56-4.75; P<.001), previous smoking (OR 1.34, 95% CI 1.12-1.60; P=.001), a history of high blood pressure (OR 2.13, 95% CI 1.86-2.44; P<.001), a history of diabetes mellitus (OR 2.72, 95% CI 2.34-3.17; P<.001), a family history of coronary heart disease (OR 1.28, 95% CI 1.07-1.55; P=.009), and obesity (BMI >30 kg/m2; OR 1.19, 95% CI 1.05-1.34; P=.009) were associated with MI in age- and sex-adjusted models. Conclusions: The MAVERIK study can serve as a useful platform to investigate genetic and other risk factors for MI in an understudied Southeast Asian population. It should help to hasten the discovery of disease-causing pathways and inform regionally appropriate strategies that optimize public health action. International Registered Report Identifier (IRRID): RR1-10.2196/31885 %M 35142634 %R 10.2196/31885 %U https://www.researchprotocols.org/2022/2/e31885 %U https://doi.org/10.2196/31885 %U http://www.ncbi.nlm.nih.gov/pubmed/35142634 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e34657 %T Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review %A Ramachandran,Hadassah Joann %A Jiang,Ying %A Teo,Jun Yi Claire %A Yeo,Tee Joo %A Wang,Wenru %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Blk MD11, Level 2, Singapore, 117597, Singapore, 65 66011761, nurww@nus.edu.sg %K technology acceptance %K coronary heart disease %K home-based %K telerehabilitation %K web-based %K mobile application %K acceptance %K heart %K rehabilitation %K app %K review %K evaluation %K cardiac %K cardiology %K perspective %K usability %K acceptability %D 2022 %7 7.1.2022 %9 Review %J J Med Internet Res %G English %X Background: An understanding of the technology acceptance of home-based cardiac telerehabilitation programs is paramount if they are to be designed and delivered to target the needs and preferences of patients with coronary heart disease; however, the current state of technology acceptance of home-based cardiac telerehabilitation has not been systematically evaluated in the literature. Objective: We aimed to provide a comprehensive summary of home-based cardiac telerehabilitation technology acceptance in terms of (1) the timing and approaches used and (2) patients’ perspectives on its usability, utility, acceptability, acceptance, and external variables. Methods: We searched PubMed, CENTRAL, Embase, CINAHL, PsycINFO, and Scopus (inception to July 2021) for English-language papers that reported empirical evidence on the technology acceptance of early-phase home-based cardiac telerehabilitation in patients with coronary heart disease. Content analysis was undertaken. Results: The search identified 1798 studies, of which 18 studies, with 14 unique home-based cardiac telerehabilitation programs, met eligibility criteria. Technology acceptance (of the home-based cardiac telerehabilitation programs) was mostly evaluated at intra- and posttrial stages using questionnaires (n=10) and usage data (n=11). The least used approach was evaluation through qualitative interviews (n=3). Usability, utility, acceptability, and acceptance were generally favored. External variables that influenced home-based cardiac telerehabilitation usage included component quality, system quality, facilitating conditions, and intrinsic factors. Conclusions: Home-based cardiac telerehabilitation usability, utility, acceptability, and acceptance were high; yet, a number of external variables influenced acceptance. Findings and recommendations from this review can provide guidance for developing and evaluating patient-centered home-based cardiac telerehabilitation programs to stakeholders and clinicians. %M 34994711 %R 10.2196/34657 %U https://www.jmir.org/2022/1/e34657 %U https://doi.org/10.2196/34657 %U http://www.ncbi.nlm.nih.gov/pubmed/34994711 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e34534 %T Getting “Back on Track” After a Cardiac Event: Protocol for a Randomized Controlled Trial of a Web-Based Self-management Program %A Rogerson,Michelle C %A Jackson,Alun C %A Navaratnam,Hema S %A Le Grande,Michael R %A Higgins,Rosemary O %A Clarke,Joanne %A Murphy,Barbara M %+ Australian Centre for Heart Health, 75-79 Chetwynd St, North Melbourne, 3051, Australia, 61 3 9326 8544, michelle.rogerson@australianhearthealth.org.au %K coronary heart disease %K heart disease %K coronary %K cardiovascular %K prevention %K RCT %K randomized control trial %K secondary prevention %K self-management %K online %K randomised controlled trial %K health behaviours %K health behaviour %K health behavior %K depression %K cognitive behaviour therapy %K motivational interviewing %D 2021 %7 23.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: After a cardiac event, a large majority of patients with cardiac conditions do not achieve recommended behavior change targets for secondary prevention. Mental health issues can also impact the ability to engage in health behavior change. There is a need for innovative, flexible, and theory-driven eHealth programs, which include evidence-based strategies to assist patients with cardiac conditions with their recovery, especially in behavioral and emotional self-management. Objective: The aim of this study is to determine the short- and longer-term behavioral and emotional well-being outcomes of the Back on Track web-based self-management program. In addition, this study will test whether there is enhanced benefit of providing one-on-one telephone support from a trained lifestyle counselor, over and above benefit obtained through completing the web-based program alone. Methods: People who have experienced a cardiac event in the previous 12 months and have access to the internet will be eligible for this study (N=120). Participants will be randomly assigned to one of the two study conditions: either “self-directed” completion of the Back on Track program (without assistance) or “supported” completion of the Back on Track program (additional 2 telephone sessions with a lifestyle counselor). All participants will have access to the web-based Back on Track program for 2 months. Telephone sessions with the supported arm participants will occur at approximately 2 and 6 weeks post enrollment. Measures will be assessed at baseline, and then 2 and 6 months later. Outcome measures assessed at all 3 timepoints include dietary intake, physical activity and sitting time, smoking status, anxiety and depression, stage of change, and self-efficacy in relation to behavioral and emotional self-management, quality of life, and self-rated health and well-being. A demographic questionnaire will be included at baseline only and program acceptability at 2 months only. Results: Recruitment began in May 2020 and concluded in August 2021. Data collection for the 6-month follow-up will be completed by February 2022, and data analysis and publication of results will be completed by June 2022. A total of 122 participants were enrolled in this study. Conclusions: The Back on Track trial will enable us to quantify the behavioral and emotional improvements obtained and maintained for patients with cardiac conditions and, in particular, to compare two modes of delivery: (1) fully self-directed delivery and (2) supported by a lifestyle counselor. We anticipate that the web-based Back on Track program will assist patients in their recovery and self-management after an acute event, and represents an effective, flexible, and easily accessible adjunct to center-based rehabilitation programs. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000102976; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378920&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/34534 %M 34941550 %R 10.2196/34534 %U https://www.researchprotocols.org/2021/12/e34534 %U https://doi.org/10.2196/34534 %U http://www.ncbi.nlm.nih.gov/pubmed/34941550 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e26439 %T An Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) for Individuals With Coronary Heart Disease: Development and Usability Testing Analysis %A Chen,Yuling %A Ji,Meihua %A Wu,Ying %A Wang,Qingyu %A Deng,Ying %A Liu,Yong %A Wu,Fangqin %A Liu,Mingxuan %A Guo,Yiqiang %A Fu,Ziyuan %A Zheng,Xiaoying %+ School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069, China, 86 83911766, helenywu@vip.163.com %K mobile health %K health behavior %K system %K development %K usability %K coronary heart disease %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Death and disability from coronary heart disease (CHD) can be largely reduced by improving risk factor management. However, adhering to evidence-based recommendations is challenging and requires interventions at the level of the patient, provider, and health system. Objective: The aim of this study was to develop an Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) to facilitate adherence to health behaviors and preventive medications, and to test the usability of iCARE. Methods: We developed iCARE based on a user-centered design approach, which included 4 phases: (1) function design, (2) iterative design, (3) expert inspections and walkthroughs of the prototypes, and (4) usability testing with end users. The usability testing of iCARE included 2 stages: stage I, which included a task analysis and a usability evaluation (January to March 2019) of the iCARE patient app using the modified Health Information Technology Usability Survey (Health-ITUES); and stage II (June 2020), which used the Health-ITUES among end users who used the app for 6 months. The end users were individuals with a confirmed diagnosis of CHD from 2 university-affiliated hospitals in Beijing, China. Results: iCARE consists of a patient app, a care provider app, and a cloud platform. It has a set of algorithms that trigger tailored feedback and can send individualized interventions based on data from initial assessment and health monitoring via manual entry or wearable devices. For stage I usability testing, 88 hospitalized patients (72% [63/88] male; mean age 60 [SD 9.9] years) with CHD were included in the study. The mean score of the usability testing was 90.1 (interquartile range 83.3-99.0). Among enrolled participants, 90% (79/88) were satisfied with iCARE; 94% (83/88) and 82% (72/88) reported that iCARE was useful and easy to use, respectively. For stage II usability testing, 61 individuals with CHD (85% [52/61] male; mean age 53 [SD 8.2] years) who were from an intervention arm and used iCARE for at least six months were included. The mean total score on usability testing based on the questionnaire was 89.0 (interquartile distance: 77.0-99.5). Among enrolled participants, 89% (54/61) were satisfied with the use of iCARE, 93% (57/61) perceived it as useful, and 70% (43/61) as easy to use. Conclusions: This study developed an intelligent, individualized, evidence-based, and theory-driven app (iCARE) to improve patients’ adherence to health behaviors and medication management. iCARE was identified to be highly acceptable, useful, and easy to use among individuals with a diagnosis of CHD. Trial Registration: Chinese Clinical Trial Registry ChiCTR-INR-16010242; https://tinyurl.com/2p8bkrew %M 34898449 %R 10.2196/26439 %U https://mhealth.jmir.org/2021/12/e26439 %U https://doi.org/10.2196/26439 %U http://www.ncbi.nlm.nih.gov/pubmed/34898449 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 12 %P e23285 %T A Smartphone App (AnSim) With Various Types and Forms of Messages Using the Transtheoretical Model for Cardiac Rehabilitation in Patients With Coronary Artery Disease: Development and Usability Study %A Choi,Jah Yeon %A Kim,Ji Bak %A Lee,Sunki %A Lee,Seo-Joon %A Shin,Seung Eon %A Park,Se Hyun %A Park,Eun Jin %A Kim,Woohyeun %A Na,Jin Oh %A Choi,Cheol Ung %A Rha,Seung-Woon %A Park,Chang Gyu %A Seo,Hong Seog %A Ahn,Jeonghoon %A Jeong,Hyun-Ghang %A Kim,Eung Ju %+ Sports Medical Center, Korea University Guro Hospital, Seoul, 08308, Republic of Korea, 82 2 2626 3020, withnoel@empas.com %K cardiac rehabilitation %K smartphone app %K coronary heart disease %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Despite strong evidence of clinical benefit, cardiac rehabilitation (CR) programs are currently underutilized and smartphone-based CR strategies are thought to address this unmet need. However, data regarding the detailed process of development are scarce. Objective: This study focused on the development of a smartphone-based, patient-specific, messaging app for patients who have undergone percutaneous coronary intervention (PCI). Methods: The AnSim app was developed in collaboration with a multidisciplinary team that included cardiologists, psychiatrists, nurses, pharmacists, nutritionists, and rehabilitation doctors and therapists. First, a focus group interview was conducted, and the narratives of the patients were analyzed to identify their needs and preferences. Based on the results, health care experts and clinicians drafted messages into 5 categories: (1) general information regarding cardiovascular health and medications, (2) nutrition, (3) physical activity, (4) destressing, and (5) smoking cessation. In each category, 90 messages were developed according to 3 simplified steps of the transtheoretical model of behavioral change: (1) precontemplation, (2) contemplation and preparation, and (3) action and maintenance. After an internal review and feedback from potential users, a bank of 450 messages was developed. Results: The focus interview was conducted with 8 patients with PCI within 1 year, and 450 messages, including various forms of multimedia, were developed based on the transtheoretical model of behavioral change in each category. Positive feedback was obtained from the potential users (n=458). The mean Likert scale score was 3.95 (SD 0.39) and 3.91 (SD 0.39) for readability and usefulness, respectively, and several messages were refined based on the feedback. Finally, the patient-specific message delivery system was developed according to the baseline characteristics and stages of behavioral change in each participant. Conclusions: We developed an app (AnSim), which includes a bank of 450 patient-specific messages, that provides various medical information and CR programs regarding coronary heart disease. The detailed process of multidisciplinary collaboration over the course of the study provides a scientific basis for various medical professionals planning smartphone-based clinical research. %M 34878987 %R 10.2196/23285 %U https://medinform.jmir.org/2021/12/e23285 %U https://doi.org/10.2196/23285 %U http://www.ncbi.nlm.nih.gov/pubmed/34878987 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 4 %P e16864 %T Biopsychosocial Profiles of Patients With Cardiac Disease in Remote Rehabilitation Processes: Mixed Methods Grounded Theory Approach %A Anttila,Marjo-Riitta %A Soderlund,Anne %A Paajanen,Teemu %A Kivistö,Heikki %A Kokko,Katja %A Sjögren,Tuulikki %+ Faculty of Sport and Health Sciences, University of Jyväskylä, PO BOX 35, Jyväskylä, FI-40014 University of Jyväskylä, Finland, 358 408054648, marjo-riitta.m-r.anttila@jyu.fi %K coronary disease %K experience %K biopsychosocial model %K digital cardiac rehabilitation %K mixed methods grounded theory %K web-based program %K physical activity %K self-efficacy %K quality of life %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Digital development has caused rehabilitation services and rehabilitees to become increasingly interested in using technology as a part of rehabilitation. This study was based on a previously published study that categorized 4 groups of patients with cardiac disease based on different experiences and attitudes toward technology (e-usage groups): feeling outsider, being uninterested, reflecting benefit, and enthusiastic using. Objective: This study identifies differences in the biopsychosocial profiles of patients with cardiac disease in e-usage groups and deepen the understanding of these profiles in cardiac rehabilitation. Methods: Focus group interviews and measurements were conducted with 39 patients with coronary heart disease, and the mean age was 54.8 (SD 9.4, range 34-77) years. Quantitative data were gathered during a 12-month rehabilitation period. First, we used analysis of variance and Tukey honestly significant difference test, a t test, or nonparametric tests—Mann–Whitney and Kruskal–Wallis tests—to compare the 4 e-usage groups—feeling outsider, being uninterested, reflecting benefit, and enthusiastic using—in biopsychosocial variables. Second, we compared the results of the 4 e-groups in terms of recommended and reference values. This analysis contained 13 variables related to biomedical, psychological, and social functioning. Finally, we formed biopsychosocial profiles based on the integration of the findings by constant comparative analysis phases through classic grounded theory. Results: The biomedical variables were larger for waistline (mean difference [MD] 14.2; 95% CI 1.0-27.5; P=.03) and lower for physical fitness (MD −0.72; 95% CI −1.4 to −0.06; P=.03) in the being uninterested group than in the enthusiastic using group. The feeling outsider group had lower physical fitness (MD −55.8; 95% CI −110.7 to −0.92; P=.047) than the enthusiastic using group. For psychosocial variables, such as the degree of self-determination in exercise (MD −7.3; 95% CI −13.5 to −1.1; P=.02), the being uninterested group had lower values than the enthusiastic using group. Social variables such as performing guided tasks in the program (P=.03) and communicating via messages (P=.03) were lower in the feeling outsider group than in the enthusiastic using group. The feeling outsider and being uninterested groups had high-risk lifestyle behaviors, and adherence to the web-based program was low. In contrast, members of the being uninterested group were interested in tracking their physical activity. The reflecting benefit and enthusiastic using groups had low-risk lifestyle behavior and good adherence to web-based interventions; however, the enthusiastic using group had low self-efficacy in exercise. These profiles showed how individuals reflected their lifestyle risk factors differently. We renamed the 4 groups as building self-awareness, increasing engagement, maintaining a healthy lifestyle balance, and strengthening self-confidence. Conclusions: The results facilitate more effective and meaningful personalization guidance and inform the remote rehabilitation. Professionals can tailor individual web-based lifestyle risk interventions using these biopsychosocial profiles. %M 34730548 %R 10.2196/16864 %U https://rehab.jmir.org/2021/4/e16864 %U https://doi.org/10.2196/16864 %U http://www.ncbi.nlm.nih.gov/pubmed/34730548 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e32548 %T The Effect of a WeChat-Based Tertiary A-Level Hospital Intervention on Medication Adherence and Risk Factor Control in Patients With Stable Coronary Artery Disease: Multicenter Prospective Study %A Shi,Boqun %A Liu,Xi %A Dong,Qiuting %A Yang,Yuxiu %A Cai,Zhongxing %A Wang,Haoyu %A Yin,Dong %A Wang,Hongjian %A Dou,Kefei %A Song,Weihua %+ Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No 167 North Lishi Road, Xicheng District, Beijing, 100037, China, 86 1088396863, songweihua@fuwai.com %K WeChat %K telemedicine %K coronary artery disease %K medication adherence %K mobile phone %D 2021 %7 27.