%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e67438 %T Physical Activity Measurement Reactivity Among Midlife Adults With Elevated Risk for Cardiovascular Disease: Protocol for Coordinated Analyses Across Six Studies %A Baga,Kiri %A Salvatore,Gabrielle M %A Bercovitz,Iris %A Folk,Amanda L %A Singh,Ria %A König,Laura M %A Butryn,Meghan L %A Mogle,Jacqueline A %A Arigo,Danielle %+ Department of Psychology, Rowan University, 201 Mullica Hill Road, Robinson 116G, Glassboro, NJ, 08028, United States, 1 8562564500, arigo@rowan.edu %K physical activity %K measurement reactivity %K gender difference %K cardiovascular risk %K intensive assessment %K midlife %K research participation effects %D 2025 %7 23.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cardiovascular disease (CVD) remains the leading cause of death in the United States, and adults aged 40-60 years with specific health conditions are at particularly elevated risk for developing CVD. Physical activity (PA) is a key cardioprotective behavior and many interventions exist to promote PA in this group. Effective promotion requires accurate assessment of PA behavior; as PA is often estimated by averaging across multiple days, a threat to accurate assessment is measurement reactivity, or an atypical increase in PA behavior at the start of measurement periods that may bias conclusions. Evidence for PA measurement reactivity is equivocal, though concern has resulted in recommendations to add or drop PA measurement days from inclusion, which may introduce undue burden on participants. At present, the extent of PA measurement reactivity and the behaviors most likely to be affected (eg, steps vs minutes of exercise) among those at risk for CVD are unclear, as are participant characteristics such as gender and study expectations (eg, intervention vs observation only) that may contribute to differences in these patterns. Objective: The goal of this study is to improve on the current understanding of the extent of PA measurement reactivity and potential moderators among US adults aged 40-60 years with CVD risk factors. Methods: To achieve this goal, we will conduct coordinated multilevel analyses across 6 studies. Data are from nationally representative, publicly available datasets (observation only: 2 studies) and baseline weeks of observation from behavioral weight loss clinical trials (4 studies), all collected in the United States. The publicly available datasets National Health and Nutrition Examination Survey (NHANES; 2013-2014) and the Midlife in the United States (MIDUS) Study (2004-2009; total n=1385) were used, which are available from the Inter-university Consortium for Political and Social Research website. Behavioral weight loss trials were conducted by the Drexel University Weight Eating and Lifestyle (WELL) Center (2011-2023; total n=444), in person or remotely via Zoom. Relevant data from each study were extracted for adults aged 40-60 years who have ≥1 risk factor for CVD (total n=1832; 11,707 total days of PA measurement with 6-7 days per person). Changes in PA behavior across the measurement period will be examined at the day level, using 2-level multilevel models (days nested within persons) and cross-level interactions (for moderation effects). Results: This project was funded in August 2022 and received supplementary funding in September 2023. Dataset acquisition and data cleaning were completed in October 2024. Analyses are expected to be completed in April 2025, and findings are anticipated to be shared in July 2025. Conclusions: Results from this coordinated analysis project will provide the first large-scale estimation of the extent of PA measurement reactivity in an at-risk group. Findings will inform best practices for mitigating potential measurement reactivity in multiday assessments of PA behavior. International Registered Report Identifier (IRRID): DERR1-10.2196/67438 %M 40267469 %R 10.2196/67438 %U https://www.researchprotocols.org/2025/1/e67438 %U https://doi.org/10.2196/67438 %U http://www.ncbi.nlm.nih.gov/pubmed/40267469 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e57032 %T Telemedicine Booths for Screening Cardiovascular Risk Factors: Prospective Multicenter Study %A Decambron,Mélanie %A Tchikladze Merand,Christine %K cardiovascular disease risk factors %K cardiovascular disease %K CVD %K cardiology %K cardiac %K cardiologists %K health check %K hypertension %K HTN %K hypertensive %K high blood pressure %K blood pressure %K obesity %K screening %K health screening %K telemedicine %K telehealth %K virtual care %K virtual health %K virtual medicine %K COVID-19 %K SARS-CoV-2 %K Coronavirus %K respiratory %K infectious %K pulmonary %K pandemic %D 2025 %7 22.4.2025 %9 %J JMIR Hum Factors %G English %X Background: Cardiovascular risk factors such as hypertension often remain undetected and untreated. This was particularly problematic during the COVID-19 pandemic when there were fewer in-person medical consultations. Objective: This study aimed to determine whether health screening using a telemedicine booth would have an impact on people’s medical care during the COVID-19 pandemic. Methods: Health screening was run using a telemedicine booth (the consult station) that was placed in three different vaccination centers in northern France between July 2021 and September 2021. Participants followed a series of instructions to obtain various measures, including their blood pressure, BMI, and heart rate. If any measures were found to be outside of the normal range, participants were advised to consult a doctor. After 3 months, the participants with abnormal readings were contacted by telephone and were asked a series of standardized questions. The primary outcome was the percentage of respondents who reported that they had consulted a doctor since the health check. Results: Approximately 6000 people attended the 3 vaccination centers over the study period. Of these, around 2500 used the consult station. A total of 1333 participants (53.3%) were found to have abnormal readings, which mostly concerned their blood pressure, heart rate, or BMI. There were 638 participants who responded to the follow-up call, and 234 of these (37%) reported that they had consulted a doctor since the health check. However, 158 of the 638 respondents (24.8%) reported that they would have consulted a doctor even without the screening. Conclusions: We succeeded in screening large numbers of people for cardiovascular risk factors during the COVID-19 pandemic by using a telemedicine booth. Although relatively few follow-up call respondents reported that they went on to consult a physician, the screening would nevertheless have raised people’s awareness of their cardiovascular risk factors. %R 10.2196/57032 %U https://humanfactors.jmir.org/2025/1/e57032 %U https://doi.org/10.2196/57032 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65649 %T The Effectiveness of a Race-Based Stress Reduction Intervention on Improving Stress-Related Symptoms and Inflammation in African American Women at Risk for Cardiometabolic Disease: Protocol for Recruitment and Intervention for a Randomized Controlled Trial %A Saban,Karen L %A Joyce,Cara %A Nyembwe,Alexandria %A Janusek,Linda %A Tell,Dina %A de la Pena,Paula %A Motley,Darnell %A Shawahin,Lamise %A Prescott,Laura %A Potts-Thompson,Stephanie %A Taylor,Jacquelyn Y %+ Center for Translational Research and Education, Loyola University Chicago Marcella Niehoff School of Nursing, 2160 S. First Ave., Maywood, IL, 60153, United States, 1 4642209809, Ksaban@luc.edu %K cardiometabolic disease %K stress %K Resilience, Stress, and Ethnicity %K RiSE intervention %K health of minoritized groups %D 2025 %7 18.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: In recent years, the prevalence of cardiometabolic disease (CMD) in African American women has risen; the risk also increases with age, in comparison to men. Evidence demonstrates that stressful life events, including experiences of racism and perceived discrimination, contribute substantially to inflammatory diseases, such as CMD. Despite this evidence, few evidence-based interventions are available to assist individuals from minoritized communities in coping with the chronic stress related to their racial or ethnic identity. Objective: Our proposed randomized controlled trial will test a novel, race-based intervention tailored to African American women, called Resilience, Stress, and Ethnicity (RiSE). Methods: In this randomized controlled trial, we will randomize participants 1:1 to the 8-week, group-based RiSE program (intervention) or a health education program (active control group). Both programs will consist of synchronous classes on Zoom and will be led by experts. The primary end point will be stress at 6 months after the intervention, and the efficacy of RiSE will be evaluated for improving stress-related symptoms (current perceived stress, depressive symptoms, fatigue, and sleep disturbance), improving coping strategies, and reducing inflammatory burden in African American women at risk for CMD. Validated survey measures and inflammatory biomarkers will be assessed at baseline, midintervention, intervention completion, and 6 months after the intervention, and differences over time by intervention will be evaluated using mixed effects models. Results: This study was funded by the National Institute on Aging on March 30, 2023, with recruitment and enrollment beginning in October 2023. The study is underway, with 120 participants enrolled as of March 2025. Conclusions: This study will be one of the first to examine a race-based stress reduction intervention in African American women and has the potential to improve the health of minoritized groups faced with chronic stress associated with experiencing racism and discrimination. We anticipate that RiSE will reduce stress-related symptoms, enhance adaptive coping, and reduce inflammation. Trial Registration: ClinicalTrials.gov NCT05902741; https://www.clinicaltrials.gov/study/NCT05902741 %M 40250840 %R 10.2196/65649 %U https://www.researchprotocols.org/2025/1/e65649 %U https://doi.org/10.2196/65649 %U http://www.ncbi.nlm.nih.gov/pubmed/40250840 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e67120 %T Interventions to Reduce Serum Per- and Poly-Fluoroalkyl Substances Levels, Improve Cardiovascular Risk Profiles, and Improve Epigenetic Age Acceleration in US Firefighters: Protocol for Randomized Controlled Trial %A Conner,Reagan %A Porter,Cynthia %A Lutrick,Karen %A Beitel,Shawn C %A Hollister,James %A Healy,Olivia %A Kern,Krystal J %A Wardenaar,Floris %A Gulotta,John J %A Jack,Kepra %A Huentelman,Matthew %A Burgess,Jefferey L %A Furlong,Melissa %+ Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, United States, 1 512 663 1594, mfurlong@arizona.edu %K firefighters %K PFAS %K epigenetics %K phenotype %K heart disease %K cardiovascular disease %K CVD %K atherosclerosis %K occupational health %K RCT %K cardiovascular %K fasting %K exercise %D 2025 %7 16.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Occupational cancer and acute cardiac events are the leading causes of death among firefighters. Increased exposure to toxicants on the fire ground, such as polycyclic aromatic hydrocarbons, benzene, and per- and poly-fluoroalkyl substances (PFAS), has been linked to certain cancers, cardiovascular disease, accelerated epigenetic aging, and other adverse health effects. PFAS are a major concern because they are persistent, can bioaccumulate, and are present in several firefighting tools. Compared to the general population, firefighters have elevated serum levels of some types of PFAS. A randomized clinical trial in Australian firefighters found that routine blood and plasma donation for 1 year led to decreased serum PFAS levels, although health outcomes were not directly measured in that study. Objective: In collaboration with fire service leadership in Arizona, the Firefighter Collaborative Research Project (FCRP) was established to evaluate the effectiveness of 3 interventions in a randomized controlled trial design to reduce serum PFAS levels, reduce cancer and cardiovascular risk, and improve overall health and wellness in US firefighters. Methods: This study aimed to recruit and enroll up to 1500 active firefighters between August 2023 and October 2024. Between August 2023 and October 2024, active firefighters were recruited and randomized into a study arm based on their eligibility, including serum PFOS levels, for the specific arms. The trial arms include (1) blood and plasma donation, (2) zone 2 physical activity, and (3) intermittent fasting. FCRP outcomes include serum PFAS reduction (arm 1), epigenetic age acceleration (all arms), cardiovascular conditioning (arm 2) and cognitive outcomes (all arms), mental health (all arms), and overall disease risk (all arms). Each study arm includes an intervention and a control group. At enrollment and end of the study, participants provide blood and urine samples and complete a comprehensive questionnaire on their occupational and health history, exposures, and lifestyle behaviors. At the end of the study, participants also participated in a cognitive evaluation. Depending on the study arm, participants may additionally complete a cardiopulmonary exercise test at baseline and follow-up, a mid-study survey, and a mid-study blood and urine collection. Results: Participant activities and data collection will conclude by December 2025. Conclusions: The FCRP is a randomized controlled trial that aims to test the effectiveness of fire service–selected interventions in reducing serum PFAS levels. Study results will contribute to potential interventions that could be used to reduce serum PFAS levels in firefighters. Trial Registration: ClinicalTrials.gov NCT05869747; https://clinicaltrials.gov/study/NCT05869747 International Registered Report Identifier (IRRID): DERR1-10.2196/67120 %M 40239196 %R 10.2196/67120 %U https://www.researchprotocols.org/2025/1/e67120 %U https://doi.org/10.2196/67120 %U http://www.ncbi.nlm.nih.gov/pubmed/40239196 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e58124 %T Acceptability of a Web-Based Health App (PortfolioDiet.app) to Translate a Nutrition Therapy for Cardiovascular Disease in High-Risk Adults: Mixed Methods Randomized Ancillary Pilot Study %A Kavanagh,Meaghan E %A Chiavaroli,Laura %A Quibrantar,Selina M %A Viscardi,Gabrielle %A Ramboanga,Kimberly %A Amlin,Natalie %A Paquette,Melanie %A Sahye-Pudaruth,Sandhya %A Patel,Darshna %A Grant,Shannan M %A Glenn,Andrea J %A Ayoub-Charette,Sabrina %A Zurbau,Andreea %A Josse,Robert G %A Malik,Vasanti S %A Kendall,Cyril W C %A Jenkins,David J A %A Sievenpiper,John L %+ Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, C. David Naylor Building, Room 201, 6 Queen’s Park Crescent, Toronto, ON, M5S 3H2, Canada, 1 416 867 3732, john.sievenpiper@utoronto.ca %K diet %K apps %K dietary app %K Portfolio Diet %K dietary portfolio %K cholesterol reduction %K cardiovascular disease %K eHealth %K usability %K acceptability %D 2025 %7 28.3.2025 %9 Original Paper %J JMIR Cardio %G English %X Background: The Portfolio Diet is a dietary pattern for cardiovascular disease (CVD) risk reduction with 5 key categories including nuts and seeds; plant protein from specific food sources; viscous fiber sources; plant sterols; and plant-derived monounsaturated fatty acid sources. To enhance implementation of the Portfolio Diet, we developed the PortfolioDiet.app, an automated, web-based, multicomponent, patient-facing health app that was developed with psychological theory. Objective: We aimed to evaluate the effect of the PortfolioDiet.app on dietary adherence and its acceptability among adults with a high risk of CVD over 12 weeks. Methods: Potential participants with evidence of atherosclerosis and a minimum of one additional CVD risk factor in an ongoing trial were invited to participate in a remote web-based ancillary study by email. Eligible participants were randomized in a 1:1 ratio using a concealed computer-generated allocation sequence to the PortfolioDiet.app group or a control group for 12 weeks. Adherence to the Portfolio Diet was assessed by weighed 7-day diet records at baseline and 12 weeks using the clinical Portfolio Diet Score, ranging from 0 to 25. Acceptability of the app was evaluated using a multifaceted approach, including usability through the System Usability Scale ranging from 0 to 100, with a score >70 being considered acceptable, and a qualitative analysis of open-ended questions using NVivo 12. Results: In total, 41 participants were invited from the main trial to join the ancillary study by email, of which 15 agreed, and 14 were randomized (8 in the intervention group and 6 in the control group) and completed the ancillary study. At baseline, adherence to the Portfolio Diet was high in both groups with a mean clinical Portfolio Diet Score of 13.2 (SD 3.7; 13.2/25, 53%) and 13.7 (SD 5.8; 13.7/25, 55%) in the app and control groups, respectively. After the 12 weeks, there was a tendency for a mean increase in adherence to the Portfolio Diet by 1.25 (SD 2.8; 1.25/25, 5%) and 0.19 (SD 4.4; 0.19/25, 0.8%) points in the app and control group, respectively, with no difference between groups (P=.62). Participants used the app on average for 18 (SD 14) days per month and rated the app as usable (System Usability Scale of mean 80.9, SD 17.3). Qualitative analyses identified 4 main themes (user engagement, usability, external factors, and added components), which complemented the quantitative data obtained. Conclusions: Although adherence was higher for the PortfolioDiet.app group, no difference in adherence was found between the groups in this small ancillary study. However, this study demonstrates that the PortfolioDiet.app is considered usable by high-risk adults and may reinforce dietitian advice to follow the Portfolio Diet when it is a part of a trial for CVD management. Trial Registration: ClinicalTrials.gov NCT02481466; https://clinicaltrials.gov/study/NCT02481466 %M 40152922 %R 10.2196/58124 %U https://cardio.jmir.org/2025/1/e58124 %U https://doi.org/10.2196/58124 %U http://www.ncbi.nlm.nih.gov/pubmed/40152922 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60092 %T Effectiveness of an mHealth- and School-Based Health Education Program for Salt Reduction (EduSaltS) in China: Cluster Randomized Controlled Trial Within Scale-Up %A Wang,Naibo %A Wang,Chen %A Zhang,Puhong %A Li,Yinghua %A He,Feng J %A Li,Li %A Li,Yuan %A Luo,Rong %A Wan,Dezhi %A Xu,Lewei %A Deng,Lifang %A Wu,Lei %+ School of Public Health, Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Jiangxi Medical College, Nanchang University, No. 461 Ba Yi Avenue, Donghu District, Jiangxi Province, Nanchang, 330006, China, 86 18970813850, leiwu@ncu.edu.cn %K school-based health education %K EduSaltS %K mobile health %K salt reduction %K cluster randomized trial %D 2025 %7 27.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, cardiovascular diseases are leading causes of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure are among the most cost-effective health promotion strategies. While mobile health (mHealth)– and school-based salt reduction interventions have proven effective in trials, their impact when scaled up in real-world contexts remains uncertain. Objective: We evaluated the effectiveness of the real-world implementation of an mHealth- and school-based health education scale-up program to reduce salt intake (EduSaltS [mHealth and school-based education program to reduce salt intake scaling up in China]). Methods: A parallel cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in 2 districts and 2 counties within Ganzhou City, Jiangxi Province, China. Schools were randomized 1:1 to intervention or control groups within each district or county. One third-grade class per school and 26 students per class were randomly sampled. One parent, or alternative family member (aged 18-75 years, residing with the student), of each student was invited to join. The EduSaltS intervention, spanning over 1 academic year, incorporated both app-based health education courses and offline salt reduction activities, with participation monitored through the backend management system. The intervention’s effectiveness was assessed by comparing changes in salt intake and blood pressure between groups from baseline to 1-year follow-up using surveys, physical examination, and 24-hour urine tests. Results: Of 524 children (boys: n=288, 54.96%; age: mean 9.16, SD 0.35 years) and 524 adults (men: n=194, 37.02%; age: mean 40.99, SD 11.04 years) who completed the baseline assessments in 10 intervention and 10 control schools, 13 (2.48%) children and 47 (8.97%) adults were lost to follow-up. All schools and participants showed satisfactory intervention adherence. Measured differences in schoolchildren’s salt intake, systolic blood pressure, and diastolic blood pressure, between the intervention and control schools, were –0.24 g/day (95% CI –0.82 to 0.33), –0.68 mm Hg (95% CI –2.32 to 0.95), and –1.37 mm Hg (95% CI –2.79 to 0.06), respectively. For adults, the intervention group’s salt intake decreased from 9.0 (SE 0.2) g/day to 8.3 (SE 0.2) g/day post intervention. Adjusted changes in the intervention (vs control) group in salt intake, systolic blood pressure, and diastolic blood pressure were –1.06 g/day (95% CI –1.81 to –0.30), –2.26 mm Hg (95% CI –4.26 to –0.26), and –2.33 mm Hg (95% CI –3.84 to –0.82), respectively. Conclusions: The EduSaltS program, delivered through primary schools with a child-to-parent approach, was effective in reducing salt intake and controlling blood pressure in adults, but its effects on children were not significant. While promising for nationwide scaling, further improvements are needed to ensure its effectiveness in reducing salt intake among schoolchildren. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079893; https://tinyurl.com/4maz7dyv (retrospectively registered); Chinese Clinical Trial Registry ChiCTR2000039767; https://tinyurl.com/5n6hc4s2 %M 40017342 %R 10.2196/60092 %U https://www.jmir.org/2025/1/e60092 %U https://doi.org/10.2196/60092 %U http://www.ncbi.nlm.nih.gov/pubmed/40017342 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e67128 %T Exploring Climate Change’s Impact on the Cardiopulmonary Health of Adults Living in the Canton of Valais, Switzerland: Protocol for a Development and Usability Pilot Study %A Portela Dos Santos,Omar %A Alves,Paulo Jorge Pereira %A Verloo,Henk %+ Department of Nursing Sciences, School of Health Sciences, HES-SO Valais/Wallis, Chemin de l'Agasse 5, Sion, 1950, Switzerland, 41 786680125, omar.porteladossantos@hevs.ch %K climate change %K global warming %K emergency department %K emergency nursing %K sustainable care %K ecological medicine %K cardiopulmonary %K cardio health %K Valais %K Switzerland %K pilot study %K study protocol %K humanity %K air pollution %K impact %K comorbidities %K adults %K mixed methods design %K feasibility %K health promotion %K disease prevention %K acceptability %D 2025 %7 25.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Climate change is affecting public health and well-being. In 2016, Swiss emergency departments (EDs) treated 1,722,000 cases, with 4718 daily admissions. In 2023, the ED of Sion Regional Hospital recorded 75,000 consultations. The links between climate change and health are complex, necessitating urgent research on its impact on cardiopulmonary health in Valais, Switzerland. Raising awareness among frontline professionals is crucial for developing health promotion and disease prevention strategies. Objective: This study explores the preliminary effects of climate change on cardiopulmonary health in Valais and assesses adult patients’ knowledge of its health consequences. Findings will inform adaptations in patient care, health promotion, and disease prevention at Sion Hospital’s ED. The feasibility of patient selection and data collection will also be evaluated. Methods: Using a convergent, parallel, mixed methods design, data will be collected from September 21, 2024, to September 20, 2025, with a target sample of 60 patients. The quantitative phase will examine patient recruitment feasibility, consultation reasons, and triage levels, correlating them with climate variables (temperature, nitrogen dioxide, particulate matter, sulfur dioxide, and ozone). It will also analyze sociodemographic profiles. The qualitative phase will explore patients’ knowledge of climate change and its potential links to their ED visits. The feasibility and acceptability of the study process will be assessed. The protocol follows the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) Extension for Pilot and Feasibility Trials. Results: Data collection started on September 21, 2024, following the approval by the ethical commission. Data collection will take place over 1 year, until September 20, 2025. Conclusions: This study will test the feasibility of a larger investigation and examine potential associations between Valais’ changing microclimate and population health. Findings will establish patient profiles and explore their perceptions and knowledge of climate change, informing future health interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/67128 %M 40132196 %R 10.2196/67128 %U https://www.researchprotocols.org/2025/1/e67128 %U https://doi.org/10.2196/67128 %U http://www.ncbi.nlm.nih.gov/pubmed/40132196 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69204 %T Enhancing Digital Health Interventions for Medication Adherence: Considerations for Broader Applicability and Long-Term Impact %A Du,ShanShan %A Zhao,Yining %+ Renhe Rehabilitation Hospital, Renhe Street, Hubei, China, 86 15767853433, 1547838432@qq.com %K mobile apps %K digital health %K atrial fibrillation %K anticoagulants %K medication adherence %K mobile phone %D 2025 %7 14.3.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %R 10.2196/69204 %U https://www.jmir.org/2025/1/e69204 %U https://doi.org/10.2196/69204 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68442 %T Two-Year Hypertension Incidence Risk Prediction in Populations in the Desert Regions of Northwest China: Prospective Cohort Study %A Cheng,Yinlin %A Gu,Kuiying %A Ji,Weidong %A Hu,Zhensheng %A Yang,Yining %A Zhou,Yi %+ Zhongshan School of Medicine, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China, 86 020 87332139, zhouyi@mail.sysu.edu.cn %K hypertension %K desert %K machine learning %K deep learning %K prevention %K clinical applicability %D 2025 %7 12.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Hypertension is a major global health issue and a significant modifiable risk factor for cardiovascular diseases, contributing to a substantial socioeconomic burden due to its high prevalence. In China, particularly among populations living near desert regions, hypertension is even more prevalent due to unique environmental and lifestyle conditions, exacerbating the disease burden in these areas, underscoring the urgent need for effective early detection and intervention strategies. Objective: This study aims to develop, calibrate, and prospectively validate a 2-year hypertension risk prediction model by using large-scale health examination data collected from populations residing in 4 regions surrounding the Taklamakan Desert of northwest China. Methods: We retrospectively analyzed the health examination data of 1,038,170 adults (2019-2021) and prospectively validated our findings in a separate cohort of 961,519 adults (2021-2023). Data included demographics, lifestyle factors, physical examinations, and laboratory measurements. Feature selection was performed using light gradient-boosting machine–based recursive feature elimination with cross-validation and Least Absolute Shrinkage and Selection Operator, yielding 24 key predictors. Multiple machine learning (logistic regression, random forest, extreme gradient boosting, light gradient-boosting machine) and deep learning (Feature Tokenizer + Transformer, SAINT) models were trained with Bayesian hyperparameter optimization. Results: Over a 2-year follow-up, 15.20% (157,766/1,038,170) of the participants in the retrospective cohort and 10.50% (101,077/961,519) in the prospective cohort developed hypertension. Among the models developed, the CatBoost model demonstrated the best performance, achieving area under the curve (AUC) values of 0.888 (95% CI 0.886-0.889) in the retrospective cohort and 0.803 (95% CI 0.801-0.804) in the prospective cohort. Calibration via isotonic regression improved the model’s probability estimates, with Brier scores of 0.090 (95% CI 0.089-0.091) and 0.102 (95% CI 0.101-0.103) in the internal validation and prospective cohorts, respectively. Participants were ranked by the positive predictive value calculated using the calibrated model and stratified into 4 risk categories (low, medium, high, and very high), with the very high group exhibiting a 41.08% (5741/13,975) hypertension incidence over 2 years. Age, BMI, and socioeconomic factors were identified as significant predictors of hypertension. Conclusions: Our machine learning model effectively predicted the 2-year risk of hypertension, making it particularly suitable for preventive health care management in high-risk populations residing in the desert regions of China. Our model exhibited excellent predictive performance and has potential for clinical application. A web-based application was developed based on our predictive model, which further enhanced the accessibility for clinical and public health use, aiding in reducing the burden of hypertension through timely prevention strategies. %M 40072485 %R 10.2196/68442 %U https://www.jmir.org/2025/1/e68442 %U https://doi.org/10.2196/68442 %U http://www.ncbi.nlm.nih.gov/pubmed/40072485 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 10 %N %P e65366 %T Cardiac Repair and Regeneration via Advanced Technology: Narrative Literature Review %A Lee,Yugyung %A Shelke,Sushil %A Lee,Chi %+ Division of Pharmacology and Pharmaceutics Sciences, School of Pharmacy, University of Missouri Kansas City, 5000 Holmes St, Kansas City, MO, 64110, United States, 1 8162352408, leech@umkc.edu %K advanced technologies %K genetics %K biomaterials %K bioengineering %K medical devices %K implantable devices %K wearables %K cardiovascular repair and regeneration %K cardiac care %K cardiovascular disease %D 2025 %7 8.3.2025 %9 Review %J JMIR Biomed Eng %G English %X Background: Cardiovascular diseases (CVDs) are the leading cause of death globally, and almost one-half of all adults in the United States have at least one form of heart disease. This review focused on advanced technologies, genetic variables in CVD, and biomaterials used for organ-independent cardiovascular repair systems. Objective: A variety of implantable and wearable devices, including biosensor-equipped cardiovascular stents and biocompatible cardiac patches, have been developed and evaluated. The incorporation of those strategies will hold a bright future in the management of CVD in advanced clinical practice. Methods: This study employed widely used academic search systems, such as Google Scholar, PubMed, and Web of Science. Recent progress in diagnostic and treatment methods against CVD, as described in the content, are extensively examined. The innovative bioengineering, gene delivery, cell biology, and artificial intelligence–based technologies that will continuously revolutionize biomedical devices for cardiovascular repair and regeneration are also discussed. The novel, balanced, contemporary, query-based method adapted in this manuscript defined the extent to which an updated literature review could efficiently provide research on the evidence-based, comprehensive applicability of cardiovascular devices for clinical treatment against CVD. Results: Advanced technologies along with artificial intelligence–based telehealth will be essential to create efficient implantable biomedical devices, including cardiovascular stents. The proper statistical approaches along with results from clinical studies including model-based risk probability prediction from genetic and physiological variables are integral for monitoring and treatment of CVD risk. Conclusions: To overcome the current obstacles in cardiac repair and regeneration and achieve successful therapeutic applications, future interdisciplinary collaborative work is essential. Novel cardiovascular devices and their targeted treatments will accomplish enhanced health care delivery and improved therapeutic efficacy against CVD. As the review articles contain comprehensive sources for state-of-the-art evidence for clinicians, these high-quality reviews will serve as a first outline of the updated progress on cardiovascular devices before undertaking clinical studies. %R 10.2196/65366 %U https://biomedeng.jmir.org/2025/1/e65366 %U https://doi.org/10.2196/65366 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65152 %T Oncology Provider and Patient Perspectives on a Cardiovascular Health Assessment Tool Used During Posttreatment Survivorship Care in Community Oncology (Results from WF-1804CD): Mixed Methods Observational Study %A Nightingale,Chandylen L %A Dressler,Emily V %A Kepper,Maura %A Klepin,Heidi D %A Lee,Simon Craddock %A Smith,Sydney %A Aguilar,Aylin %A Wiseman,Kimberly D %A Sohl,Stephanie J %A Wells,Brian J %A DeMari,Joseph A %A Throckmorton,Alyssa %A Kulbacki,Lindsey W %A Hanna,Jenny %A Foraker,Randi E %A Weaver,Kathryn E %+ Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, United States, 1 3367131432, cnightin@wakehealth.edu %K cancer %K cardiovascular health %K cancer survivors %K community oncology %K electronic health record integration %K provider acceptability %K patient-provider %K assessment tool %K electronic health records %K clinical decision support %K surveys %K interviews %K survivors %K Automated Heart-Health Assessment %D 2025 %7 6.