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In China, ischemic heart disease is the main cause of mortality. Having cardiac rehabilitation and a secondary prevention program in place is a class IA recommendation for individuals with coronary artery disease. WeChat-based interventions seem to be feasible and efficient for the follow-up and management of chronic diseases. Objective: This study aims to evaluate the effectiveness of a tertiary A-level hospital, WeChat-based telemedicine intervention in comparison with conventional community hospital follow-up on medication adherence and risk factor control in individuals with stable coronary artery disease. Methods: In this multicenter prospective study, 1424 patients with stable coronary artery disease in Beijing, China, were consecutively enrolled between September 2018 and September 2019 from the Fuwai Hospital and 4 community hospitals. At 1-, 3-, 6-, and 12-month follow-up, participants received healthy lifestyle recommendations and medication advice. Subsequently, the control group attended an offline outpatient clinic at 4 separate community hospitals. The intervention group had follow-up visits through WeChat-based telemedicine management. The main end point was medication adherence, which was defined as participant compliance in taking all 4 cardioprotective medications that would improve the patient’s outcome (therapies included antiplatelet therapy, β-blockers, statins, and angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers). Multivariable generalized estimating equations were used to compare the primary and secondary outcomes between the 2 groups and to calculate the relative risk (RR) at 12 months. Propensity score matching and inverse probability of treatment weighting were performed as sensitivity analyses, and propensity scores were calculated using a multivariable logistic regression model. Results: At 1 year, 88% (565/642) of patients in the intervention group and 91.8% (518/564) of patients in the control group had successful follow-up data. We matched 257 pairs of patients between the intervention and control groups. There was no obvious advantage in medication adherence with the 4 cardioprotective drugs in the intervention group (172/565, 30.4%, vs 142/518, 27.4%; RR 0.99, 95% CI 0.97-1.02; P=.65). The intervention measures improved smoking cessation (44/565, 7.8%, vs 118/518, 22.8%; RR 0.48, 95% CI 0.44-0.53; P<.001) and alcohol restriction (33/565, 5.8%, vs 91/518, 17.6%; RR 0.47, 95% CI 0.42-0.54; P<.001). Conclusions: The tertiary A-level hospital, WeChat-based intervention did not improve adherence to the 4 cardioprotective medications compared with the traditional method. Tertiary A-level hospital, WeChat-based interventions have a positive effect on improving lifestyle, such as quitting drinking and smoking, in patients with stable coronary artery disease and can be tried as a supplement to community hospital follow-up. Trial Registration: ClinicalTrials.gov NCT04795505; https://clinicaltrials.gov/ct2/show/NCT04795505 %M 34569467 %R 10.2196/32548 %U https://mhealth.jmir.org/2021/10/e32548 %U https://doi.org/10.2196/32548 %U http://www.ncbi.nlm.nih.gov/pubmed/34569467 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e12262 %T Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study %A Abid,Leila %A Kammoun,Ikram %A Ben Halima,Manel %A Charfeddine,Salma %A Ben Slima,Hedi %A Drissa,Meriem %A Mzoughi,Khadija %A Mbarek,Dorra %A Riahi,Leila %A Antit,Saoussen %A Ben Halima,Afef %A Ouechtati,Wejdene %A Allouche,Emna %A Mechri,Mehdi %A Yousfi,Chedi %A Khorchani,Ali %A Abid,Omar %A Sammoud,Kais %A Ezzaouia,Khaled %A Gtif,Imen %A Ouali,Sana %A Triki,Feten %A Hamdi,Sonia %A Boudiche,Selim %A Chebbi,Marwa %A Hentati,Mouna %A Farah,Amani %A Triki,Habib %A Ghardallou,Houda %A Raddaoui,Haythem %A Zayed,Sofien %A Azaiez,Fares %A Omri,Fadwa %A Zouari,Akram %A Ben Ali,Zine %A Najjar,Aymen %A Thabet,Houssem %A Chaker,Mouna %A Mohamed,Samar %A Chouaieb,Marwa %A Ben Jemaa,Abdelhamid %A Tangour,Haythem %A Kammoun,Yassmine %A Bouhlel,Mahmoud %A Azaiez,Seifeddine %A Letaief,Rim %A Maskhi,Salah %A Amri,Aymen %A Naanaa,Hela %A Othmani,Raoudha %A Chahbani,Iheb %A Zargouni,Houcine %A Abid,Syrine %A Ayari,Mokdad %A ben Ameur,Ines %A Gasmi,Ali %A ben Halima,Nejeh %A Haouala,Habib %A Boughzela,Essia %A Zakhama,Lilia %A ben Youssef,Soraya %A Nasraoui,Wided %A Boujnah,Mohamed Rachid %A Barakett,Nadia %A Kraiem,Sondes %A Drissa,Habiba %A Ben Khalfallah,Ali %A Gamra,Habib %A Kachboura,Salem %A Bezdah,Leila %A Baccar,Hedi %A Milouchi,Sami %A Sdiri,Wissem %A Ben Omrane,Skander %A Abdesselem,Salem %A Kanoun,Alifa %A Hezbri,Karima %A Zannad,Faiez %A Mebazaa,Alexandre %A Kammoun,Samir %A Mourali,Mohamed Sami %A Addad,Faouzi %+ Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Residence Pergolas, Maison du coeur de la Tunisie Appartement 201, Rue du Lac Huron, Tunis, 1053, Tunisia, 216 22739092, addad.faouzi@planet.tn %K heart failure %K acute heart failure %K chronic heart failure %K diagnosis %K prognosis %K treatment %D 2021 %7 27.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). Objective: The aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. Methods: A total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. Results: At the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. Conclusions: The NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. Trial Registration: ClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 International Registered Report Identifier (IRRID): DERR1-10.2196/12262 %M 34704958 %R 10.2196/12262 %U https://www.researchprotocols.org/2021/10/e12262 %U https://doi.org/10.2196/12262 %U http://www.ncbi.nlm.nih.gov/pubmed/34704958 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 10 %P e31288 %T Verifying the Feasibility of Implementing Semantic Interoperability in Different Countries Based on the OpenEHR Approach: Comparative Study of Acute Coronary Syndrome Registries %A Min,Lingtong %A Atalag,Koray %A Tian,Qi %A Chen,Yani %A Lu,Xudong %+ College of Biomedical Engineering & Instrument Science, Zhejiang University, Room 512, Zhouyiqing Building, 38 Zheda Road, Hangzhou, China, 86 13957118891, lvxd@zju.edu.cn %K semantic interoperability %K openEHR %K archetype %K registry %K acute coronary syndrome %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The semantic interoperability of health care information has been a critical challenge in medical informatics and has influenced the integration, sharing, analysis, and use of medical big data. International standard organizations have developed standards, approaches, and models to improve and implement semantic interoperability. The openEHR approach—one of the standout semantic interoperability approaches—has been implemented worldwide to improve semantic interoperability based on reused archetypes. Objective: This study aimed to verify the feasibility of implementing semantic interoperability in different countries by comparing the openEHR-based information models of 2 acute coronary syndrome (ACS) registries from China and New Zealand. Methods: A semantic archetype comparison method was proposed to determine the semantics reuse degree of reused archetypes in 2 ACS-related clinical registries from 2 countries. This method involved (1) determining the scope of reused archetypes; (2) identifying corresponding data items within corresponding archetypes; (3) comparing the semantics of corresponding data items; and (4) calculating the number of mappings in corresponding data items and analyzing results. Results: Among the related archetypes in the two ACS-related, openEHR-based clinical registries from China and New Zealand, there were 8 pairs of reusable archetypes, which included 89 pairs of corresponding data items and 120 noncorresponding data items. Of the 89 corresponding data item pairs, 87 pairs (98%) were mappable and therefore supported semantic interoperability, and 71 pairs (80%) were labeled as “direct mapping” data items. Of the 120 noncorresponding data items, 114 (95%) data items were generated via archetype evolution, and 6 (5%) data items were generated via archetype localization. Conclusions: The results of the semantic comparison between the two ACS-related clinical registries prove the feasibility of establishing the semantic interoperability of health care data from different countries based on the openEHR approach. Archetype reuse provides data on the degree to which semantic interoperability exists when using the openEHR approach. Although the openEHR community has effectively promoted archetype reuse and semantic interoperability by providing archetype modeling methods, tools, model repositories, and archetype design patterns, the uncontrolled evolution of archetypes and inconsistent localization have resulted in major challenges for achieving higher levels of semantic interoperability. %M 34665150 %R 10.2196/31288 %U https://medinform.jmir.org/2021/10/e31288 %U https://doi.org/10.2196/31288 %U http://www.ncbi.nlm.nih.gov/pubmed/34665150 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e28015 %T The Effect of Cardiovascular Comorbidities on Women Compared to Men: Longitudinal Retrospective Analysis %A Dervic,Elma %A Deischinger,Carola %A Haug,Nils %A Leutner,Michael %A Kautzky-Willer,Alexandra %A Klimek,Peter %+ Section for Science of Complex Systems, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria, 43 1 40160 36252, Peter.Klimek@meduniwien.ac.at %K gender gap %K sex differences %K cardiovascular diseases %K acute myocardial infarction %K chronic ischemic heart disease %K gender %K diabetes %K smoking %K risk factors %K comorbidities %D 2021 %7 4.10.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: Although men are more prone to developing cardiovascular disease (CVD) than women, risk factors for CVD, such as nicotine abuse and diabetes mellitus, have been shown to be more detrimental in women than in men. Objective: We developed a method to systematically investigate population-wide electronic health records for all possible associations between risk factors for CVD and other diagnoses. The developed structured approach allows an exploratory and comprehensive screening of all possible comorbidities of CVD, which are more connected to CVD in either men or women. Methods: Based on a population-wide medical claims dataset comprising 44 million records of inpatient stays in Austria from 2003 to 2014, we determined comorbidities of acute myocardial infarction (AMI; International Classification of Diseases, Tenth Revision [ICD-10] code I21) and chronic ischemic heart disease (CHD; ICD-10 code I25) with a significantly different prevalence in men and women. We introduced a measure of sex difference as a measure of differences in logarithmic odds ratios (ORs) between male and female patients in units of pooled standard errors. Results: Except for lipid metabolism disorders (OR for females [ORf]=6.68, 95% confidence interval [CI]=6.57-6.79, OR for males [ORm]=8.31, 95% CI=8.21-8.41), all identified comorbidities were more likely to be associated with AMI and CHD in females than in males: nicotine dependence (ORf=6.16, 95% CI=5.96-6.36, ORm=4.43, 95% CI=4.35-4.5), diabetes mellitus (ORf=3.52, 95% CI=3.45-3.59, ORm=3.13, 95% CI=3.07-3.19), obesity (ORf=3.64, 95% CI=3.56-3.72, ORm=3.33, 95% CI=3.27-3.39), renal disorders (ORf=4.27, 95% CI=4.11-4.44, ORm=3.74, 95% CI=3.67-3.81), asthma (ORf=2.09, 95% CI=1.96-2.23, ORm=1.59, 95% CI=1.5-1.68), and COPD (ORf=2.09, 95% CI 1.96-2.23, ORm=1.59, 95% CI 1.5-1.68). Similar results could be observed for AMI. Conclusions: Although AMI and CHD are more prevalent in men, women appear to be more affected by certain comorbidities of AMI and CHD in their risk for developing CVD. %M 34605767 %R 10.2196/28015 %U https://cardio.jmir.org/2021/2/e28015 %U https://doi.org/10.2196/28015 %U http://www.ncbi.nlm.nih.gov/pubmed/34605767 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e29928 %T mHealth Interventions for Lifestyle and Risk Factor Modification in Coronary Heart Disease: Randomized Controlled Trial %A Bae,Jang-Whan %A Woo,Seoung-Il %A Lee,Joongyub %A Park,Sang-Don %A Kwon,Sung Woo %A Choi,Seong Huan %A Yoon,Gwang-Seok %A Kim,Mi-Sook %A Hwang,Seung-Sik %A Lee,Won Kyung %+ Department of Prevention and Management, School of Medicine, Inha University Hospital, Inha University, 27 Inhang-Ro, Jung-Gu, Incheon, Republic of Korea, 82 10 6360 7965, bluewhale65@gmail.com %K coronary heart disease %K prevention %K lifestyle modification %K mobile health %K text message %K mHealth %D 2021 %7 24.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-management of lifestyle and cardiovascular disease risk factors is challenging in older patients with coronary heart disease (CHD). SMS text messaging could be a potential support tool for self-management and the most affordable and accessible method through a mobile phone. High-quality evidence had been lacking, and previous studies evaluated the effects of SMS text messaging on the subjective measures of short-term outcomes. Recently, a large-sized randomized controlled trial in Australia reported promising findings on the objective measures upon 6-month follow-up. However, an examination of the effectiveness of such interventions in an Asian population with unique demographic characteristics would be worthwhile. Objective: This study examined the effectiveness of a 1-way SMS text messaging program to modify the lifestyle and cardiovascular disease risk factors of patients who underwent the first percutaneous coronary intervention (PCI). Methods: A parallel, single-blinded, 1:1 random allocation clinical trial was conducted with 879 patients treated through PCI. They were recruited during hospital admission from April 2017 to May 2020 at 2 university hospitals in the Republic of Korea. In addition to standard care, the intervention group received access to a supporting website and 4 SMS text messages per week for 6 months regarding a healthy diet, physical activity, smoking cessation, and cardiovascular health. Random allocation upon study enrollment and SMS text messaging after hospital discharge were performed automatically using a computer program. The coprimary outcomes were low-density-lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and BMI. The secondary outcomes were change in lifestyle and adherence to the recommended health behaviors. Results: Of the eligible population, 440 and 439 patients who underwent PCI were assigned to the intervention and control groups, respectively. The 1-way SMS text messaging program significantly enhanced physical activity (P=.02), healthy diet (P<.01), and medication adherence (P<.04) among patients with CHD. Hence, more people were likely to control their cardiovascular disease risk factors per the recommendations. The intervention group was more likely to control all 5 risk factors by 62% (relative risk 1.62, 95% CI 1.05-2.50) per the recommendations. On the other hand, physiological measures of the primary outcomes, including LDL-C levels, SBP, and BMI, were not significant. Most participants found the SMS text messaging program useful and helpful in motivating lifestyle changes. Conclusions: Lifestyle-focused SMS text messages were effective in the self-management of a healthy diet, exercise, and medication adherence, but their influence on the physiological measures was not significant. One-way SMS text messages can be used as an affordable adjuvant method for lifestyle modification to help prevent the recurrence of cardiovascular disease. Trial Registration: Clinical Research Information Service (CRiS) KCT0005087; https://cris.nih.go.kr/cris/search/detailSearch.do/19282 %M 34559058 %R 10.2196/29928 %U https://mhealth.jmir.org/2021/9/e29928 %U https://doi.org/10.2196/29928 %U http://www.ncbi.nlm.nih.gov/pubmed/34559058 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e21906 %T Use of Smartphone Apps for Improving Physical Function Capacity in Cardiac Patient Rehabilitation: Systematic Review %A Tuttle,Katherine %A Kelemen,Arpad %A Liang,Yulan %+ Department of Family and Community Health, University of Maryland, Baltimore, 655 West Lombard Street, Baltimore, MD, 21201, United States, 1 410 706 4812, liang@umaryland.edu %K cardiac rehabilitation %K physical capacity %K exercise %K smartphone apps %D 2021 %7 17.9.2021 %9 Review %J JMIRx Med %G English %X Background: Cardiac rehabilitation (CR) is an evidence-based approach for preventing secondary cardiac events. Smartphone apps are starting to be used in CR to give patients real-time feedback on their health, connect them remotely with their medical team, and allow them to perform their rehabilitation at home. The use of smartphone apps is becoming omnipresent and has real potential in impacting patients in need of CR. Objective: This paper provides critical examinations and summaries of existing research studies with an in-depth analysis of not only the individual studies but also the larger patterns that have emerged with smartphone apps in CR as well as their significance for practice change. Methods: A systematic review was conducted through broad database searches that focused on evaluating randomized controlled trials, in compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) expectations. A total of 43 articles were evaluated, and 6 were chosen for this review. The dates of the articles ranged from 2014-2020, and the studies focused on the population of cardiac outpatients who needed CR after suffering a cardiac event, with interventions using a smartphone that incorporated the CR standards of the American Heart Association. The outcomes measured were directed at focusing on improved exercise function capacity, valued at a significance level of P<.05, for improved 6-minute walk test (6MWT) and peak oxygen uptake (PVO2) results. Results: In the evaluated articles, the results were inconsistent for significant positive effects of CR smartphone apps on cardiac patients’ physical function capacity in terms of the 6MWT and PVO2 when using a smartphone app to aid in CR. Conclusions: Because evidence in the literature suggests nonhomogeneous results for successful use of smartphone apps in CR, it is crucial to investigate the potential reasons for this inconsistency. An important observation from this systematic review is that smartphone apps used in CR have better clinical outcomes related to physical function capacity if the app automatically records information or provides real-time feedback to participants about their progress, compared to apps that only educate and encourage use while requiring the participant to manually log their CR activities. Additional factors to consider during these studies include the starting health of the patients, the sample sizes, and the specific components of CR that the smartphone apps are using. Overall, more clinical trials are needed that implement smartphone apps with these factors in mind, while placing stronger emphasis on using biosensing capabilities that can automatically log results and send them to providers on a real-time dashboard. %M 37725554 %R 10.2196/21906 %U https://med.jmirx.org/2021/3/e21906 %U https://doi.org/10.2196/21906 %U http://www.ncbi.nlm.nih.gov/pubmed/37725554 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e27867 %T Financial Incentives for Healthy Living for Patients With Cardiac Disease From the Perspective of Health Care Professionals: Interview Study %A de Buisonjé,David %A Van der Geer,Jessica %A Keesman,Mike %A Van der Vaart,Roos %A Reijnders,Thomas %A Wentzel,Jobke %A Kemps,Hareld %A Kraaijenhagen,Roderik %A Janssen,Veronica %A Evers,Andrea %+ Health, Medical and Neuropsychology Unit, Leiden University, Faculty of Social Sciences, Room 2A22, Wassenaarseweg 52, Leiden, 2333 AK, Netherlands, 31 630665252, d.r.de.buisonje@fsw.leidenuniv.nl %K financial incentives %K material rewards %K healthy lifestyle %K cardiovascular disease %K cardiac rehabilitation %K CVD %D 2021 %7 30.8.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: A promising new approach to support lifestyle changes in patients with cardiovascular disease (CVD) is the use of financial incentives. Although financial incentives have proven to be effective, their implementation remains controversial, and ethical objections have been raised. It is unknown whether health care professionals (HCPs) involved in CVD care find it acceptable to provide financial incentives to patients with CVD as support for lifestyle change. Objective: This study aims to investigate HCPs’ perspectives on using financial incentives to support healthy living for patients with CVD. More specifically, we aim to provide insight into attitudes toward using financial incentives as well as obstacles and facilitators of implementing financial incentives in current CVD care. Methods: A total of 16 semistructured, in-depth, face-to-face interviews were conducted with Dutch HCPs involved in supporting patients with CVD with lifestyle changes. The topics discussed were attitudes toward an incentive system, obstacles to using an incentive system, and possible solutions to facilitate the use of an incentive system. Results: HCPs perceived an incentive system for healthy living for patients with CVD as possibly effective and showed generally high acceptance. However, there were concerns related to focusing too much on the extrinsic aspects of lifestyle change, disengagement when rewards are insignificant, paternalization and threatening autonomy, and low digital literacy in the target group. According to HCPs, solutions to mitigate these concerns included emphasizing intrinsic aspects of healthy living while giving extrinsic rewards, integrating social aspects to increase engagement, supporting autonomy by allowing freedom of choice in rewards, and aiming for a target group that can work with the necessary technology. Conclusions: This study mapped perspectives of Dutch HCPs and showed that attitudes are predominantly positive, provided that contextual factors, design, and target groups are accurately considered. Concerns about digital literacy in the target group are novel findings that warrant further investigation. Follow-up research is needed to validate these insights among patients with CVD. %M 34459748 %R 10.2196/27867 %U https://cardio.jmir.org/2021/2/e27867 %U https://doi.org/10.2196/27867 %U http://www.ncbi.nlm.nih.gov/pubmed/34459748 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e24952 %T An Intervention to Improve Medication Adherence in People With Heart Disease (Text4HeartII): Randomized Controlled Trial %A Maddison,Ralph %A Jiang,Yannan %A Stewart,Ralph %A Scott,Tony %A Kerr,Andrew %A Whittaker,Robyn %A Benatar,Jocelyn %A Rolleston,Anna %A Estabrooks,Paul %A Dale,Leila %+ Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 3 924 46218, ralph.maddison@deakin.edu.au %K cardiovascular disease %K self-management %K text messaging %K risk factors %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health technologies have the potential to improve the reach and delivery of interventions for promoting long-term secondary prevention of coronary heart disease. Objective: This study aims to determine the effectiveness of an SMS text messaging intervention (Text4HeartII) for improving adherence to medication and lifestyle changes over and above usual care in people with coronary heart disease at 24 and 52 weeks. Methods: A two-arm, parallel, randomized controlled trial was conducted in New Zealand. Participants with a recent acute coronary syndrome were randomized to receive usual cardiac services alone (control, n=153) or a 24-week SMS text message program for supporting self-management plus usual cardiac services (n=153). The primary outcome was adherence to medication at 24 weeks, defined as a medication possession ratio of 80% or more for aspirin, statin, and antihypertensive therapy. Secondary outcomes included medication possession ratio at 52 weeks, self-reported medication adherence, adherence to healthy lifestyle behaviors, and health-related quality of life at 24 and 52 weeks. Results: Participants were predominantly male (113/306, 80.3%) and European New Zealanders (210/306, 68.6%), with a mean age of 61 years (SD 11 years). Groups were comparable at baseline. National hospitalization and pharmacy dispensing records were available for all participants; 92% (282/306, 92.1%) of participants completed a 24-week questionnaire and 95.1% (291/306) of participants completed a 52-week questionnaire. Adherence with 3 medication classes were lower in the intervention group than in the control group (87/153, 56.8% vs 105/153, 68.6%, odds ratio 0.60, 95% CI 0.38-0.96; P=.03) and 52 weeks (104/153, 67.9% vs 83/153, 54.2%; odds ratio 0.56, 95% CI 0.35-0.89; P=.01). Self-reported medication adherence scores showed the same trend at 52 weeks (mean difference 0.3; 95% CI 0.01-0.59; P=.04). Moreover, self-reported adherence to health-related behaviors was similar between groups. Conclusions: Text4HeartII did not improve dispensed medication or adherence to a favorable lifestyle over and above usual care. This finding contrasts with previous studies and highlights that the benefits of text interventions may depend on the context in which they are used. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000422426; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370398. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2468-z %M 34106081 %R 10.2196/24952 %U https://mhealth.jmir.org/2021/6/e24952 %U https://doi.org/10.2196/24952 %U http://www.ncbi.nlm.nih.gov/pubmed/34106081 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24346 %T The Costs and Cardiovascular Benefits in Patients With Peripheral Artery Disease From a Fourth-Generation Synchronous Telehealth Program: Retrospective Cohort Study %A Lee,Jen-Kuang %A Hung,Chi-Sheng %A Huang,Ching-Chang %A Chen,Ying-Hsien %A Wu,Hui-Wen %A Chuang,Pao-Yu %A Yu,Jiun-Yu %A Ho,Yi-Lwun %+ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, 7 South Chung Shan Road, Taipei, , Taiwan, 886 2 23123456 ext 62152, ylho@ntu.edu.tw %K peripheral artery disease %K fourth-generation synchronous telehealth program %K ischemic stroke %K hospitalization %K cardiovascular disease %K telehealth %K stroke %K cost %K benefit %K heart %D 2021 %7 18.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with peripheral artery disease (PAD) are at high risk for major cardiovascular events, including myocardial infarction, stroke, and hospitalization for heart failure. We have previously shown the clinical efficacy of a fourth-generation synchronous telehealth program for some patients, but the costs and cardiovascular benefits of the program for PAD patients remain unknown. Objective: The telehealth program is now widely used by higher-risk cardiovascular patients to prevent further cardiovascular events. This study investigated whether patients with PAD would also have better cardiovascular outcomes after participating in the fourth-generation synchronous telehealth program. Methods: This was a retrospective cohort study. We screened 5062 patients with cardiovascular diseases who were treated at National Taiwan University Hospital and then enrolled 391 patients with a diagnosis of PAD. Of these patients, 162 took part in the telehealth program, while 229 did not and thus served as control patients. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to mitigate possible selection bias. Follow-up outcomes included heart failure hospitalization, acute coronary syndrome, stroke, and all-cause readmission during the 1-year follow-up period and through the last follow-up. Results: The mean follow-up duration was 3.1 (SD 1.8) years for the patients who participated in the telehealth program and 3.2 (SD 1.8) for the control group. The telehealth program patients exhibited lower risk of ischemic stroke than did the control group in the first year after IPTW (0.9% vs 3.5%; hazard ratio [HR] 0.24; 95% CI 0.07-0.80). The 1-year composite endpoint of vascular accident, including acute coronary syndrome and stroke, was also significantly lower in the telehealth program group after IPTW (2.4% vs 5.2%; HR 0.46; 95% CI 0.21-0.997). At the end of the follow-up, the telehealth program group continued to exhibit a significantly lower rate of ischemic stroke than did the control group after IPTW (0.9% vs 3.5%; HR 0.52, 95% CI 0.28-0.93). Furthermore, the medical costs of the telehealth program patients were not higher than those of the control group, whether in terms of outpatient, emergency department, hospitalization, or total costs. Conclusions: The PAD patients who participated in the fourth-generation synchronous telehealth program exhibited lower risk of ischemic stroke events over both mid- and long-term follow-up periods. However, larger-scale and prospective randomized clinical trials are needed to confirm our findings. %M 34003132 %R 10.2196/24346 %U https://www.jmir.org/2021/5/e24346 %U https://doi.org/10.2196/24346 %U http://www.ncbi.nlm.nih.gov/pubmed/34003132 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e24530 %T The Use of SMS Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2Prevent): Results From a Pilot Randomized Controlled Trial %A Ross,Emily S %A Sakakibara,Brodie M %A Mackay,Martha H %A Whitehurst,David G T %A Singer,Joel %A Toma,Mustafa %A Corbett,Kitty K %A Van Spall,Harriette G C %A Rutherford,Kimberly %A Gheorghiu,Bobby %A Code,Jillianne %A Lear,Scott A %+ Division of Cardiology, Providence Health Care, Healthy Heart Program St Paul's Hospital, B180-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada, 1 604 682 2344 ext 62778, slear@providencehealth.bc.ca %K SMS text messaging %K mHealth %K acute coronary syndrome %K cardiovascular disease %D 2021 %7 14.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Acute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. SMS text messaging has the potential to provide support to patients during this postdischarge period. Objective: This study pilot tested a 60-day SMS text messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and health care resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention. Methods: This was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul’s Hospital in Vancouver, Canada, and randomized them to 1 of 2 groups within 7 days of discharge. The Txt2Prevent program included automated 1-way SMS text messages about follow-up care, self-management, and healthy living. Data were collected during the index admission and at 60 days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ-5D-5L Visual Analog Scale, a modified Sullivan Cardiac Self-Efficacy Scale, and Morisky Medication Adherence Scale scores, and self-reported health care resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with 2 survey questions and semistructured interviews. Results: There were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference [Txt2Prevent minus usual care] for each domain—Health-directed activity: –0.13, 95% CI –0.39 to 0.13, P=.31; Positive and active engagement in life: 0.03, 95% CI –0.19 to 0.25, P=.76; Emotional distress: 0.04, 95% CI –0.22 to 0.29, P=.77; Self-monitoring and insight: –0.14, 95% CI –0.33 to 0.05, P=.15; Constructive attitudes and approaches: –0.10, 95% CI –0.36 to 0.17, P=.47; Skill technique and acquisition: 0.05, 95% CI –0.18 to 0.27, P=.69; Social integration and support: –0.12, 95% CI –0.34 to 0.10, P=.27; and Health services navigation: –0.05, 95% CI –0.29 to 0.19, P=.69). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in 1 self-efficacy domain (Total plus), where the Txt2Prevent group had lower scores (mean difference –0.36, 95% CI –0.66 to –0.50, P=.03). The study protocol was feasible, but recruitment took longer than expected. Over 90% (29/31 [94%]) of participants reported they were satisfied with the program. Conclusions: The Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the 2 groups in adjusted analyses except for 1 self-efficacy domain. As the intervention appeared acceptable, there is potential in using SMS text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures. Trial Registration: ClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6968 %M 33988519 %R 10.2196/24530 %U https://mhealth.jmir.org/2021/5/e24530 %U https://doi.org/10.2196/24530 %U http://www.ncbi.nlm.nih.gov/pubmed/33988519 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e24188 %T Human–Computer Agreement of Electrocardiogram Interpretation for Patients Referred to and Declined for Primary Percutaneous Coronary Intervention: Retrospective Data Analysis Study %A Iftikhar,Aleeha %A Bond,Raymond %A Mcgilligan,Victoria %A Leslie,Stephen J %A Knoery,Charles %A Shand,James %A Ramsewak,Adesh %A Sharma,Divyesh %A McShane,Anne %A Rjoob,Khaled %A Peace,Aaron %+ Computing Engineering and Build Environment, Ulster University, Jordanstown, Belfast, BT37 0QB, United Kingdom, 44 7496635353, Iftikhar-a1@ulster.ac.uk %K ECG interpretation %K agreement between human and computer %K primary percutaneous coronary intervention service %K acute myocardial infarction %K scan %K electrocardiogram %K heart %K intervention %K infarction %K human-computer %K diagnostic %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: When a patient is suspected of having an acute myocardial infarction, they are accepted or declined for primary percutaneous coronary intervention partly based on clinical assessment of their 12-lead electrocardiogram (ECG) and ST-elevation myocardial infarction criteria. Objective: We retrospectively determined the agreement rate between human (specialists called activator nurses) and computer interpretations of ECGs of patients who were declined for primary percutaneous coronary intervention. Methods: Various features of patients who were referred for primary percutaneous coronary intervention were analyzed. Both the human and computer ECG interpretations were simplified to either “suggesting” or “not suggesting” acute myocardial infarction to avoid analysis of complex heterogeneous and synonymous diagnostic terms. Analyses, to measure agreement, and logistic regression, to determine if these ECG interpretations (and other variables such as patient age, chest pain) could predict patient mortality, were carried out. Results: Of a total of 1464 patients referred to and declined for primary percutaneous coronary intervention, 722 (49.3%) computer diagnoses suggested acute myocardial infarction, whereas 634 (43.3%) of the human interpretations suggested acute myocardial infarction (P<.001). The human and computer agreed that there was a possible acute myocardial infarction for 342 out of 1464 (23.3%) patients. However, there was a higher rate of human–computer agreement for patients not having acute myocardial infarctions (450/1464, 30.7%). The overall agreement rate was 54.1% (792/1464). Cohen κ showed poor agreement (κ=0.08, P=.001). Only the age (odds ratio [OR] 1.07, 95% CI 1.05-1.09) and chest pain (OR 0.59, 95% CI 0.39-0.89) independent variables were statistically significant (P=.008) in predicting mortality after 30 days and 1 year. The odds for mortality within 1 year of referral were lower in patients with chest pain compared to those patients without chest pain. A referral being out of hours was a trending variable (OR 1.41, 95% CI 0.95-2.11, P=.09) for predicting the odds of 1-year mortality. Conclusions: Mortality in patients who were declined for primary percutaneous coronary intervention was higher than the reported mortality for ST-elevation myocardial infarction patients at 1 year. Agreement between computerized and human ECG interpretation is poor, perhaps leading to a high rate of inappropriate referrals. Work is needed to improve computer and human decision making when reading ECGs to ensure that patients are referred to the correct treatment facility for time-critical therapy. %M 33650984 %R 10.2196/24188 %U https://medinform.jmir.org/2021/3/e24188 %U https://doi.org/10.2196/24188 %U http://www.ncbi.nlm.nih.gov/pubmed/33650984 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e17542 %T A Smartphone App for Patients With Acute Coronary Syndrome (MoTER-ACS): User-Centered Design Approach %A Bashi,Nazli %A Varnfield,Marlien %A Karunanithi,Mohanraj %+ Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 5 - UQ Health Sciences, Building 901/16, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia, 61 732533611, ghafouryan@hotmail.com %K mobile health %K mHealth %K mobile health apps %K smartphone %K mobile phone %K self-management %K patient education %K cardiovascular disease %K acute coronary syndrome %D 2020 %7 18.