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Most survivors of cancer have multiple cardiovascular risk factors, increasing their risk of poor cardiovascular and cancer outcomes. The Automated Heart-Health Assessment (AH-HA) tool is a novel electronic health record clinical decision support tool based on the American Heart Association’s Life’s Simple 7 cardiovascular health metrics to promote cardiovascular health assessment and discussion in outpatient oncology. Before proceeding to future implementation trials, it is critical to establish the acceptability of the tool among providers and survivors. Objective: This study aims to assess provider and survivor acceptability of the AH-HA tool and provider training at practices randomized to the AH-HA tool arm within WF-1804CD. Methods: Providers (physicians, nurse practitioners, and physician assistants) completed a survey to assess the acceptability of the AH-HA training, immediately following training. Providers also completed surveys to assess AH-HA tool acceptability and potential sustainability. Tool acceptability was assessed after 30 patients were enrolled at the practice with both a survey developed for the study as well as with domains from the Unified Theory of Acceptance and Use of Technology survey (performance expectancy, effort expectancy, attitude toward using technology, and facilitating conditions). Semistructured interviews at the end of the study captured additional provider perceptions of the AH-HA tool. Posttreatment survivors (breast, prostate, colorectal, endometrial, and lymphomas) completed a survey to assess the acceptability of the AH-HA tool immediately after the designated study appointment. Results: Providers (n=15) reported high overall acceptability of the AH-HA training (mean 5.8, SD 1.0) and tool (mean 5.5, SD 1.4); provider acceptability was also supported by the Unified Theory of Acceptance and Use of Technology scores (eg, effort expectancy: mean 5.6, SD 1.5). Qualitative data also supported provider acceptability of different aspects of the AH-HA tool (eg, “It helps focus the conversation and give the patient a visual of continuum of progress”). Providers were more favorable about using the AH-HA tool for posttreatment survivorship care. Enrolled survivors (n=245) were an average of 4.4 (SD 3.7) years posttreatment. Most survivors reported that they strongly agreed or agreed that they liked the AH-HA tool (n=231, 94.3%). A larger proportion of survivors with high health literacy strongly agreed or agreed that it was helpful to see their heart health score (n=161, 98.2%) compared to survivors with lower health literacy scores (n=68, 89.5%; P=.005). Conclusions: Quantitative surveys and qualitative interview data both demonstrate high acceptability of the AH-HA tool among both providers and survivors. Although most survivors found it helpful to see their heart health score, there may be room for improving communication with survivors who have lower health literacy. Trial Registration: ClinicalTrials.gov NCT03935282; http://clinicaltrials.gov/ct2/show/NCT03935282 International Registered Report Identifier (IRRID): RR2-https://doi-org.wake.idm.oclc.org/10.1016/j.conctc.2021.100808 %M 39854647 %R 10.2196/65152 %U https://www.jmir.org/2025/1/e65152 %U https://doi.org/10.2196/65152 %U http://www.ncbi.nlm.nih.gov/pubmed/39854647 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e64349 %T The Role of AI in Cardiovascular Event Monitoring and Early Detection: Scoping Literature Review %A Elvas,Luis B %A Almeida,Ana %A Ferreira,Joao C %K artificial intelligence %K machine learning %K cardiovascular diseases %K cardiovascular events %K health care %K monitoring %K early detection %K AI %K cardiovascular %K literature review %K medical data %K detect %K patient outcomes %K neural network %K ML model %K mobile phone %D 2025 %7 6.3.2025 %9 %J JMIR Med Inform %G English %X Background: Artificial intelligence (AI) has shown exponential growth and advancements, revolutionizing various fields, including health care. However, domain adaptation remains a significant challenge, as machine learning (ML) models often need to be applied across different health care settings with varying patient demographics and practices. This issue is critical for ensuring effective and equitable AI deployment. Cardiovascular diseases (CVDs), the leading cause of global mortality with 17.9 million annual deaths, encompass conditions like coronary heart disease and hypertension. The increasing availability of medical data, coupled with AI advancements, offers new opportunities for early detection and intervention in cardiovascular events, leveraging AI’s capacity to analyze complex datasets and uncover critical patterns. Objective: This review aims to examine AI methodologies combined with medical data to advance the intelligent monitoring and detection of CVDs, identifying areas for further research to enhance patient outcomes and support early interventions. Methods: This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology to ensure a rigorous and transparent literature review process. This structured approach facilitated a comprehensive overview of the current state of research in this field. Results: Through the methodology used, 64 documents were retrieved, of which 40 documents met the inclusion criteria. The reviewed papers demonstrate advancements in AI and ML for CVD detection, classification, prediction, diagnosis, and patient monitoring. Techniques such as ensemble learning, deep neural networks, and feature selection improve prediction accuracy over traditional methods. ML models predict cardiovascular events and risks, with applications in monitoring via wearable technology. The integration of AI in health care supports early detection, personalized treatment, and risk assessment, possibly improving the management of CVDs. Conclusions: The study concludes that AI and ML techniques can improve the accuracy of CVD classification, prediction, diagnosis, and monitoring. The integration of multiple data sources and noninvasive methods supports continuous monitoring and early detection. These advancements help enhance CVD management and patient outcomes, indicating the potential for AI to offer more precise and cost-effective solutions in health care. %R 10.2196/64349 %U https://medinform.jmir.org/2025/1/e64349 %U https://doi.org/10.2196/64349 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59856 %T Auricular Acupressure Versus an Intermittent Low-Carbohydrate Diet in Children With Overweight or Obesity With Gastric-Heat and Dampness-Obstruction Syndrome: Protocol for a Randomized Controlled Trial %A Sun,Wen %A He,Jingwei %A Wang,Wenqin %A Lu,Chen %A Lin,Yating %A Dou,Yalan %A Yan,Weili %A Yu,Jian %+ Department of Clinical Epidemiology and Clinical Trial Unit, Children’s Hospital of Fudan University, National Children’s Medical Center, 399 Wanyuan Road, Shanghai, 201102, China, 86 13761794333, yanwl@fudan.edu.cn %K children with obesity %K traditional Chinese medicine %K TCM auricular acupressure treatment %K intermittent low carbohydrate diet %K study protocol %D 2025 %7 3.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Childhood obesity frequently persists into adulthood and is associated with an increased risk and earlier onset of cardiovascular disease in later life. Behavioral change strategies have been proposed as the first-line weight management approach for children and adolescents with obesity. Nonpharmacological interventions, such as traditional Chinese medicine (TCM) auricular acupressure treatment and intermittent low-carbohydrate diet (ILCD), are increasingly being investigated in the young obese population. However, there is limited high-quality evidence about effectiveness and safety in weight control and reducing cardiometabolic risk in the pediatric population. Objective: This study aimed to compare the effect of cardiometabolic risk reduction between TCM auricular acupressure treatment (TAAT) and ILCD in children with overweight or obesity with gastric-heat and dampness-obstruction syndrome. Methods: This is a randomized controlled trial. Eligible participants are children with overweight or obesity and enrolled at the obesity clinic of the department of TCM at a tertiary children’s hospital. Eligible participants must meet the following criteria: (1) be aged between 6 and 18 years, (2) be overweight, and (3) have gastric-heat and dampness-obstruction syndrome. Recruited children will be randomized 3:1 to receive either TAAT or a self-administered ILCD for 1 month: 150 in the TAAT group and 50 in the ILCD group. The primary outcome is the change in body weight from the beginning of treatment to the end of 1 month. Secondary outcomes included body weight, waist circumference, waist-to-height ratio, BMI, blood pressure, body fat content, indexes of liver and renal function, indexes of glucose metabolism, gut microbiota, and TCM syndrome scores at the end of 1 month and 3 months, respectively. Primary statistical analyses were conducted using the intention-to-treat strategy. A generalized linear model was used to compare the difference in weight change between the groups, with the baseline body weight as the covariate, to obtain the estimate of the mean difference in body weight change and its 95% CI, using Gaussian for family function and identity for link function. Results: The study protocol was approved by the institutional ethical committee and registered on ClinicalTrials.gov on May 5, 2023, before recruitment. Recruitment began in June 2023 and is expected to be completed by December 2025. As of November 2024, we have enrolled 112 participants. Conclusions: This randomized controlled trial will provide evidence on the treatment effects and safety of TAAT versus ILCD among children with overweight or obesity with gastric-heat and dampness-obstruction syndrome, in reducing body weight and improving cardiometabolic risks. Exploratory aims include potential underlying mechanisms of the 2 kinds of interventions, based on biosamples. Trial Registration: ClinicalTrials.gov NCT05847478. https://clinicaltrials.gov/study/NCT05847478 International Registered Report Identifier (IRRID): DERR1-10.2196/59856 %M 40053799 %R 10.2196/59856 %U https://www.researchprotocols.org/2025/1/e59856 %U https://doi.org/10.2196/59856 %U http://www.ncbi.nlm.nih.gov/pubmed/40053799 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58964 %T Step Count Accuracy of the Life Plus Connected Watch at Different Localizations and Speeds in Healthy Adults, Patients With Cardiovascular Disease, and Patients With Peripheral Artery Disease: Step Count Validation Study in Laboratory Settings %A Heizmann,Anne-Noëlle %A Ollier,Edouard %A Labeix,Pierre %A Goujon,Ivan %A Roche,Frédéric %A Le Hello,Claire %K physical activity assessment %K accuracy %K validation %K steps %K smartwatches %K wearables %K cardiovascular disease %K cardiovascular %K cardiology %K heart %K artery %K peripheral artery disease %K wearable physical activity monitoring device %K physical activity %K exercise %K walking %K monitoring %K mobile phone %D 2025 %7 10.2.2025 %9 %J JMIR Form Res %G English %X Background: Smartwatches are increasingly used to monitor and motivate physical activity. Patients with cardiovascular disease (CVD) and peripheral artery disease (PAD) often do not meet national physical activity recommendations. They may, thus, benefit from a physical activity program using smartwatches. The Life Plus smartwatch is designed to facilitate activity monitoring by counting steps, but its validity needs to be determined, particularly in patients who may not have a normal gait, such as those with cardiovascular pathology. Objective: This study evaluates the accuracy of the Life Plus smartwatch (versions 2 and 3) in healthy adults, patients with CVD, and patients with PAD at different walking speeds (1.8, 2.5, 3.2, and 4 km/h) and different localizations (wrists, hips, and ankles) to determine best accuracy. Methods: In total, 34 participants, comprising healthy individuals (n=10), patients with CVD (n=14), and patients with PAD (n=10), wore 6 Life Plus watches simultaneously (3 of version 2 and 3 of version 3), located on wrists, hips, and ankles. Participants walked on a treadmill for 3-minute sessions at speeds of 1.8, 2.5, 3.2, and 4 km/h; they then performed a 10-minute free walking on the ground and again walked for 3-minute sessions on a treadmill at the same speeds. Actual step counts were recorded through video footage. Results: When worn at the wrist, no significant difference between the actual number of steps and step count by version 2 watches was found in each group independently (healthy group: P=.25; CVD group: P=.50; and PAD group: P=.37). Significant differences were found with the version 2 watches at the wrist in the healthy group at 3.2 (−5.26%; P=.01) and 4 km/h (−6.13%; P=.008) and in the CVD group at 2.5 (−5.94%; P=.008), 3.2(−13.1%; P=.008), and 4 km/h (−13.96%; P=.004). When worn at the wrist, no significant difference between actual number of steps and step count by version 3 watches was found in the healthy group (P=.02) and the PAD group (P=.90). Significant differences were found with the version 3 watches at the wrist in the CVD group at 3.2 (−6.43%; P=.001) and 4 km/h (−7.3%; P=.01) and in the PAD group at 4 km/h (−5.77%; P=.04). Conclusions: For optimized counting when worn at the wrist, healthy individuals should prefer version 2 watches for slow walking (1.8 and 2.5 km/h) and version 3 for higher speeds (3.2 and 4 km/h). Patients (CVD and PAD) should prefer version 2 watches at 1.8 km/h and version 3 watches for higher speeds (2.5, 3.2, and 4 km/h). %R 10.2196/58964 %U https://formative.jmir.org/2025/1/e58964 %U https://doi.org/10.2196/58964 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e64188 %T Urgency Prediction for Medical Laboratory Tests Through Optimal Sparse Decision Tree: Case Study With Echocardiograms %A Jiang,Yiqun %A Li,Qing %A Huang,Yu-Li %A Zhang,Wenli %+ Department of Information Systems and Business Analytics, Iowa State University, 2167 Union Drive, Ames, IA, 50011-2027, United States, 1 5152942469, wlzhang@iastate.edu %K interpretable machine learning %K urgency prediction %K appointment scheduling %K echocardiogram %K health care management %D 2025 %7 29.1.2025 %9 Original Paper %J JMIR AI %G English %X Background: In the contemporary realm of health care, laboratory tests stand as cornerstone components, driving the advancement of precision medicine. These tests offer intricate insights into a variety of medical conditions, thereby facilitating diagnosis, prognosis, and treatments. However, the accessibility of certain tests is hindered by factors such as high costs, a shortage of specialized personnel, or geographic disparities, posing obstacles to achieving equitable health care. For example, an echocardiogram is a type of laboratory test that is extremely important and not easily accessible. The increasing demand for echocardiograms underscores the imperative for more efficient scheduling protocols. Despite this pressing need, limited research has been conducted in this area. Objective: The study aims to develop an interpretable machine learning model for determining the urgency of patients requiring echocardiograms, thereby aiding in the prioritization of scheduling procedures. Furthermore, this study aims to glean insights into the pivotal attributes influencing the prioritization of echocardiogram appointments, leveraging the high interpretability of the machine learning model. Methods: Empirical and predictive analyses have been conducted to assess the urgency of patients based on a large real-world echocardiogram appointment dataset (ie, 34,293 appointments) sourced from electronic health records encompassing administrative information, referral diagnosis, and underlying patient conditions. We used a state-of-the-art interpretable machine learning algorithm, the optimal sparse decision tree (OSDT), renowned for its high accuracy and interpretability, to investigate the attributes pertinent to echocardiogram appointments. Results: The method demonstrated satisfactory performance (F1-score=36.18% with an improvement of 1.7% and F2-score=28.18% with an improvement of 0.79% by the best-performing baseline model) in comparison to the best-performing baseline model. Moreover, due to its high interpretability, the results provide valuable medical insights regarding the identification of urgent patients for tests through the extraction of decision rules from the OSDT model. Conclusions: The method demonstrated state-of-the-art predictive performance, affirming its effectiveness. Furthermore, we validate the decision rules derived from the OSDT model by comparing them with established medical knowledge. These interpretable results (eg, attribute importance and decision rules from the OSDT model) underscore the potential of our approach in prioritizing patient urgency for echocardiogram appointments and can be extended to prioritize other laboratory test appointments using electronic health record data. %M 39879091 %R 10.2196/64188 %U https://ai.jmir.org/2025/1/e64188 %U https://doi.org/10.2196/64188 %U http://www.ncbi.nlm.nih.gov/pubmed/39879091 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e64410 %T Effectiveness of Mobile Health–Based Gamification Interventions for Improving Physical Activity in Individuals With Cardiovascular Diseases: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Yu,Tianzhuo %A Parry,Monica %A Yu,Tianyue %A Xu,Linqi %A Wu,Yuejin %A Zeng,Ting %A Leng,Xin %A Tong,Qian %A Li,Feng %+ School of Nursing, Jilin University, School of Nursing Office Building, 4th Fl., 965 Xinjiang St, Changchun, 130021, China, 86 0431 85619377, fli@jlu.edu.cn %K cardiovascular diseases %K digital health %K mobile health %K gamification %K exercise %K physical activity %K systematic review %K meta-analysis %D 2025 %7 24.1.2025 %9 Review %J JMIR Serious Games %G English %X Background: Gamification refers to using game design elements in nongame contexts. Promoting physical activity (PA) through gamification is a novel and promising avenue for improving lifestyles and mitigating the advancement of cardiovascular diseases (CVDs). However, evidence of its effectiveness remains mixed. Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of gamification interventions in promoting PA during short-term and follow-up periods in individuals with CVDs and to explore the most effective game design elements. Methods: A comprehensive search of 7 electronic databases was conducted for randomized controlled trials published in English from January 1, 2010, to February 3, 2024. Eligible studies used mobile health–based gamification interventions to promote PA or reduce sedentary behavior in individuals with CVDs. In total, 2 independent reviewers screened the retrieved records, extracted data, and evaluated the risk of bias using the RoB 2 tool. Discrepancies were resolved by a third reviewer. Meta-analyses were performed using a random-effects model with the Sidik-Jonkman method adjusted by the Knapp-Hartung method. Sensitivity analysis and influence analysis examined the robustness of results, while prediction intervals indicated heterogeneity. A meta-regression using a multimodel inference approach explored the most important game design elements. Statistical analyses were conducted using R (version 4.3.2; R Foundation for Statistical Computing). Results: In total, 6 randomized controlled trials were included. Meta-analysis of 5 studies revealed a small effect of gamification interventions on short-term PA (after sensitivity analysis: Hedges g=0.32, 95% CI 0.19-0.45, 95% prediction interval [PI] 0.02-0.62). Meta-analysis of 3 studies found the maintenance effect (measured with follow-up averaging 2.5 months after the end of the intervention) was small (Hedges g=0.20, 95% CI 0.12-0.29, 95% PI –0.01 to 0.41). A meta-analysis of 3 studies found participants taking 696.96 more steps per day than the control group (95% CI 327.80 to 1066.12, 95% PI –121.39 to 1515.31). “Feedback” was the most important game design element, followed by “Avatar.” Conclusions: This meta-analysis demonstrates that gamification interventions effectively promote PA in individuals with CVD, with effects persisting beyond the intervention period, indicating they are not merely novel effects caused by the game nature of gamification. The 95% PI suggests that implementing gamification interventions in similar populations in the future will lead to actual effects in promoting PA in the vast majority of cases. However, the limited number of included studies underscores the urgent need for more high-quality research in this emerging field. Trial Registration: PROSPERO CRD42024518795; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=518795 %M 39854099 %R 10.2196/64410 %U https://games.jmir.org/2025/1/e64410 %U https://doi.org/10.2196/64410 %U http://www.ncbi.nlm.nih.gov/pubmed/39854099 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64981 %T Digital Health Solutions for Cardiovascular Disease Prevention: Systematic Review %A Qi,Yihan %A Mohamad,Emma %A Azlan,Arina Anis %A Zhang,Chenglin %A Ma,Yilian %A Wu,Anqi %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, UKM, Selangor, 43600, Malaysia, 60 389215457, emmamohamad@ukm.edu.my %K cardiovascular disease prevention %K cardiovascular outcomes %K digital technologies %K remote care %K mobile phone %D 2025 %7 23.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Cardiovascular disease (CVD) is a major global health issue, with approximately 70% of cases linked to modifiable risk factors. Digital health solutions offer potential for CVD prevention; yet, their effectiveness in covering the full range of prevention strategies is uncertain. Objective: This study aimed to synthesize current literature on digital solutions for CVD prevention, identify the key components of effective digital interventions, and highlight critical research gaps to inform the development of sustainable strategies for CVD prevention. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a comprehensive search in Web of Science, Scopus, and PubMed to identify original English-language studies published between January 2000 and May 2024 that examined primary or secondary CVD prevention through digital solutions. The exclusion criteria included: telephone-only interventions, abstract-only publications, methodology-focused studies without primary data, studies without participants or specific groups, and studies with no follow-up period. The literature search used the string with terms like “digital health,” “mHealth,” “mobile health,” “text message,” “short message service,” “SMS,” “prevention,” “prevent,” “cardiovascular disease,” “CVD,” etc. Study bias was assessed using the RoB 2 (Cochrane Collaboration) and the ROBINS-I tool (Cochrane Collaboration). Data on prevention components, prevention types, study design, population, intervention, follow-up duration, personnel, and delivery settings were extracted. Results: A total of 2871 studies were identified through the search. After excluding ineligible studies, 30 studies remained, including 24 randomized controlled trials. The reviewed digital solutions for CVD prevention focused on baseline assessment (29/30, 97%), physical activity counseling (18/30, 60%), tobacco cessation (14/30, 47%), blood pressure management (13/30, 43%), and medication adherence (10/30, 33%). The technologies used were categorized into 3 types, smartphones and wearables (16/30, 53%), email and SMS communications (12/30, 40%), and websites or web portals (3/30, 10%). The majority of the study outcomes addressed blood pressure (14/30, 47%), exercise capacity (12/30, 40%), weight (12/30, 40%), and lipid profile (11/30, 37%), while fewer focused on nicotine dependence (9/30, 30%), medication use (8/30, 27%), quality of life (7/30, 23%), dietary habits (5/30, 17%), intervention adherence (4/30, 13%), waist circumference (4/30, 13%), and blood glucose levels (2/30, 7%). Conclusions: Digital solutions can address challenges in traditional CVD prevention by improving preventive behaviors and monitoring health indicators. However, most evaluated interventions have focused on medication use, quality of life, dietary habits, adherence, and waist circumference. Further studies are needed to assess the long-term impact of more comprehensive interventions on key cardiovascular outcomes. %M 39847411 %R 10.2196/64981 %U https://www.jmir.org/2025/1/e64981 %U https://doi.org/10.2196/64981 %U http://www.ncbi.nlm.nih.gov/pubmed/39847411 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e57423 %T Cardiometabolic Health Intervention Using Music and Exercise (CHIME) Delivered via Telehealth to Wheelchair Users: Protocol for a Randomized Controlled Trial %A Kim,Yumi %A Rimmer,James H %A Lai,Byron %A Oster,Robert %A Cowan,Rachel %A Young,Hui-Ju %A Fisher,Gordon %A Kim,Younguk %A Giannone,John %A Wilroy,Jereme D %+ Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, 1717 6th Avenue South, Birmingham, AL, United States, 1 2059344508, jdwilroy@uab.edu %K exercise %K physical activity %K wheelchair user %K telehealth %K disability %D 2025 %7 15.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Wheelchair users live predominantly sedentary lifestyles and have a substantially higher risk for cardiometabolic disease and mortality compared to people without disabilities. Exercise training has been found to be effective in improving cardiometabolic health (CMH) outcomes among people without disabilities, but research on wheelchair users is limited and of poor quality. Objective: The primary aim of this study is to examine the immediate and sustained effects of a 24-week, telehealth, movement-to-music cardiovascular (M2M-C) exercise program on core indicators of CMH among adult wheelchair users compared to an active control group. The secondary aim is to explore the beneficial effects of M2M-C exercises on cardiovascular capacity, physical activity, and quality of life. Intervention components include tailored exercises and remote performance monitoring, delivered via live videoconference training by a telecoach and asynchronous videos. Methods: This study’s design is a parallel-arm randomized controlled trial enrolling 132 physically inactive adult wheelchair users with poor cardiometabolic profiles. The M2M-C intervention group involves 24 weeks of virtual live and monitored home exercise training (3×/wk, 15-40 min/session), followed by a 12-week maintenance period where participants have access to an online media library of exercise videos. The control group involves 36 weeks of self-guided exercise through access to a media library of exercise videos, including videos for range of motion, muscle strength, and balance. The primary outcomes are cardiometabolic indicators of health, and assessors are blinded. Results: Recruitment procedures started in January 2024 with the first participant enrolled on March 18, 2024. All data are anticipated to be collected by November 2027, and the main results of the trial are anticipated to be published by February 2028. Secondary analyses of data will be subsequently published. A total of 16 participants have been recruited as of paper submission. Conclusions: The knowledge obtained from this trial will provide evidence to inform exercise prescriptions aimed at improving CMH among adult wheelchair users. Trial Registration: ClinicalTrials.gov NCT05606432; https://clinicaltrials.gov/study/NCT05606432 International Registered Report Identifier (IRRID): DERR1-10.2196/57423 %M 39814364 %R 10.2196/57423 %U https://www.researchprotocols.org/2025/1/e57423 %U https://doi.org/10.2196/57423 %U http://www.ncbi.nlm.nih.gov/pubmed/39814364 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e50627 %T Application of Dragonnet and Conformal Inference for Estimating Individualized Treatment Effects for Personalized Stroke Prevention: Retrospective Cohort Study %A Lolak,Sermkiat %A Attia,John %A McKay,Gareth J %A Thakkinstian,Ammarin %K stroke %K causal effect %K ITE %K individual treatment effect %K Dragonnet %K conformal inference %K mortality %K hospital records %K hypertension %K risk factor %K diabetes %K dyslipidemia %K atrial fibrillation %K machine learning %K treatment %D 2025 %7 8.1.2025 %9 %J JMIR Cardio %G English %X Background: Stroke is a major cause of death and disability worldwide. Identifying individuals who would benefit most from preventative interventions, such as antiplatelet therapy, is critical for personalized stroke prevention. However, traditional methods for estimating treatment effects often focus on the average effect across a population and do not account for individual variations in risk and treatment response. Objective: This study aimed to estimate the individualized treatment effects (ITEs) for stroke prevention using a novel combination of Dragonnet, a causal neural network, and conformal inference. The study also aimed to determine and validate the causal effects of known stroke risk factors—hypertension (HT), diabetes mellitus (DM), dyslipidemia (DLP), and atrial fibrillation (AF)—using both a conventional causal model and machine learning models. Methods: A retrospective cohort study was conducted using data from 275,247 high-risk patients treated at Ramathibodi Hospital, Thailand, between 2010 and 2020. Patients aged >18 years with HT, DM, DLP, or AF were eligible. The main outcome was ischemic or hemorrhagic stroke, identified using International Classification of Diseases, 10th Revision (ICD-10) codes. Causal effects of the risk factors were estimated using a range of methods, including: (1) propensity score–based methods, such as stratified propensity scores, inverse probability weighting, and doubly robust estimation; (2) structural causal models; (3) double machine learning; and (4) Dragonnet, a causal neural network, which was used together with weighted split-conformal quantile regression to estimate ITEs. Results: AF, HT, and DM were identified as significant stroke risk factors. Average causal risk effect estimates for these risk factors ranged from 0.075 to 0.097 for AF, 0.017 to 0.025 for HT, and 0.006 to 0.010 for DM, depending on the method used. Dragonnet yielded causal risk ratios of 4.56 for AF, 2.44 for HT, and 1.41 for DM, which is comparable to other causal models and the standard epidemiological case-control study. Mean ITE analysis indicated that several patients with DM or DM with HT, who were not receiving antiplatelet treatment at the time of data collection, showed reductions in total risk of −0.015 and −0.016, respectively. Conclusions: This study provides a comprehensive evaluation of stroke risk factors and demonstrates the feasibility of using Dragonnet and conformal inference to estimate ITEs of antiplatelet therapy for stroke prevention. The mean ITE analysis suggested that those with DM or DM with HT, who were not receiving antiplatelet treatment at the time of data collection, could potentially benefit from this therapy. The findings highlight the potential of these advanced techniques to inform personalized treatment strategies for stroke, enabling clinicians to identify individuals who are most likely to benefit from specific interventions. %R 10.2196/50627 %U https://cardio.jmir.org/2025/1/e50627 %U https://doi.org/10.2196/50627 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e63020 %T Autonomous International Classification of Diseases Coding Using Pretrained Language Models and Advanced Prompt Learning Techniques: Evaluation of an Automated Analysis System Using Medical Text %A Zhuang,Yan %A Zhang,Junyan %A Li,Xiuxing %A Liu,Chao %A Yu,Yue %A Dong,Wei %A He,Kunlun %+ Medical Big Data Research Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China, 86 13911232619, kunlunhe@plagh.org %K BERT %K bidirectional encoder representations from transformers %K pretrained language models %K prompt learning %K ICD %K International Classification of Diseases %K cardiovascular disease %K few-shot learning %K multicenter medical data %D 2025 %7 6.1.2025 %9 Original Paper %J JMIR Med Inform %G English %X Background: Machine learning models can reduce the burden on doctors by converting medical records into International Classification of Diseases (ICD) codes in real time, thereby enhancing the efficiency of diagnosis and treatment. However, it faces challenges such as small datasets, diverse writing styles, unstructured records, and the need for semimanual preprocessing. Existing approaches, such as naive Bayes, Word2Vec, and convolutional neural networks, have limitations in handling missing values and understanding the context of medical texts, leading to a high error rate. We developed a fully automated pipeline based on the Key–bidirectional encoder representations from transformers (BERT) approach and large-scale medical records for continued pretraining, which effectively converts long free text into standard ICD codes. By adjusting parameter settings, such as mixed templates and soft verbalizers, the model can adapt flexibly to different requirements, enabling task-specific prompt learning. Objective: This study aims to propose a prompt learning real-time framework based on pretrained language models that can automatically label long free-text data with ICD-10 codes for cardiovascular diseases without the need for semiautomatic preprocessing. Methods: We integrated 4 components into our framework: a medical pretrained BERT, a keyword filtration BERT in a functional order, a fine-tuning phase, and task-specific prompt learning utilizing mixed templates and soft verbalizers. This framework was validated on a multicenter medical dataset for the automated ICD coding of 13 common cardiovascular diseases (584,969 records). Its performance was compared against robustly optimized BERT pretraining approach, extreme language network, and various BERT-based fine-tuning pipelines. Additionally, we evaluated the framework’s performance under different prompt learning and fine-tuning settings. Furthermore, few-shot learning experiments were conducted to assess the feasibility and efficacy of our framework in scenarios involving small- to mid-sized datasets. Results: Compared with traditional pretraining and fine-tuning pipelines, our approach achieved a higher micro–F1-score of 0.838 and a macro–area under the receiver operating characteristic curve (macro-AUC) of 0.958, which is 10% higher than other methods. Among different prompt learning setups, the combination of mixed templates and soft verbalizers yielded the best performance. Few-shot experiments showed that performance stabilized and the AUC peaked at 500 shots. Conclusions: These findings underscore the effectiveness and superior performance of prompt learning and fine-tuning for subtasks within pretrained language models in medical practice. Our real-time ICD coding pipeline efficiently converts detailed medical free text into standardized labels, offering promising applications in clinical decision-making. It can assist doctors unfamiliar with the ICD coding system in organizing medical record information, thereby accelerating the medical process and enhancing the efficiency of diagnosis and treatment. %M 39761555 %R 10.2196/63020 %U https://medinform.jmir.org/2025/1/e63020 %U https://doi.org/10.2196/63020 %U http://www.ncbi.nlm.nih.gov/pubmed/39761555 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59179 %T Complete Lifestyle Medicine Intervention Program–Ontario: Implementation Protocol for a Rural Study %A Patel,Kush %A Allen,Lisa %A Boucher,Karine %A Fedele,Michelle %A Fong,Debbie %A Kumar,Sangeeta %A Lavigne,Deanna %A Marin-Couture,Elisa %A Partyka-Sitnik,Magdalena %A Rietze,Nicole %A Smith-Turchyn,Jenna %A Juneau,Mylene %A Rhéaume,Caroline %+ Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, 2325 Rue de l'Université, Québec, QC, G1V0A6, Canada, 1 418 575 1595, caroline.rheaume@fmed.ulaval.ca %K chronic disease %K nutrition, exercise %K sleep %K relationships %K stress reduction %K self-compassion %K risky substance use %K holistic medicine %K whole health %K implementation %K lifestyle medicine %K rural medicine %K web-based platform %K substance use %K feasibility %K wellness %K barriers %K opportunities %D 2024 %7 31.