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Postdischarge interventions are limited for patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and the need to travel from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions. Objective: The aim of this study was to develop a smartphone-based intervention for providing postdischarge support to patients with ACS. Methods: The content of Mobile Technology–Enabled Rehabilitation for Patients with ACS (MoTER-ACS) was derived from a series of small studies, termed prestudy surveys, conducted in 2017. The prestudy surveys were conducted in Prince Charles Hospital, Queensland, Australia, and consisted of questionnaires among a convenience sample of patients with ACS (n=30), a focus group discussion with health care professionals (n=10), and an online survey among cardiologists (n=15). Responses from the patient survey identified educational topics of MoTER-ACS. The focus group with health care professionals assisted with identifying educational materials, health monitoring, and self-management interventions. Based on the results of the cardiologists’ survey, monitoring of symptoms related to heart failure exacerbation was considered as a weekly diary. Results: The MoTER-ACS app covers multimedia educational materials to adopt a healthy lifestyle and includes user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain, assisting patients in self-managing their condition. A web portal that is linked to the data from the smartphone app is available to clinicians to regularly access patients’ data and provide support. Conclusions: The MoTER-ACS platform extends the capabilities of previous mobile health platforms by providing a home-based educational and self-management intervention for patients with ACS following discharge from the hospital. The MoTER-ACS intervention narrows the gap between existing hospital-based programs and home-based interventions by complementing the postdischarge program for patients with ACS. %M 33337339 %R 10.2196/17542 %U http://formative.jmir.org/2020/12/e17542/ %U https://doi.org/10.2196/17542 %U http://www.ncbi.nlm.nih.gov/pubmed/33337339 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e17957 %T Implementation of Telerehabilitation Interventions for the Self-Management of Cardiovascular Disease: Systematic Review %A Subedi,Narayan %A Rawstorn,Jonathan C %A Gao,Lan %A Koorts,Harriet %A Maddison,Ralph %+ School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood Victoria, Melbourne, 3125, Australia, 61 404745397, nsubedi@deakin.edu.au %K heart diseases %K cardiac rehabilitation %K telerehabilitation %K implementation science %K smartphone %K systematic review %D 2020 %7 27.11.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Coronary heart disease (CHD) is a leading cause of disability and deaths worldwide. Secondary prevention, including cardiac rehabilitation (CR), is crucial to improve risk factors and to reduce disease burden and disability. Accessibility barriers contribute to underutilization of traditional center-based CR programs; therefore, alternative delivery models, including cardiac telerehabilitation (ie, delivery via mobile, smartphone, and/or web-based apps), have been tested. Experimental studies have shown cardiac telerehabilitation to be effective and cost-effective, but there is inadequate evidence about how to translate this research into routine clinical practice. Objective: This systematic review aimed to synthesize research evaluating the effectiveness of implementing cardiac telerehabilitation interventions at scale in routine clinical practice, including factors underlying successful implementation processes, and experimental research evaluating implementation-related outcomes. Methods: MEDLINE, Embase, PsycINFO, and Global Health databases were searched from 1990 through November 9, 2018, for studies evaluating the implementation of telerehabilitation for the self-management of CHD. Reference lists of included studies and relevant systematic reviews were hand searched to identify additional studies. Implementation outcomes of interest included acceptability, appropriateness, adoption, feasibility, fidelity, implementation cost, penetration, and sustainability. A narrative synthesis of results was carried out. Results: No included studies evaluated the implementation of cardiac telerehabilitation in routine clinical practice. A total of 10 studies of 2250 participants evaluated implementation outcomes, including acceptability (8/10, 80%), appropriateness (9/10, 90%), adoption (6/10, 60%), feasibility (6/10, 60%), fidelity (7/10, 70%), and implementation cost (4/10, 40%), predominantly from the participant perspective. Cardiac telerehabilitation interventions had high acceptance among the majority of participants, but technical challenges such as reliable broadband internet connectivity can impact acceptability and feasibility. Many participants considered telerehabilitation to be an appropriate alternative CR delivery model, as it was convenient, flexible, and easy to access. Participants valued interactive intervention components, such as real-time exercise monitoring and feedback as well as individualized support. The penetration and sustainability of cardiac telerehabilitation, as well as the perspectives of CR practitioners and health care organizations, have received little attention in existing cardiac telerehabilitation research. Conclusions: Experimental trials suggest that participants perceive cardiac telerehabilitation to be an acceptable and appropriate approach to improve the reach and utilization of CR, but pragmatic implementation studies are needed to understand how interventions can be sustainably translated from research into clinical practice. Addressing this gap could help realize the potential impact of telerehabilitation on CR accessibility and participation as well as person-centered, health, and economic outcomes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019124254; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=124254 %M 33245286 %R 10.2196/17957 %U http://mhealth.jmir.org/2020/11/e17957/ %U https://doi.org/10.2196/17957 %U http://www.ncbi.nlm.nih.gov/pubmed/33245286 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e19456 %T Telomerase Activation to Reverse Immunosenescence in Elderly Patients With Acute Coronary Syndrome: Protocol for a Randomized Pilot Trial %A Maier,Rebecca %A Bawamia,Bilal %A Bennaceur,Karim %A Dunn,Sarah %A Marsay,Leanne %A Amoah,Roland %A Kasim,Adetayo %A Filby,Andrew %A Austin,David %A Hancock,Helen %A Spyridopoulos,Ioakim %+ Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle Upon Tyne, , United Kingdom, 44 1912418675, Ioakim.spyridopoulos@newcastle.ac.uk %K coronary heart disease %K acute coronary syndrome %K immunosenescence %K telomerase activator %D 2020 %7 23.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Inflammation plays a key role in the pathophysiology of coronary heart disease (CHD) and its acute manifestation, acute coronary syndrome (ACS). Aging is associated with a decline of the immune system, a process known as immunosenescence. This is characterized by an increase in highly proinflammatory T cells that are involved in CHD progression, plaque destabilization, and myocardial ischemia–reperfusion injury. Telomere dysfunction has been implicated in immunosenescence of T lymphocytes. Telomerase is the enzyme responsible for maintaining telomeres during cell divisions. It has a protective effect on cells under oxidative stress and helps regulate flow-mediated dilation in microvasculature. Objective: The TACTIC (Telomerase ACTivator to reverse Immunosenescence in Acute Coronary Syndrome) trial will investigate whether a telomerase activator, TA-65MD, can reduce the proportion of senescent T cells in patients with ACS with confirmed CHD. It will also assess the effect of TA-65MD on decreasing telomere shortening, reducing oxidative stress, and improving endothelial function. Methods: The study was designed as a single-center, randomized, double-blind, parallel-group, placebo-controlled phase II trial. Recruitment started in January 2019. A total of 90 patients, aged 65 years or older, with treated ACS who have had CHD confirmed by angiography will be enrolled. They will be randomized to one of two groups: TA-65MD oral therapy (8 mg twice daily) or placebo taken for 12 months. The primary outcome is the effect on immunosenescence determined by a decrease in the proportion of CD8+ TEMRA (T effector memory cells re-expressing CD45RA [CD45 expressing exon A]) cells at 12 months. Secondary outcomes include leukocyte telomere length, endothelial function, cardiac function as measured by echocardiography and NT-proBNP (N-terminal fragment of the prohormone brain-type natriuretic peptide), systemic inflammation, oxidative stress, and telomerase activity. Results: The study received National Health Service (NHS) ethics approval on August 9, 2018; Medicines and Healthcare products Regulatory Agency approval on October 19, 2018; and NHS Health Research Authority approval on October 22, 2018. The trial began recruiting participants in January 2019 and completed recruitment in March 2020; the trial is due to report results in 2021. Conclusions: This pilot trial in older patients with CHD will explore outcomes not previously investigated outside in vitro or preclinical models. The robust design ensures that bias has been minimized. Should the results indicate reduced frequency of immunosenescent CD8+ T cells as well as improvements in telomere length and endothelial function, we will plan a larger, multicenter trial in patients to determine if TA-65MD is beneficial in the treatment of CHD in elderly patients. Trial Registration: ISRCTN Registry ISRCTN16613292; http://www.isrctn.com/ISRCTN16613292 and European Union Drug Regulating Authorities Clinical Trials Database (EudraCT), European Union Clinical Trials Register 2017-002876-26; https://tinyurl.com/y4m2so8g International Registered Report Identifier (IRRID): DERR1-10.2196/19456 %M 32965237 %R 10.2196/19456 %U http://www.researchprotocols.org/2020/9/e19456/ %U https://doi.org/10.2196/19456 %U http://www.ncbi.nlm.nih.gov/pubmed/32965237 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 4 %N 1 %P e20426 %T Google Trends Insights Into Reduced Acute Coronary Syndrome Admissions During the COVID-19 Pandemic: Infodemiology Study %A Senecal,Conor %A Gulati,Rajiv %A Lerman,Amir %+ Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States, 1 507 255 1622, Lerman.amir@mayo.edu %K Google Trends %K acute coronary syndrome %K coronary heart disease %K online search %K internet %K trend %K COVID-19 %K heart %K cardiovascular %D 2020 %7 24.8.2020 %9 Original Paper %J JMIR Cardio %G English %X Background: During the coronavirus disease (COVID-19) pandemic, a reduction in the presentation of acute coronary syndrome (ACS) has been noted in several countries. However, whether these trends reflect a reduction in ACS incidence or a decrease in emergency room visits is unknown. Using Google Trends, queries for chest pain that have previously been shown to closely correlate with coronary heart disease were compared with searches for myocardial infarction and COVID-19 symptoms. Objective: The current study evaluates if search terms (or topics) pertaining to chest pain symptoms correlate with the reported decrease in presentations of ACS. Methods: Google Trends data for search terms “chest pain,” “myocardial infarction,” “cough,” and “fever” were obtained from June 1, 2019, to May 31, 2020. Related queries were evaluated for a relationship to coronary heart disease. Results: Following the onset of the COVID-19 pandemic, chest pain searches increased in all countries studied by at least 34% (USA P=.003, Spain P=.007, UK P=.001, Italy P=.002), while searches for myocardial infarction dropped or remained unchanged. Rising searches for chest pain included “coronavirus chest pain,” “home remedies for chest pain,” and “natural remedies for chest pain.” Searches on COVID-19 symptoms (eg, cough, fever) rose initially but returned to baseline while chest pain–related searches remained elevated throughout May. Conclusions: Search engine queries for chest pain have risen during the pandemic as have related searches with alternative attribution for chest pain or home care for chest pain, suggesting that recent drops in ACS presentations may be due to patients avoiding the emergency room and potential treatment in the midst of the COVID-19 pandemic. %M 32831186 %R 10.2196/20426 %U http://cardio.jmir.org/2020/1/e20426/ %U https://doi.org/10.2196/20426 %U http://www.ncbi.nlm.nih.gov/pubmed/32831186 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17312 %T Psychometric Properties of the Norwegian Version of the Electronic Health Literacy Scale (eHEALS) Among Patients After Percutaneous Coronary Intervention: Cross-Sectional Validation Study %A Brørs,Gunhild %A Wentzel-Larsen,Tore %A Dalen,Håvard %A Hansen,Tina B %A Norman,Cameron D %A Wahl,Astrid %A Norekvål,Tone M %A , %+ Department of Heart Disease, Haukeland University Hospital, Postbox 1400, Bergen, 5020, Norway, 47 99044635, tone.merete.norekval@helse-bergen.no %K eHealth literacy %K eHEALS %K health literacy %K percutaneous coronary intervention %K psychometric properties %K validation %D 2020 %7 28.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based technology has recently become an important source for sharing health information with patients after an acute cardiac event. Therefore, consideration of patients’ perceived electronic health (eHealth) literacy skills is crucial for improving the delivery of patient-centered health information. Objective: The aim of this study was to translate and adapt the eHealth Literacy Scale (eHEALS) to conditions in Norway, and to determine its psychometric properties. More specifically, we set out to determine the reliability (internal consistency, test-retest) and construct validity (structural validity, hypotheses testing, and cross-cultural validity) of the eHEALS in self-report format administered to patients after percutaneous coronary intervention. Methods: The original English version of the eHEALS was translated into Norwegian following a widely used cross-cultural adaptation process. Internal consistency was calculated using Cronbach α. The intraclass correlation coefficient (ICC) was used to assess the test-retest reliability. Confirmatory factor analysis (CFA) was performed for a priori-specified 1-, 2-, and 3-factor models. Demographic, health-related internet use, health literacy, and health status information was collected to examine correlations with eHEALS scores. Results: A total of 1695 patients after percutaneous coronary intervention were included in the validation analysis. The mean age was 66 years, and the majority of patients were men (1313, 77.46%). Cronbach α for the eHEALS was >.99. The corresponding Cronbach α for the 2-week retest was .94. The test-retest ICC for eHEALS was 0.605 (95% CI 0.419-0.743, P<.001). The CFA showed a modest model fit for the 1- and 2-factor models (root mean square error of approximation>0.06). After modifications in the 3-factor model, all of the goodness-of-fit indices indicated a good fit. There was a weak correlation with age (r=–0.206). Between-groups analysis of variance showed a difference according to educational groups and the eHEALS score, with a mean difference ranging from 2.24 (P=.002) to 4.61 (P<.001), and a higher eHEALS score was found for patients who were employed compared to those who were retired (mean difference 2.31, P<.001). The eHEALS score was also higher among patients who reported using the internet to find health information (95% CI –21.40 to –17.21, P<.001), and there was a moderate correlation with the patients’ perceived usefulness (r=0.587) and importance (r=0.574) of using the internet for health information. There were also moderate correlations identified between the eHEALS score and the health literacy domains appraisal of health information (r=0.380) and ability to find good health information (r=0.561). Weak correlations with the mental health composite score (r=0.116) and physical health composite score (r=0.116) were identified. Conclusions: This study provides new information on the psychometric properties of the eHEALS for patients after percutaneous coronary intervention, suggesting a multidimensional rather than unidimensional construct. However, the study also indicated a redundancy of items, indicating the need for further validation studies. Trial Registration: ClinicalTrials.gov NCT03810612; https://clinicaltrials.gov/ct2/show/NCT03810612 %M 32720900 %R 10.2196/17312 %U https://www.jmir.org/2020/7/e17312 %U https://doi.org/10.2196/17312 %U http://www.ncbi.nlm.nih.gov/pubmed/32720900 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 7 %P e17257 %T Accurate Prediction of Coronary Heart Disease for Patients With Hypertension From Electronic Health Records With Big Data and Machine-Learning Methods: Model Development and Performance Evaluation %A Du,Zhenzhen %A Yang,Yujie %A Zheng,Jing %A Li,Qi %A Lin,Denan %A Li,Ye %A Fan,Jianping %A Cheng,Wen %A Chen,Xie-Hui %A Cai,Yunpeng %+ Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Blvd, Nanshan District, Shenzhen, China, 86 755 86392202, yp.cai@siat.ac.cn %K coronary heart disease %K machine learning %K electronic health records %K predictive algorithms %K hypertension %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Predictions of cardiovascular disease risks based on health records have long attracted broad research interests. Despite extensive efforts, the prediction accuracy has remained unsatisfactory. This raises the question as to whether the data insufficiency, statistical and machine-learning methods, or intrinsic noise have hindered the performance of previous approaches, and how these issues can be alleviated. Objective: Based on a large population of patients with hypertension in Shenzhen, China, we aimed to establish a high-precision coronary heart disease (CHD) prediction model through big data and machine-learning Methods: Data from a large cohort of 42,676 patients with hypertension, including 20,156 patients with CHD onset, were investigated from electronic health records (EHRs) 1-3 years prior to CHD onset (for CHD-positive cases) or during a disease-free follow-up period of more than 3 years (for CHD-negative cases). The population was divided evenly into independent training and test datasets. Various machine-learning methods were adopted on the training set to achieve high-accuracy prediction models and the results were compared with traditional statistical methods and well-known risk scales. Comparison analyses were performed to investigate the effects of training sample size, factor sets, and modeling approaches on the prediction performance. Results: An ensemble method, XGBoost, achieved high accuracy in predicting 3-year CHD onset for the independent test dataset with an area under the receiver operating characteristic curve (AUC) value of 0.943. Comparison analysis showed that nonlinear models (K-nearest neighbor AUC 0.908, random forest AUC 0.938) outperform linear models (logistic regression AUC 0.865) on the same datasets, and machine-learning methods significantly surpassed traditional risk scales or fixed models (eg, Framingham cardiovascular disease risk models). Further analyses revealed that using time-dependent features obtained from multiple records, including both statistical variables and changing-trend variables, helped to improve the performance compared to using only static features. Subpopulation analysis showed that the impact of feature design had a more significant effect on model accuracy than the population size. Marginal effect analysis showed that both traditional and EHR factors exhibited highly nonlinear characteristics with respect to the risk scores. Conclusions: We demonstrated that accurate risk prediction of CHD from EHRs is possible given a sufficiently large population of training data. Sophisticated machine-learning methods played an important role in tackling the heterogeneity and nonlinear nature of disease prediction. Moreover, accumulated EHR data over multiple time points provided additional features that were valuable for risk prediction. Our study highlights the importance of accumulating big data from EHRs for accurate disease predictions. %M 32628616 %R 10.2196/17257 %U https://medinform.jmir.org/2020/7/e17257 %U https://doi.org/10.2196/17257 %U http://www.ncbi.nlm.nih.gov/pubmed/32628616 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e16420 %T A Mobile Health Intervention System for Women With Coronary Heart Disease: Usability Study %A Sengupta,Avijit %A Beckie,Theresa %A Dutta,Kaushik %A Dey,Arup %A Chellappan,Sriram %+ Information Systems and Decision Sciences, University of South Florida, 4202 E Fowler Avenue, Tampa, FL, 33620, United States, 1 8139746338, duttak@usf.edu %K coronary heart disease %K mobile health technology %K behavior change interventions %K women %K mobile phone %D 2020 %7 3.