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sedentary lifestyles, poor nutritional choices, inadequate sleep, risky substance use, limited social connections, and high stress contribute to the growing prevalence of chronic diseases. Lifestyle medicine, emphasizing therapeutic lifestyle changes for prevention and treatment, has demonstrated effectiveness but remains underutilized in clinical settings. The Complete Lifestyle Medicine Intervention Program–Ontario (CLIP-ON) was developed to educate the rural population of Northern Ontario in lifestyle medicine to improve health outcomes and engagement. Objective: This study evaluates the implementation and effectiveness of the CLIP-ON program for patients with chronic diseases in the Parry Sound area, focusing on lifestyle behaviors, health outcomes, enrollment, retention rates, and interdisciplinary team engagement. Methods: This observational cohort study guided by the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) includes pre- and postintervention assessments from participants and health care providers. A hybrid type II mixed methods design evaluates the intervention’s effectiveness and implementation process in real-world settings through quantitative and qualitative data collection. CLIP-ON is tailored to the residents of the Parry Sound catchment area in Northern Ontario. Participants (≥18 years old) with chronic conditions such as prediabetes, type II diabetes, systemic hypertension, cardiovascular vascular disease, dyslipidemia, or high BMI (≥25) will be recruited through self-referral or provider referral. Approximately 10 participants per cohort will be enrolled in the CLIP-ON program, consisting of 22 weeks of weekly group sessions and monthly individual consultations with physicians, health coaches, kinesiologists, and registered dieticians either in person or through a web-based platform. CLIP-ON will cover the 6 pillars of lifestyle medicine through 14 group sessions followed by an 8-week supervised exercise program. Anthropometric and cardiometabolic variables will be measured before and after the program. Participants will be surveyed on lifestyle habits, wellness, perceived barriers, and program satisfaction at 3 and 6 months. Focus groups and dropout interviews with participants (n=10 per cohort) and providers (n=6 per cohort) will guide program adaptations. Quantitative and qualitative data collected at baseline and follow-up will assess the program’s implementation and identify barriers and opportunities for improvement. Results: This study was approved by the Laurentian University Research Ethics Board (6021397) on July 6, 2023. The first cohort was enrolled in late 2023 and is still under evaluation. The second cohort began in mid-2024, and data collection is currently underway. A mixed methods analysis will be used at enrollment, program completion (22 weeks), and follow-up (6 months after program completion). Focus groups assessing the program’s effectiveness and implementation will take place after the 22-week intervention. Data will be analyzed in early 2025. Conclusions: This protocol provides insights into the implementation of this lifestyle medicine program and its impact on participants’ health. The findings will guide future advancements and establish a scalable model for other communities. Trial Registration: ClinicalTrials.gov NCT06192251; https://clinicaltrials.gov/study/NCT06192251 International Registered Report Identifier (IRRID): DERR1-10.2196/59179 %M 39740215 %R 10.2196/59179 %U https://www.researchprotocols.org/2024/1/e59179 %U https://doi.org/10.2196/59179 %U http://www.ncbi.nlm.nih.gov/pubmed/39740215 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e60697 %T The Role of Machine Learning in the Detection of Cardiac Fibrosis in Electrocardiograms: Scoping Review %A Handra,Julia %A James,Hannah %A Mbilinyi,Ashery %A Moller-Hansen,Ashley %A O'Riley,Callum %A Andrade,Jason %A Deyell,Marc %A Hague,Cameron %A Hawkins,Nathaniel %A Ho,Kendall %A Hu,Ricky %A Leipsic,Jonathon %A Tam,Roger %+ Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada, 1 (604) 822 2421, jhandra@student.ubc.ca %K machine learning %K cardiac fibrosis %K electrocardiogram %K ECG %K detection %K ML %K cardiovascular disease %K review %D 2024 %7 30.12.2024 %9 Review %J JMIR Cardio %G English %X Background: Cardiovascular disease remains the leading cause of mortality worldwide. Cardiac fibrosis impacts the underlying pathophysiology of many cardiovascular diseases by altering structural integrity and impairing electrical conduction. Identifying cardiac fibrosis is essential for the prognosis and management of cardiovascular disease; however, current diagnostic methods face challenges due to invasiveness, cost, and inaccessibility. Electrocardiograms (ECGs) are widely available and cost-effective for monitoring cardiac electrical activity. While ECG-based methods for inferring fibrosis exist, they are not commonly used due to accuracy limitations and the need for cardiac expertise. However, the ECG shows promise as a target for machine learning (ML) applications in fibrosis detection. Objective: This study aims to synthesize and critically evaluate the current state of ECG-based ML approaches for cardiac fibrosis detection. Methods: We conducted a scoping review of research in ECG-based ML applications to identify cardiac fibrosis. Comprehensive searches were performed in PubMed, IEEE Xplore, Scopus, Web of Science, and DBLP databases, including publications up to October 2024. Studies were included if they applied ML techniques to detect cardiac fibrosis using ECG or vectorcardiogram data and provided sufficient methodological details and outcome metrics. Two reviewers independently assessed eligibility and extracted data on the ML models used, their performance metrics, study designs, and limitations. Results: We identified 11 studies evaluating ML approaches for detecting cardiac fibrosis using ECG data. These studies used various ML techniques, including classical (8/11, 73%), ensemble (3/11, 27%), and deep learning models (4/11, 36%). Support vector machines were the most used classical model (6/11, 55%), with the best-performing models of each study achieving accuracies of 77% to 93%. Among deep learning approaches, convolutional neural networks showed promising results, with one study reporting an area under the receiver operating characteristic curve (AUC) of 0.89 when combined with clinical features. Notably, a large-scale convolutional neural network study (n=14,052) achieved an AUC of 0.84 for detecting cardiac fibrosis, outperforming cardiologists (AUC 0.63-0.66). However, many studies had limited sample sizes and lacked external validation, potentially impacting the generalizability of the findings. Variability in reporting methods may affect the reproducibility and applicability of these ML-based approaches. Conclusions: ML-augmented ECG analysis shows promise for accessible and cost-effective detection of cardiac fibrosis. However, there are common limitations with respect to study design and insufficient external validation, raising concerns about the generalizability and clinical applicability of the findings. Inconsistencies in methodologies and incomplete reporting further impede cross-study comparisons. Future work may benefit from using prospective study designs, larger and more clinically and demographically diverse datasets, advanced ML models, and rigorous external validation. Addressing these challenges could pave the way for the clinical implementation of ML-based ECG detection of cardiac fibrosis to improve patient outcomes and health care resource allocation. %M 39753213 %R 10.2196/60697 %U https://cardio.jmir.org/2024/1/e60697 %U https://doi.org/10.2196/60697 %U http://www.ncbi.nlm.nih.gov/pubmed/39753213 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e59614 %T Implementation of Regular Lifestyle Counseling During Long-Term Follow-Up Care of Childhood Cancer Survivors: Monocentric Prospective Study %A Richter,Franziska %A Kronziel,Lea Louisa %A König,Inke %A Langer,Thorsten %A Gebauer,Judith %K lifestyle counseling %K long-term follow-up %K childhood cancer survivors %K physical activity %K metabolic disorders %K cancer survivor %K treatment-related %K risk of obesity %K metabolic syndrome %K healthy lifestyle %K morbidity %K patient %K hypercholesterolemia %K diabetes mellitus %K health care professionals %D 2024 %7 26.12.2024 %9 %J JMIR Cancer %G English %X Background: Many childhood cancer survivors (CCS) develop treatment-related late effects, including an increased risk of obesity and metabolic syndrome. A healthy lifestyle can reduce the risk of associated comorbidities. Therefore, at-risk CCS could benefit from lifestyle counseling during regular long-term follow-up (LTFU). Objective: We implemented a new form of care to decrease the long-term morbidity among CCS and to gain new insights into the lifestyle of those patients. Methods: Over a 1-year study period, lifestyle counseling was integrated into LTFU care. Metabolic disorders, including hypercholesterolemia, diabetes mellitus, overweight or underweight, and low activity levels, were assessed as screening parameters for various risk groups. The perspectives of CCS, physicians, and sports scientists were compared to identify those with the highest needs. Each lifestyle counseling included general recommendations for physical activity, as well as an assessment of individual preferences for and barriers to the implementation of a healthy lifestyle. A follow-up appointment after 1 month was performed. Results: Of the 155 CCS aged 18 to 63 years (n=100, 65% female and n=55, 35% male), 112 (72%) had an indication for lifestyle counseling, identified by physicians, sports scientists, or the CCS themselves. Metabolic disorders affected 45% (n=70) of these CCS, and 46% (n=72) did not meet recommended activity levels. A total of 120 (77%) CCS received lifestyle counseling, including 8 initially uninterested individuals who became open to recommendations. Those with intensive cancer treatment history showed the greatest need. A total of 65 (54%) CCS were advised to change their lifestyle in both areas (diet and exercise) while 51 (43%) CCS received recommendations for only exercise (n=43 CCS, 36%) or diet (n=8 CCS, 7%). A total of 4 (3%) CCS, although interested in counseling, received no advice, as they already met the recommendations. Follow-up revealed high adherence to recommendations and successful integration into daily lives. In total, 97% (n=150) of survivors indicated that the provision of lifestyle counseling during LTFU would be generally beneficial. Conclusions: Incorporating specialized health care professionals such as sports scientists into survivorship care enhances the multidisciplinary approach of LTFU care. Promoting a healthy lifestyle by offering guideline-based lifestyle counseling is broadly accepted among CCS and may reduce long-term morbidity. %R 10.2196/59614 %U https://cancer.jmir.org/2024/1/e59614 %U https://doi.org/10.2196/59614 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e47730 %T Targeting Key Risk Factors for Cardiovascular Disease in At-Risk Individuals: Developing a Digital, Personalized, and Real-Time Intervention to Facilitate Smoking Cessation and Physical Activity %A Versluis,Anke %A Penfornis,Kristell M %A van der Burg,Sven A %A Scheltinga,Bouke L %A van Vliet,Milon H M %A Albers,Nele %A Meijer,Eline %+ Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 712568433, E.Meijer@lumc.nl %K smoking %K physical activity %K virtual coach %K eHealth %K development %K collaboration %K conversational agent %K risk factor %K cardiovascular disease %K CVD %K digital %K smoking cessation %K intervention %D 2024 %7 20.12.2024 %9 Viewpoint %J JMIR Cardio %G English %X Health care is under pressure due to an aging population with an increasing prevalence of chronic diseases, including cardiovascular disease. Smoking and physical inactivity are 2 key preventable risk factors for cardiovascular disease. Yet, as with most health behaviors, they are difficult to change. In the interdisciplinary Perfect Fit project, scientists from different fields join forces to develop an evidence-based virtual coach (VC) that supports smokers in quitting smoking and increasing their physical activity. In this Viewpoint paper, intervention content, design, and implementation, as well as lessons learned, are presented to support other research groups working on similar projects. A total of 6 different approaches were used and combined to support the development of the Perfect Fit VC. The approaches used are (1) literature reviews, (2) empirical studies, (3) collaboration with end users, (4) content and technical development sprints, (5) interdisciplinary collaboration, and (6) iterative proof-of-concept implementation. The Perfect Fit intervention integrates evidence-based behavior change techniques with new techniques focused on identity change, big data science, sensor technology, and personalized real-time coaching. Intervention content of the virtual coaching matches the individual needs of the end users. Lessons learned include ways to optimally implement and tailor interactions with the VC (eg, clearly explain why the user is asked for input and tailor the timing and frequency of the intervention components). Concerning the development process, lessons learned include strategies for effective interdisciplinary collaboration and technical development (eg, finding a good balance between end users’ wishes and legal possibilities). The Perfect Fit development process was collaborative, iterative, and challenging at times. Our experiences and lessons learned can inspire and benefit others. Advanced, evidence-based digital interventions, such as Perfect Fit, can contribute to a healthy society while alleviating health care burden. %M 39705698 %R 10.2196/47730 %U https://cardio.jmir.org/2024/1/e47730 %U https://doi.org/10.2196/47730 %U http://www.ncbi.nlm.nih.gov/pubmed/39705698 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e51536 %T Demographics and Health Characteristics Associated With the Likelihood of Participating in Digitally Delivered Exercise Rehabilitation for Improving Heart Health Among Breast Cancer Survivors: Cross-Sectional Survey Study %A Jones,Tamara %A Edbrooke,Lara %A Rawstorn,Jonathan C %A Denehy,Linda %A Hayes,Sandra %A Maddison,Ralph %A Sverdlov,Aaron L %A Koczwara,Bogda %A Kiss,Nicole %A Short,Camille E %K digital health %K breast cancer %K exercise %K rehabilitation %K cardiotoxicity %K demographic %K cancer survivor %K exercise rehabilitation %K home-based program %K pathologic process %K radiation %K physical phenomena %K heart care %K cardiovascular disease %K diagnosis %K cross-sectional study %K chronic disease %K statistics %D 2024 %7 16.12.2024 %9 %J JMIR Cancer %G English %X Background: Strong evidence supports the benefits of exercise following both cardiovascular disease and cancer diagnoses. However, less than one-third of Australians who are referred to exercise rehabilitation complete a program following a cardiac diagnosis. Technological advances make it increasingly possible to embed real-time supervision, tailored exercise prescription, behavior change, and social support into home-based programs. Objective: This study aimed to explore demographic and health characteristics associated with the likelihood of breast cancer survivors uptaking a digitally delivered cardiac exercise rehabilitation program and to determine whether this differed according to intervention timing (ie, offered generally, before, during, or after treatment). Secondary aims were to explore the knowledge of cardiac-related treatment side-effects, exercise behavior, additional intervention interests (eg, diet, fatigue management), and service fee capabilities. Methods: This cross-sectional study involved a convenience sample of breast cancer survivors recruited via social media. A self-reported questionnaire was used to collect outcomes of interests, including the likelihood of uptaking a digitally delivered cardiac exercise rehabilitation program, and demographic and health characteristics. Descriptive statistics were used to summarize sample characteristics and outcomes. Ordered logistic regression models were used to examine associations between demographic and health characteristics and likelihood of intervention uptake generally, before, during, and after treatment, with odds ratios (ORs) <0.67 or >1.5 defined as clinically meaningful and statistical significance a priori set at P≤.05. Results: A high proportion (194/208, 93%) of the sample (mean age 57, SD 11 years; median BMI=26, IQR 23‐31 kg/m2) met recommended physical activity levels at the time of the survey. Living in an outer regional area (compared with living in a major city) was associated with higher odds of uptake in each model (OR 3.86‐8.57, 95% CI 1.04-68.47; P=.01‐.04). Receiving more cardiotoxic treatments was also associated with higher odds of general uptake (OR 1.42, 95% CI 1.02-1.96; P=.04). There was some evidence that a higher BMI, more comorbid conditions, and lower education (compared with university education) were associated with lower odds of intervention uptake, but findings differed according to intervention timing. Respondents identified the need for better education about the cardiotoxic effects of breast cancer treatment, and the desire for multifaceted rehabilitation interventions that are free or low cost (median Aus $10, IQR 10-15 per session; Aus $1=US $0.69 at time of study). Conclusions: These findings can be used to better inform future research and the development of intervention techniques that are critical to improving the delivery of a digital service model that is effective, equitable, and accessible, specifically, by enhancing digital inclusion, addressing general exercise barriers experienced by chronic disease populations, incorporating multidisciplinary care, and developing affordable delivery models. %R 10.2196/51536 %U https://cancer.jmir.org/2024/1/e51536 %U https://doi.org/10.2196/51536 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57799 %T Utility of Anthropometric Indexes for Detecting Metabolic Syndrome in Resource-Limited Regions of Northwestern China: Cross-Sectional Study %A Yang,Danyu %A Ma,Ling %A Cheng,Yin %A Shi,Hongjuan %A Liu,Yining %A Shi,Chao %K metabolic syndrome %K MetS %K anthropometric indexes %K lipid accumulation product %K LAP %K waist-to-height ratio %K WHtR %K anthropometric %K adult %K aging %K NingXia %K China %K cross-sectional study %K population-based survey %K logistic regression %K waist-to-height %K threshold %K diagnosis %K public health %D 2024 %7 29.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Anthropometric indexes offer a practical approach to identifying metabolic syndrome (MetS) and its components. However, there is a scarcity of research on anthropometric indexes tailored to predict MetS in populations from resource-limited regions. Objective: This study aimed to examine the association between 8 easy-to-collect anthropometric indexes and MetS, and determine the most appropriate indexes to identify the presence of MetS for adults in resource-limited areas. Methods: A total of 10,520 participants aged 18‐85 years from Ningxia Hui Autonomous Region, China, were included in this cross-sectional study. Participants were recruited through a stratified sampling approach from January 1, 2020, to December 31, 2021. MetS was defined using the International Diabetes Federation (IDF) criteria. Eight anthropometric indexes were examined, including BMI, waist-to-height ratio (WHtR), weight-adjusted waist index (WWI), conicity index, a body shape index (ABSI), lipid accumulation products (LAP), visceral obesity index (VAI), and the triglyceride-glucose (TyG) index. Logistic regression analysis and restricted cubic splines (RCSs) were applied to identify the association between the anthropometric indexes. The receiver operating characteristic curve and the area under the curve (AUC) were analyzed to identify and compare the discriminative power of anthropometric indexes in identifying MetS. The Youden index was used to determine a range of optimal diagnostic thresholds. Logistic regression analysis was applied to identify the association between the anthropometric indexes. Results: A total of 3324 (31.60%) participants were diagnosed with MetS. After adjusting for age, ethnicity, current residence, education level, habitual alcohol consumption, and tobacco use, all the 8 indexes were positively correlated with the risks of MetS (P<.05). LAP presented the highest adjusted odds ratios (adjOR 35.69, 95% CI 34.59‐36.80), followed by WHtR (adjOR 29.27, 95% CI 28.00‐30.55), conicity index (adjOR 11.58, 95% CI 10.95‐12.22), TyG index (adjOR 5.53, 95% CI 5.07‐6.04), BMI (adjOR 3.88, 95% CI 3.71‐4.05), WWI (adjOR 3.23, 95% CI 3.02‐3.46), VAI (adjOR 2.11, 95% CI 2.02‐2.20), and ABSI (adjOR 1.71, 95% CI 1.62‐1.80). Significantly nonlinear associations between the 8 indexes and the risk of MetS (all Pnonlinear<.001) were observed in the RCSs. WHtR was the strongest predictor of MetS for males (AUC 0.91, 95% CI 0.90-0.92; optimal cutoff 0.53). LAP were the strongest predictor of MetS for females (AUC 0.89, 95% CI 0.89-0.90; optimal cutoff 28.67). Statistical differences were present between WHtR and all other 7 anthropometric indexes among males and overall (all P<.05). In females, the AUC values between LAP and BMI, WWI, ABSI, conicity index, VAI, and TyG index were significantly different (P<.001). No statistical difference was observed between LAP and WHtR among females. Conclusions: According to 8 anthropometric and lipid-related indices, it is suggested that WHtR and LAP are the most appropriate indexes for identifying the presence of MetS in resource-limited areas. %R 10.2196/57799 %U https://publichealth.jmir.org/2024/1/e57799 %U https://doi.org/10.2196/57799 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59539 %T Wearables and Smartphones for Tracking Modifiable Risk Factors in Metabolic Health: Protocol for a Scoping Review %A Brügger,Victoria %A Kowatsch,Tobias %A Jovanova,Mia %+ School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, St. Gallen, 9000, Switzerland, 41 712243200, mia.jovanova@unisg.ch %K wearable %K smartphone %K mHealth %K metabolic disease %K lifestyle %K physiological %K risk factor %K mobile phone %D 2024 %7 28.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Metabolic diseases, such as cardiovascular diseases and diabetes, contribute significantly to global mortality and disability. Wearable devices and smartphones are increasingly used to track and manage modifiable risk factors associated with metabolic diseases. However, no established guidelines exist on how to derive meaningful signals from these devices, often hampering cross-study comparisons. Objective: This study aims to systematically overview the current empirical literature on how wearables and smartphones are used to track modifiable (physiological and lifestyle) risk factors associated with metabolic diseases. Methods: We will conduct a scoping review to overview how wearable and smartphone-based studies measure modifiable risk factors related to metabolic diseases. We will search 5 databases (Scopus, Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and SPORTDiscus) from 2019 to 2024, with search terms related to wearables, smartphones, and modifiable risk factors associated with metabolic diseases. Eligible studies will use smartphones or wearables (worn on the wrist, finger, arm, hip, and chest) to track physiological or lifestyle factors related to metabolic diseases. We will follow the reporting guideline standards from PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) guidance on scoping review methodology. Two reviewers will independently screen articles for inclusion and extract data using a standardized form. The findings will be synthesized and reported qualitatively and quantitatively. Results: Data collection is expected to begin in November 2024; data analysis in the first quarter of 2025; and submission to a peer-reviewed journal by the second quarter of 2025. We expect to identify the degree to which wearable and smartphone-based studies track modifiable risk factors collectively (versus in isolation), and the consistency and variation in how modifiable risk factors are measured across existing studies. Conclusions: Results are expected to inform more standardized guidelines on wearable and smartphone-based measurements, with the goal of aiding cross-study comparison. The final report is planned for submission to a peer-reviewed, indexed journal. This review is among the first to systematically overview the current landscape on how wearables and smartphones measure modifiable risk factors associated with metabolic diseases. International Registered Report Identifier (IRRID): PRR1-10.2196/59539 %M 39608004 %R 10.2196/59539 %U https://www.researchprotocols.org/2024/1/e59539 %U https://doi.org/10.2196/59539 %U http://www.ncbi.nlm.nih.gov/pubmed/39608004 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65010 %T Smartphone App for Improving Self-Awareness of Adherence to Edoxaban Treatment in Patients With Atrial Fibrillation (ADHERE-App Trial): Randomized Controlled Trial %A Yoon,Minjae %A Lee,Ji Hyun %A Kim,In-Cheol %A Lee,Ju-Hee %A Kim,Mi-Na %A Kim,Hack-Lyoung %A Lee,Sunki %A Kim,In Jai %A Choi,Seonghoon %A Park,Sung-Ji %A Hur,Taeho %A Hussain,Musarrat %A Lee,Sungyoung %A Choi,Dong-Ju %+ Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil,, Bundang-gu, Seongnam, 13620, Republic of Korea, 82 31 787 7007, djchoi.snu@gmail.com %K mobile apps %K digital health %K atrial fibrillation %K anticoagulants %K medication adherence %K mobile phone %D 2024 %7 21.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Adherence to oral anticoagulant therapy is essential to prevent ischemic stroke in patients with atrial fibrillation (AF). Objective: This study aimed to evaluate whether smartphone app–based interventions improve medication adherence in patients with AF. Methods: This open-label, multicenter randomized controlled trial (ADHERE-App [Self-Awareness of Drug Adherence to Edoxaban Using an Automatic App Feedback System] study) enrolled patients with AF treated with edoxaban for stroke prevention. They were randomly assigned to app-conditioned feedback (intervention; n=248) and conventional treatment (control; n=250) groups. The intervention group received daily alerts via a smartphone app to take edoxaban and measure blood pressure and heart rate at specific times. The control group received only standard, guideline-recommended care. The primary end point was edoxaban adherence, measured by pill count at 3 or 6 months. Medication adherence and the proportion of adequate medication adherence, which was defined as ≥95% of continuous medication adherence, were evaluated. Results: Medication adherence at 3 or 6 months was not significantly different between the intervention and control groups (median 98%, IQR 95%-100% vs median 98%, IQR 91%-100% at 3 months, P=.06; median 98%, IQR 94.5%-100% vs median 97.5%, IQR 92.8%-100% at 6 months, P=.15). However, the proportion of adequate medication adherence (≥95%) was significantly higher in the intervention group at both time points (76.8% vs 64.7% at 3 months, P=.01; 73.9% vs 61% at 6 months, P=.007). Among patients aged >65 years, the intervention group showed a higher medication adherence value and a higher proportion of adequate medication adherence (≥95%) at 6 months. Conclusions: There was no difference in edoxaban adherence between the groups. However, the proportion of adequate medication adherence was higher in the intervention group, and the benefit of the smartphone app–based intervention on medication adherence was more pronounced among older patients than among younger patients. Given the low adherence to oral anticoagulants, especially among older adults, using a smartphone app may potentially improve medication adherence. Trial Registration: International Clinical Trials Registry Platform KCT0004754; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=28496&search_page=L International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-048777 %M 39570659 %R 10.2196/65010 %U https://www.jmir.org/2024/1/e65010 %U https://doi.org/10.2196/65010 %U http://www.ncbi.nlm.nih.gov/pubmed/39570659 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60037 %T An Investigation of the Feasibility and Acceptability of Using a Commercial DASH (Dietary Approaches to Stop Hypertension) App in People With High Blood Pressure: Mixed Methods Study %A Alnooh,Ghadah %A AlTamimi,Jozaa Z %A Williams,Elizabeth A %A Hawley,Mark S %+ Centre for Assistive Technology and Connected Healthcare, School of Medicine and Population Health, University of Sheffield, The Innovation Centre, 217 Portobello, Sheffield, S1 4DP, United Kingdom, 44 1142222000, mark.hawley@sheffield.ac.uk %K hypertension %K blood pressure %K Dietary Approaches to Stop Hypertension %K DASH diet %K self-efficacy %K mobile health %K mHealth %K Saudi Arabia %K mobile phone %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of smartphone apps for dietary self-management among patients with high blood pressure is becoming increasingly common. Few commercially available DASH (Dietary Approaches to Stop Hypertension) diet apps have the potential to be effective, and only a few of these have adequate security and privacy measures. In previous studies, we identified 2 high-quality apps that are likely effective and safe. One of these, the Noom app, was selected as the most suitable app for use in the Saudi Arabian context based on health care professionals’ and patients’ preferences. Objective: This study aims to determine the feasibility and acceptability of using the Noom app to support DASH diet self-management among people with high blood pressure in Saudi Arabia. Methods: This mixed methods study evaluated the feasibility and acceptability of using the Noom app among people with high blood pressure in Riyadh, Saudi Arabia. Fourteen participants with high blood pressure were recruited and asked to use the app for 8 weeks. The quantitative outcome measures were DASH diet adherence and self-efficacy. Feasibility and acceptability were assessed during and after the intervention via the Noom diet-tracking engagement questionnaire, the System Usability Scale, and semistructured interviews. Results: Most participants (8/13, 62%) logged their meals for 3 to 5 days a week; the frequency of logging increased over time. Snacks were the foods they most often forgot to log. The interviews revealed four main themes: (1) acceptance, (2) app usability, (3) technical issues, and (4) suggestions for improvement. Most participants found the Noom app acceptable, and most had no difficulties integrating it into their daily routines. The results of this feasibility study provided insights into the app’s educational content, some of which was deemed unsuitable for Saudi Arabian users. App usability was identified as a critical theme: the app and its database were easy to use, convenient, and valuable to most of the participants. Despite this, some of the participants reported difficulties in identifying some foods because of a lack of local options on the app. Technical issues included the app freezing or responding slowly. Most participants also suggested developing an Arabic version of the app and simplifying the method of food logging. The participants showed some improvement in self-efficacy and adherence to the DASH diet, although these improvements were not statistically significant. The mean self-efficacy score increased from 18 (SD 4.7) to 20 (SD 6.3), and the mean DASH diet score increased from 3.4 (SD 1.4) to 4.3 (SD 1.1). Conclusions: The app was feasible and acceptable among the participants who completed the study. Further studies are needed to examine the potential of smartphone apps in promoting adherence to the DASH diet and their impact on blood pressure among individuals with hypertension in Saudi Arabia. %M 39561360 %R 10.2196/60037 %U https://formative.jmir.org/2024/1/e60037 %U https://doi.org/10.2196/60037 %U http://www.ncbi.nlm.nih.gov/pubmed/39561360 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55667 %T Clinical Acceptability of a Quality Improvement Program for Reducing Cardiovascular Disease Risk in People With Chronic Kidney Disease in Australian General Practice: Qualitative Study %A McBride,Caroline %A Hunter,Barbara %A Lumsden,Natalie %A Somasundaram,Kaleswari %A McMorrow,Rita %A Boyle,Douglas %A Emery,Jon %A Nelson,Craig %A Manski-Nankervis,Jo-Anne %K clinical decision support %K general practice %K GP %K primary care %K family medicine %K general medicine %K family physician %K implementation science %K chronic kidney disease %K CKD %K nephrology %K nephrologist %K chronic disease %K cardiovascular risk %K cardiology %K quality improvement %K EHR %K electronic health record %K clinical software %D 2024 %7 13.11.2024 %9 %J JMIR Hum Factors %G English %X Background: Future Health Today (FHT) is a technology program that integrates with general practice clinical software to provide point of care (PoC) clinical decision support and a quality improvement dashboard. This qualitative study looks at the use of FHT in the context of cardiovascular disease risk in chronic kidney disease (CKD). Objective: This study aims to explore factors influencing clinical implementation of the FHT module focusing on cardiovascular risk in CKD, from the perspectives of participating general practitioner staff. Methods: Practices in Victoria were recruited to participate in a pragmatic cluster randomized controlled trial using FHT, of which 19 practices were randomly assigned to use FHT’s cardiovascular risk in CKD program. A total of 13 semistructured interviews were undertaken with a nominated general practitioner (n=7) or practice nurse (n=6) from 10 participating practices. Interview questions focused on the clinical usefulness of the tool and its place in clinical workflows. Qualitative data were coded by 2 researchers and analyzed using framework analysis and Clinical Performance Feedback Intervention Theory. Results: All 13 interviewees had used the FHT PoC tool, and feedback was largely positive. Overall, clinicians described engaging with the tool as a “prompt” or “reminder” system. Themes reflected that the tool’s goals and clinical content were aligned with clinician’s existing priorities and knowledge, and the tool’s design facilitated easy integration into existing workflows. The main barrier to implementation identified by 2 clinicians was notification fatigue. A total of 7 interviewees had used the FHT dashboard tool. The main barriers to use were its limited integration into clinical workflows, such that some participants did not know of its existence; clinicians’ competing clinical priorities; and limited time to learn and use the tool. Conclusions: This study identified many facilitators for the successful use of the FHT PoC program, in the context of cardiovascular risk in CKD, and barriers to the use of the dashboard program. This work will be used to inform the wider implementation of FHT, as well as the development of future modules of FHT for other risk or disease states. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12620000993998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380119&is %R 10.2196/55667 %U https://humanfactors.jmir.org/2024/1/e55667 %U https://doi.org/10.2196/55667 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60713 %T Considerations for Future Research and Methodological Clarifications on Smoking Behavior Change and Heart Failure Risk in Patients With Type 2 Diabetes %A Malinovská,Jana %A Michalec,Juraj %A Brož,Jan %K type 2 diabetes %K smoking %K heart failure %K cardiovascular disease %K smoking cessation %D 2024 %7 12.11.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/60713 %U https://publichealth.jmir.org/2024/1/e60713 %U https://doi.org/10.2196/60713 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57931 %T Clinical and Biochemical Outcomes in Transgender Individuals Undergoing Hormone Therapy: Protocol for a Systematic Review %A Sattora,Emily %A Teelin,Karen %A Prendergast,Christopher %A Smith,Abigail %A Evans,James %A Imdad,Aamer %+ Division of Pediatric Gastroenterology, Hepatology, Pancreatology, and Nutrition, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, United States, 1 319 356 2950, aamer-imdad@uiowa.edu %K transgender %K lipid levels %K hormone therapy %K biochemical outcomes %K clinical outcomes %K comprehensive data %K systematic review %K meta-analysis %K adolescent %K adults %K electronic databases %K testosterone %K estrogen %D 2024 %7 12.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Monitoring of various clinical outcomes and parameters, such as lipid levels, is recommended in transgender individuals undergoing hormone therapies. However, comprehensive data to inform these recommendations is scarce. Objective: This study aims to conduct a systematic review and meta-analysis to synthesize evidence from existing literature on the effect of exogenous hormone therapy on clinical and biochemical outcomes for transgender adolescents and adults. Methods: We will search multiple electronic databases and will include prospective and retrospective observational studies with and without a control group. The study population will include transgender individuals undergoing hormone therapy with testosterone or estrogen. Comparisons will include age-matched, cisgender individuals and changes from baseline. Primary outcomes include changes in or the development of abnormal lipid parameters. Secondary outcomes include BMI, weight, height, and blood pressure for age, serum testosterone or estrogen levels, and development of disease including hypertension, diabetes, fatty liver disease, obesity, adverse cardiac events, as well as all-cause mortality. The meta-analysis will pool the studies where applicable, and meta-regressions will be conducted to evaluate effect modifiers. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach will be used to evaluate the overall certainty of evidence. Results: We will summarize the selection of the eligible studies using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The results will be presented in a table summarizing the evidence. Data collection is ongoing, and the paper is expected to be published in Spring 2025. Conclusions: This systematic review will summarize and evaluate the evidence of the clinical and biochemical outcomes associated with hormone therapies for transgender individuals. Trial Registration: PROSPERO CRD42024483138; https://tinyurl.com/yc4sfvnb International Registered Report Identifier (IRRID): PRR1-10.2196/57931 %M 39531266 %R 10.2196/57931 %U https://www.researchprotocols.org/2024/1/e57931 %U https://doi.org/10.2196/57931 %U http://www.ncbi.nlm.nih.gov/pubmed/39531266 %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 e46983 %T Characterization of Telecare Conversations on Lifestyle Management and Their Relation to Health Care Utilization for Patients with Heart Failure: Mixed Methods Study %A Erdt,Mojisola %A Yusof,Sakinah Binte %A Chai,Liquan %A Md Salleh,Siti Umairah %A Liu,Zhengyuan %A Sarim,Halimah Binte %A Lim,Geok Choo %A Lim,Hazel %A Suhaimi,Nur Farah Ain %A Yulong,Lin %A Guo,Yang %A Ng,Angela %A Ong,Sharon %A Choo,Bryan Peide %A Lee,Sheldon %A Weiliang,Huang %A Oh,Hong Choon %A Wolters,Maria Klara %A Chen,Nancy F %A Krishnaswamy,Pavitra %+ Institute for Infocomm Research (I²R), Agency for Science, Technology and Research (A*STAR), 1 Fusionopolis Way, #21-01, Connexis South Tower, Singapore, 138632, Singapore, 65 6408 2450, pavitrak@i2r.a-star.edu.sg %K telehealth %K telecare %K heart failure %K chronic disease %K self-management %K lifestyle management %K behavior %K health care utilization %K conversation %K dialogue %K medical informatics %D 2024 %7 30.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how they relate to health care utilization remains incomplete. Objective: This study aimed to characterize the content and structure of telecare conversations on lifestyle management for patients with HF and investigate how these conversations relate to health care utilization. Methods: We leveraged real-world data from 50 patients with HF enrolled in a postdischarge telehealth program, with the primary intervention comprising a series of telephone calls from nurse telecarers over a 12-month period. For the full cohort, we transcribed 729 English-language calls and annotated conversation topics. For a subcohort (25 patients with both HF and T2DM), we annotated lifestyle management content with fine-grained dialogue acts describing typical conversational structures. For each patient, we identified calls with unusually high ratios of utterances on lifestyle management as lifestyle-focused calls. We further extracted structured data for inpatient admissions from 6 months before to 6 months after the intervention period. First, to understand conversational structures and content of lifestyle-focused calls, we compared the number of utterances, dialogue acts, and symptom attributes in lifestyle-focused calls to those in calls containing but not focused on lifestyle management. Second, to understand the perspectives of nurse telecarers on these calls, we conducted an expert evaluation where 2 nurse telecarers judged levels of concern and follow-up actions for lifestyle-focused and other calls (not focused on lifestyle management content). Finally, we assessed how the number of lifestyle-focused calls relates to the number of admissions, and to the average length of stay per admission. Results: In comparative analyses, lifestyle-focused calls had significantly fewer utterances (P=.01) and more dialogue acts (Padj=.005) than calls containing but not focused on lifestyle management. Lifestyle-focused calls did not contain deeper discussions on clinical symptoms. These findings indicate that lifestyle-focused calls entail short, intense discussions with greater emphasis on understanding patient experience and coaching than on clinical content. In the expert evaluation, nurse telecarers identified 24.2% (29/120) of calls assessed as concerning enough for follow-up. For these 29 calls, nurse telecarers were more attuned to concerns about symptoms and vitals (19/29, 65.5%) than lifestyle management concerns (4/29, 13.8%). The number of lifestyle-focused calls a patient had was modestly (but not significantly) associated with a lower average length of stay for inpatient admissions (Spearman ρ=-0.30; Padj=.06), but not with the number of admissions (Spearman ρ=-0.03; Padj=.84). Conclusions: Our approach and findings offer novel perspectives on the content, structure, and clinical associations of telehealth conversations on lifestyle management for patients with HF. Hence, our study could inform ways to enhance telehealth programs for self-care management in chronic conditions. %M 39476370 %R 10.2196/46983 %U https://www.jmir.org/2024/1/e46983 %U https://doi.org/10.2196/46983 %U http://www.ncbi.nlm.nih.gov/pubmed/39476370 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e63707 %T Development of a Digital Health Intervention for the Secondary Prevention of Cardiovascular Disease (INTERCEPT): Co-Design and Usability Testing Study %A Gibson,Irene %A Neubeck,Lis %A Corcoran,Marissa %A Morland,Chris %A Donovan,Steve %A Jones,Jennifer %A Costello,Caroline %A Hynes,Lisa %A Harris,Aisling %A Harrahill,Mary %A Lillis,Mary %A Atrey,Alison %A Ski,Chantal F %A Savickas,Vilius %A Byrne,Molly %A Murphy,Andrew W %A McEvoy,John William %A Wood,David %A Jennings,Catriona %+ School of Medicine, University of Galway, University Road, Galway, H91 TK33, Ireland, 353 91 544310, irene.gibson@universityofgalway.ie %K cardiovascular disease %K secondary prevention %K digital health %K intervention development %K co-design %K usability testing %K mobile health %K usability %K design %K conline workshop %K social support %K behavioral change %K self-monitoring %D 2024 %7 23.10.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Secondary prevention is an important strategy to reduce the burden of cardiovascular disease (CVD), a leading cause of death worldwide. Despite the growing evidence for the effectiveness of digital health interventions (DHIs) for the secondary prevention of CVD, the majority are designed with minimal input from target end users, resulting in poor uptake and usage. Objective: This study aimed to optimize the acceptance and effectiveness of a DHI for the secondary prevention of CVD through co-design, integrating end users’ perspectives throughout. Methods: A theory-driven, person-based approach using co-design was adopted for the development of the DHI, known as INTERCEPT. This involved a 4-phase iterative process using online workshops. In phase 1, a stakeholder team of health care professionals, software developers, and public and patient involvement members was established. Phase 2 involved identification of the guiding principles, content, and design features of the DHI. In phase 3, DHI prototypes were reviewed for clarity of language, ease of navigation, and functionality. To anticipate and interpret DHI usage, phase 4 involved usability testing with participants who had a recent cardiac event (<2 years). To assess the potential impact of usability testing, the System Usability Scale was administered before and after testing. The GUIDED (Guidance for Reporting Intervention Development Studies in Health Research) checklist was used to report the development process. Results: Five key design principles were identified: simplicity and ease of use, behavioral change through goal setting and self-monitoring, personalization, system credibility, and social support. Usability testing resulted in 64 recommendations for the app, of which 51 were implemented. Improvements in System Usability Scale scores were observed when comparing the results before and after implementing the recommendations (61 vs 83; P=.02). Conclusions: Combining behavior change theory with a person-based, co-design approach facilitated the development of a DHI for the secondary prevention of CVD that optimized responsiveness to end users’ needs and preferences, thereby potentially improving future engagement. %M 39441626 %R 10.2196/63707 %U https://humanfactors.jmir.org/2024/1/e63707 %U https://doi.org/10.2196/63707 %U http://www.ncbi.nlm.nih.gov/pubmed/39441626 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e58137 %T Comparing Insulin Against Glucagon-Like Peptide-1 Receptor Agonists, Dipeptidyl Peptidase-4 Inhibitors, and Sodium-Glucose Cotransporter 2 Inhibitors on 5-Year Incident Heart Failure Risk for Patients With Type 2 Diabetes Mellitus: Real-World Evidence Study Using Insurance Claims %A Wang,Xuan %A Plantinga,Anna M %A Xiong,Xin %A Cromer,Sara J %A Bonzel,Clara-Lea %A Panickan,Vidul %A Duan,Rui %A Hou,Jue %A Cai,Tianxi %K type 2 diabetes mellitus %K diabetes %K diabetes complications %K heart failure %K antidiabetic drug %K diabetes pharmacotherapy %K insulin %K GLP-1 RA %K DPP-4I %K SGLT2I %K real-world data %K insurance data %K claims data %K glucagon-like peptide-1 receptor agonist %K dipeptidyl peptidase-4 inhibitor %K sodium-glucose cotransporter 2 inhibitor %D 2024 %7 22.10.2024 %9 %J JMIR Diabetes %G English %X Background: Type 2 diabetes mellitus (T2DM) is a common health issue, with heart failure (HF) being a common and lethal long-term complication. Although insulin is widely used for the treatment of T2DM, evidence regarding the efficacy of insulin compared to noninsulin therapies on incident HF risk is missing among randomized controlled trials. Real-world evidence on insulin’s effect on long-term HF risk may supplement existing guidelines on the management of T2DM. Objective: This study aimed to compare insulin therapy against other medications on HF risk among patients with T2DM using real-world data extracted from insurance claims. Methods: A retrospective, observational study was conducted based on insurance claims data from a single health care network. The study period was from January 1, 2016, to August 11, 2021. The cohort was defined as patients having a T2DM diagnosis code. The inclusion criteria were patients who had at least 1 record of a glycated hemoglobin laboratory test result; full insurance for at least 1 year (either commercial or Medicare Part D); and received glucose-lowering therapy belonging to 1 of the following groups: insulin, glucagon-like peptide 1 receptor agonists (GLP-1 RAs), dipeptidyl peptidase-4 inhibitors (DPP-4Is), or sodium-glucose cotransporter-2 inhibitors (SGLT2Is). The main outcome was the 5-year incident HF rate. Baseline covariates, including demographic characteristics, comorbidities, and laboratory test results, were adjusted to correct for confounding. Results: After adjusting for a broad list of confounders, patients receiving insulin were found to be associated with an 11.8% (95% CI 11.0%‐12.7%), 12.0% (95% CI 11.5%‐12.4%), and 15.1% (95% CI 14.3%‐16.0%) higher 5-year HF rate compared to those using GLP-1 RAs, DPP-4Is, and SGLT2Is, respectively. Subgroup analysis showed that insulin’s effect of a higher HF rate was significant in the subgroup with high HF risk but not significant in the subgroup with low HF risk. Conclusions: This study generated real-world evidence on the association of insulin therapy with a higher 5-year HF rate compared to GLP-1 RAs, DPP-4Is, and SGLT2Is based on insurance claims data. These findings also demonstrated the value of real-world data for comparative effectiveness studies to complement established guidelines. On the other hand, the study shares the common limitations of observational studies. Even though high-dimensional confounders are adjusted, remaining confounding may exist and induce bias in the analysis. %R 10.2196/58137 %U https://diabetes.jmir.org/2024/1/e58137 %U https://doi.org/10.2196/58137 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e56207 %T Dynamics of Blood Lipids Before, During, and After Diurnal Fasting in Inactive Men: Quasi-Experimental Study %A Aljaloud,Khalid %A Al-Barha,Naif %A Noman,Abeer %A Aldayel,Abdulaziz %A Alsharif,Yahya %A Alshuwaier,Ghareeb %+ Department of Exercise Physiology, College of Sport Sciences and Physical Activity, King Saud University, P O Box 2454, Riyadh, 11451, Saudi Arabia, 966 0118063100, khaljaloud@ksu.edu.sa %K cardiovascular diseases %K cardiovascular risk factors %K lipids %K glucose measurement %K fasting %K Ramadan %K body composition %D 2024 %7 17.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: There is a lack of investigation into the dynamics of blood lipids before, during, and after diurnal fasting, especially in inactive men. Objective: This study determined dynamic changes in blood lipids in inactive men before, during, and after they underwent diurnal fasting. Methods: A total of 44 young men aged a mean 27.6 (SD 5.8) years were recruited to evaluate their habitual physical activity and diet using a questionnaire developed for this study. Body composition was evaluated using a bioelectrical impedance analysis machine (Tanita BC-980). An 8-ml blood sample was collected to evaluate blood lipids and glucose. All measurements were taken 2-3 days before Ramadan, during Ramadan (at week 2 and week 3), and 1 month after Ramadan. A 1-way repeated measures ANOVA was used to compare the measured variables before, during, and after the month of Ramadan. When a significant difference was found, post hoc testing was used. Differences were considered significant at P<.05. Results: There was a significant reduction in low-density lipoprotein during Ramadan compared to before and after Ramadan (83.49 mg/dl at week 3 vs 93.11 mg/dl before Ramadan [P=.02] and 101.59 mg/dl after Ramadan [P=.007]). There were significant elevations in fasting blood glucose (74.60 mmol/L before Ramadan vs 81.52 mmol/L at week 3 [P=.03] and 86.51 mmol/L after Ramadan [P=.01]) and blood pressure (109 mm Hg before Ramadan vs 114 mm Hg after Ramadan; P=.02) reported during and even after the month of Ramadan, although both fasting blood glucose and blood pressure were within normal levels. Conclusions: Ramadan fasting could be an independent factor in reducing low-density lipoprotein. Further investigations are encouraged to clarify the impact of diurnal fasting on blood lipids in people with special conditions. %M 39419506 %R 10.2196/56207 %U https://www.i-jmr.org/2024/1/e56207 %U https://doi.org/10.2196/56207 %U http://www.ncbi.nlm.nih.gov/pubmed/39419506 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60128 %T The Role of Visualization in Estimating Cardiovascular Disease Risk: Scoping Review %A Svenšek,Adrijana %A Lorber,Mateja %A Gosak,Lucija %A Verbert,Katrien %A Klemenc-Ketis,Zalika %A Stiglic,Gregor %+ Faculty of Health Sciences, University of Maribor, Žitna ulica 15, Maribor, 2000, Slovenia, 386 2 30 04 762, adrijana.svensek1@um.si %K cardiovascular disease prevention %K risk factors %K visual analytics %K visualization %K mobile phone %K PRISMA %D 2024 %7 14.10.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Supporting and understanding the health of patients with chronic diseases and cardiovascular disease (CVD) risk is often a major challenge. Health data are often used in providing feedback to patients, and visualization plays an important role in facilitating the interpretation and understanding of data and, thus, influencing patients’ behavior. Visual analytics enable efficient analysis and understanding of large datasets in real time. Digital health technologies can promote healthy lifestyle choices and assist in estimating CVD risk. Objective: This review aims to present the most-used visualization techniques to estimate CVD risk. Methods: In this scoping review, we followed the Joanna Briggs Institute PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search strategy involved searching databases, including PubMed, CINAHL Ultimate, MEDLINE, and Web of Science, and gray literature from Google Scholar. This review included English-language articles on digital health, mobile health, mobile apps, images, charts, and decision support systems for estimating CVD risk, as well as empirical studies, excluding irrelevant studies and commentaries, editorials, and systematic reviews. Results: We found 774 articles and screened them against the inclusion and exclusion criteria. The final scoping review included 17 studies that used different methodologies, including descriptive, quantitative, and population-based studies. Some prognostic models, such as the Framingham Risk Profile, World Health Organization and International Society of Hypertension risk prediction charts, Cardiovascular Risk Score, and a simplified Persian atherosclerotic CVD risk stratification, were simpler and did not require laboratory tests, whereas others, including the Joint British Societies recommendations on the prevention of CVD, Systematic Coronary Risk Evaluation, and Framingham-Registre Gironí del COR, were more complex and required laboratory testing–related results. The most frequently used prognostic risk factors were age, sex, and blood pressure (16/17, 94% of the studies); smoking status (14/17, 82%); diabetes status (11/17, 65%); family history (10/17, 59%); high-density lipoprotein and total cholesterol (9/17, 53%); and triglycerides and low-density lipoprotein cholesterol (6/17, 35%). The most frequently used visualization techniques in the studies were visual cues (10/17, 59%), followed by bar charts (5/17, 29%) and graphs (4/17, 24%). Conclusions: On the basis of the scoping review, we found that visualization is very rarely included in the prognostic models themselves even though technology-based interventions improve health care worker performance, knowledge, motivation, and compliance by integrating machine learning and visual analytics into applications to identify and respond to estimation of CVD risk. Visualization aids in understanding risk factors and disease outcomes, improving bioinformatics and biomedicine. However, evidence on mobile health’s effectiveness in improving CVD outcomes is limited. %M 39401079 %R 10.2196/60128 %U https://publichealth.jmir.org/2024/1/e60128 %U https://doi.org/10.2196/60128 %U http://www.ncbi.nlm.nih.gov/pubmed/39401079 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51321 %T The Influence of Physical Activity and Diet Mobile Apps on Cardiovascular Disease Risk Factors: Meta-Review %A Bushey,Erica %A Wu,Yin %A Wright,Alexander %A Pescatello,Linda %+ University of Connecticut, 2098 Hillside Rd, Storrs, CT, United States, 1 860 486 0008, erica.bushey@uconn.edu %K physical activity %K diet %K mobile applications %K obesity %K hypertension %K dyslipidemia %K diabetes %K mobile phone %D 2024 %7 9.10.2024 %9 Review %J J Med Internet Res %G English %X Background: The literature on whether physical activity (PA) and PA and diet (PA+Diet) mobile apps improve cardiovascular disease (CVD) risk factors is promising. Objective: The aim of this meta-review is to provide an evidence synthesis of systematic reviews and meta-analyses examining the influence of PA and PA+Diet apps on the major CVD risk factors. Methods: We systematically searched 5 databases until January 12, 2022. Included systematic reviews and meta-analyses (1) reported the CVD risk factor outcomes of BMI, waist circumference, body weight, blood pressure (BP), hemoglobin A1c (HbA1c), fasting blood glucose, blood lipids, or PA; (2) enrolled healthy participants ≥18 years who may or may not have the metabolic syndrome, diabetes mellitus, or preexisting CVD risk factors; (3) reviewed PA or PA+Diet app interventions integrating behavioral change techniques (BCT) to deliver their information; and (4) had a nonapp control. Results: In total, 17 reviews (9 systematic reviews and 8 meta-analyses) published between 2012 and 2021 qualified. Participants were middle-aged, mostly women ranging in number from 10 to 62,219. Interventions lasted from 1 to 24 months, with the most common behavioral strategies being personalized feedback (n=8), self-monitoring (n=7), and goal setting (n=5). Of the PA app systematic reviews (N=4), the following CVD risk factors improved: body weight and BMI (n=2, 50%), BP (n=1, 25%), HbA1c (n=1, 25%), and blood lipids (n=1, 25%) decreased, while PA (n=4, 100%) increased. Of the PA+Diet app systematic reviews (N=5), the following CVD risk factors improved: body weight and BMI (n=3, 60%), BP (n=1, 20%), and HbA1c (n=3, 60%) decreased, while PA (n=3, 60%) increased. Of the PA app meta-analyses (N=1), the following CVD risk factors improved: body weight decreased (–0.73 kg, 95% CI –1.45 to –0.01; P=.05) and PA increased by 25 minutes/week (95% CI 0.58-1.68; P<.001), while BMI (–0.09 kg/m2, 95% CI –0.29 to 0.10; P=.35) and waist circumference (–1.92 cm, 95% CI –3.94 to 0.09; P=.06) tended to decrease. Of the PA+Diet app meta-analyses (n=4), the following CVD risk factors improved: body weight (n=4, 100%; from –1.79 kg 95% CI –3.17 to –0.41; P=.01 to –2.80 kg 95% CI –4.54 to –1.06, P=.002), BMI (n=1, 25%; –0.64 kg/m2, 95% CI –1.09 to –0.18; P=.01), waist circumference (n=1, 25%; –2.46 cm, 95% CI –4.56 to –0.36; P=.02), systolic/diastolic BP (n=1, 25%; –4.22/–2.87 mm Hg, 95% CI –6.54 to –1.91/ –4.44 to –1.29; P<.01), and HbA1c (n=1, 25%; –0.43%, 95% CI –0.68 to –0.19; P<.001) decreased. Conclusions: PA and PA+Diet apps appear to be most consistent in improving PA and anthropometric measures with favorable but less consistent effects on other CVD risk factors. Future studies are needed that directly compare and better quantify the effects of PA and PA+Diet apps on CVD risk factors. Trial Registration: PROSPERO CRD42023392359; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392359 %M 39382958 %R 10.2196/51321 %U https://www.jmir.org/2024/1/e51321 %U https://doi.org/10.2196/51321 %U http://www.ncbi.nlm.nih.gov/pubmed/39382958 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56547 %T Feasibility of Monitoring Heart and Respiratory Rates Using Nonwearable Devices and Consistency of the Measured Parameters: Pilot Feasibility Study %A Ikuta,Kasumi %A Aishima,Miya %A Noguchi-Watanabe,Maiko %A Fukui,Sakiko %K heart rate %K older adults %K respiratory rate %K nonwearable devices %K vital signs %D 2024 %7 8.10.2024 %9 %J JMIR Hum Factors %G English %X Background: As Japan is the world’s fastest-aging society with a declining population, it is challenging to secure human resources for care providers. Therefore, the Japanese government is promoting digital transformation and the use of nursing care equipment, including nonwearable devices that monitor heart and respiratory rates. However, the feasibility of monitoring heart and respiratory rates with nonwearable devices and the consistency of the rates measured have not been reported. Objective: In this study, we focused on a sheet-type nonwearable device (Safety Sheep Sensor) introduced in many nursing homes. We evaluated the feasibility of monitoring heart rate (HR) and respiratory rate (RR) continuously using nonwearable devices and the consistency of the HR and RR measured. Methods: A sheet-type nonwearable device that measured HR and RR every minute through body vibrations was placed under the mattress of each participant. The participants in study 1 were healthy individuals aged 20‐60 years (n=21), while those in study 2 were older adults living in multidwelling houses and required nursing care (n=20). The HR was measured using standard methods by the nurse and using the wearable device (Silmee Bar-type Lite sensor), and RR was measured by the nurse. The primary outcome was the mean difference in HR and RR between nonwearable devices and standard methods. Results: The mean difference in HR was −0.32 (SD 3.12) in study 1 and 0.04 (SD: 3.98) in study 2; both the differences were within the predefined accepted discrepancies (<5 beats/min). The mean difference in RR was −0.98 (SD 3.01) in study 1 and −0.49 (SD 2.40) in study 2; both the differences were within the predefined accepted discrepancies (3 breaths/min). Conclusions: HR and RR measurements obtained using the nonwearable devices and the standard method were similar. Continuous monitoring of vital signs using nonwearable devices can aid in the early detection of abnormal conditions in older people. %R 10.2196/56547 %U https://humanfactors.jmir.org/2024/1/e56547 %U https://doi.org/10.2196/56547 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58316 %T Graded Intensity Aerobic Exercise to Improve Cerebrovascular Function and Performance in Older Veterans: Protocol for a Randomized Controlled Trial %A Bello,Medina Oneyi %A Mammino,Kevin Michael %A Vernon,Mark Anthony %A Wakeman,Daniel G %A Denmon,Chanse Aerius %A Krishnamurthy,Lisa Crystal %A Krishnamurthy,Venkatagiri %A McGregor,Keith Matthew %A Novak,Thomas Samuel %A Nocera,Joe Robert %+ Joseph Maxwell Cleland Atlanta Veteran Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA, 30033, United States, 1 404 321 6111 ext 207099, Medina.Bello@va.gov %K aerobic exercise %K exercise %K functional magnetic resonance imaging %K fMRI %K veterans %K quality of life %K sedentary lifestyle %K elderly %K geriatrics %K geriatric %K older adults %K cardiovascular disease %K health promotion %K aging %K cognitive %K cognitive health %K physical health %D 2024 %7 26.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Growing health care challenges resulting from a rapidly expanding aging population necessitate examining effective rehabilitation techniques that mitigate age-related comorbidity and improve quality of life. To date, exercise is one of a few proven interventions known to attenuate age-related declines in cognitive and sensorimotor functions critical to sustained independence. Objective: This work aims to implement a multimodal imaging approach to better understand the mechanistic underpinnings of the beneficial exercise-induced adaptations to sedentary older adults’ brains and behaviors. Due to the complex cerebral and vascular dynamics that encompass neuroplastic change with aging and exercise, we propose an imaging protocol that will model exercise-induced changes to cerebral perfusion, cerebral vascular reactivity (CVR), and cognitive and sensorimotor task-dependent functional magnetic resonance imaging (fMRI) after prescribed exercise. Methods: Sedentary older adults (aged 65-80 years) were randomly assigned to either a 12-week aerobic-based interval-based cycling intervention or a 12-week balance and stretching intervention. Assessments of cardiovascular fitness used the YMCA submaximal VO2 test, basal cerebral perfusion using arterial spin labeling (ASL), CVR using hypercapnic fMRI, and cortical activation using fMRI during verbal fluency and motor tapping tasks. A battery of cognitive-executive and motor function tasks outside the scanning environment will be performed before and after the interventions. Results: Our studies and others show that improved cardiovascular fitness in older adults results in improved outcomes related to physical and cognitive health as well as quality of life. A consistent but unexplained finding in many of these studies is a change in cortical activation patterns during task-based fMRI, which corresponds with improved task performance (cognitive-executive and motor). We hypothesize that the 12-week aerobic exercise intervention will increase basal perfusion and improve CVR through a greater magnitude of reactivity in brain areas susceptible to neural and vascular decline (inferior frontal and motor cortices) in previously sedentary older adults. To differentiate between neural and vascular adaptations in these regions, we will map changes in basal perfusion and CVR over the inferior frontal and the motor cortices—regions we have previously shown to be beneficially altered during fMRI BOLD (blood oxygen level dependent), such as verbal fluency and motor tapping, through improved cardiovascular fitness. Conclusions: Exercise is one of the most impactful interventions for improving physical and cognitive health in aging. This study aims to better understand the mechanistic underpinnings of improved health and function of the cerebrovascular system. If our hypothesis of improved perfusion and cerebrovascular reactivity following a 12-week aerobic exercise intervention is supported, it would add critically important insights into the potential of exercise to improve brain health in aging and could inform exercise prescription for older adults at risk for neurodegenerative disease brought on by cerebrovascular dysfunction. Trial Registration: ClinicalTrials.gov NCT05932069; https://clinicaltrials.gov/study/NCT05932069 International Registered Report Identifier (IRRID): DERR1-10.2196/58316 %M 39326042 %R 10.2196/58316 %U https://www.researchprotocols.org/2024/1/e58316 %U https://doi.org/10.2196/58316 %U http://www.ncbi.nlm.nih.gov/pubmed/39326042 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55261 %T Changes in 10-Year Predicted Cardiovascular Disease Risk for a Multiethnic Semirural Population in South East Asia: Prospective Study %A Johar,Hamimatunnisa %A Ang,Chiew Way %A Ismail,Roshidi %A Kassim,Zaid %A Su,Tin Tin %+ South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya, 47500, Malaysia, 60 55146000, TinTin.Su@monash.edu %K cardiovascular risk trajectory %K Framingham risk score %K population-based study %K low- and middle-income countries %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Cardiovascular disease (CVD) risk factors tend to cluster and interact multiplicatively and have been incorporated into risk equations such as the Framingham risk score, which can reasonably predict CVD over short- and long-term periods. Beyond risk factor levels at a single time point, recent evidence demonstrated that risk trajectories are differentially related to CVD risk. However, factors associated with suboptimal control or unstable CVD risk trajectories are not yet established. Objective: This study aims to examine factors associated with CVD risk trajectories in a semirural, multiethnic community-dwelling population. Methods: Data on demographic, socioeconomic, lifestyle, mental health, and cardiovascular factors were measured at baseline (2013) and during follow-up (2018) of the South East Asia Community Observatory cohort. The 10-year CVD risk change transition was computed. The trajectory patterns identified were improved; remained unchanged in low, moderate, or high CVD risk clusters; and worsened CVD risk trajectories. Multivariable regression analyses were used to examine the association between risk factors and changes in Framingham risk score and predicted CVD risk trajectory patterns with adjustments for concurrent risk factors. Results: Of the 6599 multiethnic community-dwelling individuals (n=3954, 59.92% female participants and n=2645, 40.08% male participants; mean age 55.3, SD 10.6 years), CVD risk increased over time in 33.37% (n=2202) of the sample population, while 24.38% (n=1609 remained in the high-risk trajectory pattern, which was reflected by the increased prevalence of all major CVD risk factors over the 5-year follow-up. Meanwhile, sex-specific prevalence data indicate that 21.44% (n=567) of male and 41.35% (n=1635) of female participants experienced an increase in CVD risk. However, a stark sex difference was observed in those remaining in the high CVD risk cluster, with 45.1% (n=1193) male participants and 10.52% (n=416) female participants. Regarding specific CVD risk factors, male participants exhibited a higher percentage increase in the prevalence of hypertension, antihypertensive medication use, smoking, and obesity, while female participants showed a higher prevalence of diabetes. Further regression analyses identified that Malay compared to Chinese (P<.001) and Indian (P=.04) ethnicity, nonmarried status (P<.001), full-time employment (P<.001), and depressive symptoms (P=.04) were all significantly associated with increased CVD risk scores. In addition, lower educational levels and frequently having meals from outside were significantly associated to higher odds of both worsening and remaining in high CVD risk trajectories. Conclusions: Sociodemographics and mental health were found to be differently associated with CVD risk trajectories, warranting future research to disentangle the role of psychosocial disparities in CVD. Our findings carry public health implications, suggesting that the rise in major risk factors along with psychosocial disparities could potentially elevate CVD risk among individuals in underserved settings. More prevention efforts that continuously monitor CVD risk and consider changes in risk factors among vulnerable populations should be emphasized. %M 39326046 %R 10.2196/55261 %U https://publichealth.jmir.org/2024/1/e55261 %U https://doi.org/10.2196/55261 %U http://www.ncbi.nlm.nih.gov/pubmed/39326046 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54909 %T Developing a Youth-Led Digital Hypertension Education Intervention for Adults With Hypertension: Qualitative Study on Refinement and Acceptability %A Heinert,Sara W %A Guzman-Baez,Kelvin %A Aamir,Affan %A Penugonda,Ananya %A Crabtree,Benjamin F %A Greene,Kathryn %A Heckman,Carolyn J %A Levy,Phillip %A Strickland,Pamela Ohman %A Hudson,Shawna V %+ Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, One Robert Wood Johnson Place, New Brunswick, NJ, 08901, United States, 1 732 235 7872, sara.heinert@rutgers.edu %K hypertension %K adolescents %K adults %K emergency department %K digital health intervention %K dyad intervention %K intervention development %K qualitative research %K youth %K adolescent %K teen %K teens %K teenager %K teenagers %K adult %K youth-led %K digital health %K health education %K refinement %K acceptability %K USA %K United States %K care navigation %K effectiveness %K formative study %K prototype %K self-guided %K online module %K online modules %K engagement %K blood pressure %K health knowledge %K health promotion %K nutrition education %K support intervention %K support %K supports %D 2024 %7 6.9.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Hypertension affects one-third of adults in the United States and is the leading risk factor for death. Underserved populations are seen disproportionately in the emergency department (ED) and tend to have worse blood pressure (BP) control. For adults, a lack of hypertension knowledge is a common barrier to hypertension control, while social support is a strong facilitator, and providing information that is culturally sensitive and relevant is especially important in this context. The youth experience increased confidence when given the responsibility to provide health education and care navigation to others. As such, we planned a randomized controlled trial (RCT) for the effectiveness of a digital youth-led hypertension education intervention for adult patients in the ED with hypertension, focusing on change in BP and hypertension knowledge. Objective: In preparation for an RCT, we conducted a formative study to determine acceptable and easily comprehensible ways to present hypertension information to adults with hypertension and optimal ways to engage youth to support adults on how to achieve better hypertension control. Methods: After creating an intervention prototype with 6 weekly self-guided hypertension online modules, we recruited 12 youth (adolescents, aged 15-18 years) for 3 focus groups and 10 adult ED patients with hypertension for individual online interviews to garner feedback on the prototype. After completing a brief questionnaire, participants were asked about experiences with hypertension, preferences for a hypertension education intervention, and acceptability, feasibility, obstacles, and solutions for intervention implementation with youth and adults. The moderator described and showed participants the prototyped intervention process and materials and asked for feedback. Questionnaire data were descriptively summarized, and qualitative data were analyzed using the template organizing style of analysis by 3 study team members. Results: Participants showed great interest in the intervention prototype, thought their peers would find it acceptable, and appreciated its involvement of youth. Youth with family members with hypertension reported that their family members need more support for their hypertension. Youth suggested adding more nutrition education activities to the intervention, such as a sodium tracker and examples of high-sodium foods. Adults discussed the need for a hypertension support intervention for themselves and the expected benefits to youth. They mentioned the overwhelming amount of hypertension information available and appreciated the intervention’s concise content presentation. They suggested adding more mental health and smoking cessation resources, information about specific hypertension medications, and adding active links for health care information. Conclusions: Based on focus groups and interviews with participants, a youth-led digital hypertension intervention is an acceptable strategy to engage both adults with hypertension and youth. Incorporating participant suggestions into the intervention may improve its clarity, engagement, and impact when used in a subsequent RCT. %M 39240662 %R 10.2196/54909 %U https://formative.jmir.org/2024/1/e54909 %U https://doi.org/10.2196/54909 %U http://www.ncbi.nlm.nih.gov/pubmed/39240662 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54509 %T Reliability Issues of Mobile Nutrition Apps for Cardiovascular Disease Prevention: Comparative Study %A Ho,Dang Khanh Ngan %A Chiu,Wan-Chun %A Kao,Jing-Wen %A Tseng,Hsiang-Tung %A Lin,Cheng-Yu %A Huang,Pin-Hsiang %A Fang,Yu-Ren %A Chen,Kuei-Hung %A Su,Ting-Ying %A Yang,Chia-Hui %A Yao,Chih-Yuan %A Su,Hsiu-Yueh %A Wei,Pin-Hui %A Chang,Jung-Su %K mobile apps %K mHealth %K dietary assessment %K validity %K cardiovascular disease prevention %K app %K apps %K applications %K application %K nutrition %K cardiovascular %K nutrients %K fitness %K diet %K mobile health %D 2024 %7 4.9.