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Coronary heart disease (CHD) is the leading cause of death and disability among American women. The prevalence of CHD is expected to increase by more than 40% by 2035. In 2015, the estimated cost of caring for patients with CHD was US $182 billion in the United States; hospitalizations accounted for more than half of the costs. Compared with men, women with CHD or those who have undergone coronary revascularization have up to 30% more rehospitalizations within 30 days and up to 1 year. Center-based cardiac rehabilitation is the gold standard of care after an acute coronary event, but few women attend these valuable programs. Effective home-based interventions for improving cardiovascular health among women with CHD are vital for addressing this gap in care. Objective: The ubiquity of mobile phones has made mobile health (mHealth) behavioral interventions a viable option to improve healthy behaviors of both women and men with CHD. First, this study aimed to examine the usability of a prototypic mHealth intervention designed specifically for women with CHD (herein referred to as HerBeat). Second, we examined the influence of HerBeat on selected health behaviors (self-efficacy for diet, exercise, and managing chronic illness) and psychological (perceived stress and depressive symptoms) characteristics of the participants. Methods: Using a single-group, pretest, posttest design, 10 women participated in the 12-week usability study. Participants were provided a smartphone and a smartwatch on which the HerBeat app was installed. Using a web portal dashboard, a health coach monitored participants’ ecological momentary assessment data, their behavioral data, and their heart rate and step count. Participants then completed a 12-week follow-up assessment. Results: All 10 women (age: mean 64.4 years, SD 6.3 years) completed the study. The usability and acceptability of HerBeat were good, with a mean system usability score of 83.60 (SD 16.3). The participants demonstrated statistically significant improvements in waist circumference (P=.048), weight (P=.02), and BMI (P=.01). Furthermore, depressive symptoms, measured with the Patient Health Questionnaire-9, significantly improved from baseline (P=.04). Conclusions: The mHealth prototype was feasible and usable for women with CHD. Participants provided data that were useful for further development of HerBeat. The mHealth intervention is expected to help women with CHD self-manage their health behaviors. A randomized controlled trial is needed to further verify the findings. %M 32348270 %R 10.2196/16420 %U https://formative.jmir.org/2020/6/e16420 %U https://doi.org/10.2196/16420 %U http://www.ncbi.nlm.nih.gov/pubmed/32348270 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 4 %N 1 %P e16975 %T Minimal Patient Clinical Variables to Accurately Predict Stress Echocardiography Outcome: Validation Study Using Machine Learning Techniques %A Bennasar,Mohamed %A Banks,Duncan %A Price,Blaine A %A Kardos,Attila %+ School of Life, Health and Chemical Sciences, The Open University, Walton Hall, Milton Keynes, , United Kingdom, 44 190 865 9198, Duncan.Banks@open.ac.uk %K stress echocardiography %K coronary heart disease %K risk factors %K machine learning %K feature selection %K risk prediction %D 2020 %7 29.5.2020 %9 Original Paper %J JMIR Cardio %G English %X Background: Stress echocardiography is a well-established diagnostic tool for suspected coronary artery disease (CAD). Cardiovascular risk factors are used in the assessment of the probability of CAD. The link between the outcome of stress echocardiography and patients’ variables including risk factors, current medication, and anthropometric variables has not been widely investigated. Objective: This study aimed to use machine learning to predict significant CAD defined by positive stress echocardiography results in patients with chest pain based on anthropometrics, cardiovascular risk factors, and medication as variables. This could allow clinical prioritization of patients with likely prediction of CAD, thus saving clinician time and improving outcomes. Methods: A machine learning framework was proposed to automate the prediction of stress echocardiography results. The framework consisted of four stages: feature extraction, preprocessing, feature selection, and classification stage. A mutual information–based feature selection method was used to investigate the amount of information that each feature carried to define the positive outcome of stress echocardiography. Two classification algorithms, support vector machine (SVM) and random forest classifiers, have been deployed. Data from 529 patients were used to train and validate the framework. Patient mean age was 61 (SD 12) years. The data consists of anthropological data and cardiovascular risk factors such as gender, age, weight, family history, diabetes, smoking history, hypertension, hypercholesterolemia, prior diagnosis of CAD, and prescribed medications at the time of the test. There were 82 positive (abnormal) and 447 negative (normal) stress echocardiography results. The framework was evaluated using the whole dataset including cases with prior diagnosis of CAD. Five-fold cross-validation was used to validate the performance of the framework. We also investigated the model in the subset of patients with no prior CAD. Results: The feature selection methods showed that prior diagnosis of CAD, sex, and prescribed medications such as angiotensin-converting enzyme inhibitor/angiotensin receptor blocker were the features that shared the most information about the outcome of stress echocardiography. SVM classifiers showed the best trade-off between sensitivity and specificity and was achieved with three features. Using only these three features, we achieved an accuracy of 67.63% with sensitivity and specificity 72.87% and 66.67% respectively. However, for patients with no prior diagnosis of CAD, only two features (sex and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use) were needed to achieve accuracy of 70.32% with sensitivity and specificity at 70.24%. Conclusions: This study shows that machine learning can predict the outcome of stress echocardiography based on only a few features: patient prior cardiac history, gender, and prescribed medication. Further research recruiting higher number of patients who underwent stress echocardiography could further improve the performance of the proposed algorithm with the potential of facilitating patient selection for early treatment/intervention avoiding unnecessary downstream testing. %M 32469316 %R 10.2196/16975 %U http://cardio.jmir.org/2020/1/e16975/ %U https://doi.org/10.2196/16975 %U http://www.ncbi.nlm.nih.gov/pubmed/32469316 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e14508 %T Usability of Wearable Devices to Remotely Monitor Sleep Patterns Among Patients With Ischemic Heart Disease: Observational Study %A Fortunato,Michael %A Adusumalli,Srinath %A Chokshi,Neel %A Harrison,Joseph %A Rareshide,Charles %A Patel,Mitesh %+ Crescenz Veterans Affairs Medical Center, 3800 Woodland Ave, South Pavilion 14-176, Philadelphia, PA, , United States, 1 215 823 5800, mpatel@pennmedicine.upenn.edu %K sleep %K wearable devices %K ischemic heart disease %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing interest in using wearable devices to remotely monitor patient behaviors. However, there has been little evaluation of how often these technologies are used to monitor sleep patterns over longer term periods, particularly among more high-risk patients. Objective: The goal of the research was to evaluate the proportion of time that patients with ischemic heart disease used wearable devices to monitor their sleep and identify differences in characteristics of patients with higher versus lower use. Methods: We evaluated wearable device data from a previously conducted clinical trial testing the use of wearable devices with personalized goal-setting and financial incentives. Patients with ischemic heart disease established a sleep baseline and were then followed for 24 weeks. The proportion of days that sleep data was collected was compared over the 24 weeks and by study arm. Characteristics of patients were compared to groups with high, low, or no sleep data. Results: The sample comprised 99 patients with ischemic heart disease, among which 79% (78/99) used the wearable device to track their sleep. During the 6-month trial, sleep data were collected on 60% (10,024/16,632) of patient-days. These rates declined over time from 77% (4292/5544) in months 1 and 2 to 58% (3188/5544) in months 3 and 4 to 46% (2544/5544) in months 5 and 6. Sleep data were collected at higher rates among the intervention group compared with control (67% vs 55%, P<.001). In the main intervention period (months 3 and 4), patients with higher rates of sleep data were on average older (P=.03), had a history of smoking (P=.007), and had higher rates of commercial health insurance (P=.03). Conclusions: Among patients with ischemic heart disease in a physical activity trial, a high proportion used wearable devices to track their sleep; however, rates declined over time. Future research should consider larger evaluations coupled with behavioral interventions. Trial Registration: ClinicalTrials.gov NCT02531022; https://clinicaltrials.gov/ct2/show/NCT02531022 %M 32254044 %R 10.2196/14508 %U https://formative.jmir.org/2020/4/e14508 %U https://doi.org/10.2196/14508 %U http://www.ncbi.nlm.nih.gov/pubmed/32254044 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 12 %P e15045 %T Usefulness of Modern Activity Trackers for Monitoring Exercise Behavior in Chronic Cardiac Patients: Validation Study %A Herkert,Cyrille %A Kraal,Jos Johannes %A van Loon,Eline Maria Agnes %A van Hooff,Martijn %A Kemps,Hareld Marijn Clemens %+ Máxima Medical Center, Flow, Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Dominee Theodor Fliednerstraat 1, Eindhoven, 5631 BM, Netherlands, 31 408888200, cyrille.herkert@mmc.nl %K cardiac diseases %K activity trackers %K energy metabolism %K physical activity %K validation studies %D 2019 %7 19.12.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Improving physical activity (PA) is a core component of secondary prevention and cardiac (tele)rehabilitation. Commercially available activity trackers are frequently used to monitor and promote PA in cardiac patients. However, studies on the validity of these devices in cardiac patients are scarce. As cardiac patients are being advised and treated based on PA parameters measured by these devices, it is highly important to evaluate the accuracy of these parameters in this specific population. Objective: The aim of this study was to determine the accuracy and responsiveness of 2 wrist-worn activity trackers, Fitbit Charge 2 (FC2) and Mio Slice (MS), for the assessment of energy expenditure (EE) in cardiac patients. Methods: EE assessed by the activity trackers was compared with indirect calorimetry (Oxycon Mobile [OM]) during a laboratory activity protocol. Two groups were assessed: patients with stable coronary artery disease (CAD) with preserved left ventricular ejection fraction (LVEF) and patients with heart failure with reduced ejection fraction (HFrEF). Results: A total of 38 patients were included: 19 with CAD and 19 with HFrEF (LVEF 31.8%, SD 7.6%). The CAD group showed no significant difference in total EE between FC2 and OM (47.5 kcal, SD 112 kcal; P=.09), in contrast to a significant difference between MS and OM (88 kcal, SD 108 kcal; P=.003). The HFrEF group showed significant differences in EE between FC2 and OM (38 kcal, SD 57 kcal; P=.01), as well as between MS and OM (106 kcal, SD 167 kcal; P=.02). Agreement of the activity trackers was low in both groups (CAD: intraclass correlation coefficient [ICC] FC2=0.10, ICC MS=0.12; HFrEF: ICC FC2=0.42, ICC MS=0.11). The responsiveness of FC2 was poor, whereas MS was able to detect changes in cycling loads only. Conclusions: Both activity trackers demonstrated low accuracy in estimating EE in cardiac patients and poor performance to detect within-patient changes in the low-to-moderate exercise intensity domain. Although the use of activity trackers in cardiac patients is promising and could enhance daily exercise behavior, these findings highlight the need for population-specific devices and algorithms. %M 31855191 %R 10.2196/15045 %U http://mhealth.jmir.org/2019/12/e15045/ %U https://doi.org/10.2196/15045 %U http://www.ncbi.nlm.nih.gov/pubmed/31855191 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 11 %P e13901 %T Home-Based Cardiac Rehabilitation in Brazil’s Public Health Care: Protocol for a Randomized Controlled Trial %A Lima,Ana Paula %A Nascimento,Isabella Oliveira %A Oliveira,Anne Caroline A %A Martins,Thiago Henrique S %A Pereira,Danielle A Gomes %A Britto,Raquel Rodrigues %+ Physical Therapy Department, Universidade Federal de Minas Gerais, Av Antonio Carlos, 6627, Belo Horizonte, 31270-901, Brazil, 55 31991037415, danielleufmg@gmail.com %K cardiac rehabilitation %K coronary disease %K exercise %D 2019 %7 7.11.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Coronary artery disease (CAD) is among the main causes of hospitalization and death worldwide, therefore, the implementation of programs to reduce its impact is necessary. Supervised cardiac rehabilitation has been shown to have positive effects on CAD control. However, there are barriers to patient participation in the traditional, face-to-face cardiac rehabilitation programs, mainly in low-resource environments. Objective: This study aimed to verify patient compliance to a home-based cardiac rehabilitation program, which includes unsupervised health education and physical exercises, guided by telephone. Moreover, we compare this new method to the traditional supervised cardiac rehabilitation offered in most hospital centers. Methods: We present here a two-arm, single-blinded, and randomized controlled design protocol, which compares the traditional cardiac rehabilitation (CenterRehab) with the home-based cardiac rehabilitation (Home-Based) in 72 patients affected by CAD. The primary outcome is the compliance to the cardiac rehabilitation sessions. The secondary outcomes (to evaluate effectiveness) include measurable variables such as functional capacity, CAD risk factors (blood pressure, waist circumference, glycemic, cholesterol levels, depressive symptoms, and the level of physical activity), the patient’s quality of life, the disease knowledge, and the morbidity rate. Parameters such as the program cost and the usability will also be evaluated. The programs will last 12 weeks, with a total of 60 rehabilitation and 6 educational sessions. Patients of the CenterRehab program will participate in 24 supervised sessions and 36 home sessions, while the patients of the Home-Based program will participate in 2 supervised sessions and 58 home sessions, guided by telephone. After the 12-week period all participants will be recommended to continue practicing physical exercises at home or at a community center, and they will be invited for re-evaluation after 3 months. The outcomes will be evaluated at baseline, and after 3 and 6 months. Results: Participants are currently being recruited for the trial. Data collection is anticipated to be completed by October 2019. Conclusions: This is the first study in Brazil comparing the traditional cardiac rehabilitation approach with a novel, home-based protocol that uses an accessible and low-cost technology. If positive results are obtained, the study will contribute to establish a new and viable model of cardiac rehabilitation. Trial Registration: ClinicalTrials.gov NCT03605992; https://clinicaltrials.gov/ct2/show/NCT03605992 International Registered Report Identifier (IRRID): DERR1-10.2196/13901 %M 31697246 %R 10.2196/13901 %U https://www.researchprotocols.org/2019/11/e13901 %U https://doi.org/10.2196/13901 %U http://www.ncbi.nlm.nih.gov/pubmed/31697246 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 3 %P e14107 %T Common Data Elements for Acute Coronary Syndrome: Analysis Based on the Unified Medical Language System %A Kentgen,Markus %A Varghese,Julian %A Samol,Alexander %A Waltenberger,Johannes %A Dugas,Martin %+ Institute of Medical Informatics, University of Münster, Institut für Medizinische Informatik Münster, Albert-Schweitzer-Campus 1, Münster, 48149, Germany, 49 2518354714, julian.varghese@uni-muenster.de %K common data elements %K acute coronary syndrome %K documentation %K standardization %D 2019 %7 23.08.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Standardization in clinical documentation can increase efficiency and can save time and resources. Objective: The objectives of this work are to compare documentation forms for acute coronary syndrome (ACS), check for standardization, and generate a list of the most common data elements using semantic form annotation with the Unified Medical Language System (UMLS). Methods: Forms from registries, studies, risk scores, quality assurance, official guidelines, and routine documentation from four hospitals in Germany were semantically annotated using UMLS. This allowed for automatic comparison of concept frequencies and the generation of a list of the most common concepts. Results: A total of 3710 forms items from 86 sources were semantically annotated using 842 unique UMLS concepts. Half of all medical concept occurrences were covered by 60 unique concepts, which suggests the existence of a core dataset of relevant concepts. Overlap percentages between forms were relatively low, hinting at inconsistent documentation structures and lack of standardization. Conclusions: This analysis shows a lack of standardized and semantically enriched documentation for patients with ACS. Efforts made by official institutions like the European Society for Cardiology have not yet been fully implemented. Utilizing a standardized and annotated core dataset of the most important data concepts could make export and automatic reuse of data easier. The generated list of common data elements is an exemplary implementation suggestion of the concepts to use in a standardized approach. %M 31444871 %R 10.2196/14107 %U http://medinform.jmir.org/2019/3/e14107/ %U https://doi.org/10.2196/14107 %U http://www.ncbi.nlm.nih.gov/pubmed/31444871 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10874 %T Evaluating the Impact of the HeartHab App on Motivation, Physical Activity, Quality of Life, and Risk Factors of Coronary Artery Disease Patients: Multidisciplinary Crossover Study %A Sankaran,Supraja %A Dendale,Paul %A Coninx,Karin %+ Expertise Center for Digital Media, Hasselt University, Wetenschapspark 2, Diepenbeek, 3590, Belgium, 32 011 26 84 11, supraja.sankaran@uhasselt.be %K heart diseases %K cardiac rehabilitation %K human factors engineering %K evaluation studies %K telerehabilitation %K mobile app %K multidisciplinary research %D 2019 %7 04.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Telerehabilitation approaches have been successful in supporting coronary artery disease (CAD) patients to rehabilitate at home after hospital-based rehabilitation. However, on completing a telerehabilitation program, the effects are not sustained beyond the intervention period because of the lack of lifestyle adaptations. Furthermore, decline in patients’ motivation lead to recurrence of disease and increased rehospitalization rates. We developed HeartHab, using persuasive design principles and personalization, to enable sustenance of rehabilitation effects beyond the intervention period. HeartHab promotes patients’ understanding, motivates them to reach personalized rehabilitation goals, and helps to maintain positive lifestyle adaptations during telerehabilitation. Objective: This study aimed to investigate the impact of the HeartHab app on patients’ overall motivation, increasing physical activities, reaching exercise targets, quality of life, and modifiable risk factors in patients with CAD during telerehabilitation. The study also investigated carryover effects to determine the maintenance of effects after the conclusion of the intervention. Methods: A total of 32 CAD patients were randomized on a 1:1 ratio to telerehabilitation or usual care. We conducted a 4-month crossover study with a crossover point at 2 months using a mixed-methods approach for evaluation. We collected qualitative data on users’ motivation, user experience, and quality of life using questionnaires, semistructured interviews and context-based sentiment analysis. Quantitative data on health parameters, exercise capacity, and risk factors were gathered from blood tests and ergo-spirometry tests. Data procured during the app usage phase were compared against baseline values to assess the impact of the app on parameters such as motivation, physical activity, quality of life, and risk factors. Carryover effects were used to gather insights on the maintenance of effects. Results: The qualitative data showed that 75% (21/28) of patients found the HeartHab app motivating and felt encouraged to achieve their rehabilitation targets. 84% (21/25) of patients either reached or exceeded their prescribed physical activity targets. We found positive significant effects on glycated hemoglobin (P=.01; d=1.03; 95% CI 0.24-1.82) with a mean decrease of 1.5 mg/dL and high-density lipoprotein (HDL) cholesterol (P=.04; d=0.78; 95% CI 0.02-1.55) with a mean increase of 0.61 mg/dL after patients used the HeartHab app. We observed significant carryover effects on weight, HDL cholesterol, and maximal oxygen consumption (VO2 max), indicating the maintenance of effects. Conclusions: Persuasive design techniques integrated in HeartHab and tailoring of exercise targets were effective in motivating patients to reach their telerehabilitation targets. This study demonstrated significant effects on glucose and HDL cholesterol and positive carryover effects on weight, HDL cholesterol, and VO2 max. There was also a perceived improvement in quality of life. A longer-term evaluation with more patients could possibly reveal effectiveness on other risk factors and maintenance of the positive health behavior change. Trial Registration: ClinicalTrials.gov NCT03102671; https://clinicaltrials.gov/ct2/show/NCT03102671 (Archived by WebCite at http://www.webcitation.org/76gzI9Pvd) %M 30946021 %R 10.2196/10874 %U https://mhealth.jmir.org/2019/4/e10874/ %U https://doi.org/10.2196/10874 %U http://www.ncbi.nlm.nih.gov/pubmed/30946021 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 3 %P e10970 %T Concentric and Eccentric Pedaling-Type Interval Exercise on a Soft Robot for Stable Coronary Artery Disease Patients: Toward a Personalized Protocol %A Fitze,Daniel P %A Franchi,Martino %A Popp,Werner L %A Ruoss,Severin %A Catuogno,Silvio %A Camenisch,Karin %A Lehmann,Debora %A Schmied,Christian M %A Niederseer,David %A Frey,Walter O %A Flück,Martin %+ Laboratory for Muscle Plasticity, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Balgrist Campus, Lengghalde 5, Zurich, 8008, Switzerland, 41 445107350, mflueck@research.balgrist.ch %K cardiovascular rehabilitation %K concentric and eccentric exercise %K high-intensity interval training %K muscle oxygen saturation %K near-infrared spectroscopy %K peak oxygen uptake %K ramp test %K skeletal muscle power %K soft robot %D 2019 %7 27.03.2019 %9 Early Report %J JMIR Res Protoc %G English %X Background: Cardiovascular diseases are the leading causes of death worldwide, and coronary artery disease (CAD) is one of the most common causes of death in Europe. Leading cardiac societies recommend exercise as an integral part of cardiovascular rehabilitation because it reduces the morbidity and mortality of patients with CAD. Continuous low-intensity exercise using shortening muscle actions (concentric, CON) is a common training modality during cardiovascular rehabilitation. However, a growing clinical interest has been recently developed in high-intensity interval training (HIIT) for stable patients with CAD. Exercise performed with lengthening muscle actions (eccentric, ECC) could be tolerated better by patients with CAD as they can be performed with higher loads and lower metabolic cost than CON exercise. Objective: We developed a clinical protocol on a soft robot to compare cardiovascular and muscle effects of repeated and work-matched CON versus ECC pedaling-type interval exercise between patients with CAD during cardiovascular rehabilitation. This study aims to ascertain whether the developed training protocols affect peak oxygen uptake (VO2peak), peak aerobic power output (Ppeak), and parameters of muscle oxygen saturation (SmO2) during exercise, and anaerobic muscle power. Methods: We will randomize 20-30 subjects to either the CON or ECC group. Both groups will perform a ramp test to exhaustion before and after the training period to measure cardiovascular parameters and SmO2. Moreover, the aerobic skeletal muscle power (Ppeak) is measured weekly during the 8-week training period using a simulated squat jump and a counter movement jump on the soft robot and used to adjust the training load. The pedaling-type interval exercise on the soft robot is performed involving either CON or ECC muscle actions. The soft robotic device being used is a closed kinetic chain, force-controlled interactive training, and testing device for the lower extremities, which consists of two independent pedals and free footplates that are operated by pneumatic artificial muscles. Results: The first patients with CAD, who completed the training, showed protocol-specific improvements, reflecting, in part, the lower aerobic training status of the patient completing the CON protocol. Rehabilitation under the CON protocol, more than under the ECC protocol, improved cardiovascular parameters, that is, VO2peak (+26% vs −6%), and Ppeak (+20% vs 0%), and exaggerated muscle deoxygenation during the ramp test (248% vs 49%). Conversely, markers of metabolic stress and recovery from the exhaustive ramp test improved more after the ECC than the CON protocol, that is, peak blood lactate (−9% vs +20%) and peak SmO2 (+7% vs −7%). Anaerobic muscle power only improved after the CON protocol (+18% vs −15%). Conclusions: This study indicates the potential of the implemented CON and ECC protocols of pedaling-type interval exercise to improve oxygen metabolism of exercised muscle groups while maintaining or even increasing the Ppeak. The ECC training protocol seemingly provided a lower cardiovascular stimulus in patients with CAD while specifically enhancing the reoxygenation and blood lactate clearance in recruited muscle groups during recovery from exercise. Trial Registration: ClinicalTrials.gov NCT02845063; https://clinicaltrials.gov/ct2/show/NCT02845063 %M 30916659 %R 10.2196/10970 %U https://www.researchprotocols.org/2019/3/e10970/ %U https://doi.org/10.2196/10970 %U http://www.ncbi.nlm.nih.gov/pubmed/30916659 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e12052 %T Evaluation of a Web-Based Intervention for Multiple Health Behavior Changes in Patients With Coronary Heart Disease in Home-Based Rehabilitation: Pilot Randomized Controlled Trial %A Duan,Yan Ping %A Liang,Wei %A Guo,Lan %A Wienert,Julian %A Si,Gang Yan %A Lippke,Sonia %+ Department of Sport and Physical Education, Faculty of Social Sciences, Hong Kong Baptist University, 12/F, Shek Mun Campus, 8 On Muk Street, Shek Mun, Shatin, Hong Kong,, China (Hong Kong), 852 3411 3080, duanyp@hkbu.edu.hk %K eHealth %K physical activity %K diet %K cardiac rehabilitation %K health resources %D 2018 %7 19.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based and theory-based interventions for multiple health behaviors appears to be a promising approach with respect to the adoption and maintenance of a healthy lifestyle in cardiac patients who have been discharged from the hospital. Until now, no randomized controlled trials have tested this assumption among Chinese rehabilitation patients with coronary heart disease using a Web-based intervention. Objective: The study aim was to evaluate the effect of an 8-week Web-based intervention in terms of physical activity (PA), fruit and vegetable consumption (FVC), lifestyle changes, social-cognitive outcomes, and health outcomes compared with a waiting control group in Chinese cardiac patients. The intervention content was theory-based on the health action process approach. Self-reported data were evaluated, including PA, FVC, healthy lifestyle (the synthesis of PA and FVC), internal resources (combination of intention, self-efficacy, and planning), and an external resource (social support) of PA and FVC behaviors, as well as perceived health outcomes (body mass index, quality of life, and depression). Methods: In a randomized controlled trial, 136 outpatients with coronary heart disease from the cardiac rehabilitation center of a hospital in China were recruited. After randomization and exclusion of unsuitable participants, 114 patients were assigned to 1 of the 2 groups: (1) the intervention group: first 4 weeks on PA and subsequent 4 weeks on FVC and (2) the waiting control group. A total of 2 Web-based assessments were conducted, including 1 at the beginning of the intervention (T1, N=114), and 1 at the end of the 8-week intervention (T2, N=83). The enrollment and follow-up took place from December 2015 to May 2016. Results: The Web-based intervention outperformed the control condition for PA, FVC, internal resources of PA and FVC, and an external resource of FVC, with an eta-squared effect size ranging from 0.06 to 0.43. Furthermore, the intervention effect was seen in the improvement of quality of life (F1,79=16.36, P<.001, η2=.17). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR 145.60, 95% CI 11.24-1886; P<.001) and the intervention (OR 21.32, 95% CI 2.40-189.20; P=.006) were found to be significant predictors. Internal resources for FVC mediated the effect of the intervention on the adoption of a healthy lifestyle (R2adj=.29; P=.001), indicating that if the intervention increased the internal resource of behavior, the adoption of a healthy lifestyle was more likely. Conclusions: Patients’ psychological resources such as motivation, self-efficacy, planning, and social support as well as lifestyle can be improved by a Web-based intervention that focuses on both PA and FVC. Such an intervention enriches extended rehabilitation approaches for cardiac patients to be active and remain healthy in daily life after hospital discharge. Trial Registration: ClinicalTrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6pHV1A0G1) %M 30455167 %R 10.2196/12052 %U http://www.jmir.org/2018/11/e12052/ %U https://doi.org/10.2196/12052 %U http://www.ncbi.nlm.nih.gov/pubmed/30455167 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 2 %P e10183 %T Multidisciplinary Smartphone-Based Interventions to Empower Patients With Acute Coronary Syndromes: Qualitative Study on Health Care Providers’ Perspectives %A Bashi,Nazli %A Hassanzadeh,Hamed %A Varnfield,Marlien %A Wee,Yong %A Walters,Darren %A Karunanithi,Mohanraj %+ Australian e-Health Research Centre, Level 5 - UQ Health Sciences Building 901/16, Royal Brisbane and Women's Hospital, Herston, 4029, Australia, 61 7 3253 3611, nazli.bashi@csiro.au %K acute coronary syndrome %K focus group %K health care professionals %K mobile phone %K multidisciplinary %K thematic analysis %D 2018 %7 31.10.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Postdischarge interventions are limited in patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and travel from remote areas. Smartphones have become a viable lifestyle technology to deliver educational and health interventions following discharge from hospital. Objective: The purpose of this study was to identify the requirements for the delivery of a mobile health intervention for the postdischarge management of patients with ACS via a multidisciplinary focus group. Methods: We conducted a focus group among health care professionals (n=10) from a large metropolitan hospital in May 2017. These participants from a multidisciplinary team contributed to a 1-hour discussion by responding to 8 questions relating to the applicability of smartphone-based educational and health interventions. Descriptive statistics of the focus group data were analyzed using SPSS. The qualitative data were analyzed according to relevant themes extracted from the focus group transcription, using a qualitative description software program (NVivo 11) and an ontology-based concept mapping approach. Results: The mean age of the participants was 47 (SD 8) years: 3 cardiologists; 2 nurse practitioners; 2 clinical nurses; 2 research scientists; and 1 physiotherapist. Of these participants, 70% (7/10) had experience using electronic health intervention during their professional practice. A total of 7 major themes and their subthemes emerged from the qualitative analysis. Health care providers indicated that comprehensive education on diet, particularly providing daily meal plans, is critical for patients with ACS. In terms of ACS symptoms, a strong recommendation was to focus on educating patients instead of daily monitoring of chest pain and shortness of breathing due to subjectivity and insufficient information for clinicians. Participants pointed that monitoring health measures such as blood pressure and body weight may result in increased awareness of patient physical health, yet may not be sufficient to support patients with ACS via the smartphone-based intervention. Therefore, monitoring pain and emotional status along with other health measures was recommended. Real-time support via FaceTime or video conferencing was indicated as motivational and supportive for patient engagement and self-monitoring. The general demographics of patients with ACS being older, having a low educational level, and a lack of computer skills were identified as potential barriers for engagement with the smartphone-based intervention. Conclusions: A smartphone-based program that incorporates the identified educational materials and health interventions would motivate patients with ACS to engage in the multidisciplinary intervention and improve their health outcomes following discharge from hospital. %M 31758781 %R 10.2196/10183 %U http://cardio.jmir.org/2018/2/e10183/ %U https://doi.org/10.2196/10183 %U http://www.ncbi.nlm.nih.gov/pubmed/31758781 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e225 %T Home-Based Rehabilitation With Telemonitoring Guidance for Patients With Coronary Artery Disease (Short-Term Results of the TRiCH Study): Randomized Controlled Trial %A Avila,Andrea %A Claes,Jomme %A Goetschalckx,Kaatje %A Buys,Roselien %A Azzawi,May %A Vanhees,Luc %A Cornelissen,Véronique %+ Department of Rehabilitation Science, KU Leuven, O&N IV Herestraat 49 - Bus 1510, Leuven, 3000, Belgium, 32 16 32 91 52, veronique.cornelissen@kuleuven.be %K cardiac rehabilitation %K telemonitoring %K exercise %K coronary artery disease %D 2018 %7 22.