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Controlling saturated fat and cholesterol intake is important for the prevention of cardiovascular diseases. Although the use of mobile diet-tracking apps has been increasing, the reliability of nutrition apps in tracking saturated fats and cholesterol across different nations remains underexplored. Objective: This study aimed to examine the reliability and consistency of nutrition apps focusing on saturated fat and cholesterol intake across different national contexts. The study focused on 3 key concerns: data omission, inconsistency (variability) of saturated fat and cholesterol values within an app, and the reliability of commercial apps across different national contexts. Methods: Nutrient data from 4 consumer-grade apps (COFIT, MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!) and an academic app (Formosa FoodApp) were compared against 2 national reference databases (US Department of Agriculture [USDA]–Food and Nutrient Database for Dietary Studies [FNDDS] and Taiwan Food Composition Database [FCD]). Percentages of missing nutrients were recorded, and coefficients of variation were used to compute data inconsistencies. One-way ANOVAs were used to examine differences among apps, and paired 2-tailed t tests were used to compare the apps to national reference data. The reliability across different national contexts was investigated by comparing the Chinese and English versions of MyFitnessPal with the USDA-FNDDS and Taiwan FCD. Results: Across the 5 apps, 836 food codes from 42 items were analyzed. Four apps, including COFIT, MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!, significantly underestimated saturated fats, with errors ranging from −13.8% to −40.3% (all P<.05). All apps underestimated cholesterol, with errors ranging from −26.3% to −60.3% (all P<.05). COFIT omitted 47% of saturated fat data, and MyFitnessPal-Chinese missed 62% of cholesterol data. The coefficients of variation of beef, chicken, and seafood ranged from 78% to 145%, from 74% to 112%, and from 97% to 124% across MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!, respectively, indicating a high variability in saturated fats across different food groups. Similarly, cholesterol variability was consistently high in dairy (71%-118%) and prepackaged foods (84%-118%) across all selected apps. When examining the reliability of MyFitnessPal across different national contexts, errors in MyFitnessPal were consistent across different national FCDs (USDA-FNDSS and Taiwan FCD). Regardless of the FCDs used as a reference, these errors persisted to be statistically significant, indicating that the app’s core database is the source of the problems rather than just mismatches or variances in external FCDs. Conclusions: The findings reveal substantial inaccuracies and inconsistencies in diet-tracking apps’ reporting of saturated fats and cholesterol. These issues raise concerns for the effectiveness of using consumer-grade nutrition apps in cardiovascular disease prevention across different national contexts and within the apps themselves. %R 10.2196/54509 %U https://mhealth.jmir.org/2024/1/e54509 %U https://doi.org/10.2196/54509 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57920 %T Gender Disparities in the Association Between Educational Attainment and Cardiovascular-Kidney-Metabolic Syndrome: Cross-Sectional Study %A Ding,Yi %A Wu,Xianglin %A Cao,Qiuyu %A Huang,Jiaojiao %A Xu,Xiaoli %A Jiang,Youjin %A Huo,Yanan %A Wan,Qin %A Qin,Yingfen %A Hu,Ruying %A Shi,Lixin %A Su,Qing %A Yu,Xuefeng %A Yan,Li %A Qin,Guijun %A Tang,Xulei %A Chen,Gang %A Xu,Min %A Wang,Tiange %A Zhao,Zhiyun %A Gao,Zhengnan %A Wang,Guixia %A Shen,Feixia %A Luo,Zuojie %A Chen,Li %A Li,Qiang %A Ye,Zhen %A Zhang,Yinfei %A Liu,Chao %A Wang,Youmin %A Yang,Tao %A Deng,Huacong %A Chen,Lulu %A Zeng,Tianshu %A Zhao,Jiajun %A Mu,Yiming %A Wu,Shengli %A Chen,Yuhong %A Lu,Jieli %A Wang,Weiqing %A Ning,Guang %A Xu,Yu %A Bi,Yufang %A Li,Mian %K cardiovascular-kidney-metabolic syndrome %K education %K health behavior %K sex difference %K cross-sectional study %K gender %D 2024 %7 23.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Cardiovascular-kidney-metabolic (CKM) health is affected by social determinants of health, especially education. CKM syndrome has not been evaluated in Chinese population, and the association of education with CKM syndrome in different sexes and its intertwined relation with lifestyles have not been explored. Objective: We aimed to explore the association between educational attainment and the prevalence of CKM syndrome stages in middle-aged and older Chinese men and women as well as the potential role of health behavior based on Life’s Essential 8 construct. Methods: This study used data from the nationwide, community-based REACTION (Risk Evaluation of Cancers in Chinese diabetic individuals: a longitudinal study). A total of 132,085 participants with complete information to determine CKM syndrome stage and education level were included. Educational attainment was assessed by the self-reported highest educational level achieved by the participants and recategorized as low (elementary school or no formal education) or high (middle school, high school, technical school/college, or above). CKM syndrome was ascertained and classified into 5 stages according to the American Heart Association presidential advisory released in 2023. Results: Among 132,085 participants (mean age 56.95, SD 9.19 years; n=86,675, 65.62% women) included, most had moderate-risk CKM syndrome (stages 1 and 2), and a lower proportion were at higher risk of CKM (stages 3 and 4). Along the CKM continuum, low education was associated with 34% increased odds of moderate-risk CKM syndrome for women (odds ratio 1.36, 95% CI 1.23-1.49) with a significant sex disparity, but was positively correlated with high-risk CKM for both sexes. The association between low education and high-risk CKM was more evident in women with poor health behavior but not in men, which was also interactive with and partly mediated by behavior. Conclusions: Low education was associated with adverse CKM health for both sexes but was especially detrimental to women. Such sex-specific educational disparity was closely correlated with health behavior but could not be completely attenuated by behavior modification. These findings highlight the disadvantage faced by women in CKM health ascribed to low education, underscoring the need for public health support to address this inequality. %R 10.2196/57920 %U https://publichealth.jmir.org/2024/1/e57920 %U https://doi.org/10.2196/57920 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56380 %T Exploring the Feasibility and Initial Impact of an mHealth-Based Disease Management Program for Chronic Ischemic Heart Disease: Formative Study %A Miki,Takahiro %A Yamada,Junya %A Ishida,Shinpei %A Sakui,Daisuke %A Kanai,Masashi %A Hagiwara,Yuta %+ PREVENT Inc, 1 Aoi, Higashi-ku, IKKO Shinsakae Building 9F, Aichi, 461-0004, Japan, 81 8092149725, miki.takahiro@prevent.co.jp %K mobile health %K chronic ischemic heart disease %K disease management program %K mobile phone %K behavior change %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide, requiring innovative management strategies. Traditional disease management programs often struggle to maintain patient engagement and ensure long-term adherence to lifestyle modifications and treatment plans. Mobile health (mHealth) technologies have emerged as a promising approach to address these challenges by providing continuous, personalized support and monitoring. However, the reported use and effectiveness of mHealth in the management of chronic diseases, such as IHD, have not been fully explored. Objective: The primary aim of this study was to evaluate the feasibility and initial impact of an mHealth-based disease management program on coronary risk factors, specifically focusing on low-density lipoprotein cholesterol (LDL-C) levels, in individuals with chronic IHD. This formative study assessed changes in LDL-C and other metabolic health indicators over a 6-month period to determine the initial impact of the program on promoting cardiovascular health and lifestyle modification. Methods: This study was conducted using data from 266 individuals enrolled in an mHealth-based disease management program between December 2018 and October 2022. Eligibility was based on a documented history of IHD, with participants undergoing a comprehensive cardiac risk assessment before enrollment. The program included biweekly telephone sessions, health tracking via a smartphone app, and regular progress reports to physicians. The study measured change in LDL-C levels as the primary outcome, with secondary outcomes including body weight, triglyceride levels, and other metabolic health indicators. Statistical analysis used paired 2-tailed t tests and stratified analyses to assess the impact of the program. Results: Participants experienced a significant reduction in LDL-C, with LDL-C levels decreasing from a mean of 98.82 (SD 40.92) mg/dL to 86.62 (SD 39.86) mg/dL (P<.001). The intervention was particularly effective in individuals with high baseline LDL-C levels. Additional improvements were seen in body weight and triglyceride levels, suggesting a broader impact on metabolic health. Program adherence and engagement metrics suggested high participant satisfaction and compliance. Conclusions: The results of this study suggest that the mHealth-based disease management program is feasible and has an initial positive impact on reducing LDL-C levels and improving metabolic health in individuals with chronic IHD. However, the study design does not allow for a definitive conclusion regarding whether mHealth-based disease management programs are more effective than traditional face-to-face care. Future studies are needed to further validate these findings and to examine the comparative effectiveness of these interventions in more detail. %M 39173150 %R 10.2196/56380 %U https://formative.jmir.org/2024/1/e56380 %U https://doi.org/10.2196/56380 %U http://www.ncbi.nlm.nih.gov/pubmed/39173150 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57351 %T Perceptions of HIV-Related Comorbidities and Usability of a Virtual Environment for Cardiovascular Disease Prevention Education in Sexual Minority Men With HIV: Formative Phases of a Pilot Randomized Controlled Trial %A Ramos,S Raquel %A Reynolds,Harmony %A Johnson,Constance %A Melkus,Gail %A Kershaw,Trace %A Thayer,Julian F %A Vorderstrasse,Allison %+ School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, United States, 1 2037372339, raquel.ramos@yale.edu %K virtual environment %K digital health %K gamification %K eHealth %K sexual minorities %K cardiovascular disease %K HIV %K cardiometabolic risk %K mental health %K lesbian, gay, bisexual, transgender, and queer %K LGBTQ health %K HIV care %K prevention %K virtual %K minority %K men %K Latin %K Black %K men who have sex with men %K intervention %K high blood pressure %K myocardial infarction %K preventive health screenings %K gay %K bisexual %K patients %K cancer %D 2024 %7 22.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual minority men with HIV are at an increased risk of cardiovascular disease (CVD) and have been underrepresented in behavioral research and clinical trials. Objective: This study aims to explore perceptions of HIV-related comorbidities and assess the interest in and usability of a virtual environment for CVD prevention education in Black and Latinx sexual minority men with HIV. Methods: This is a 3-phase pilot behavioral randomized controlled trial. We report on formative phases 1 and 2 that informed virtual environment content and features using qualitative interviews, usability testing, and beta testing with a total of 25 individuals. In phase 1, a total of 15 participants completed interviews exploring HIV-related illnesses of concern that would be used to tailor the virtual environment. In phase 2, usability testing and beta testing were conducted with 10 participants to assess interest, features, and content. Results: In phase 1, we found that CVD risk factors included high blood pressure, myocardial infarction, stroke, and diabetes. Cancer (prostate, colon, and others) was a common concern, as were mental health conditions. In phase 2, all participants completed the 12-item usability checklist with favorable feedback within 30 to 60 minutes. Beta-testing interviews suggested (1) mixed perceptions of health and HIV, (2) high risk for comorbid conditions, (3) virtual environment features were promising, and (4) the need for diverse avatar representations. Conclusions: We identified several comorbid conditions of concern, and findings carry significant implications for mitigating barriers to preventive health screenings, given the shared risk factors between HIV and related comorbidities. Highly rated aspects of the virtual environment were anonymity; meeting others with HIV who identify as gay or bisexual; validating lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) images and content; and accessibility to CVD prevention education. Critical end-user feedback from beta testing suggested more options for avatar customization in skin, hair, and body representation. Our next phase will test the virtual environment as a new approach to advancing cardiovascular health equity in ethnic and racial sexual minority men with HIV. Trial Registration: ClinicalTrials.gov NCT04061915; https://clinicaltrials.gov/study/NCT05242952 International Registered Report Identifier (IRRID): RR2-10.2196/38348 %M 38924481 %R 10.2196/57351 %U https://www.jmir.org/2024/1/e57351 %U https://doi.org/10.2196/57351 %U http://www.ncbi.nlm.nih.gov/pubmed/38924481 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54604 %T Multicomponent Support Program for Secondary Prevention of Stroke Using Digital Health Technology: Co-Design Study With People Living With Stroke or Transient Ischemic Attack %A Silvera-Tawil,David %A Cameron,Jan %A Li,Jane %A Varnfield,Marlien %A Allan,Liam P %A Harris,Mitch %A Lannin,Natasha A %A Redd,Christian %A Cadilhac,Dominique A %+ Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, 158-164 Hawkesbury Road, Westmead, Sydney, 2145, Australia, 61 2 9372 4282, david.silvera@csiro.au %K mobile app %K stroke %K transient ischemic attack %K health service delivery %K mobile health %K mHealth %K mobile phone %D 2024 %7 22.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Few individuals (<2%) who experience a stroke or transient ischemic attack (TIA) participate in secondary prevention lifestyle programs. Novel approaches that leverage digital health technology may provide a viable alternative to traditional interventions that support secondary prevention in people living with stroke or TIA. To be successful, these strategies should focus on user needs and preferences and be acceptable to clinicians and people living with stroke or TIA. Objective: This study aims to co-design, with people with lived experience of stroke or TIA (referred to as consumers) and clinicians, a multicomponent digital technology support program for secondary prevention of stroke. Methods: A consumer user needs survey (108 items) was distributed through the Australian Stroke Clinical Registry and the Stroke Association of Victoria. An invitation to a user needs survey (135 items) for clinicians was circulated via web-based professional forums and national organizations (eg, the Stroke Telehealth Community of Practice Microsoft Teams Channel) and the authors’ research networks using Twitter (subsequently rebranded X, X Corp) and LinkedIn (LinkedIn Corp). Following the surveys, 2 rounds of user experience workshops (design and usability testing workshops) were completed with representatives from each end user group (consumers and clinicians). Feedback gathered after each round informed the final design of the digital health program. Results: Overall, 112 consumers (male individuals: n=63, 56.3%) and 54 clinicians (female individuals: n=43, 80%) responded to the survey; all items were completed by 75.8% (n=85) of consumers and 78% (n=42) of clinicians. Most clinicians (46/49, 94%) indicated the importance of monitoring health and lifestyle measures more frequently than current practice, particularly physical activity, weight, and sleep. Most consumers (87/96, 90%) and clinicians (41/49, 84%) agreed that providing alerts about potential deterioration in an individual’s condition were important functions for a digital program. Intention to use a digital program for stroke prevention and discussing the data collected during face-to-face consultations was high (consumers: 79/99, 80%; clinicians 36/42, 86%). In addition, 7 consumers (male individuals: n=5, 71%) and 9 clinicians (female individuals: n=6, 67%) took part in the user experience workshops. Participants endorsed using a digital health program to help consumers manage stroke or TIA and discussed preferred functions and health measures in a digital solution for secondary prevention of stroke. They also noted the need for a mobile app that is easy to use. Clinician feedback highlighted the need for a customizable clinician portal that captures individual consumer goals. Conclusions: Following an iterative co-design process, supported by evidence from user needs surveys and user experience workshops, a consumer-facing app that integrates wearable activity trackers and a clinician web portal were designed and developed to support secondary prevention of stroke. Feasibility testing is currently in progress to assess acceptability and use. %M 39172512 %R 10.2196/54604 %U https://www.jmir.org/2024/1/e54604 %U https://doi.org/10.2196/54604 %U http://www.ncbi.nlm.nih.gov/pubmed/39172512 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54318 %T Dose-Response Relationship Between Physical Activity and the Morbidity and Mortality of Cardiovascular Disease Among Individuals With Diabetes: Meta-Analysis of Prospective Cohort Studies %A Chen,Yang %A Jin,Xingsheng %A Chen,Guochong %A Wang,Ru %A Tian,Haili %+ School of Exercise and Health, Shanghai University of Sport, Yangpu District Qingyuan Huan Road 650, Shanghai, 200438, China, 86 13512281696, tianhaili123@163.com %K cardiovascular risk %K diabetics %K exercise %K dose-response association %K meta-analysis %K physical activity %K diabetes %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Diabetes, a chronic condition affecting various organs, is frequently associated with abnormal lipid metabolism, notably increased cholesterol and triglyceride levels. These lipid abnormalities are closely linked to the development and advancement of cardiovascular disease (CVD). Although regular physical activity (PA) has consistently shown benefits in reducing CVD risk in the general population, its precise influence on CVD risk among patients with diabetes remains uncertain, particularly regarding dose-response relationships. Objective: This study aimed to summarize the evidence from prospective studies on the association between PA and CVD morbidity and mortality in individuals with diabetes and explore the optimal levels for public health recommendation. Methods: We systematically reviewed prospective cohort studies in PubMed, Embase, and Web of Science up to December 2022, with inclusion criteria specifying the studies published in English and included adult participants diagnosed with diabetes. A random effects model was used to pool the relative risk (RR) with the corresponding 95% CI comparing the highest with the lowest PA categories in each study for qualitative evaluation. In addition, linear and spline regression analyses were used to estimate dose-response associations. Results: The meta-analysis included 12 prospective cohort studies, involving a total of 109,820 participants with diabetes. The combined results revealed that higher levels of PA were associated with a reduced risk of CVD. The RR of CVD for the highest compared with the lowest PA category was 0.62 (95% CI 0.51-0.73). In addition, there were 4 studies describing leisure-time PA, and the pooled RR was 0.68 (95% CI 0.52-0.83) for the highest versus the lowest activity. The linear regression model revealed that each 10 MET (metabolic equivalent of task)-hours per week of incrementally higher PA was associated with a 19% (95% CI 11.6-25.7) and a 6.9% (95% CI 4.5-9.3) reduction in CVD morbidity and mortality. Additionally, spline regression curves showed nonlinear relationships between PA levels and the risk of CVD and CVD mortality (both Pnonlinearity<.001), with a limited reduction in CVD risk and some further reduction in CVD mortality above 20 MET-hours per week of PA levels. Conclusions: For patients with diabetes, especially type 2 diabetes, there was a dose-response relationship between increased PA and reduced risk of CVD morbidity and mortality. The observed PA threshold is consistent with the recommended level for the general population. Gradually moving from inactivity to a guideline-recommended PA level could therefore significantly reduce the burden of CVD in patients with diabetes. %M 38780218 %R 10.2196/54318 %U https://publichealth.jmir.org/2024/1/e54318 %U https://doi.org/10.2196/54318 %U http://www.ncbi.nlm.nih.gov/pubmed/38780218 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e57241 %T Contactless and Calibration-Free Blood Pressure and Pulse Rate Monitor for Screening and Monitoring of Hypertension: Cross-Sectional Validation Study %A Kapoor,Melissa %A Holman,Blair %A Cohen,Carolyn %+ Mind over Matter Medtech Ltd, Kemp House, 160 City Road, London, EC1V 2NX, United Kingdom, 44 07881 927063, melissa@mind-medtech.com %K remote photoplethysmography %K vital signs %K calibration-free blood pressure monitor %K medical device %K hypertension screening %K home blood pressure monitoring %K vital %K vitals %K device %K devices %K hypertension %K hypertensive %K cardiovascular %K cardiology %K heart %K blood pressure %K monitoring %K monitor %K mHealth %K mobile health %K validation %D 2024 %7 5.8.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: The key to reducing the immense morbidity and mortality burdens of cardiovascular diseases is to help people keep their blood pressure (BP) at safe levels. This requires that more people with hypertension be identified, diagnosed, and given tools to lower their BP. BP monitors are critical to hypertension diagnosis and management. However, there are characteristics of conventional BP monitors (oscillometric cuff sphygmomanometers) that hinder rapid and effective hypertension diagnosis and management. Calibration-free, software-only BP monitors that operate on ubiquitous mobile devices can enable on-demand BP monitoring, overcoming the hardware barriers of conventional BP monitors. Objective: This study aims to investigate the accuracy of a contactless BP monitor software app for classifying the full range of clinically relevant BPs as hypertensive or nonhypertensive and to evaluate its accuracy for measuring the pulse rate (PR) and BP of people with BPs relevant to stage-1 hypertension. Methods: The software app, known commercially as Lifelight, was investigated following the data collection and data analysis methodology outlined in International Organization for Standardization (ISO) 81060-2:2018/AMD 1:2020 “Non-invasive Sphygmomanometers—Part 2: Clinical investigation of automated measurement type.” This validation study was conducted by the independent laboratory Element Materials Technology Boulder (formerly Clinimark). The study generated data from 85 people aged 18-85 years with a wide-ranging distribution of BPs specified in ISO 81060-2:2018/AMD 1:2020. At least 20% were required to have Fitzpatrick scale skin tones of 5 or 6 (ie, dark skin tones). The accuracy of the app’s BP measurements was assessed by comparing its BP measurements with measurements made by dual-observer manual auscultation using the same-arm sequential method specified in ISO 81060-2:2018/AMD 1:2020. The accuracy of the app’s PR measurements was assessed by comparing its measurements with concurrent electroencephalography-derived heart rate values. Results: The app measured PR with an accuracy root-mean-square of 1.3 beats per minute and mean absolute error of 1.1 (SD 0.8) beats per minute. The sensitivity and specificity with which it determined that BPs exceeded the in-clinic systolic threshold for hypertension diagnosis were 70.1% and 71.7%, respectively. These rates are consistent with those reported for conventional BP monitors in a literature review by The National Institute for Health and Care Excellence. The app’s mean error for measuring BP in the range of normotension and stage-1 hypertension (ie, 65/85, 76% of participants) was 6.5 (SD 12.9) mm Hg for systolic BP and 0.4 (SD 10.6) mm Hg for diastolic BP. Mean absolute error was 11.3 (SD 10.0) mm Hg and 8.6 (SD 6.8) mm Hg, respectively. Conclusions: A calibration-free, software-only medical device was independently tested against ISO 81060-2:2018/AMD 1:2020. The safety and performance demonstrated in this study suggest that this technique could be a potential solution for rapid and scalable screening and management of hypertension. %M 39102277 %R 10.2196/57241 %U https://cardio.jmir.org/2024/1/e57241 %U https://doi.org/10.2196/57241 %U http://www.ncbi.nlm.nih.gov/pubmed/39102277 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47645 %T Pitfalls in Developing Machine Learning Models for Predicting Cardiovascular Diseases: Challenge and Solutions %A Cai,Yu-Qing %A Gong,Da-Xin %A Tang,Li-Ying %A Cai,Yue %A Li,Hui-Jun %A Jing,Tian-Ci %A Gong,Mengchun %A Hu,Wei %A Zhang,Zhen-Wei %A Zhang,Xingang %A Zhang,Guang-Wei %+ Smart Hospital Management Department, The First Hospital of China Medical University, , Shenyang, , China, 86 24 88283350, gwzhang@cmu.edu.cn %K cardiovascular diseases %K risk prediction models %K machine learning %K problem %K solution %D 2024 %7 26.7.2024 %9 Viewpoint %J J Med Internet Res %G English %X In recent years, there has been explosive development in artificial intelligence (AI), which has been widely applied in the health care field. As a typical AI technology, machine learning models have emerged with great potential in predicting cardiovascular diseases by leveraging large amounts of medical data for training and optimization, which are expected to play a crucial role in reducing the incidence and mortality rates of cardiovascular diseases. Although the field has become a research hot spot, there are still many pitfalls that researchers need to pay close attention to. These pitfalls may affect the predictive performance, credibility, reliability, and reproducibility of the studied models, ultimately reducing the value of the research and affecting the prospects for clinical application. Therefore, identifying and avoiding these pitfalls is a crucial task before implementing the research. However, there is currently a lack of a comprehensive summary on this topic. This viewpoint aims to analyze the existing problems in terms of data quality, data set characteristics, model design, and statistical methods, as well as clinical implications, and provide possible solutions to these problems, such as gathering objective data, improving training, repeating measurements, increasing sample size, preventing overfitting using statistical methods, using specific AI algorithms to address targeted issues, standardizing outcomes and evaluation criteria, and enhancing fairness and replicability, with the goal of offering reference and assistance to researchers, algorithm developers, policy makers, and clinical practitioners. %M 38869157 %R 10.2196/47645 %U https://www.jmir.org/2024/1/e47645 %U https://doi.org/10.2196/47645 %U http://www.ncbi.nlm.nih.gov/pubmed/38869157 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49530 %T Rest-Activity Rhythm Differences in Acute Rehabilitation Between Poststroke Patients and Non–Brain Disease Controls: Comparative Study %A Liang,Huey-Wen %A Wu,Chueh-Hung %A Lin,Chen %A Chang,Hsiang-Chih %A Lin,Yu-Hsuan %A Chen,Shao-Yu %A Hsu,Wei-Chen %+ Institute of Population Health Sciences, National Health Research Institutes, No 35 Keyan Road, Miaoli County, 35053, Taiwan, 886 37 206166 ext 36383, yuhsuanlin@nhri.edu.tw %K circadian rhythms %K stroke rehabilitation, rest-activity rhythms, relative amplitude, delirium screening, interdaily stability %D 2024 %7 4.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Circadian rhythm disruptions are a common concern for poststroke patients undergoing rehabilitation and might negatively impact their functional outcomes. Objective: Our research aimed to uncover unique patterns and disruptions specific to poststroke rehabilitation patients and identify potential differences in specific rest-activity rhythm indicators when compared to inpatient controls with non–brain-related lesions, such as patients with spinal cord injuries. Methods: We obtained a 7-day recording with a wearable actigraphy device from 25 poststroke patients (n=9, 36% women; median age 56, IQR 46-71) and 25 age- and gender-matched inpatient control participants (n=15, 60% women; median age 57, IQR 46.5-68.5). To assess circadian rhythm, we used a nonparametric method to calculate key rest-activity rhythm indicators—relative amplitude, interdaily stability, and intradaily variability. Relative amplitude, quantifying rest-activity rhythm amplitude while considering daily variations and unbalanced amplitudes, was calculated as the ratio of the difference between the most active 10 continuous hours and the least active 5 continuous hours to the sum of these 10 and 5 continuous hours. We also examined the clinical correlations between rest-activity rhythm indicators and delirium screening tools, such as the 4 A’s Test and the Barthel Index, which assess delirium and activities of daily living. Results: Patients who had a stroke had higher least active 5-hour values compared to the control group (median 4.29, IQR 2.88-6.49 vs median 1.84, IQR 0.67-4.34; P=.008). The most active 10-hour values showed no significant differences between the groups (stroke group: median 38.92, IQR 14.60-40.87; control group: median 31.18, IQR 18.02-46.84; P=.93). The stroke group presented a lower relative amplitude compared to the control group (median 0.74, IQR 0.57-0.85 vs median 0.88, IQR 0.71-0.96; P=.009). Further analysis revealed no significant differences in other rest-activity rhythm metrics between the two groups. Among the patients who had a stroke, a negative correlation was observed between the 4 A’s Test scores and relative amplitude (ρ=–0.41; P=.045). Across all participants, positive correlations emerged between the Barthel Index scores and both interdaily stability (ρ=0.34; P=.02) and the most active 10-hour value (ρ=0.42; P=.002). Conclusions: This study highlights the relevance of circadian rhythm disruptions in poststroke rehabilitation and provides insights into potential diagnostic and prognostic implications for rest-activity rhythm indicators as digital biomarkers. %M 38963936 %R 10.2196/49530 %U https://www.jmir.org/2024/1/e49530 %U https://doi.org/10.2196/49530 %U http://www.ncbi.nlm.nih.gov/pubmed/38963936 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53517 %T Effects of Lifestyle Interventions on Cardiovascular Disease Risk and Risk Factors Among Individuals at High Risk for Type 2 Diabetes: Protocol for a Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Demissie,Getu Debalkie %A Birungi,Josephine %A Haregu,Tilahun %A Thirunavukkarasu,Sathish %A Oldenburg,Brian %+ School of Psychology and Public Health, La Trobe University, Plenty Road & Kingsbury Drive, Bundoora VIC, Melbourne, 3086, Australia, 61 0410 689 847, 21377861@students.latrobe.edu.au %K diabetes %K prediabetes %K cardiovascular disease %K CVD %K CVD risk %K CVD risk factors %K lifestyle interventions %K systematic review %K meta-analysis %D 2024 %7 27.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals at high risk for type 2 diabetes are also at an increased risk for developing cardiovascular disease (CVD). Although there are separate trials examining the effects of lifestyle interventions on absolute CVD risk among people at high risk for type 2 diabetes, a comprehensive evidence synthesis of these trials is lacking. Objective: We will systematically synthesize the evidence on the effects of lifestyle interventions in reducing absolute CVD risk and CVD risk factors among people at high risk for type 2 diabetes. Methods: We adhered to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) statement in reporting the details of this protocol. Randomized controlled trials of diabetes prevention that examined the effects of lifestyle interventions for at least 6 months on absolute CVD risk and CVD risk factors among individuals at high risk for type 2 diabetes will be eligible. We will systematically search the MEDLINE, Embase, PsycINFO, CENTRAL, and Scopus databases and ClinicalTrials.gov using a mix of Medical Subject Headings and text words. Two authors will independently screen the abstract and title of the articles retrieved from the search, followed by full-text reviews using the inclusion and exclusion criteria and data extraction from the eligible studies. Article screening and data extraction will be performed in the Covidence software. The primary outcome will be the changes in absolute 10-year CVD risk, as estimated by risk prediction models. The secondary outcomes are the changes in CVD risk factors, including behavioral, clinical, biochemical, and psychosocial risk factors, and incidence of type 2 diabetes. Results: An initial database search was conducted in July 2023. After screening 1935 articles identified through the database search, 42 articles were considered eligible for inclusion. It is anticipated that the study findings will be submitted for publication in a peer-reviewed journal by the end of 2024. Conclusions: This study will provide up-to-date, systematically synthesized evidence on the effects of lifestyle interventions on absolute CVD risk and CVD risk factors among individuals at high risk for type 2 diabetes. Trial Registration: PROSPERO CRD42023429869; https://tinyurl.com/59ajy7rw International Registered Report Identifier (IRRID): DERR1-10.2196/53517 %M 38935416 %R 10.2196/53517 %U https://www.researchprotocols.org/2024/1/e53517 %U https://doi.org/10.2196/53517 %U http://www.ncbi.nlm.nih.gov/pubmed/38935416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51094 %T Mediterranean Diet Information on TikTok and Implications for Digital Health Promotion Research: Social Media Content Analysis %A Raber,Margaret %A Allen,Haley %A Huang,Sophia %A Vazquez,Maria %A Warner,Echo %A Thompson,Debbe %+ Department of Health Disparities Research, MD Anderson Cancer Center, 1400 Pressler Street Dr., Houston, TX, 77030, United States, 1 713 702 4801, mpraber@mdanderson.org %K misinformation %K social media %K Mediterranean Diet %K content analysis %K health communication %K communication %K TikTok %K diet %K cardiometabolic disease %K cardiometabolic %K consumer %K eating %K social media %K quality %K mHealth %K mobile health %K digital health %K promotion research %K nutrition therapy %K healthy diet %D 2024 %7 19.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Mediterranean diet has been linked to reduced risk for several cardiometabolic diseases. The lack of a clear definition of the Mediterranean diet in the scientific literature and the documented proliferation of nutrition misinformation on the internet suggest the potential for confusion among consumers seeking web-based Mediterranean diet information. Objective: We conducted a social media content analysis of information about the Mediterranean diet on the influential social media platform, TikTok, to examine public discourse about the diet and identify potential areas of misinformation. We then analyzed these findings in the context of health promotion to identify potential challenges and opportunities for the use of TikTok in promoting the Mediterranean diet for healthy living. Methods: The first-appearing 202 TikTok posts that resulted from a search of the hashtag #mediterraneandiet were downloaded and qualitatively examined. Post features and characteristics, poster information, and engagement metrics were extracted and synthesized across posts. Posts were categorized as those created by health professionals and those created by nonhealth professionals based on poster-reported credentials. In addition to descriptive statistics of the entire sample, we compared posts created by professionals and nonprofessionals for content using chi-square tests. Results: TikTok posts varied in content, but posts that were developed by health professionals versus nonprofessionals were more likely to offer a definition of the Mediterranean diet (16/106, 15.1% vs 2/96, 2.1%; P=.001), use scientific citations to support claims (26/106, 24.5% vs 0/96, 0%; P<.001), and discuss specific nutrients (33/106, 31.1% vs 6/96, 6.3%; P<.001) and diseases related to the diet (27/106, 25.5% vs 5/96, 5.2%; P<.001) compared to posts created by nonhealth professionals. Conclusions: Social media holds promise as a venue to promote the Mediterranean diet, but the variability in information found in this study highlights the need to create clear definitions about the diet and its components when developing Mediterranean diet interventions that use new media structures. %M 38896841 %R 10.2196/51094 %U https://formative.jmir.org/2024/1/e51094 %U https://doi.org/10.2196/51094 %U http://www.ncbi.nlm.nih.gov/pubmed/38896841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56676 %T Association of Smartwatch-Based Heart Rate and Physical Activity With Cardiorespiratory Fitness Measures in the Community: Cohort Study %A Zhang,Yuankai %A Wang,Xuzhi %A Pathiravasan,Chathurangi H %A Spartano,Nicole L %A Lin,Honghuang %A Borrelli,Belinda %A Benjamin,Emelia J %A McManus,David D %A Larson,Martin G %A Vasan,Ramachandran S %A Shah,Ravi V %A Lewis,Gregory D %A Liu,Chunyu %A Murabito,Joanne M %A Nayor,Matthew %+ Sections of Cardiology and Preventive Medicine and Epidemiology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E Concord St, Suite L-516, Boston, MA, 02118, United States, 1 617 638 8771, mnayor@bu.edu %K mobile health %K smartwatch %K heart rate %K physical activity %K cardiorespiratory fitness %K cardiopulmonary exercise testing %D 2024 %7 13.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Resting heart rate (HR) and routine physical activity are associated with cardiorespiratory fitness levels. Commercial smartwatches permit remote HR monitoring and step count recording in real-world settings over long periods of time, but the relationship between smartwatch-measured HR and daily steps to cardiorespiratory fitness remains incompletely characterized in the community. Objective: This study aimed to examine the association of nonactive HR and daily steps measured by a smartwatch with a multidimensional fitness assessment via cardiopulmonary exercise testing (CPET) among participants in the electronic Framingham Heart Study. Methods: Electronic Framingham Heart Study participants were enrolled in a research examination (2016-2019) and provided with a study smartwatch that collected longitudinal HR and physical activity data for up to 3 years. At the same examination, the participants underwent CPET on a cycle ergometer. Multivariable linear models were used to test the association of CPET indices with nonactive HR and daily steps from the smartwatch. Results: We included 662 participants (mean age 53, SD 9 years; n=391, 59% women, n=599, 91% White; mean nonactive HR 73, SD 6 beats per minute) with a median of 1836 (IQR 889-3559) HR records and a median of 128 (IQR 65-227) watch-wearing days for each individual. In multivariable-adjusted models, lower nonactive HR and higher daily steps were associated with higher peak oxygen uptake (VO2), % predicted peak VO2, and VO2 at the ventilatory anaerobic threshold, with false discovery rate (FDR)–adjusted P values <.001 for all. Reductions of 2.4 beats per minute in nonactive HR, or increases of nearly 1000 daily steps, corresponded to a 1.3 mL/kg/min higher peak VO2. In addition, ventilatory efficiency (VE/VCO2; FDR-adjusted P=.009), % predicted maximum HR (FDR-adjusted P<.001), and systolic blood pressure-to-workload slope (FDR-adjusted P=.01) were associated with nonactive HR but not associated with daily steps. Conclusions: Our findings suggest that smartwatch-based assessments are associated with a broad array of cardiorespiratory fitness responses in the community, including measures of global fitness (peak VO2), ventilatory efficiency, and blood pressure response to exercise. Metrics captured by wearable devices offer a valuable opportunity to use extensive data on health factors and behaviors to provide a window into individual cardiovascular fitness levels. %M 38870519 %R 10.2196/56676 %U https://www.jmir.org/2024/1/e56676 %U https://doi.org/10.2196/56676 %U http://www.ncbi.nlm.nih.gov/pubmed/38870519 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50446 %T Evaluating a New Digital App–Based Program for Heart Health: Feasibility and Acceptability Pilot Study %A Lockwood,Kimberly G %A Kulkarni,Priya R %A Paruthi,Jason %A Buch,Lauren S %A Chaffard,Mathieu %A Schitter,Eva C %A Branch,OraLee H %A Graham,Sarah A %+ Lark Health, 809 Cuesta Dr, Suite B #1033, Mountain View, CA, 94040, United States, 1 5033801340, kimberly.lockwood@lark.com %K digital health %K cardiovascular disease %K artificial intelligence %K AI %K acceptability and feasibility %K pilot study %K lifestyle coaching %K mobile phone %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death in the United States, affecting a significant proportion of adults. Digital health lifestyle change programs have emerged as a promising method of CVD prevention, offering benefits such as on-demand support, lower cost, and increased scalability. Prior research has shown the effectiveness of digital health interventions in reducing negative CVD outcomes. This pilot study focuses on the Lark Heart Health program, a fully digital artificial intelligence (AI)–powered smartphone app, providing synchronous CVD risk counseling, educational content, and personalized coaching. Objective: This pilot study evaluated the feasibility and acceptability of a fully digital AI-powered lifestyle change program called Lark Heart Health. Primary analyses assessed (1) participant satisfaction, (2) engagement with the program, and (3) the submission of health screeners. Secondary analyses were conducted to evaluate weight loss outcomes, given that a major focus of the Heart Health program is weight management. Methods: This study enrolled 509 participants in the 90-day real-world single-arm pilot study of the Heart Health app. Participants engaged with the app by participating in coaching conversations, logging meals, tracking weight, and completing educational lessons. The study outcomes included participant satisfaction, app engagement, the completion of screeners, and weight loss. Results: On average, Heart Health study participants were aged 60.9 (SD 10.3; range 40-75) years, with average BMI indicating class I obesity. Of the 509 participants, 489 (96.1%) stayed enrolled until the end of the study (dropout rate: 3.9%). Study retention, based on providing a weight measurement during month 3, was 80% (407/509; 95% CI 76.2%-83.4%). Participant satisfaction scores indicated high satisfaction with the overall app experience, with an average score of ≥4 out of 5 for all satisfaction indicators. Participants also showed high engagement with the app, with 83.4% (408/489; 95% CI 80.1%-86.7%) of the sample engaging in ≥5 coaching conversations in month 3. The results indicated that participants were successfully able to submit health screeners within the app, with 90% (440/489; 95% CI 87%-92.5%) submitting all 3 screeners measured in the study. Finally, secondary analyses showed that participants lost weight during the program, with analyses showing an average weight nadir of 3.8% (SD 2.9%; 95% CI 3.5%-4.1%). Conclusions: The study results indicate that participants in this study were satisfied with their experience using the Heart Health app, highly engaged with the app features, and willing and able to complete health screening surveys in the app. These acceptability and feasibility results provide a key first step in the process of evidence generation for a new AI-powered digital program for heart health. Future work can expand these results to test outcomes with a commercial version of the Heart Health app in a diverse real-world sample. %M 38787598 %R 10.2196/50446 %U https://formative.jmir.org/2024/1/e50446 %U https://doi.org/10.2196/50446 %U http://www.ncbi.nlm.nih.gov/pubmed/38787598 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53905 %T The Use of Metabolomes in Risk Stratification of Heart Failure Patients: Protocol for a Scoping Review %A Adamu,Umar Gati %A Badianyama,Marheb %A Mpanya,Dineo %A Maseko,Muzi %A Tsabedze,Nqoba %+ Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 Jubilee Road, Parktown, Johannesburg, 2193, South Africa, 27 738603613, umar.adamu@wits.ac.za %K metabolomes %K metabolomics %K heart failure %K risk stratification %K morbidity %K mortality %K metabolic abnormality %K scoping review protocol %K electronic database %D 2024 %7 23.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Heart failure (HF) is a significant health problem that is often associated with major morbidity and mortality. Metabolic abnormalities occur in HF and may be used to identify individuals at risk of developing the condition. Furthermore, these metabolic changes may play a role in the pathogenesis and progression of HF. Despite this knowledge, the utility of metabolic changes in diagnosis, management, prognosis, and therapy for patients with chronic HF has not been systematically reviewed. Objective: This scoping review aims to systematically appraise the literature on metabolic changes in patients with HF, describe the role of these changes in pathogenesis, progression, and care, and identify knowledge gaps to inform future research. Methods: This review will be conducted using a strategy based on previous reports, the JBI Manual for Evidence Synthesis, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search of electronic databases (Medline, EBSCOhost, Scopus, and Web of Science) will be conducted using keywords related to HF, myocardial failure, metabolomes, metabonomics, and analytical chemistry techniques. The search will include original peer-reviewed research papers (clinical studies conducted on humans and systematic reviews with or without a meta-analysis) published between January 2010 and September 2023. Studies that include patients with HF younger than 18 years or those not published in English will be excluded. Two authors (UGA and MB) will screen the titles and abstracts independently and perform a full-text screen of the relevant and eligible papers. Relevant data will be extracted and synthesized, and a third author or group will be consulted to resolve discrepancies. Results: This scoping review will span from January 2010 to September 2023, and the results will be published in a peer-reviewed, open-access journal as a scoping review in 2024. The presentation of the findings will use the PRISMA-ScR flow diagram and descriptive and narrative formats, including tables and graphical displays, to provide a comprehensive overview of the extracted data. Conclusions: This review aims to collect and analyze the available evidence on metabolic changes in patients with HF, aiming to enhance our current understanding of this topic. Additionally, this review will identify the most commonly used and suitable sample, analytical method, and specific metabolomes to facilitate standardization, reproducibility of results, and application in the diagnosis, treatment, and risk stratification of patients with HF. Finally, it is hoped that this review’s outcomes will inspire further research into the metabolomes of patients with HF in low- and middle-income countries. Trial Registration: Open Science Framework; https://osf.io/sp6xj International Registered Report Identifier (IRRID): DERR1-10.2196/53905 %M 38781584 %R 10.2196/53905 %U https://www.researchprotocols.org/2024/1/e53905 %U https://doi.org/10.2196/53905 %U http://www.ncbi.nlm.nih.gov/pubmed/38781584 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56054 %T Out-of-Hospital Cardiac Arrest Before and During the COVID-19 Pandemic in Hong Kong: Registry-Based Study From 2017 to 2023 %A Xu,Richard Huan %A Sun,Ruiqi %A Fu,Siu-Ngor %+ Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, China (Hong Kong), 852 27664199, richard.xu@polyu.edu.hk %K out-of-hospital cardiac arrest %K OHCA %K COVID-19 %K pandemic %K survival %K Chinese %K Asian %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has exerted a significant toll on individual health and the efficacy of health care systems. However, the influence of COVID-19 on the frequency and outcomes of out-of-hospital cardiac arrest (OHCA) within the Chinese population, both before and throughout the entire pandemic period, remains to be clarified. Objective: This study aimed to fill the gaps by investigating the prevalence and outcomes of OHCA in Hong Kong (HK) both before and during the whole pandemic period. Methods: This is a retrospective regional registry study. The researchers matched OHCA data with COVID-19–confirmed case records between December 2017 and May 2023. The data included information on response times, location of OHCA, witness presence, initial rhythm, bystander cardiopulmonary resuscitation (CPR), use of public-access defibrillation, resuscitation in the accident and emergency department, and survival to admission. Descriptive analyses were conducted, and statistical tests such as analysis of variance and χ2 were used to examine differences between variables. The incidence of OHCA and survival rates were calculated, and logistic regression analysis was performed to assess associations. The prevalence of OHCA and COVID-19 during the peak of the pandemic was also described. Results: A total of 43,882 cases of OHCA were reported in HK and included in our analysis. Around 13,946 cases were recorded during the prepandemic period (2017-2019), and the remaining 29,936 cases were reported during the pandemic period (2020-2023). During the pandemic period, the proportion of female patients increased to 44.1% (13,215/29,936), and the average age increased slightly to 76.5 (SD 18.5) years. The majority of OHCAs (n=18,143, 61.1% cases) occurred at home. A witness was present in 45.9% (n=10,723) of the cases, and bystander CPR was initiated in 44.6% (n=13,318) of the cases. There was a significant increase in OHCA incidence, with a corresponding decrease in survival rates compared to the prepandemic period. The location of OHCA shifted, with a decrease in incidents in public places and a potential increase in incidents at home. We found that CPR (odds ratio 1.48, 95% CI 1.17-1.86) and public-access defibrillation (odds ratio 1.16, 95% CI 1.05-1.28) were significantly associated with a high survival to admission rate during the pandemic period. There was a correlation between the development of OHCA and the prevalence of COVID-19 in HK. Conclusions: The COVID-19 pandemic has had a significant impact on OHCA in HK, resulting in increased incidence and decreased survival rates. The findings highlight the importance of addressing the indirect effects of the pandemic, such as increased stress levels and strain on health care systems, on OHCA outcomes. Strategies should be developed to improve OHCA prevention, emergency response systems, and health care services during public health emergencies to mitigate the impact on population health. %M 38771620 %R 10.2196/56054 %U https://publichealth.jmir.org/2024/1/e56054 %U https://doi.org/10.2196/56054 %U http://www.ncbi.nlm.nih.gov/pubmed/38771620 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55388 %T Evaluation of Prompts to Simplify Cardiovascular Disease Information Generated Using a Large Language Model: Cross-Sectional Study %A Mishra,Vishala %A Sarraju,Ashish %A Kalwani,Neil M %A Dexter,Joseph P %+ Data Science Initiative, Harvard University, Science and Engineering Complex 1.312-10, 150 Western Avenue, Allston, MA, 02134, United States, 1 8023381330, jdexter@fas.harvard.edu %K artificial intelligence %K ChatGPT %K GPT %K digital health %K large language model %K NLP %K language model %K language models %K prompt engineering %K health communication %K generative %K health literacy %K natural language processing %K patient-physician communication %K health communication %K prevention %K cardiology %K cardiovascular %K heart %K education %K educational %K human-in-the-loop %K machine learning %D 2024 %7 22.4.2024 %9 Research Letter %J J Med Internet Res %G English %X In this cross-sectional study, we evaluated the completeness, readability, and syntactic complexity of cardiovascular disease prevention information produced by GPT-4 in response to 4 kinds of prompts. %M 38648104 %R 10.2196/55388 %U https://www.jmir.org/2024/1/e55388 %U https://doi.org/10.2196/55388 %U http://www.ncbi.nlm.nih.gov/pubmed/38648104 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55285 %T Assessing Priorities in a Statewide Cardiovascular and Diabetes Health Collaborative Based on the Results of a Needs Assessment: Cross-Sectional Survey Study %A Beverly,Elizabeth A %A Koopman-Gonzalez,Sarah %A Wright,Jackson %A Dungan,Kathleen %A Pallerla,Harini %A Gubitosi-Klug,Rose %A Baughman,Kristin %A Konstan,Michael W %A Bolen,Shari D %+ Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, 1 Ohio University, 122 Medical Education Center, Athens, OH, 45701, United States, 1 7405934616, beverle1@ohio.edu %K health collaborative %K cardiovascular disease %K type 2 diabetes %K needs assessment %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites general and subspecialty medical staff at the 7 medical schools in Ohio with community and public health partnerships to improve cardiovascular and diabetes health outcomes and eliminate disparities in Ohio’s Medicaid population. Although statewide collaboratives exist to address health improvements, few deploy needs assessments to inform their work. Objective: Cardi-OH conducts an annual needs assessment to identify high-priority clinical topics, screening practices, policy changes for home monitoring devices and referrals, and preferences for the dissemination and implementation of evidence-based best practices. The results of the statewide needs assessment could also be used by others interested in disseminating best practices to primary care teams. Methods: A cross-sectional survey was distributed electronically via REDCap (Research Electronic Data Capture; Vanderbilt University) to both Cardi-OH grant-funded and non–grant-funded members (ie, people who have engaged with Cardi-OH but are not funded by the grant). Results: In total, 88% (103/117) of Cardi-OH grant-funded members and 8.14% (98/1204) of non–grant-funded members completed the needs assessment survey. Of these, 51.5% (53/103) of Cardi-OH grant-funded members and 47% (46/98) of non–grant-funded members provided direct clinical care. The top cardiovascular medicine and diabetes clinical topics for Cardi-OH grant-funded members (clinical and nonclinical) were lifestyle prescriptions (50/103, 48.5%), atypical diabetes (38/103, 36.9%), COVID-19 and cardiovascular disease (CVD; 38/103, 36.9%), and mental health and CVD (38/103, 36.9%). For non–grant-funded members, the top topics were lifestyle prescriptions (53/98, 54%), mental health and CVD (39/98, 40%), alcohol and CVD (27/98, 28%), and cardiovascular complications (27/98, 28%). Regarding social determinants of health, Cardi-OH grant-funded members prioritized 3 topics: weight bias and stigma (44/103, 42.7%), family-focused interventions (40/103, 38.8%), and adverse childhood events (37/103, 35.9%). Non–grant-funded members’ choices were family-focused interventions (51/98, 52%), implicit bias (43/98, 44%), and adverse childhood events (39/98, 40%). Assessment of other risk factors for CVD and diabetes across grant- and non–grant-funded members revealed screening for social determinants of health in approximately 50% of patients in each practice, whereas some frequency of depression and substance abuse screening occurred in 80% to 90% of the patients. Access to best practice home monitoring devices was challenging, with 30% (16/53) and 41% (19/46) of clinical grant-funded and non–grant-funded members reporting challenges in obtaining home blood pressure monitoring devices and 68% (36/53) and 43% (20/46) reporting challenges with continuous glucose monitors. Conclusions: Cardi-OH grant- and non–grant-funded members shared the following high-priority topics: lifestyle prescriptions, CVD and mental health, family-focused interventions, alcohol and CVD, and adverse childhood experiences. Identifying high-priority educational topics and preferred delivery modalities for evidence-based materials is essential for ensuring that the dissemination of resources is practical and useful for providers. %M 38607661 %R 10.2196/55285 %U https://formative.jmir.org/2024/1/e55285 %U https://doi.org/10.2196/55285 %U http://www.ncbi.nlm.nih.gov/pubmed/38607661 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52616 %T Assessing and Improving the Care of Patients With Heart Failure in Ghana: Protocol for a Prospective Observational Study and the Ghana Heart Initiative-Heart Failure Registry %A Awindaogo,Felix %A Acheamfour-Akowuah,Emmanuel %A Doku,Alfred %A Kokuro,Collins %A Agyekum,Francis %A Owusu,Isaac Kofi %+ Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, 22nd Guggisberg Avenue, Korle-Bu, PO Box GP 4236, Accra, Ghana, 233 244273573, dokukavin@gmail.com %K clinical %K cross-sectional %K epidemiology %K Ghana %K heart failure %K heart %K management %K medium-term %K monitoring %K mortality %K outcome %K patient data %K prevention %K protocol %K teaching %K treatment %D 2024 %7 8.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Heart failure (HF) is a leading cause of morbidity and mortality globally, with a high disease burden. The prevalence of HF in Ghana is increasing rapidly, but epidemiological profiles, treatment patterns, and survival data are scarce. The national capacity to diagnose and manage HF appropriately is also limited. To address the growing epidemic of HF, it is crucial to recognize the epidemiological characteristics and medium-term outcomes of HF in Ghana and improve the capability to identify and manage HF promptly and effectively at all levels of care. Objective: This study aims to determine the epidemiological characteristics and medium-term HF outcomes in Ghana. Methods: We conducted a prospective, multicenter, multilevel cross-sectional observational study of patients with HF from January to December 2023. Approximately 5000 patients presenting with HF to 9 hospitals, including teaching, regional, and municipal hospitals, will be recruited and evaluated according to a standardized protocol, including the use of an echocardiogram and an N-terminal pro-brain natriuretic peptide (NT-proBNP) test. Guideline-directed medical treatment of HF will be initiated for 6 months, and the medium-term outcomes of interventions, including rehospitalization and mortality, will be assessed. Patient data will be collated into a HF registry for continuous assessment and monitoring. Results: This intervention will generate the necessary information on the etiology of HF, clinical presentations, the diagnostic yield of various tools, and management outcomes. In addition, it will build the necessary capacity and support for HF management in Ghana. As of July 30, 2023, the training and onboarding of all 9 centers had been completed. Preliminary analyses will be conducted by the end of the second quarter of 2024, and results are expected to be publicly available by the middle of 2024. Conclusions: This study will provide the necessary data on HF, which will inform decisions on the prevention and management of HF and form the basis for future research. Trial Registration: ISRCTN Registry (United Kingdom) ISRCTN18216214; https:www.isrctn.com/ISRCTN18216214 International Registered Report Identifier (IRRID): DERR1-10.2196/52616 %M 38588528 %R 10.2196/52616 %U https://www.researchprotocols.org/2024/1/e52616 %U https://doi.org/10.2196/52616 %U http://www.ncbi.nlm.nih.gov/pubmed/38588528 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e54801 %T Association of Arterial Stiffness With Mid- to Long-Term Home Blood Pressure Variability in the Electronic Framingham Heart Study: Cohort Study %A Wang,Xuzhi %A Zhang,Yuankai %A Pathiravasan,Chathurangi H %A Ukonu,Nene C %A Rong,Jian %A Benjamin,Emelia J %A McManus,David D %A Larson,Martin G %A Vasan,Ramachandran S %A Hamburg,Naomi M %A Murabito,Joanne M %A Liu,Chunyu %A Mitchell,Gary F %+ Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, United States, 1 6176385104, liuc@bu.edu %K arterial stiffness %K mobile health %K mHealth %K blood pressure %K blood pressure variability %K risk factors %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies have examined associations between arterial stiffness and digital home BPV over a mid- to long-term time span, irrespective of underlying hypertension. Objective: This study aims to investigate if arterial stiffness traits were associated with subsequent mid- to long-term home BPV in the electronic Framingham Heart Study (eFHS). We hypothesized that higher arterial stiffness was associated with higher home BPV over up to 1-year follow-up. Methods: At a Framingham Heart Study research examination (2016-2019), participants underwent arterial tonometry to acquire measures of arterial stiffness (carotid-femoral pulse wave velocity [CFPWV]; forward pressure wave amplitude [FWA]) and wave reflection (reflection coefficient [RC]). Participants who agreed to enroll in eFHS were provided with a digital blood pressure (BP) cuff to measure home BP weekly over up to 1-year follow-up. Participants with less than 3 weeks of BP readings were excluded. Linear regression models were used to examine associations of arterial measures with average real variability (ARV) of week-to-week home systolic (SBP) and diastolic (DBP) BP adjusting for important covariates. We obtained ARV as an average of the absolute differences of consecutive home BP measurements. ARV considers not only the dispersion of the BP readings around the mean but also the order of BP readings. In addition, ARV is more sensitive to measurement-to-measurement BPV compared with traditional BPV measures. Results: Among 857 eFHS participants (mean age 54, SD 9 years; 508/857, 59% women; mean SBP/DBP 119/76 mm Hg; 405/857, 47% hypertension), 1 SD increment in FWA was associated with 0.16 (95% CI 0.09-0.23) SD increments in ARV of home SBP and 0.08 (95% CI 0.01-0.15) SD increments in ARV of home DBP; 1 SD increment in RC was associated with 0.14 (95% CI 0.07-0.22) SD increments in ARV of home SBP and 0.11 (95% CI 0.04-0.19) SD increments in ARV of home DBP. After adjusting for important covariates, there was no significant association between CFPWV and ARV of home SBP, and similarly, no significant association existed between CFPWV and ARV of home DBP (P>.05). Conclusions: In eFHS, higher FWA and RC were associated with higher mid- to long-term ARV of week-to-week home SBP and DBP over 1-year follow-up in individuals across the BP spectrum. Our findings suggest that higher aortic stiffness and wave reflection are associated with higher week-to-week variation of BP in a home-based setting over a mid- to long-term time span. %M 38587880 %R 10.2196/54801 %U https://cardio.jmir.org/2024/1/e54801 %U https://doi.org/10.2196/54801 %U http://www.ncbi.nlm.nih.gov/pubmed/38587880 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53006 %T Development of a Health Behavioral Digital Intervention for Patients With Hypertension Based on an Intelligent Health Promotion System and WeChat: Randomized Controlled Trial %A Sun,Ting %A Xu,Xuejie %A Ding,Zenghui %A Xie,Hui %A Ma,Linlin %A Zhang,Jing %A Xia,Yuxin %A Zhang,Guoli %A Ma,Zuchang %+ Hefei Institutes of Physical Science, Chinese Academy of Sciences, #350 Shushan Lake Road, Shushan District, Hefei, 230031, China, 86 13956984669, ZCMa121@126.com %K adherence %K hypertension %K health behavior %K mHealth %K digital health %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with “adherence” playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension. Objective: The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the behavior change wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence. Methods: A 2-arm, randomized trial design was used. We randomly assigned 68 individuals aged >60 years with hypertension in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: (1) developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP; (2) using the BCW theory to select behavior change techniques; (3) constructing the intervention's logic following the guidelines of the DMIC model; (4) creating an intervention manual including the aforementioned elements. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes included BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t tests, chi-square tests, paired t tests, and McNemar tests. A P value <.05 was considered statistically significant. Results: The final analysis included 54 participants with a mean age of 67.24 (SD 4.19) years (n=23 experimental group, n=31 control group). The experimental group had improvements in systolic BP (–7.36 mm Hg, P=.002), exercise time (856.35 metabolic equivalent [MET]-min/week, P<.001), medication adherence (0.56, P=.001), BP monitoring frequency (P=.02), and learning performance (3.23, P<.001). Both groups experienced weight reduction (experimental: 1.2 kg, P=.002; control: 1.11 kg, P=.009) after the intervention. The diet types and quantities for both groups (P<.001) as well as the subendocardial viability ratio (0.16, P=.01) showed significant improvement. However, there were no statistically significant changes in other health outcomes. Conclusions: The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in older adults with hypertension. However, a longer-term, larger-scale trial is necessary to validate the effectiveness. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200062643; https://www.chictr.org.cn/showprojEN.html?proj=172782 International Registered Report Identifier (IRRID): RR2-10.2196/46883 %M 38578692 %R 10.2196/53006 %U https://mhealth.jmir.org/2024/1/e53006 %U https://doi.org/10.2196/53006 %U http://www.ncbi.nlm.nih.gov/pubmed/38578692 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52744 %T Machine Learning Model for Readmission Prediction of Patients With Heart Failure Based on Electronic Health Records: Protocol for a Quasi-Experimental Study for Impact Assessment %A Nair,Monika %A Lundgren,Lina E %A Soliman,Amira %A Dryselius,Petra %A Fogelberg,Ebba %A Petersson,Marcus %A Hamed,Omar %A Triantafyllou,Miltiadis %A Nygren,Jens %+ School of Health and Welfare, Halmstad University, Kristian IV:s väg 3, Halmstad, 30118, Sweden, 46 707993854, monika.nair@hh.se %K artificial intelligence %K machine learning %K readmission prediction %K heart failure %K clinical decision support %K machine learning model %K CHF %K congestive heart failure %K readmission %K prediction %K electronic health records %K electronic health record %K EHR %K quasi-experimental study %K decision-making process %K risk assessment %K risk assessment tool %K predictive models %K predictive model %K Sweden %K physician %K nurse %K nurses %K clinician %K clinicians %D 2024 %7 11.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Care for patients with heart failure (HF) causes a substantial load on health care systems where a prominent challenge is the elevated rate of readmissions within 30 days following initial discharge. Clinical professionals face high levels of uncertainty and subjectivity in the decision-making process on the optimal timing of discharge. Unwanted hospital stays generate costs and cause stress to patients and potentially have an impact on care outcomes. Recent studies have aimed to mitigate the uncertainty by developing and testing risk assessment tools and predictive models to identify patients at risk of readmission, often using novel methods such as machine learning (ML). Objective: This study aims to investigate how a developed clinical decision support (CDS) tool alters the decision-making processes of health care professionals in the specific context of discharging patients with HF, and if so, in which ways. Additionally, the aim is to capture the experiences of health care practitioners as they engage with the system’s outputs to analyze usability aspects and obtain insights related to future implementation. Methods: A quasi-experimental design with randomized crossover assessment will be conducted with health care professionals on HF patients’ scenarios in a region located in the South of Sweden. In total, 12 physicians and nurses will be randomized into control and test groups. The groups shall be provided with 20 scenarios of purposefully sampled patients. The clinicians will be asked to take decisions on the next action regarding a patient. The test group will be provided with the 10 scenarios containing patient data from electronic health records and an outcome from an ML-based CDS model on the risk level for readmission of the same patients. The control group will have 10 other scenarios without the CDS model output and containing only the patients’ data from electronic medical records. The groups will switch roles for the next 10 scenarios. This study will collect data through interviews and observations. The key outcome measures are decision consistency, decision quality, work efficiency, perceived benefits of using the CDS model, reliability, validity, and confidence in the CDS model outcome, integrability in the routine workflow, ease of use, and intention to use. This study will be carried out in collaboration with Cambio Healthcare Systems. Results: The project is part of the Center for Applied Intelligent Systems Research Health research profile, funded by the Knowledge Foundation (2021-2028). Ethical approval for this study was granted by the Swedish ethical review authority (2022-07287-02). The recruitment process of the clinicians and the patient scenario selection will start in September 2023 and last till March 2024. Conclusions: This study protocol will contribute to the development of future formative evaluation studies to test ML models with clinical professionals. International Registered Report Identifier (IRRID): PRR1-10.2196/52744 %M 38466983 %R 10.2196/52744 %U https://www.researchprotocols.org/2024/1/e52744 %U https://doi.org/10.2196/52744 %U http://www.ncbi.nlm.nih.gov/pubmed/38466983 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52583 %T Tailoring of Health-Promotion Video Messaging for Reproductive-Aged Women at Risk for Developing Cardiometabolic Disease: Qualitative Focus-Groups Study %A Kent-Marvick,Jacqueline %A Gibson,Bryan %A Bristol,Alycia A %A St Clair,Stephanie %A Simonsen,Sara E %+ College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, United States, 1 4356686932, jacqueline.kent-marvick@utah.edu %K cardiometabolic disease %K type 2 diabetes mellitus %K gestational diabetes mellitus %K hypertensive disorder of pregnancy %K prediabetes %K obesity %K women’s health %K lifestyle change %K health promotion technology %K qualitative research %D 2024 %7 5.3.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Targeting reproductive-aged women at high risk for type 2 diabetes (T2D) provides an opportunity for prevention earlier in the life course. A woman’s experiences during her reproductive years may have a large impact on her future risk of T2D. Her risk is 7 to 10 times higher if she has had gestational diabetes (GDM). Despite these risks, T2D is preventable. Evidence-based programs, such as the National Diabetes Prevention Program (DPP), can reduce the risk of developing T2D by nearly 60%. However, only 0.4% of adults with prediabetes have participated in the DPP to date and reproductive-aged women are 50% less likely to participate than older women. In prior work, our team developed a mobile 360° video to address diabetes risk awareness and promote DPP enrollment among at-risk adults; this video was not designed, however, for reproductive-aged women. Objective: This study aims to obtain feedback from reproductive-aged women with cardiometabolic disease risk about a 360° video designed to promote enrollment in the DPP, and to gather suggestions about tailoring video messages to reproductive-aged women. Methods: Focus groups and a qualitative descriptive approach were used. Women with at least 1 previous pregnancy, aged 18 to 40 years, participated in one of three focus groups stratified by the following health risks: (1) a history of GDM or a hypertensive disorder of pregnancy, (2) a diagnosis of prediabetes, or (3) a BMI classified as obese. Focus-group questions addressed several topics; this report shared findings regarding video feedback. The 3 focus-group discussions were conducted via Zoom and were recorded and transcribed for analysis. Deductive codes were used to identify concepts related to the research question and inductive codes were created for novel insights shared by participants. The codes were then organized into categories and themes. Results: The main themes identified were positive feedback, negative feedback, centering motherhood, and the importance of storytelling. While some participants said the video produced a sense of urgency for health-behavior change, all participants agreed that design changes could improve the video’s motivating effect on health-behavior change in reproductive-aged women. Participants felt a tailored video should recognize the complexities of being a mother and how these dynamics contribute to women’s difficulty engaging in healthy behaviors without stirring feelings of guilt. Women desired a video with a positive, problem-solving perspective, and recommended live links as clickable resources for practical solutions promoting health behavior change. Women suggested using storytelling, both to describe how complications experienced during pregnancy impact long-term health and to motivate health behavior change. Conclusions: Reproductive-aged women require tailored lifestyle-change messaging that addresses barriers commonly encountered by this population (eg, parenting or work responsibilities). Moreover, messaging should prioritize a positive tone that harnesses storytelling and human connection while offering realistic solutions. %M 38441920 %R 10.2196/52583 %U https://formative.jmir.org/2024/1/e52583 %U https://doi.org/10.2196/52583 %U http://www.ncbi.nlm.nih.gov/pubmed/38441920 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e52576 %T User Engagement, Acceptability, and Clinical Markers in a Digital Health Program for Nonalcoholic Fatty Liver Disease: Prospective, Single-Arm Feasibility Study %A Björnsdottir,Sigridur %A Ulfsdottir,Hildigunnur %A Gudmundsson,Elias Freyr %A Sveinsdottir,Kolbrun %A Isberg,Ari Pall %A Dobies,Bartosz %A Akerlie Magnusdottir,Gudlaug Erla %A Gunnarsdottir,Thrudur %A Karlsdottir,Tekla %A Bjornsdottir,Gudlaug %A Sigurdsson,Sigurdur %A Oddsson,Saemundur %A Gudnason,Vilmundur %+ Department of Endocrinology, Metabolism and Diabetes, Karolinska Institutet, Solnavägen 1, Stockholm, 171 77, Sweden, 46 8 524 800 00, sigridur.bjornsdottir@ki.se %K digital health program %K nonalcoholic fatty liver disease %K NAFLD %K cardiometabolic health %K digital therapeutics %K liver %K chronic %K hepatic %K cardiometabolic %K cardiovascular %K cardiology %K weight %K acceptability %K digital health %K metabolic syndrome %K diabetic %K diabetes %K diabetics %K type 2 %K BMI %K lifestyle %K exercise %K physical activity %K coaching %K diet %K dietary %K nutrition %K nutritional %K patient education %K coach %K feasibility %K fat %K body composition %D 2024 %7 15.2.