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiac rehabilitation (CR) is an essential part of contemporary coronary heart disease management. However, patients exiting a center-based CR program have difficulty retaining its benefits. Objective: We aimed to evaluate the added benefit of a home-based CR program with telemonitoring guidance on physical fitness in patients with coronary artery disease (CAD) completing a phase II ambulatory CR program and to compare the effectiveness of this program in a prolonged center-based CR intervention by means of a randomized controlled trial. Methods: Between February 2014 and August 2016, 90 CAD patients (unblinded, mean age 61.2 years, SD 7.6; 80/90, 89.0% males; mean height 1.73 m, SD 0.7; mean weight 82.9 kg, SD 13; mean body mass index 27.5 kg/m2, SD 3.4) who successfully completed a 3-month ambulatory CR program were randomly allocated to one of three groups: home-based (30), center-based (30), or control group (30) on a 1:1:1 basis. Home-based patients received a home-based exercise intervention with telemonitoring guidance consisting of weekly emails or phone calls; center-based patients continued the standard in-hospital CR, and control group patients received the usual care including the advice to remain physically active. All the patients underwent cardiopulmonary exercise testing for assessment of their peak oxygen uptake (VO2 P) at baseline and after a 12-week intervention period. Secondary outcomes included physical activity behavior, anthropometric characteristics, traditional cardiovascular risk factors, and quality of life. Results: Following 12 weeks of intervention, the increase in VO2 P was larger in the center-based (P=.03) and home-based (P=.04) groups than in the control group. In addition, oxygen uptake at the first (P-interaction=.03) and second (P-interaction=.03) ventilatory thresholds increased significantly more in the home-based group than in the center-based group. No significant changes were observed in the secondary outcomes. Conclusions: Adding a home-based exercise program with telemonitoring guidance following completion of a phase II ambulatory CR program results in further improvement of physical fitness and is equally as effective as prolonging a center-based CR in patients with CAD. Trial Registration: ClinicalTrials.gov NCT02047942; https://clinicaltrials.gov/ct2/show/NCT02047942 (Archived by WebCite at http://www.webcitation.org/70CBkSURj) %M 29934286 %R 10.2196/jmir.9943 %U http://www.jmir.org/2018/6/e225/ %U https://doi.org/10.2196/jmir.9943 %U http://www.ncbi.nlm.nih.gov/pubmed/29934286 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e57 %T Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Protocol for a Randomized Controlled Trial Investigating Effects on Clinical Outcomes, Adherence, and Quality of Life %A Östbring,Malin Johansson %A Eriksson,Tommy %A Petersson,Göran %A Hellström,Lina %+ Pharmaceutical Department, Kalmar County Council, Building 2, Floor 2, County Council Hospital, Kalmar, SE-391 85, Sweden, 46 70 289 32 55, malin.johansson.ostbring@ltkalmar.se %K medication adherence %K medication therapy management %K pharmacist %K coronary artery disease %K randomized controlled trial %D 2018 %7 20.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Preventive treatment goals for blood pressure and cholesterol levels continue to be unmet for many coronary patients. The effect of drug treatment depends on both its appropriateness and the patients’ adherence to the treatment regimen. There is a need for adherence interventions that have a measurable effect on clinical outcomes. Objective: This study aims to evaluate the effects on treatment goals of an intervention designed to improve patient adherence and treatment quality in secondary prevention of coronary heart disease. A protocol for the prespecified process evaluation of the trial is published separately. Methods: The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a prospective, randomized, outcomes-blinded trial designed to compare individualized follow-up by a clinical pharmacist using motivational interviewing (MI) and medication review with standard follow-up. Patients were randomized to 2 groups after stratification according to their beliefs about medicines. After standard follow-up at the cardiology clinic, patients in the intervention group are seen individually by a clinical pharmacist 2 to 5 times as required over 7 months, at the clinic. The pharmacist reviews each patient’s medication and uses MI to manage any problems with prescribing and adherence. The primary study outcome is the proportion of patients who have reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. Secondary outcomes are the effects on patient adherence, systolic blood pressure, disease-specific quality of life, and health care use. Results: The protocol for this study was approved by the Regional Ethics Committee, Linköping, in 2013. Enrollment started in October 2013 and ended in December 2016 when 417 patients had been included. Follow-up data collection will conclude in March 2018. Publication of the primary and secondary outcome results from the MIMeRiC trial is anticipated in 2019. Conclusions: The MIMeRiC trial will assess the effectiveness of an intervention involving medication reviews and individualized support. The results will inform the continued development of support for this large group of patients who use preventive medicines for lifelong treatment. The design of this adherence intervention is based on a theoretical framework and is the first trial of an intervention that uses beliefs about medicines to individualize the intervention protocol. Trial Registration: ClinicalTrials.gov NCT02102503; https://clinicaltrials.gov/ct2/show/NCT02102503 (Archived by WebCite at http://www.webcitation.org/6x7iUDohy) %M 29463490 %R 10.2196/resprot.8659 %U http://www.researchprotocols.org/2018/2/e57/ %U https://doi.org/10.2196/resprot.8659 %U http://www.ncbi.nlm.nih.gov/pubmed/29463490 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e21 %T Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Intervention Development and Protocol for the Process Evaluation %A Östbring,Malin Johansson %A Eriksson,Tommy %A Petersson,Göran %A Hellström,Lina %+ Pharmaceutical Department, Kalmar County Council, Building 2, floor 2, County Council Hospital, Kalmar, SE-391 85, Sweden, 46 70 289 32 55, malin.johansson.ostbring@ltkalmar.se %K medication adherence %K medication therapy management %K pharmacist %K coronary artery disease, quality of health care %D 2018 %7 30.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Trials of complex interventions are often criticized for being difficult to interpret because the effects of apparently similar interventions vary across studies dependent on context, targeted groups, and the delivery of the intervention. The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a randomized controlled trial (RCT) of an intervention aimed at improving pharmacological secondary prevention. Guidelines for the development and evaluation of complex interventions have recently highlighted the need for better reporting of the development of interventions, including descriptions of how the intervention is assumed to work, how this theory informed the process evaluation, and how the process evaluation relates to the outcome evaluation. Objective: This paper aims to describe how the intervention was designed and developed. The aim of the process evaluation is to better understand how and why the intervention in the MIMeRiC trial was effective or not effective. Methods: The research questions for evaluating the process are based on the conceptual model of change processes assumed in the intervention and will be analyzed by qualitative and quantitative methods. Quantitative data are used to evaluate the medication review in terms of drug-related problems, to describe how patients’ beliefs about medicines are affected by the intervention, and to evaluate the quality of motivational interviewing. Qualitative data will be used to analyze whether patients experienced the intervention as intended, how cardiologists experienced the collaboration and intervention, and how the intervention affected patients’ overall experience of care after coronary heart disease. Results: The development and piloting of the intervention are described in relation to the theoretical framework. Data for the process evaluation will be collected until March 2018. Some process evaluation questions will be analyzed before, and others will be analyzed after the outcomes of the MIMeRiC RCT are known. Conclusions: This paper describes the framework for the design of the intervention tested in the MIMeRiC trial, development of the intervention from the pilot stage to the complete trial intervention, and the framework and methods for the process evaluation. Providing the protocol of the process evaluation allows prespecification of the processes that will be evaluated, because we hypothesize that they will determine the outcomes of the MIMeRiC trial. This protocol also constitutes a contribution to the new field of process evaluations as made explicit in health services research and clinical trials of complex interventions. %M 29382630 %R 10.2196/resprot.8660 %U http://www.researchprotocols.org/2018/1/e21/ %U https://doi.org/10.2196/resprot.8660 %U http://www.ncbi.nlm.nih.gov/pubmed/29382630 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e9 %T Using Mobile Health Intervention to Improve Secondary Prevention of Coronary Heart Diseases in China: Mixed-Methods Feasibility Study %A Chen,Shu %A Gong,Enying %A Kazi,Dhruv S %A Gates,Ann B %A Bai,Rong %A Fu,Hua %A Peng,Weixia %A De La Cruz,Ginny %A Chen,Lei %A Liu,Xianxia %A Su,Qingjie %A Girerd,Nicolas %A Karaye,Kamilu M %A Alhabib,Khalid F %A Yan,Lijing L %A Schwalm,JD %+ Global Health Research Center, Duke Kunshan University, No 8 Duke Avenue, Duke Kunshan University, Kunshan, Jiangsu, China, Kunshan, 215316, China, 86 51236657057, lijing.yan@duke.edu %K coronary heart disease %K secondary prevention %K medication adherence %K mobile applications %K text messaging %D 2018 %7 25.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Coronary heart disease (CHD) is the leading cause of cardiovascular mortality worldwide, yet implementation of evidence-based strategies for secondary prevention remains suboptimal. Objective: This study aimed to evaluate the feasibility, specifically the usability and acceptability, and estimate the preliminary effectiveness of a mobile health (mHealth) intervention targeting both physicians and patients to improve adherence to evidence-based medications and lifestyle modifications. Methods: We conducted a 12-week pre-post interventional pilot study at two sites in Shanghai and Hainan, China. Physicians used the app designed in this study to prescribe evidence-based medicines and record patient information. Eligible and consenting patients received automatic text messages or voice calls 4 to 5 times per week for 12 weeks on medication adherence and healthy behaviors. Interviews were conducted among 10 physicians and 24 patients at the two sites for their thoughts on medication adherence and feedback on the usability and acceptability. Questions on usability and acceptability were also asked in a patient follow-up survey. With regard to estimating effectiveness, the primary outcome was medication adherence (as estimated by the Morisky Green Levine Scale) at 12 weeks. Secondary outcomes included physical activity, smoking status, fruits and vegetables consumption, and facility visit frequency. Results: Interview findings and patient survey showed the good usability and acceptability of the intervention. Among 190 patients who completed the intervention, there was a significant increase in medication adherence (odds ratio [OR] 1.80, 95% CI 1.14-2.85). The study also showed decrease of smokers’ percentage (−5%, P=.05), increase of daily vegetables consumption frequency (+0.3/day, P=.01), and community health care center visit frequency (+3 in 3 months, P=.04). The following site-specific differences were noted: medication adherence appeared to increase in Hainan (OR 14.68, 95% CI 5.20-41.45) but not in Shanghai (OR 0.61, 95% CI 0.33-1.12). Conclusions: Our study demonstrated that the intervention was feasible in both a tertiary care center and an urban community health center in China. Preliminary results from pre-post comparison suggest the possibility that provider and patient-linked mHealth interventions may improve medication adherence and lifestyle modifications among CHD patients, especially in resource-scarce settings. Randomized controlled trials are needed to verify the findings. %M 29371178 %R 10.2196/mhealth.7849 %U http://mhealth.jmir.org/2018/1/e9/ %U https://doi.org/10.2196/mhealth.7849 %U http://www.ncbi.nlm.nih.gov/pubmed/29371178 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e21 %T Facebook Groups for the Management of Chronic Diseases %A Partridge,Stephanie R %A Gallagher,Patrick %A Freeman,Becky %A Gallagher,Robyn %+ Sydney Nursing School, Charles Perkins Centre, The University of Sydney, Room 2210, Level 2, Building D17, The University of Sydney, Sydney, 2006, Australia, 61 2 86270279, robyn.gallagher@sydney.edu.au %K social media, prevention, intervention, Facebook %D 2018 %7 17.01.2018 %9 Viewpoint %J J Med Internet Res %G English %X The use of Facebook groups by health care researchers and professionals for chronic disease management, namely type 2 diabetes mellitus and coronary heart disease, is in its early stages and challenges are emerging. While Facebook groups offer great potential to deliver health support, research of Facebook groups for chronic disease management remains in its infancy, with robust evidence not yet available. Designing Facebook groups that are acceptable to users, health care researchers as well as health care professionals is a challenge, and there is a poor fit with traditional research and evaluation methods. Key recommendations for future research of Facebook groups for chronic disease management include: (1) iterative content development with input from the target patient population; (2) further understanding of the potential role of group “champions”; (3) ensuring the social media policies of health care institutions allow for real time online communication; and (4) utilizing comprehensive evaluation strategies, including the use of process evaluations. %M 29343460 %R 10.2196/jmir.7558 %U http://www.jmir.org/2018/1/e21/ %U https://doi.org/10.2196/jmir.7558 %U http://www.ncbi.nlm.nih.gov/pubmed/29343460 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e23 %T The Impact of mHealth Interventions: Systematic Review of Systematic Reviews %A Marcolino,Milena Soriano %A Oliveira,João Antonio Queiroz %A D'Agostino,Marcelo %A Ribeiro,Antonio Luiz %A Alkmim,Maria Beatriz Moreira %A Novillo-Ortiz,David %+ Pan American Health Organization, 525 23rd St NW, Washington, DC, 20037, United States, 1 2028124726, novillod@paho.org %K telemedicine %K medical informatics %K mobile phones %D 2018 %7 17.01.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone usage has been rapidly increasing worldwide. mHealth could efficiently deliver high-quality health care, but the evidence supporting its current effectiveness is still mixed. Objective: We performed a systematic review of systematic reviews to assess the impact or effectiveness of mobile health (mHealth) interventions in different health conditions and in the processes of health care service delivery. Methods: We used a common search strategy of five major scientific databases, restricting the search by publication date, language, and parameters in methodology and content. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist. Results: The searches resulted in a total of 10,689 articles. Of these, 23 systematic reviews (371 studies; more than 79,665 patients) were included. Seventeen reviews included studies performed in low- and middle-income countries. The studies used diverse mHealth interventions, most frequently text messaging (short message service, SMS) applied to different purposes (reminder, alert, education, motivation, prevention). Ten reviews were rated as low quality (AMSTAR score 0-4), seven were rated as moderate quality (AMSTAR score 5-8), and six were categorized as high quality (AMSTAR score 9-11). A beneficial impact of mHealth was observed in chronic disease management, showing improvement in symptoms and peak flow variability in asthma patients, reducing hospitalizations and improving forced expiratory volume in 1 second; improving chronic pulmonary diseases symptoms; improving heart failure symptoms, reducing deaths and hospitalization; improving glycemic control in diabetes patients; improving blood pressure in hypertensive patients; and reducing weight in overweight and obese patients. Studies also showed a positive impact of SMS reminders in improving attendance rates, with a similar impact to phone call reminders at reduced cost, and improved adherence to tuberculosis and human immunodeficiency virus therapy in some scenarios, with evidence of decrease of viral load. Conclusions: Although mHealth is growing in popularity, the evidence for efficacy is still limited. In general, the methodological quality of the studies included in the systematic reviews is low. For some fields, its impact is not evident, the results are mixed, or no long-term studies exist. Exceptions include the moderate quality evidence of improvement in asthma patients, attendance rates, and increased smoking abstinence rates. Most studies were performed in high-income countries, implying that mHealth is still at an early stage of development in low-income countries. %M 29343463 %R 10.2196/mhealth.8873 %U http://mhealth.jmir.org/2018/1/e23/ %U https://doi.org/10.2196/mhealth.8873 %U http://www.ncbi.nlm.nih.gov/pubmed/29343463 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 12 %P e255 %T Daily Activity Measured With Wearable Technology as a Novel Measurement of Treatment Effect in Patients With Coronary Microvascular Dysfunction: Substudy of a Randomized Controlled Crossover Trial %A Birkeland,Kade %A Khandwalla,Raj M %A Kedan,Ilan %A Shufelt,Chrisandra L %A Mehta,Puja K %A Minissian,Margo B %A Wei,Janet %A Handberg,Eileen M %A Thomson,Louise EJ %A Berman,Daniel S %A Petersen,John W %A Anderson,R David %A Cook-Wiens,Galen %A Pepine,Carl J %A Bairey Merz,C Noel %+ Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, 127 S San Vicente Blvd, Advanced Health Sciences Pavilion, A3206, Los Angeles, CA, 90048, United States, 1 310 423 9680, noel.baireymerz@cshs.org %K angina %K coronary microvascular dysfunction %K physical activity %D 2017 %7 20.12.