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in the world. Common comorbidities are central obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome. Cardiovascular disease is the most common cause of death among people with NAFLD, and lifestyle changes can improve health outcomes. Objective: This study aims to explore the acceptability of a digital health program in terms of engagement, retention, and user satisfaction in addition to exploring changes in clinical outcomes, such as weight, cardiometabolic risk factors, and health-related quality of life. Methods: We conducted a prospective, open-label, single-arm, 12-week study including 38 individuals with either a BMI >30, metabolic syndrome, or type 2 diabetes mellitus and NAFLD screened by FibroScan. An NAFLD-specific digital health program focused on disease education, lowering carbohydrates in the diet, food logging, increasing activity level, reducing stress, and healthy lifestyle coaching was offered to participants. The coach provided weekly feedback on food logs and other in-app activities and opportunities for participants to ask questions. The coaching was active throughout the 12-week intervention period. The primary outcome was feasibility and acceptability of the 12-week program, assessed through patient engagement, retention, and satisfaction with the program. Secondary outcomes included changes in weight, liver fat, body composition, and other cardiometabolic clinical parameters at baseline and 12 weeks. Results: In total, 38 individuals were included in the study (median age 59.5, IQR 46.3-68.8 years; n=23, 61% female). Overall, 34 (89%) participants completed the program and 29 (76%) were active during the 12-week program period. The median satisfaction score was 6.3 (IQR 5.8-6.7) of 7. Mean weight loss was 3.5 (SD 3.7) kg (P<.001) or 3.2% (SD 3.4%), with a 2.2 (SD 2.7) kg reduction in fat mass (P<.001). Relative liver fat reduction was 19.4% (SD 23.9%). Systolic blood pressure was reduced by 6.0 (SD 13.5) mmHg (P=.009). The median reduction was 0.14 (IQR 0-0.47) mmol/L for triglyceride levels (P=.003), 3.2 (IQR 0.0-5.4) µU/ml for serum insulin (s-insulin) levels (P=.003), and 0.5 (IQR –0.7 to 3.8) mmol/mol for hemoglobin A1c (HbA1c) levels (P=.03). Participants who were highly engaged (ie, who used the app at least 5 days per week) had greater weight loss and liver fat reduction. Conclusions: The 12-week-long digital health program was feasible for individuals with NAFLD, receiving high user engagement, retention, and satisfaction. Improved liver-specific and cardiometabolic health was observed, and more engaged participants showed greater improvements. This digital health program could provide a new tool to improve health outcomes in people with NAFLD. Trial Registration: Clinicaltrials.gov NCT05426382; https://clinicaltrials.gov/study/NCT05426382 %M 38152892 %R 10.2196/52576 %U https://cardio.jmir.org/2024/1/e52576 %U https://doi.org/10.2196/52576 %U http://www.ncbi.nlm.nih.gov/pubmed/38152892 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e51399 %T Physical Activity, Heart Rate Variability, and Ventricular Arrhythmia During the COVID-19 Lockdown: Retrospective Cohort Study %A Texiwala,Sikander Z %A de Souza,Russell J %A Turner,Suzette %A Singh,Sheldon M %+ Schulich Heart Center, Sunnybrook Health Sciences, Room A222, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada, 1 416 480 6100 ext 86359, sheldon.singh@sunnybrook.ca %K implantable cardioverter defibrillator %K heart rate variability %K physical activity %K lockdown %K ICD %K ventricular arrhythmias %K defibrillator %K implementation %D 2024 %7 5.2.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Ventricular arrhythmias (VAs) increase with stress and national disasters. Prior research has reported that VA did not increase during the onset of the COVID-19 lockdown in March 2020, and the mechanism for this is unknown. Objective: This study aimed to report the presence of VA and changes in 2 factors associated with VA (physical activity and heart rate variability [HRV]) at the onset of COVID-19 lockdown measures in Ontario, Canada. Methods: Patients with implantable cardioverter defibrillator (ICD) followed at a regional cardiac center in Ontario, Canada with data available for both HRV and physical activity between March 1 and 31, 2020, were included. HRV, physical activity, and the presence of VA were determined during the pre- (March 1-10, 2020) and immediate postlockdown (March 11-31) period. When available, these data were determined for the same period in 2019. Results: In total, 68 patients had complete data for 2020, and 40 patients had complete data for 2019. Three (7.5%) patients had VA in March 2019, whereas none had VA in March 2020 (P=.048). Physical activity was reduced during the postlockdown period (mean 2.3, SD 1.6 hours vs mean 2.1, SD 1.6 hours; P=.003). HRV was unchanged during the pre- and postlockdown period (mean 91, SD 30 ms vs mean 92, SD 28 ms; P=.84). Conclusions: VA was infrequent during the COVID-19 pandemic. A reduction in physical activity with lockdown maneuvers may explain this observation. %M 38315512 %R 10.2196/51399 %U https://cardio.jmir.org/2024/1/e51399 %U https://doi.org/10.2196/51399 %U http://www.ncbi.nlm.nih.gov/pubmed/38315512 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46821 %T Assessing Global, Regional, and National Time Trends and Associated Risk Factors of the Mortality in Ischemic Heart Disease Through Global Burden of Disease 2019 Study: Population-Based Study %A Shu,Tingting %A Tang,Ming %A He,Bo %A Liu,Xiaozhu %A Han,Yu %A Liu,Chang %A Jose,Pedro A %A Wang,Hongyong %A Zhang,Qing-Wei %A Zeng,Chunyu %+ Department of Cardiology, Daping Hospital, The Third Military Medical University (Army Medical University), 10 Daping Branch Road, Yuzhong District, Chongqing, 400016, China, 86 023 68729501, chunyuzeng01@163.com %K age-period-cohort analysis %K GBD 2019 %K Global Burden of Disease 2019 study %K ischemic heart disease %K mortality %K risk factors %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Ischemic heart disease (IHD) is the leading cause of death among noncommunicable diseases worldwide, but data on current epidemiological patterns and associated risk factors are lacking. Objective: This study assessed the global, regional, and national trends in IHD mortality and attributable risks since 1990. Methods: Mortality data were obtained from the Global Burden of Disease 2019 Study. We used an age-period-cohort model to calculate longitudinal age curves (expected longitudinal age-specific rate), net drift (overall annual percentage change), and local drift (annual percentage change in each age group) from 15 to >95 years of age and estimate cohort and period effects between 1990 and 2019. Deaths from IHD attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and theoretical minimum risk exposure level. Results: IHD is the leading cause of death in noncommunicable disease–related mortality (118.1/598.8, 19.7%). However, the age-standardized mortality rate for IHD decreased by 30.8% (95% CI –34.83% to –27.17%) over the past 30 years, and its net drift ranged from –2.89% (95% CI –3.07% to –2.71%) in high sociodemographic index (SDI) region to –0.24% (95% CI –0.32% to –0.16%) in low-middle–SDI region. The greatest decrease in IHD mortality occurred in the Republic of Korea (high SDI) with net drift –6.06% (95% CI –6.23% to –5.88%), followed by 5 high-SDI nations (Denmark, Norway, Estonia, the Netherlands, and Ireland) and 2 high-middle–SDI nations (Israel and Bahrain) with net drift less than –5.00%. Globally, age groups of >60 years continued to have the largest proportion of IHD-related mortality, with slightly higher mortality in male than female group. For period and birth cohort effects, the trend of rate ratios for IHD mortality declined across successive period groups from 2000 to 2004 and birth cohort groups from 1985 to 2000, with noticeable improvements in high-SDI regions. In low-SDI regions, IHD mortality significantly declined in female group but fluctuated in male group across successive periods; sex differences were greater in those born after 1945 in middle- and low-middle–SDI regions and after 1970 in low-SDI regions. Metabolic risks were the leading cause of mortality from IHD worldwide in 2019. Moreover, smoking, particulate matter pollution, and dietary risks were also important risk factors, increasingly occurring at a younger age. Diets low in whole grains and legumes were prominent dietary risks in both male and female groups, and smoking and high-sodium diet mainly affect male group. Conclusions: IHD, a major concern, needs focused health care attention, especially for older male individuals and those in low-SDI regions. Metabolic risks should be prioritized for prevention, and behavioral and environmental risks should attract more attention to decrease IHD mortality. %M 38265846 %R 10.2196/46821 %U https://publichealth.jmir.org/2024/1/e46821 %U https://doi.org/10.2196/46821 %U http://www.ncbi.nlm.nih.gov/pubmed/38265846 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46450 %T Smoking Behavior Change and the Risk of Heart Failure in Patients With Type 2 Diabetes: Nationwide Retrospective Cohort Study %A Yoo,Jung Eun %A Jeong,Su-Min %A Lee,Kyu Na %A Lee,Heesun %A Yoon,Ji Won %A Han,Kyungdo %A Shin,Dong Wook %+ Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 2 3410 5252, dwshin.md@gmail.com %K smoking %K change in smoking behavior %K cessation %K heart failure %K type 2 diabetes %K diabetes %K cardiovascular disease %K smoking cessation %K smoker %K risk factor %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Heart failure (HF) is one of the most common initial manifestations of cardiovascular disease in patients with type 2 diabetes. Although smoking is an independent risk factor for HF, there is a lack of data for the incidence of HF according to changes in smoking behaviors in patients with type 2 diabetes. Objective: We aimed to examine the association between interval changes in smoking behavior and the risk of HF among patients with type 2 diabetes. Methods: We conducted a retrospective cohort study using the National Health Insurance Service database. We identified 365,352 current smokers with type 2 diabetes who had 2 consecutive health screenings (2009-2012) and followed them until December 31, 2018, for the incident HF. Based on smoking behavior changes between 2 consecutive health screenings, participants were categorized into quitter, reducer I (≥50% reduction) and II (<50% reduction), sustainer (reference group), and increaser groups. Results: During a median follow-up of 5.1 (IQR 4.0-6.1) years, there were 13,879 HF cases (7.8 per 1000 person-years). Compared to sustainers, smoking cessation was associated with lower risks of HF (adjusted hazard ratio [aHR] 0.90, 95% CI0.86-0.95), whereas increasers showed higher risks of HF than sustainers; heavy smokers who increased their level of smoking had a higher risk of HF (aHR 1.13, 95% CI 1.04-1.24). In the case of reducers, the risk of HF was not reduced but rather increased slightly (reducer I: aHR 1.14, 95% CI 1.08-1.21; reducer II: aHR 1.03, 95% CI 0.98-1.09). Consistent results were noted for subgroup analyses including type 2 diabetes severity, age, and sex. Conclusions: Smoking cessation was associated with a lower risk of HF among patients with type 2 diabetes, while increasing smoking amount was associated with a higher risk for HF than in those sustaining their smoking amount. There was no benefit from reduction in smoking amount. %M 38198206 %R 10.2196/46450 %U https://publichealth.jmir.org/2024/1/e46450 %U https://doi.org/10.2196/46450 %U http://www.ncbi.nlm.nih.gov/pubmed/38198206 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46277 %T Association Between the Composite Cardiovascular Risk and mHealth Use Among Adults in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study %A Chen,Yuling %A Turkson-Ocran,Ruth-Alma %A Koirala,Binu %A Davidson,Patricia M %A Commodore-Mensah,Yvonne %A Himmelfarb,Cheryl Dennison %+ Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, United States, 1 443 514 7323, chimmelfarb@jhu.edu %K mobile health %K usage %K cardiovascular risk %K association %K mobile phone %D 2024 %7 4.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Numerous studies have suggested that the relationship between cardiovascular disease (CVD) risk and the usage of mobile health (mHealth) technology may vary depending on the total number of CVD risk factors present. However, whether higher CVD risk is associated with a greater likelihood of engaging in specific mHealth use among US adults is currently unknown. Objective: We aim to assess the associations between the composite CVD risk and each component of mHealth use among US adults regardless of whether they have a history of CVD or not. Methods: This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey. The exposure was CVD risk (diabetes, hypertension, smoking, physical inactivity, and overweight or obesity). We defined low, moderate, and high CVD risk as having 0-1, 2-3, and 4-5 CVD risk factors, respectively. The outcome variables of interest were each component of mHealth use, including using mHealth to make health decisions, track health progress, share health information, and discuss health decisions with health providers. We used multivariable logistic regression models to examine the association between CVD risk and mHealth use adjusted for demographic factors. Results: We included 10,531 adults, with a mean age of 54 (SD 16.2) years. Among the included participants, 50.2% were men, 65.4% were non-Hispanic White, 41.9% used mHealth to make health decisions, 50.8% used mHealth to track health progress toward a health-related goal, 18.3% used mHealth to share health information with health providers, and 37.7% used mHealth to discuss health decisions with health providers (all are weighted percentages). Adults with moderate CVD risk were more likely to use mHealth to share health information with health providers (adjusted odds ratio 1.49, 95% CI 1.24-1.80) and discuss health decisions with health providers (1.22, 95% CI 1.04-1.44) compared to those with low CVD risk. Similarly, having high CVD risk was associated with higher odds of using mHealth to share health information with health providers (2.61, 95% CI 1.93-3.54) and discuss health decisions with health providers (1.56, 95% CI 1.17-2.10) compared to those with low CVD risk. Upon stratifying by age and gender, we observed age and gender disparities in the relationship between CVD risk and the usage of mHealth to discuss health decisions with health providers. Conclusions: Adults with a greater number of CVD risk factors were more likely to use mHealth to share health information with health providers and discuss health decisions with health providers. These findings suggest a promising avenue for enhancing health care communication and advancing both primary and secondary prevention efforts related to managing CVD risk factors through the effective usage of mHealth technology. %M 38175685 %R 10.2196/46277 %U https://www.jmir.org/2024/1/e46277 %U https://doi.org/10.2196/46277 %U http://www.ncbi.nlm.nih.gov/pubmed/38175685 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44610 %T Evaluation of the Needs and Experiences of Patients with Hypertriglyceridemia: Social Media Listening Infosurveillance Study %A Song,Junxian %A Cui,Yuxia %A Song,Jing %A Lee,Chongyou %A Wu,Manyan %A Chen,Hong %+ Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Department of Cardiology, Center for Cardiovascular Translational Research, Peking University People’s Hospital, No 11 Xizhimen South Road, Xicheng district, Beijing, 100044, China, 86 10 88325940, chenhongbj@medmail.com.cn %K social media listening %K hypertriglyceridemia %K infosurveillance study %K disease cognition %K lifestyle intervention %K lipid disorder %K awareness %K online search %K telemedicine %K self-medication %K Chinese medicine %K natural language processing %K cardiovascular disease %K stroke %K online platform %K self-management %K Q&A search platform %K social media %D 2023 %7 19.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Hypertriglyceridemia is a risk factor for cardiovascular diseases. Internet usage in China is increasing, giving rise to large-scale data sources, especially to access, disseminate, and discuss medical information. Social media listening (SML) is a new approach to analyze and monitor online discussions related to various health-related topics in diverse diseases, which can generate insights into users’ experiences and expectations. However, to date, no studies have evaluated the utility of SML to understand patients’ cognizance and expectations pertaining to the management of hypertriglyceridemia. Objective: The aim of this study was to utilize SML to explore the disease cognition level of patients with hypertriglyceridemia, choice of intervention measures, and the status quo of online consultations and question-and-answer (Q&A) search platforms. Methods: An infosurveillance study was conducted wherein a disease-specific comprehensive search was performed between 2004 and 2020 in Q&A search and online consultation platforms. Predefined single and combined keywords related to hypertriglyceridemia were used in the search, including disease, symptoms, diagnosis, and treatment indicators; lifestyle interventions; and therapeutic agents. The search output was aggregated using an aggregator tool and evaluated. Results: Disease-specific consultation data (n=69,845) and corresponding response data (n=111,763) were analyzed from 20 data sources (6 Q&A search platforms and 14 online consultation platforms). Doctors from inland areas had relatively high voice volumes and appear to exert a substantial influence on these platforms. Patients with hypertriglyceridemia engaging on the internet have an average level of cognition about the disease and its intervention measures. However, a strong demand for the concept of the disease and “how to treat it” was observed. More emphasis on the persistence of the disease and the safety of medications was observed. Young patients have a lower willingness for drug interventions, whereas patients with severe hypertriglyceridemia have a clearer intention to use drug intervention and few patients have a strong willingness for the use of traditional Chinese medicine. Conclusions: Findings from this disease-specific SML study revealed that patients with hypertriglyceridemia in China actively seek information from both online Q&A search and consultation platforms. However, the integrity of internet doctors’ suggestions on lifestyle interventions and the accuracy of drug intervention recommendations still need to be improved. Further, a combined prospective qualitative study with SML is required for added rigor and confirmation of the relevance of the findings. %M 38113100 %R 10.2196/44610 %U https://www.jmir.org/2023/1/e44610 %U https://doi.org/10.2196/44610 %U http://www.ncbi.nlm.nih.gov/pubmed/38113100 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44569 %T Sex and Age Differences in the Association Between Social Determinants of Health and Cardiovascular Health According to Household Income Among Mongolian Adults: Cross-Sectional Study %A Shim,Sun Young %A Lee,Hyeonkyeong %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 22283373, hlee39@yuhs.ac %K social determinants of health %K cardiovascular health %K education %K household income %K health insurance %K association %K risk factors %K cardiovascular %K cardiovascular disease %K cross-sectional study %D 2023 %7 1.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although social determinants of health (SDH) are an underlying cause of poor cardiovascular health (CVH), there is insufficient evidence for the association between SDH and CVH, which varies by sex and age among Mongolian adults. Objective: We aimed to explore whether education, household income, and health insurance were associated with CVH according to sex and age among Mongolian adults. Methods: The final sample included data on 5691 participants (male: n=2521. 44.3% and female: n=3170, 55.7%) aged 18-69 years from the 2019 World Health Organization STEPwise approach to noncommunicable disease risk-factor surveillance. CVH was measured using a modified version of Life’s Simple 7 with 4 health behaviors (cigarette smoking, BMI, physical activity, and a healthy diet) and 3 biological factors (blood pressure, fasting glucose, and total cholesterol blood levels) and classified into poor, intermediate, and ideal levels as recommended by the American Heart Association. Multinomial logistic regression analyses examined the associations between SDH and CVH by monthly equivalized household income after adjusting for age, sex, work status, area, history of myocardial infarction or stroke, use of aspirin, and use of statin. Subgroup analyses were conducted to examine the associations between SDH and CVH based on sex and age, considering monthly equivalized household income as a key variable. Results: Using the ideal level of CVH as a reference, among those with the lowest household income, having less than 12 years of education, and not having health insurance were associated with poor CVH (education level: odds ratio [OR] 2.42, 95% CI 1.30-4.51; P=.006; health insurance: OR 2.17, 95% CI 1.13-4.18; P=.02). These associations were more profound among female individuals (education level: OR 2.99, 95% CI 1.35-6.63; P=.007; health insurance: OR 2.54, 95% CI 1.09-5.90; P=.03) and those aged 18-44 years (education level: OR 3.22, 95% CI 1.54-6.72; P=.002; health insurance: OR 2.03, 95% CI 0.98-4.18; P=.06). Conclusions: Participants in the lowest household income group with lower educational levels and without health insurance were more likely to have poor CVH, and these results were more pronounced in female individuals and young adults. These findings suggest the need to develop strategies for CVH equity in Mongolian female individuals and young adults that consider income levels, education levels, and health insurance. %M 38039072 %R 10.2196/44569 %U https://publichealth.jmir.org/2023/1/e44569 %U https://doi.org/10.2196/44569 %U http://www.ncbi.nlm.nih.gov/pubmed/38039072 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49257 %T Effects of an Individualized mHealth-Based Intervention on Health Behavior Change and Cardiovascular Risk Among People With Metabolic Syndrome Based on the Behavior Change Wheel: Quasi-Experimental Study %A Chen,Dandan %A Zhang,Hui %A Wu,Jingjie %A Xue,Erxu %A Guo,Pingping %A Tang,Leiwen %A Shao,Jing %A Cui,Nianqi %A Wang,Xiyi %A Chen,Liying %A Ye,Zhihong %+ Nursing Department, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No.3 East Qingchun Road, Shangcheng district, Hangzhou, 310020, China, 86 13606612119, yezh@zju.edu.cn %K metabolic syndrome %K health behavior %K cardiovascular risk %K mobile health %K behavior change wheel %D 2023 %7 29.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Metabolic syndrome (MetS) is a common public health challenge. Health-promoting behaviors such as diet and physical activity are central to preventing and controlling MetS. However, the adoption of diet and physical activity behaviors has always been challenging. An individualized mobile health (mHealth)–based intervention using the Behavior Change Wheel is promising in promoting health behavior change and reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, the effects of this intervention are not well understood among people with MetS in mainland China. Objective: We aimed to evaluate the effects of the individualized mHealth-based intervention using the Behavior Change Wheel on behavior change and ASCVD risk in people with MetS. Methods: We conducted a quasi-experimental, nonrandomized study. Individuals with MetS were recruited from the health promotion center of a tertiary hospital in Zhejiang province, China. The study involved 138 adults with MetS, comprising a control group of 69 participants and an intervention group of 69 participants. All participants received health education regarding diet and physical activity. The intervention group additionally received a 12-week individualized intervention through a WeChat mini program and a telephone follow-up in the sixth week of the intervention. Primary outcomes included diet, physical activity behaviors, and ASCVD risk. Secondary outcomes included diet self-efficacy, physical activity self-efficacy, knowledge of MetS, quality of life, and the quality and efficiency of health management services. The Mann-Whitney U test and Wilcoxon signed rank test were primarily used for data analysis. Data analysis was conducted based on the intention-to-treat principle using SPSS (version 25.0; IBM Corp). Results: Baseline characteristics did not differ between the 2 groups. Compared with the control group, participants in the intervention group showed statistically significant improvements in diet behavior, physical activity behavior, diet self-efficacy, physical activity self-efficacy, knowledge of MetS, physical health, and mental health after a 12-week intervention (P=.04, P=.001, P=.04, P=.04, P=.001, P=.04, P=.04, and P<.05). The intervention group demonstrated a statistically significant improvement in outcomes from pre- to postintervention evaluations (P<.001, P=.03, P<.001, P=.04, P<.001, P<.001, and P<.001). The intervention also led to enhanced health management services and quality. Conclusions: The individualized mHealth-based intervention using the Behavior Change Wheel was effective in promoting diet and physical activity behaviors in patients with MetS. Nurses and other health care professionals may incorporate the intervention into their health promotion programs. %M 38019579 %R 10.2196/49257 %U https://www.jmir.org/2023/1/e49257 %U https://doi.org/10.2196/49257 %U http://www.ncbi.nlm.nih.gov/pubmed/38019579 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e47292 %T Characterizing Real-World Implementation of Consumer Wearables for the Detection of Undiagnosed Atrial Fibrillation in Clinical Practice: Targeted Literature Review %A Simonson,Julie K %A Anderson,Misty %A Polacek,Cate %A Klump,Erika %A Haque,Saira N %+ Pfizer Inc, 66 Hudson Blvd E, New York City, NY, 10001, United States, 1 718 208 6842, julie.simonson@pfizer.com %K arrhythmias %K atrial fibrillation %K clinical workflow %K consumer wearable devices %K smartwatches %K wearables %K remote patient monitoring %K virtual care %K mobile phone %D 2023 %7 3.11.2023 %9 Review %J JMIR Cardio %G English %X Background: Atrial fibrillation (AF), the most common cardiac arrhythmia, is often undiagnosed because of lack of awareness and frequent asymptomatic presentation. As AF is associated with increased risk of stroke, early detection is clinically relevant. Several consumer wearable devices (CWDs) have been cleared by the US Food and Drug Administration for irregular heart rhythm detection suggestive of AF. However, recommendations for the use of CWDs for AF detection in clinical practice, especially with regard to pathways for workflows and clinical decisions, remain lacking. Objective: We conducted a targeted literature review to identify articles on CWDs characterizing the current state of wearable technology for AF detection, identifying approaches to implementing CWDs into the clinical workflow, and characterizing provider and patient perspectives on CWDs for patients at risk of AF. Methods: PubMed, ClinicalTrials.gov, UpToDate Clinical Reference, and DynaMed were searched for articles in English published between January 2016 and July 2023. The searches used predefined Medical Subject Headings (MeSH) terms, keywords, and search strings. Articles of interest were specifically on CWDs; articles on ambulatory monitoring tools, tools available by prescription, or handheld devices were excluded. Search results were reviewed for relevancy and discussed among the authors for inclusion. A qualitative analysis was conducted and themes relevant to our study objectives were identified. Results: A total of 31 articles met inclusion criteria: 7 (23%) medical society reports or guidelines, 4 (13%) general reviews, 5 (16%) systematic reviews, 5 (16%) health care provider surveys, 7 (23%) consumer or patient surveys or interviews, and 3 (10%) analytical reports. Despite recognition of CWDs by medical societies, detailed guidelines regarding CWDs for AF detection were limited, as was the availability of clinical tools. A main theme was the lack of pragmatic studies assessing real-world implementation of CWDs for AF detection. Clinicians expressed concerns about data overload; potential for false positives; reimbursement issues; and the need for clinical tools such as care pathways and guidelines, preferably developed or endorsed by professional organizations. Patient-facing challenges included device costs and variability in digital literacy or technology acceptance. Conclusions: This targeted literature review highlights the lack of a comprehensive body of literature guiding real-world implementation of CWDs for AF detection and provides insights for informing additional research and developing appropriate tools and resources for incorporating these devices into clinical practice. The results should also provide an impetus for the active involvement of medical societies and other health care stakeholders in developing appropriate tools and resources for guiding the real-world use of CWDs for AF detection. These resources should target clinicians, patients, and health care systems with the goal of facilitating clinician or patient engagement and using an evidence-based approach for establishing guidelines or frameworks for administrative workflows and patient care pathways. %M 37921865 %R 10.2196/47292 %U https://cardio.jmir.org/2023/1/e47292 %U https://doi.org/10.2196/47292 %U http://www.ncbi.nlm.nih.gov/pubmed/37921865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47876 %T Effects of a 20-Week High-Intensity Strength Training Program on Muscle Strength Gain and Cardiac Adaptation in Untrained Men: Preliminary Results of a Prospective Longitudinal Study %A Pamart,Nicolas %A Drigny,Joffrey %A Azambourg,Hélène %A Remilly,Marion %A Macquart,Maxime %A Lefèvre,Alexandre %A Lahjaily,Kamal %A Parienti,Jean Jacques %A Rocamora,Amélia %A Guermont,Henri %A Desvergée,Antoine %A Ollitrault,Pierre %A Tournoux,Francois %A Saloux,Eric %A Normand,Hervé %A Reboursière,Emmanuel %A Gauthier,Antoine %A Hodzic,Amir %+ Inserm Comete, GIP Cyceron, Normandie Université, 2 Rue des Rochambelles, Caen, 14000, France, 33 0768221034, hodzic-a@chu-caen.fr %K actimetry %K athlete’s heart %K athletes %K echocardiography %K exercise %K isokinetic dynamometry %K muscle strength gain %K sports physiology %K strength training %K strengthening exercise %K untrained population %K weightlifting %D 2023 %7 24.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: As strength sports gain popularity, there is a growing need to explore the impact of sustained strength training on cardiac biventricular structure and function, an area that has received less attention compared to the well-established physiological cardiac adaptation to endurance training. Objective: This study aims to implement a 20-week high-intensity strength training program to enhance maximal muscle strength and evaluate its impact on cardiac biventricular adaptation in healthy, untrained men. Methods: A total of 27 healthy and untrained young men (mean age 22.8, SD 3.2 years) participated in a strength training program designed to increase muscle strength. The training program involved concentric, eccentric, and isometric exercise phases, conducted over a consecutive 20-week time frame with a frequency of 3 weekly training sessions. Participants were evaluated before and after 12 and 20 weeks of training through body composition analysis (bioelectrical impedance), a 12-lead resting electrocardiogram, 3D transthoracic echocardiography, cardiopulmonary exercise testing, and muscle isokinetic dynamometry. The progression of strength training loads was guided by 1-repetition maximum (RM) testing during the training program. Results: Of the initial cohort, 22 participants completed the study protocol. No injuries were reported. The BMI (mean 69.8, SD 10.8 kg/m² vs mean 72, SD 11 kg/m²; P=.72) and the fat mass (mean 15.3%, SD 7.5% vs mean 16.5%, SD 7%; P=.87) remained unchanged after training. The strength training program led to significant gains in 1-RM exercise testing as early as 4 weeks into training for leg extension (mean 69.6, SD 17.7 kg vs mean 96.5, SD 31 kg; P<.001), leg curl (mean 43.2, SD 9.7 kg vs mean 52.8, SD 13.4 kg; P<.001), inclined press (mean 174.1, SD 41.1 kg vs mean 229.2, SD 50.4 kg; P<.001), butterfly (mean 26.3, SD 6.2 kg vs mean 32.5, SD 6.6 kg; P<.001), and curl biceps on desk (mean 22.9, SD 5.2 kg vs mean 29.6, SD 5.2 kg; P<.001). After 20 weeks, the 1-RM leg curl, bench press, pullover, butterfly, leg extension, curl biceps on desk, and inclined press showed significant mean percentage gains of +40%, +41.1%, +50.3%, +63.5%, +80.1%, +105%, and +106%, respectively (P<.001). Additionally, the isokinetic evaluation confirmed increases in maximal strength for the biceps (+9.2 Nm), triceps (+11.6 Nm), quadriceps (+46.8 Nm), and hamstrings (+25.3 Nm). In this paper, only the training and muscular aspects are presented; the cardiac analysis will be addressed separately. Conclusions: This study demonstrated that a short-term high-intensity strength training program was successful in achieving significant gains in muscle strength among previously untrained young men. We intend to use this protocol to gain a better understanding of the impact of high-intensity strength training on cardiac physiological remodeling, thereby providing new insights into the cardiac global response in strength athletes. Trial Registration: ClinicalTrials.gov NCT04187170; https://clinicaltrials.gov/study/NCT04187170 %M 37874630 %R 10.2196/47876 %U https://formative.jmir.org/2023/1/e47876 %U https://doi.org/10.2196/47876 %U http://www.ncbi.nlm.nih.gov/pubmed/37874630 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45564 %T Temporal Trends in Cardiovascular Health Status Among Chinese School-Aged Children From 1989 to 2018: Multiwave Cross-Sectional Analysis %A Wang,Xijie %A Dong,Bin %A Huang,Feifei %A Zhang,Ji %A He,Rongxin %A Du,Shufa %A Zhang,Jiguo %A Ma,Jun %A Wang,Huijun %A Zhang,Bing %A Liang,Wannian %+ National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No.27, Nanwei Road, Beijing, 100050, China, 86 10 66237298, zhangbing@chinacdc.cn %K cardiovascular health %K school-aged children %K temporal change %K China Health and Nutrition Survey %D 2023 %7 23.