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Digital wearable devices provide a “real-world” assessment of physical activity and quantify intervention-related changes in clinical trials. However, the value of digital wearable device-recorded physical activity as a clinical trial outcome is unknown. Objective: Because late sodium channel inhibition (ranolazine) improves stress laboratory exercise duration among angina patients, we proposed that this benefit could be quantified and translated during daily life by measuring digital wearable device-determined step count in a clinical trial. Methods: We conducted a substudy in a randomized, double-blinded, placebo-controlled, crossover trial of participants with angina and coronary microvascular dysfunction (CMD) with no obstructive coronary artery disease to evaluate the value of digital wearable device monitoring. Ranolazine or placebo were administered (500-1000 mg twice a day) for 2 weeks with a subsequent 2-week washout followed by crossover to ranolazine or placebo (500-1000 mg twice a day) for an additional 2 weeks. The outcome of interest was within-subject difference in Fitbit Flex daily step count during week 2 of ranolazine versus placebo during each treatment period. Secondary outcomes included within-subject differences in angina, quality of life, myocardial perfusion reserve, and diastolic function. Results: A total of 43 participants were enrolled in the substudy and 30 successfully completed the substudy for analysis. Overall, late sodium channel inhibition reduced within-subject daily step count versus placebo (mean 5757 [SD 3076] vs mean 6593 [SD 339], P=.01) but did not improve angina (Seattle Angina Questionnaire-7 [SAQ-7]) (P=.83). Among the subgroup with improved angina (SAQ-7), a direct correlation with increased step count (r=.42, P=.02) was observed. Conclusions: We report one of the first studies to use digital wearable device-determined step count as an outcome variable in a placebo-controlled crossover trial of late sodium channel inhibition in participants with CMD. Our substudy demonstrates that late sodium channel inhibition was associated with a decreased step count overall, although the subgroup with angina improvement had a step count increase. Our findings suggest digital wearable device technology may provide new insights in clinical trial research. Trial Registration: Clinicaltrials.gov NCT01342029; https://clinicaltrials.gov/ct2/show/NCT01342029 (Archived by WebCite at http://www.webcitation.org/6uyd6B2PO) %M 29263019 %R 10.2196/resprot.8057 %U http://www.researchprotocols.org/2017/12/e255/ %U https://doi.org/10.2196/resprot.8057 %U http://www.ncbi.nlm.nih.gov/pubmed/29263019 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 10 %P e182 %T Studying Acute Coronary Syndrome Through the World Wide Web: Experiences and Lessons %A Alonzo,Angelo A %+ Department of Sociology and School of Nursing, Ohio State University and Yale University, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, United States, 1 2034447144, angelo.alonzo@yale.edu %K acute coronary syndrome %K care-seeking %K Internet study %K Internet recruitment %D 2017 %7 13.10.2017 %9 Viewpoint %J JMIR Res Protoc %G English %X This study details my viewpoint on the experiences, lessons, and assessments of conducting a national study on care-seeking behavior for heart attack in the United States utilizing the World Wide Web. The Yale Heart Study (YHS) was funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH). Grounded on two prior studies, the YHS combined a Web-based interview survey instrument; ads placed on the Internet; flyers and posters in public libraries, senior centers, and rehabilitation centers; information on chat rooms; a viral marketing strategy; and print ads to attract potential participants to share their heart attack experiences. Along the way, the grant was transferred from Ohio State University (OSU) to Yale University, and significant administrative, information technology, and personnel challenges ensued that materially delayed the study’s execution. Overall, the use of the Internet to collect data on care-seeking behavior is very time consuming and emergent. The cost of using the Web was approximately 31% less expensive than that of face-to-face interviews. However, the quality of the data may have suffered because of the absence of some data compared with interviewing participants. Yet the representativeness of the 1154 usable surveys appears good, with the exception of a dearth of African American participants. %M 29030328 %R 10.2196/resprot.6788 %U http://www.researchprotocols.org/2017/10/e182/ %U https://doi.org/10.2196/resprot.6788 %U http://www.ncbi.nlm.nih.gov/pubmed/29030328 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 12 %P e314 %T Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional, Multicenter Trial %A Brokmann,Jörg C %A Conrad,Clemens %A Rossaint,Rolf %A Bergrath,Sebastian %A Beckers,Stefan K %A Tamm,Miriam %A Czaplik,Michael %A Hirsch,Frederik %+ Department of Anaesthesiology, Rheinisch-Westfälische Technische Hochschule, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen, 52074, Germany, 49 0241 88179, fhirsch@ukaachen.de %K acute coronary syndrome %K prehospital emergency care %K telemedicine %K telehealth %K myocardial infarction %D 2016 %7 01.12.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Prehospital treatment of acute coronary syndrome (ACS) in German emergency medical services (EMSs) is reserved for EMS physicians due to legal issues. Objective: The objective of this prospective, interventional, multicenter trial was to evaluate the quality of telemedically-delegated therapy and the possible complications in patients with ACS. Methods: After approval by the ethics committee and trial registration, a one-year study phase was started in August 2012 with 5 ambulances, telemedically equipped and staffed with paramedics, in 4 German EMS districts. The paramedics could contact an EMS-physician–staffed telemedicine center. After initiation of an audio connection, real-time data transmission was automatically established. If required, 12-lead electrocardiogram (ECG) and still pictures could be sent. Video was streamed from inside each ambulance. All drugs, including opioids, were delegated to the paramedics based on standardized, predefined algorithms. To compare telemedically-delegated medication and treatment in ACS cases with regular EMS missions, a matched pair analysis with historical controls was performed. Results: Teleconsultation was performed on 150 patients having a cardiovascular emergency. In 39 cases, teleconsultation was started due to suspected ACS. No case had a medical complication. Correct handling of 12-lead ECG was performed equally between the groups (study group, n=38 vs control group, n=39, P>.99). There were no differences in correct handling of intravenous administration of acetylsalicylic acid, heparin, or morphine between both the groups (study group vs control group): acetylsalicylic acid, n=31 vs n=33, P=.73; unfractionated heparin, n=34 vs n=33, P>.99; morphine, n=29 vs n=27, P=.50. The correct handling of oxygen administration was significantly higher in the study group (n=29 vs n=18, P=.007). Conclusions: Telemedical delegation of guideline conform medication and therapy by paramedics in patients with ACS and was found to be feasible and safe. The quality of guideline-adherent therapy was not significantly different in both the groups except for the correct administration of oxygen, which was significantly higher in the study group. Trial Registration: Clinicaltrials.gov NCT01644006; http://clinicaltrials.gov/ct2/show/NCT01644006 (Archived by WebCite at http://www.webcitation.org/6mPam3eDy). %M 27908843 %R 10.2196/jmir.6358 %U http://www.jmir.org/2016/12/e314/ %U https://doi.org/10.2196/jmir.6358 %U http://www.ncbi.nlm.nih.gov/pubmed/27908843 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e211 %T Perivascular Adipose Tissue Inflammation and Coronary Artery Disease: An Autopsy Study Protocol %A Farias-Itao,Daniela Souza %A Pasqualucci,Carlos Augusto %A Nishizawa,Aline %A Silva,Luiz Fernando Ferraz %A Campos,Fernanda Marinho %A Silva,Karen Cristina Souza da %A Leite,Renata Elaine Paraizo %A Grinberg,Lea Tenenholz %A Ferretti-Rebustini,Renata Eloah Lucena %A Jacob Filho,Wilson %A Suemoto,Claudia Kimie %+ Physiopathology in Aging Lab/Brazilian Aging Brain Study Group – LIM22, University of Sao Paulo Medical School, Avenida Doutor Arnaldo, 455, room 1353, Sao Paulo, 01246903, Brazil, 55 1130618249, cksuemoto@usp.br %K coronary artery disease %K atherosclerosis %K inflammation %K adipose tissue %K macrophages %K B lymphocytes %K T lymphocytes %D 2016 %7 18.11.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Perivascular adipose tissue (PAT) inflammation may have a role in coronary artery disease (CAD) pathophysiology. However, most evidence has come from samples obtained during surgical procedures that may imply in some limitations. Moreover, the role of B lymphocytes and inflammation in PAT that is adjacent to unstable atheroma plaques has not been investigated in humans using morphometric measurements. Objective: The objective of this study is to investigate the inflammation in PAT, subcutaneous, and perirenal adipose tissues (SAT and PrAT) among chronic CAD, acute CAD, and control groups in an autopsy study. Methods: Heart, SAT, and PrAT samples are collected from autopsied subjects in a general autopsy service, with the written informed consent of the next-of-kin (NOK). Sociodemographic and clinical data are obtained from a semistructure interview with the NOK. Coronary arteries are dissected and PAT are removed. Sections with the greatest arterial obstruction or unstable plaques, and the local with absence of atherosclerosis in all coronary arteries are sampled. PAT are represented adjacent to these fragments. Adipose tissues are fixed in 4% buffered paraformaldehyde solution and analyzed immunohistochemically for macrophages (CD68), macrophage polarization (CD11c for proinflammatory and CD206 for anti-inflammatory), B lymphocytes (CD20), and T lymphocytes (CD3). Slides will be scanned, and inflammatory cells will be quantified in 20 random fields. Participants will be categorized in CAD groups, after morphometric measurement of arterial obstruction and plaque composition analysis in accordance with American Heart Association classification. Three study groups will be investigated: acute CAD (at least one unstable plaque); chronic CAD (≥50% arterial obstruction); and controls (<50% arterial obstruction). Inflammatory cells in PAT, SAT, and PrAT will be counted and compared between groups using multivariate linear regression, adjusted for age, body mass index, hypertension, diabetes, alcohol use, and smoking. Results: We present the methods of our study that was developed from 2 pilots. Currently, data collection and tissue processing are ongoing. Data collection, histology and immunochemistry procedures, and quantification of all inflammatory cells are expected to be concluded within 1 year. Conclusions: This study will contribute for the understanding of the mechanisms of CAD pathophysiology because it will help to clarify the role of inflammation both in chronic and acute CAD. %M 27864166 %R 10.2196/resprot.6340 %U http://www.researchprotocols.org/2016/4/e211/ %U https://doi.org/10.2196/resprot.6340 %U http://www.ncbi.nlm.nih.gov/pubmed/27864166 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e237 %T Text Message and Internet Support for Coronary Heart Disease Self-Management: Results From the Text4Heart Randomized Controlled Trial %A Pfaeffli Dale,Leila %A Whittaker,Robyn %A Jiang,Yannan %A Stewart,Ralph %A Rolleston,Anna %A Maddison,Ralph %+ National Institute for Health Innovation, University of Auckland, School of Population Health, Tamaki Campus, 261 Morrin Rd, Auckland, 1072, New Zealand, 64 9 373 7599, l.pfaeffli@auckland.ac.nz %K text messaging %K mHealth %K cellular phone %K cardiovascular diseases %K intervention %K lifestyle change %K behavior %D 2015 %7 21.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile technology has the potential to deliver behavior change interventions (mHealth) to reduce coronary heart disease (CHD) at modest cost. Previous studies have focused on single behaviors; however, cardiac rehabilitation (CR), a component of CHD self-management, needs to address multiple risk factors. Objective: The aim was to investigate the effectiveness of a mHealth-delivered comprehensive CR program (Text4Heart) to improve adherence to recommended lifestyle behaviors (smoking cessation, physical activity, healthy diet, and nonharmful alcohol use) in addition to usual care (traditional CR). Methods: A 2-arm, parallel, randomized controlled trial was conducted in New Zealand adults diagnosed with CHD. Participants were recruited in-hospital and were encouraged to attend center-based CR (usual care control). In addition, the intervention group received a personalized 24-week mHealth program, framed in social cognitive theory, sent by fully automated daily short message service (SMS) text messages and a supporting website. The primary outcome was adherence to healthy lifestyle behaviors measured using a self-reported composite health behavior score (≥3) at 3 and 6 months. Secondary outcomes included clinical outcomes, medication adherence score, self-efficacy, illness perceptions, and anxiety and/or depression at 6 months. Baseline and 6-month follow-up assessments (unblinded) were conducted in person. Results: Eligible patients (N=123) recruited from 2 large metropolitan hospitals were randomized to the intervention (n=61) or the control (n=62) group. Participants were predominantly male (100/123, 81.3%), New Zealand European (73/123, 59.3%), with a mean age of 59.5 (SD 11.1) years. A significant treatment effect in favor of the intervention was observed for the primary outcome at 3 months (AOR 2.55, 95% CI 1.12-5.84; P=.03), but not at 6 months (AOR 1.93, 95% CI 0.83-4.53; P=.13). The intervention group reported significantly greater medication adherence score (mean difference: 0.58, 95% CI 0.19-0.97; P=.004). The majority of intervention participants reported reading all their text messages (52/61, 85%). The number of visits to the website per person ranged from zero to 100 (median 3) over the 6-month intervention period. Conclusions: A mHealth CR intervention plus usual care showed a positive effect on adherence to multiple lifestyle behavior changes at 3 months in New Zealand adults with CHD compared to usual care alone. The effect was not sustained to the end of the 6-month intervention. A larger study is needed to determine the size of the effect in the longer term and whether the change in behavior reduces adverse cardiovascular events. Trial Registration: ACTRN 12613000901707; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364758&isReview=true (Archived by WebCite at http://www.webcitation.org/6c4qhcHKt) %M 26490012 %R 10.2196/jmir.4944 %U http://www.jmir.org/2015/10/e237/ %U https://doi.org/10.2196/jmir.4944 %U http://www.ncbi.nlm.nih.gov/pubmed/26490012 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 7 %P e177 %T A Web-Based Peer-Modeling Intervention Aimed at Lifestyle Changes in Patients With Coronary Heart Disease and Chronic Back Pain: Sequential Controlled Trial %A Schweier,Rebecca %A Romppel,Matthias %A Richter,Cynthia %A Hoberg,Eike %A Hahmann,Harry %A Scherwinski,Inge %A Kosmützky,Gregor %A Grande,Gesine %+ Faculty of Architecture and Social Sciences, University of Applied Sciences Leipzig (HTWK Leipzig), PF 301166, Leipzig, 04251, Germany, 49 341 3076 3203, schweier@sug.htwk-leipzig.de %K coronary artery disease %K lifestyle %K health behavior %K back pain %K personal narratives as topic %K Internet %K diet %K exercise %K Web-based intervention %D 2014 %7 23.07.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Traditional secondary prevention programs often fail to produce sustainable behavioral changes in everyday life. Peer-modeling interventions and integration of peer experiences in health education are a promising way to improve long-term effects in behavior modification. However, effects of peer support modeling on behavioral change have not been evaluated yet. Therefore, we implemented and evaluated a website featuring patient narratives about successful lifestyle changes. Objective: Our aim is to examine the effects of using Web-based patient narratives about successful lifestyle change on improvements in physical activity and eating behavior for patients with coronary heart disease and chronic back pain 3 months after participation in a rehabilitation program. Methods: The lebensstil-aendern (“lifestyle-change”) website is a nonrestricted, no-cost, German language website that provides more than 1000 video, audio, and text clips from interviews with people with coronary heart disease and chronic back pain. To test efficacy, we conducted a sequential controlled trial and recruited patients with coronary heart disease and chronic back pain from 7 inpatient rehabilitation centers in Germany. The intervention group attended a presentation on the website; the control group did not. Physical activity and eating behavior were assessed by questionnaire during the rehabilitation program and 12 weeks later. Analyses were conducted based on an intention-to-treat and an as-treated protocol. Results: A total of 699 patients were enrolled and 571 cases were included in the analyses (control: n=313, intervention: n=258; female: 51.1%, 292/571; age: mean 53.2, SD 8.6 years; chronic back pain: 62.5%, 357/571). Website usage in the intervention group was 46.1% (119/258). In total, 141 trial participants used the website. Independent t tests based on the intention-to-treat protocol only demonstrated nonsignificant trends in behavioral change related to physical activity and eating behavior. Multivariate regression analyses confirmed belonging to the intervention group was an independent predictor of self-reported improvements in physical activity regularity (β=.09, P=.03) and using less fat for cooking (β=.09, P=.04). In independent t tests based on the as-treated protocol, website use was associated with higher self-reported improvements in integrating physical activity into daily routine (d=0.22, P=.02), in physical activity regularity (d=0.23, P=.02), and in using less fat for cooking (d=0.21, P=.03). Multivariate regression analyses revealed that using the website at least 3 times was the only factor associated with improved lifestyle behaviors. Conclusions: Usage of the lebensstil-aendern website corresponds to more positive lifestyle changes. However, as-treated analyses do not allow for differentiating between causal effects and selection bias. Despite these limitations, the trial indicates that more than occasional website usage is necessary to reach dose-response efficacy. Therefore, future studies should concentrate on strategies to improve adherence to Web-based interventions and to encourage more frequent usage of these programs. %M 25057119 %R 10.2196/jmir.3434 %U http://www.jmir.org/2014/7/e177/ %U https://doi.org/10.2196/jmir.3434 %U http://www.ncbi.nlm.nih.gov/pubmed/25057119