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite the release of updated metrics for Life’s Essential 8 (LE8), key indicators for assessing cardiovascular health (CVH) status, there is currently no report on their distribution among Chinese children. Objective: This study aimed to assess the nationwide distribution of CVH in Chinese school-aged children using LE8 scores and analyze temporal changes in these scores over time. Methods: Participants aged 7 to 19 years from 11 waves (between 1989 and 2018) of the China Health and Nutrition Survey were included in this study. LE8 components were grouped into 2 domains of health behaviors (diet, physical activity, nicotine exposure, sleep) and health factors (BMI, blood lipids, blood glucose, blood pressure). Scores of overall CVH and each LE8 metric were calculated individually. Temporal changes were assessed with joint point regression models by rural and urban living residence. The causal relationships between health behaviors and health factors that changed the most over time were built with cross-lagged panel models. Results: A total of 21,921 participants, 52.6% (n=11,537) of whom were male, who had data for at least 4 CVH components were included in the analysis. The mean age was 13 (SD 3.6) years. The overall CVH score remained stable in most regions, with the lowest found in Shandong from East China, which had a mean between 67 (SD 10.9) and 67.2 (SD 12.4). In contrast, the highest score was found in Guizhou from Southwest China, with a mean between 71.4 (SD 10.8) and 74.3 (SD 10.3). In rural areas, the diet score decreased significantly from 1997 onward with a speed of 0.18 (95% CI: 0.15-0.21; P<.001) per year, and the BMI score decreased significantly from 2005 onward with a speed of 0.56 (95% CI 0.44-0.68; P<.001) per year. In urban areas, the diet score decreased from 1994 onward with a speed of 0.03 (95% CI: 0.001-0.07; P=.04) per year, and the BMI score decreased from 2002 onward with a speed of 0.63 (95% CI 0.47-0.79; P<.001) per year. The sleep score dropped constantly in both urban and rural areas, with a speed of 0.69 (95% CI 0.58-0.80; P<.001) and 0.69 (95% CI: 0.52-0.86; P<.001) per year, respectively. A decline in the diet score led to a decline in the BMI score with a coefficient of 0.190 (95% CI 0.030-0.351; P=.02), while a decline in the BMI score led to a decline in sleep health with a coefficient of 0.089 (95% CI 0.010-0.168; P=.03). Conclusions: Chinese school-aged children and adolescents were generally of moderate CVH status, but mutual influences existed between CVH metrics. Dietary interventions should be prioritized for promoting overall CVH in the future. %M 37870895 %R 10.2196/45564 %U https://publichealth.jmir.org/2023/1/e45564 %U https://doi.org/10.2196/45564 %U http://www.ncbi.nlm.nih.gov/pubmed/37870895 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e43889 %T Initial Implementation of the My Heart, My Life Program by the National Heart Foundation of Australia: Pilot Mixed Methods Evaluation Study %A Kazi,Samia %A Truesdale,Chloe %A Ryan,Pauline %A Wiesner,Glen %A Jennings,Garry %A Chow,Clara %+ The University of Sydney, Science Rd, Camperdown NSW, Sydney, 2050, Australia, 61 400315228, samia.kazi@sydney.edu.au %K cardiology %K prevention %K digital health %K heart %K text message %K text messaging %K SMS %K health communication %K demographic %K preventative %K cardio %D 2023 %7 5.10.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Coronary heart disease (CHD) remains the leading cause of death in Australia, with a high residual risk of repeat events in survivors. Secondary prevention therapy is crucial for reducing the risk of both death and other major adverse cardiac events. The National Heart Foundation of Australia has developed a consumer-facing support program called My Heart, My Life (MHML) to address the gap in the secondary prevention of CHD in Australia. The MHML pilot program supplies advice and support for both patients and their caregivers, and it was conducted over 8 months from November 2019 to June 2020. Objective: This study aims to describe and examine the implementation of a novel multimodality secondary CHD prevention pilot program called MHML, which was delivered through booklets, text messages, emails, and telephone calls. Methods: This pilot study consists of a mixed methods evaluation involving surveys of participants (patients and caregivers) and health professionals, in-depth interviews, and digital communication (SMS text message, electronic direct mail, and call record analytics). This study was performed in people older than 18 years with acute coronary syndrome or angina and their caregivers in 38 Australian hospitals from November 2019 to June 2020 through the National Heart Foundation of Australia web page. The main outcome measures were reach, accessibility, feasibility, barriers, and enablers to implementation of this program. Results: Of the 1004 participants (838 patients and 164 caregivers; 2 missing), 60.9% (608/1001) were males, 50.7% (491/967) were aged between 45 and 64 years, 27.4% (276/1004) were from disadvantaged areas, 2.5% (24/946) were from Aboriginal or Torres Strait Islander background, and 16.9% (170/1004) reported English as their second language. The participants (patients and their caregivers) and health professionals reported high satisfaction with the MHML program (55/62, 88.7% and 33/38, 87%, respectively). Of the 62 participants who took the survey, 88% (55/62) used the text messaging service and reported a very high level of satisfaction. Approximately 94% (58/62) and 89% (55/62) of the participants were satisfied with the quick guide booklets 1 and 2, respectively; 79% (49/62) were satisfied with the monthly email journey and 71% (44/62) were satisfied with the helpline calls. Most participants reported that the MHML program improved preventive behaviors, that is, 73% (45/62) of them reported that they maintained increased physical activity and 84% (52/62) reported that they maintained a healthy diet even after the MHML program. Conclusions: The findings of our pilot study suggest that a multimodal support program, including digital, print, phone, and web-based media, for the secondary prevention of CHD is useful and could be a potential means of providing customized at-scale secondary prevention support for survivors of acute coronary syndrome. %M 37796544 %R 10.2196/43889 %U https://cardio.jmir.org/2023/1/e43889 %U https://doi.org/10.2196/43889 %U http://www.ncbi.nlm.nih.gov/pubmed/37796544 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e46991 %T The Impact of Physical Activity Intensity on the Dynamic Progression of Cardiometabolic Multimorbidity: Prospective Cohort Study Using UK Biobank Data %A Liu,Bao-Peng %A Zhu,Jia-Hui %A Wan,Li-Peng %A Zhao,Zhen-Yu %A Wang,Xinting %A Jia,Cun-Xian %+ Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhua Xi Road, No 44, Jinan, 250012, China, 86 88382141 ext 8809, jiacunxian@sdu.edu.cn %K physical activity intensity %K PA %K dynamic progression %K cardiometabolic multimorbidity %K cohort study %K CMM %D 2023 %7 25.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although many studies have reported on the associations between the amount of physical activity (PA) and the transitions of cardiometabolic multimorbidity (CMM), the evidence for PA intensity has not been fully evaluated. Objective: This study aimed to explore the impact of PA intensity on the dynamic progression of CMM. Methods: The prospective cohort of this study using data from the UK Biobank included 359,773 participants aged 37-73 years who were recruited from 22 centers between 2006 and 2010. The diagnoses of CMM, which included the copresence of type 2 diabetes (T2D), ischemic heart disease, and stroke, were obtained from first occurrence fields provided by the UK Biobank, which included data from primary care, hospital inpatient record, self-reported medical condition, and death registers. The PA intensity was assessed by the proportion of vigorous PA (VPA) to moderate to vigorous PA (MVPA). Multistate models were used to evaluate the effect of PA intensity on the dynamic progression of CMM. The first model (model A) included 5 transitions, namely free of cardiometabolic disease (CMD) to first occurrence of CMD (FCMD), free of CMD to death, FCMD to CMM, FCMD to mortality, and CMM to mortality. The other model (model B) used specific CMD, namely T2D, ischemic heart disease, and stroke, instead of FCMD and included 11 transitions in this study. Results: The mean age of the included participants (N=359,773) was 55.82 (SD 8.12) years at baseline, and 54.55% (196,271/359,773) of the participants were female. Compared with the participants with no VPA, participants with intensity levels of >0.75 to <1 for VPA to MVPA had a 13% and 27% lower risk of transition from free of CMD to FCMD (hazard ratio [HR] 0.87, 95% CI 0.83-0.91) and mortality (HR 0.73, 95% CI 0.66-0.79) in model A, respectively. The HR for the participants with no moderate PA was 0.82 (95% CI 0.73-0.92) compared with no VPA. There was a substantially protective effect of higher PA intensity on the transitions from free of CMD to T2D and from T2D to mortality, which reveals the importance of PA intensity for the transitions of T2D. More PA and greater intensity had a synergistic effect on decreasing the risk of the transitions from free of CMD to FCMD and mortality. Male participants, younger adults, adults with a higher BMI, current or previous smokers, and excessive alcohol drinkers could obtain more benefits from higher PA intensity for the lower risk of at least 1 transition from free of CMD, then to CMM, and finally to mortality. Conclusions: This study suggests that higher PA intensity is an effective measure for preventing CMM and mortality in the early period of CMM development. Relevant interventions related to higher PA intensity should be conducted. %M 37747776 %R 10.2196/46991 %U https://publichealth.jmir.org/2023/1/e46991 %U https://doi.org/10.2196/46991 %U http://www.ncbi.nlm.nih.gov/pubmed/37747776 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42756 %T Identification of Risk Groups for and Factors Affecting Metabolic Syndrome in South Korean Single-Person Households Using Latent Class Analysis and Machine Learning Techniques: Secondary Analysis Study %A Lee,Ji-Soo %A Lee,Soo-Kyoung %+ Big Data Convergence and Open Sharing System, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 889 5710, soo1005s@gmail.com %K latent class analysis %K machine learning %K metabolic syndrome %K risk factor %K single-person households %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid increase of single-person households in South Korea is leading to an increase in the incidence of metabolic syndrome, which causes cardiovascular and cerebrovascular diseases, due to lifestyle changes. It is necessary to analyze the complex effects of metabolic syndrome risk factors in South Korean single-person households, which differ from one household to another, considering the diversity of single-person households. Objective: This study aimed to identify the factors affecting metabolic syndrome in single-person households using machine learning techniques and categorically characterize the risk factors through latent class analysis (LCA). Methods: This cross-sectional study included 10-year secondary data obtained from the National Health and Nutrition Examination Survey (2009-2018). We selected 1371 participants belonging to single-person households. Data were analyzed using SPSS (version 25.0; IBM Corp), Mplus (version 8.0; Muthen & Muthen), and Python (version 3.0; Plone & Python). We applied 4 machine learning algorithms (logistic regression, decision tree, random forest, and extreme gradient boost) to identify important factors and then applied LCA to categorize the risk groups of metabolic syndromes in single-person households. Results: Through LCA, participants were classified into 4 groups (group 1: intense physical activity in early adulthood, group 2: hypertension among middle-aged female respondents, group 3: smoking and drinking among middle-aged male respondents, and group 4: obesity and abdominal obesity among middle-aged respondents). In addition, age, BMI, obesity, subjective body shape recognition, alcohol consumption, smoking, binge drinking frequency, and job type were investigated as common factors that affect metabolic syndrome in single-person households through machine learning techniques. Group 4 was the most susceptible and at-risk group for metabolic syndrome (odds ratio 17.67, 95% CI 14.5-25.3; P<.001), and obesity and abdominal obesity were the most influential risk factors for metabolic syndrome. Conclusions: This study identified risk groups and factors affecting metabolic syndrome in single-person households through machine learning techniques and LCA. Through these findings, customized interventions for each generational risk factor for metabolic syndrome can be implemented, leading to the prevention of metabolic syndrome, which causes cardiovascular and cerebrovascular diseases. In conclusion, this study contributes to the prevention of metabolic syndrome in single-person households by providing new insights and priority groups for the development of customized interventions using classification. %M 37698907 %R 10.2196/42756 %U https://formative.jmir.org/2023/1/e42756 %U https://doi.org/10.2196/42756 %U http://www.ncbi.nlm.nih.gov/pubmed/37698907 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e48096 %T Corrected QT Interval (QTc) Diagnostic App for the Oncological Routine: Development Study %A Klier,Kristina %A Patel,Yash J %A Schinköthe,Timo %A Harbeck,Nadia %A Schmidt,Annette %+ Institute of Sport Science, University of the Bundeswehr Munich, Werner-Heisenberg-Weg 39, Neubiberg, 85577, Germany, 49 89 6004 4412, annette.schmidt@unibw.de %K telemedicine %K mobile health %K mHealth %K eHealth %K tele-cardiology %K cardiology %K long QT syndrome %K prolonged QT interval %K electrocardiography %K ECG %K telehealth %K app %K application %K oncology %K cancer %K diagnosis %K diagnostic %K heart %K arrhythmia %K cardiotoxic %K side effects %K adverse effects %D 2023 %7 11.9.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Numerous antineoplastic drugs such as chemotherapeutics have cardiotoxic side effects and can lead to long QT syndrome (LQTS). When diagnosed and treated in time, the potentially fatal outcomes of LQTS can be prevented. Therefore, regular electrocardiogram (ECG) assessments are critical to ensure patient safety. However, these assessments are associated with patient discomfort and require timely support of the attending oncologist by a cardiologist. Objective: This study aimed to examine whether this approach can be made more efficient and comfortable by a smartphone app (QTc Tracker), supporting single-lead ECG records on site and transferring to a tele-cardiologist for an immediate diagnosis. Methods: To evaluate the QTc Tracker, it was implemented in 54 cancer centers in Germany. In total, 266 corrected QT interval (QTc) diagnoses of 122 patients were recorded. Moreover, a questionnaire on routine ECG workflow, turnaround time, and satisfaction (1=best, 6=worst) was answered by the centers before and after the implementation of the QTc Tracker. Results: Compared to the routine ECG workflow, the QTc Tracker enabled a substantial turnaround time reduction of 98% (mean 2.67, 95% CI 1.72-2.67 h) and even further time efficiency in combination with a cardiologic on-call service (mean 12.10, 95% CI 5.67-18.67 min). Additionally, nurses and patients reported higher satisfaction when using the QTc Tracker. In particular, patients’ satisfaction sharply improved from 2.59 (95% CI 2.41-2.88) for the routine ECG workflow to 1.25 (95% CI 0.99-1.51) for the QTc Tracker workflow. Conclusions: These results reveal a significant improvement regarding reduced turnaround time and increased user satisfaction. Best patient care might be guaranteed as the exposure of patients with an uncontrolled risk of QTc prolongations can be avoided by using the fast and easy QTc Tracker. In particular, as regular side-effect monitoring, the QTc Tracker app promises more convenience for patients and their physicians. Finally, future studies are needed to empirically test the usability and validity of such mobile ECG assessment methods. Trial Registration: ClinicalTrials.gov NCT04055493; https://classic.clinicaltrials.gov/ct2/show/NCT04055493 %M 37695655 %R 10.2196/48096 %U https://cardio.jmir.org/2023/1/e48096 %U https://doi.org/10.2196/48096 %U http://www.ncbi.nlm.nih.gov/pubmed/37695655 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47095 %T Combinatorial Use of Machine Learning and Logistic Regression for Predicting Carotid Plaque Risk Among 5.4 Million Adults With Fatty Liver Disease Receiving Health Check-Ups: Population-Based Cross-Sectional Study %A Deng,Yuhan %A Ma,Yuan %A Fu,Jingzhu %A Wang,Xiaona %A Yu,Canqing %A Lv,Jun %A Man,Sailimai %A Wang,Bo %A Li,Liming %+ Meinian Institute of Health, 13 Floor, Health Work, Huayuan Road, Haidian District, Beijing, 100083, China, 86 010 82097560, paul@meinianresearch.com %K machine learning %K carotid plaque %K health check-up %K prediction %K fatty liver %K risk assessment %K risk stratification %K cardiovascular %K logistic regression %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Carotid plaque can progress into stroke, myocardial infarction, etc, which are major global causes of death. Evidence shows a significant increase in carotid plaque incidence among patients with fatty liver disease. However, unlike the high detection rate of fatty liver disease, screening for carotid plaque in the asymptomatic population is not yet prevalent due to cost-effectiveness reasons, resulting in a large number of patients with undetected carotid plaques, especially among those with fatty liver disease. Objective: This study aimed to combine the advantages of machine learning (ML) and logistic regression to develop a straightforward prediction model among the population with fatty liver disease to identify individuals at risk of carotid plaque. Methods: Our study included 5,420,640 participants with fatty liver from Meinian Health Care Center. We used random forest, elastic net (EN), and extreme gradient boosting ML algorithms to select important features from potential predictors. Features acknowledged by all 3 models were enrolled in logistic regression analysis to develop a carotid plaque prediction model. Model performance was evaluated based on the area under the receiver operating characteristic curve, calibration curve, Brier score, and decision curve analysis both in a randomly split internal validation data set, and an external validation data set comprising 32,682 participants from MJ Health Check-up Center. Risk cutoff points for carotid plaque were determined based on the Youden index, predicted probability distribution, and prevalence rate of the internal validation data set to classify participants into high-, intermediate-, and low-risk groups. This risk classification was further validated in the external validation data set. Results: Among the participants, 26.23% (1,421,970/5,420,640) were diagnosed with carotid plaque in the development data set, and 21.64% (7074/32,682) were diagnosed in the external validation data set. A total of 6 features, including age, systolic blood pressure, low-density lipoprotein cholesterol (LDL-C), total cholesterol, fasting blood glucose, and hepatic steatosis index (HSI) were collectively selected by all 3 ML models out of 27 predictors. After eliminating the issue of collinearity between features, the logistic regression model established with the 5 independent predictors reached an area under the curve of 0.831 in the internal validation data set and 0.801 in the external validation data set, and showed good calibration capability graphically. Its predictive performance was comprehensively competitive compared with the single use of either logistic regression or ML algorithms. Optimal predicted probability cutoff points of 25% and 65% were determined for classifying individuals into low-, intermediate-, and high-risk categories for carotid plaque. Conclusions: The combination of ML and logistic regression yielded a practical carotid plaque prediction model, and was of great public health implications in the early identification and risk assessment of carotid plaque among individuals with fatty liver. %M 37676713 %R 10.2196/47095 %U https://publichealth.jmir.org/2023/1/e47095 %U https://doi.org/10.2196/47095 %U http://www.ncbi.nlm.nih.gov/pubmed/37676713 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44073 %T Association Between Metabolic Syndrome and Mortality: Prospective Cohort Study %A Li,Wenzhen %A Chen,Dajie %A Peng,Ying %A Lu,Zuxun %A Kwan,Mei-Po %A Tse,Lap Ah %+ Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong), 852 22528791, shelly@cuhk.edu.hk %K metabolic syndrome %K mortality %K heart disease %K diabetes mellitus %K cancer %D 2023 %7 5.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Metabolic syndrome (MetS) is a common metabolic disorder that results from the increasing prevalence of obesity, which has been an increasing concern in recent years. Previous evidence indicated that MetS was associated with mortality; however, different definitions of MetS were used. In 2005, the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III updated the definition of MetS, which has since been widely adopted. Therefore, it is necessary to conduct a novel study among other populations and countries with a larger sample size using the updated definition of MetS and death code to examine the association of MetS with all-cause and cause-specific mortality. Objective: We aimed to examine the associations of MetS with all-cause and cause-specific mortality. Methods: A total of 36,414 adults were included in this study, using data from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and the continuous NHANES (1999-2014) in the United States. Death outcomes were ascertained by linkage to National Death Index records through December 31, 2015. MetS was defined by the NCEP ATP III-2005 criterion. Complex survey design factors including sample weights, clustering, and stratification were considered for all analyses with instructions for using NHANES data. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for mortality from all causes, heart disease, diabetes, and cancer. Results: We observed 8494 deaths during the 16.71 years of follow-up. Compared with those without MetS, individuals with MetS were associated with a significantly elevated multiadjusted HR of 1.24 (95% CI 1.16-1.33), 1.44 (95% CI 1.25-1.66), and 5.15 (95% CI 3.15-8.43) for all cause, heart diseases, and diabetes mellitus, respectively, whereas no significant association was found for cancer mortality (HR 1.17, 95% CI 0.95-1.43). Conclusions: Our study provides additional evidence that MetS and its components are significantly associated with all-cause, heart disease, and diabetes mortality, but not with cancer mortality. Health care professionals should pay more attention to MetS and its individual component. %M 37669100 %R 10.2196/44073 %U https://publichealth.jmir.org/2023/1/e44073 %U https://doi.org/10.2196/44073 %U http://www.ncbi.nlm.nih.gov/pubmed/37669100 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43737 %T The Impact of Metabolic Syndrome Risk Factors on Lung Function Impairment: Cross-Sectional Study %A Molina-Luque,Rafael %A Molina-Recio,Guillermo %A de-Pedro–Jiménez,Domingo %A Álvarez Fernández,Carlos %A García–Rodríguez,María %A Romero-Saldaña,Manuel %+ Estilos de Vida, Innovación y Salud, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avd Menéndez Pidal N/N, Córdoba, 14004, Spain, 34 957 21 37 00, en1moreg@uco.es %K cardiometabolic risk factor %K lung function %K metabolic syndrome %K restrictive lung disease %K spirometry %D 2023 %7 5.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Metabolic syndrome (MetS) is a constellation of risk factors increasingly present in the world’s population. People with this syndrome are at an increased risk of cardiovascular disease and type 2 diabetes mellitus. Moreover, evidence has shown that it affects different organs. MetS and its risk factors are independently associated with impaired lung function, which can be quantified through spirometric variables. Objective: This study aims to determine whether a high number of MetS criteria is associated with increased lung function decline. Methods: We conducted a descriptive cross-sectional study with a random sample of 1980 workers. Workers with acute respiratory pathology (eg, influenza), chronic respiratory pathology (eg, chronic bronchitis), or exposure to substances harmful to the lungs (eg, organic and inorganic dust) were not included. MetS was established based on harmonized criteria, and lung function was assessed according to spirometric variables. On the basis of these, classification into restrictive lung disease (RLD), obstructive lung disease, and mixed lung disease (MLD) was performed. In addition, the association between MetS and lung function was established based on analysis of covariance, linear trend analysis, and multiple linear regression. Results: MetS was associated with worse lung function according to all the spirometric parameters analyzed (percentage of predicted forced expiratory volume in 1 second: mean 83, SD 13.8 vs mean 89.2, SD 12.8; P<.001 and percentage of predicted forced vital capacity: mean 85.9, SD 11.6 vs mean 92, SD 11.3; P<.001). Moreover, those diagnosed with MetS had a higher prevalence of lung dysfunction (41% vs 21.9%; P<.001), RLD (23.4% vs 11.2%; P<.001), and MLD (7.3% vs 2.2%; P<.001). Furthermore, an increasing number of MetS criteria was associated with a greater impairment of pulmonary mechanics (P<.001). Similarly, with an increasing number of MetS criteria, there was a significant linear trend (P<.001) in the growth of the prevalence ratio of RLD (0 criteria: 1, 1: 1.46, 2: 1.52, 3: 2.53, 4: 2.97, and 5: 5.34) and MLD (0 criteria: 1, 1: 2.68, 2: 6.18, 3: 9.69, and 4: 11.37). Regression analysis showed that the alteration of all MetS risk factors, adjusted for various explanatory variables, was significantly associated with a worsening of spirometric parameters, except for forced expiratory volume in 1 second/forced vital capacity. Conclusions: The findings have shown that an increase in cardiometabolic risk factors is associated with a more significant worsening of spirometric variables and a higher prevalence of RLD and MLD. As spirometry could be a crucial tool for monitoring patients at risk of developing chronic pathologies, we conclude that this inexpensive and easily accessible test could help detect changes in lung function in patients with cardiometabolic disorders. This highlights the need to consider the importance of cardiometabolic health in lung function when formulating public health policies. %M 37669095 %R 10.2196/43737 %U https://publichealth.jmir.org/2023/1/e43737 %U https://doi.org/10.2196/43737 %U http://www.ncbi.nlm.nih.gov/pubmed/37669095 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e41574 %T Cardiovascular Risk Assessment Among Adolescents and Youths Living With HIV: Evaluation of Electronic Health Record Findings and Implications %A Gurung,Sitaji %A Simpson,Kit N %A Grov,Christian %A Rendina,H Jonathon %A Huang,Terry T K %A Budhwani,Henna %A Jones,Stephen Scott %A Dark,Tyra %A Naar,Sylvie %+ Department of Health Sciences, New York City College of Technology (City Tech), The City University of New York, 285 Jay Street, A811D, Brooklyn, NY, 11201, United States, 1 718 260 5673, Sitaji.Gurung65@citytech.cuny.edu %K cardiovascular risk %K cluster of differentiation 4 lymphocyte %K electronic health record %K viral load %K youths living with HIV %D 2023 %7 16.8.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: The HIV epidemic remains a major public health concern, particularly among youths living with HIV. While the availability of antiretroviral therapy has significantly improved the health outcomes of people living with HIV, there is growing evidence that youths living with HIV may be at increased risk of cardiovascular disease. However, the underlying mechanisms linking HIV and cardiovascular disease among youths living with HIV remain poorly understood. One potential explanation is that HIV-related biomarkers, including detectable viral load (VL) and low cluster of differentiation 4 (CD4) lymphocyte counts, may contribute to increased cardiovascular risk. Despite the potential importance of these biomarkers, the relationship between HIV-related biomarkers and cardiovascular risk among youths living with HIV has been understudied. Objective: To address this gap, we examined whether detectable VL and low CD4 lymphocyte counts, both of which are indications of unsuppressed HIV, were associated with cardiovascular risk among youths living with HIV. Methods: We analyzed electronic health record data from 7 adolescent HIV clinics in the United States (813 youths living with HIV). We used multivariable linear regression to examine the relationship between detectable VL and CD4 lymphocyte counts of ≤200 and cardiovascular risk scores, which were adapted from the gender-specific Framingham algorithm. Results: In our study, nearly half of the participants (366/766, 47.8%) had detectable VL, indicating unsuppressed HIV, while 8.6% (51/593) of them had CD4 lymphocyte counts of ≤200, suggesting weakened immune function. We found that those with CD4 lymphocyte counts of ≤200 had significantly higher cardiovascular risk, as assessed by Cardiac Risk Score2, than those with CD4 lymphocyte counts of >200 (P=.002). After adjusting for demographic and clinical factors, we found that for every 1000-point increase in VL copies/mL, the probability of having cardiovascular risk (Cardiac Risk Score2) increased by 38%. When measuring the strength of this connection, we observed a minor effect of VL on increased cardiovascular risk (β=.134, SE 0.014; P=.006). We obtained similar results with Cardiac Risk Score1, but the effect of CD4 lymphocyte counts of ≤200 was no longer significant. Overall, our findings suggest that detectable VL is associated with increased cardiovascular risk among youths living with HIV, and that CD4 lymphocyte counts may play a role in this relationship as well. Conclusions: Our study highlights a significant association between unsuppressed HIV, indicated by detectable VL, and increased cardiovascular risk in youths living with HIV. These findings emphasize the importance of implementing interventions that address both VL suppression and cardiovascular risk reduction in this population. By tailoring interventions to meet the unique needs of youths, we can promote overall well-being throughout the HIV care continuum and across the life span. Ultimately, these efforts have the potential to improve the health outcomes and quality of life of youths living with HIV. International Registered Report Identifier (IRRID): RR2-10.2196/11185 %M 37585242 %R 10.2196/41574 %U https://www.i-jmr.org/2023/1/e41574 %U https://doi.org/10.2196/41574 %U http://www.ncbi.nlm.nih.gov/pubmed/37585242 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e43940 %T Preliminary Efficacy, Feasibility, and Perceived Usefulness of a Smartphone-Based Self-Management System With Personalized Goal Setting and Feedback to Increase Step Count Among Workers With High Blood Pressure: Before-and-After Study %A Shibuta,Tomomi %A Waki,Kayo %A Miyake,Kana %A Igarashi,Ayumi %A Yamamoto-Mitani,Noriko %A Sankoda,Akiko %A Takeuchi,Yoshinori %A Sumitani,Masahiko %A Yamauchi,Toshimasa %A Nangaku,Masaomi %A Ohe,Kazuhiko %+ Department of Healthcare Information Management, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 5800 9129, kwaki-tky@m.u-tokyo.ac.jp %K behavior change %K blood pressure %K feasibility studies %K goal setting %K mobile health %K mHealth %K self-control %K self-efficacy %K self-regulation %K smartphone %K step count %K walking %K workplace %K mobile phone %D 2023 %7 21.7.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: High blood pressure (BP) and physical inactivity are the major risk factors for cardiovascular diseases. Mobile health is expected to support patients’ self-management for improving cardiovascular health; the development of fully automated systems is necessary to minimize the workloads of health care providers. Objective: The objective of our study was to evaluate the preliminary efficacy, feasibility, and perceived usefulness of an intervention using a novel smartphone-based self-management system (DialBetes Step) in increasing steps per day among workers with high BP. Methods: On the basis of the Social Cognitive Theory, we developed personalized goal-setting and feedback functions and information delivery functions for increasing step count. Personalized goal setting and feedback consist of 4 components to support users’ self-regulation and enhance their self-efficacy: goal setting for daily steps, positive feedback, action planning, and barrier identification and problem-solving. In the goal-setting component, users set their own step goals weekly in gradual increments based on the system’s suggestion. We added these fully automated functions to an extant system with the function of self-monitoring daily step count, BP, body weight, blood glucose, exercise, and diet. We conducted a single-arm before-and-after study of workers with high BP who were willing to increase their physical activity. After an educational group session, participants used only the self-monitoring function for 2 weeks (baseline) and all functions of DialBetes Step for 24 weeks. We evaluated changes in steps per day, self-reported frequencies of self-regulation and self-management behavior, self-efficacy, and biomedical characteristics (home BP, BMI, visceral fat area, and glucose and lipid parameters) around week 6 (P1) of using the new functions and at the end of the intervention (P2). Participants rated the usefulness of the system using a paper-based questionnaire. Results: We analyzed 30 participants (n=19, 63% male; mean age 52.9, SD 5.3 years); 1 (3%) participant dropped out of the intervention. The median percentage of step measurement was 97%. Compared with baseline (median 10,084 steps per day), steps per day significantly increased at P1 (median +1493 steps per day; P<.001), but the increase attenuated at P2 (median +1056 steps per day; P=.04). Frequencies of self-regulation and self-management behavior increased at P1 and P2. Goal-related self-efficacy tended to increase at P2 (median +5%; P=.05). Home BP substantially decreased only at P2. Of the other biomedical characteristics, BMI decreased significantly at P1 (P<.001) and P2 (P=.001), and high-density lipoprotein cholesterol increased significantly only at P1 (P<.001). DialBetes Step was rated as useful or moderately useful by 97% (28/29) of the participants. Conclusions: DialBetes Step intervention might be a feasible and useful way of increasing workers’ step count for a short period and, consequently, improving their BP and BMI; self-efficacy–enhancing techniques of the system should be improved. %M 37477976 %R 10.2196/43940 %U https://cardio.jmir.org/2023/1/e43940 %U https://doi.org/10.2196/43940 %U http://www.ncbi.nlm.nih.gov/pubmed/37477976 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e40653 %T The Global Prevalence of Nonalcoholic Fatty Liver Disease and its Association With Cancers: Systematic Review and Meta-Analysis %A Muhamad,Nor Asiah %A Maamor,Nur Hasnah %A Leman,Fatin Norhasny %A Mohamad,Zuraifah Asrah %A Bakon,Sophia Karen %A Abdul Mutalip,Mohd Hatta %A Rosli,Izzah Athirah %A Aris,Tahir %A Lai,Nai Ming %A Abu Hassan,Muhammad Radzi %+ Sector for Evidence-based Healthcare, National Institutes of Health, Ministry of Health, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Malaysia, 60 33628000 ext 8705, norasiahdr@gmail.com %K fatty liver %K nonalcoholic fatty liver %K NAFL %K nonalcoholic fatty liver disease %K NAFLD %K prevalence %K cancers %K cancer %K extrahepatic %K liver %K carcinoma %D 2023 %7 19.7.2023 %9 Review %J Interact J Med Res %G English %X Background: Nonalcoholic fatty liver disease (NAFLD) is one of the common causes of chronic liver disease globally. Obesity, metabolic diseases, and exposure to some environmental agents contribute to NAFLD. NAFLD is commonly considered a precursor for some types of cancers. Since the leading causes of death in people with NAFLD are cardiovascular disease and extrahepatic cancers, it is important to understand the mechanisms of the progression of NAFLD to control its progression and identify its association with extrahepatic cancers. Thus, this review aims to estimate the global prevalence of NAFLD in association with the risk of extrahepatic cancers. Objective: We aimed to determine the prevalence of various cancers in NAFLD patients and the association between NAFLD and cancer. Methods: We searched PubMed, ProQuest, Scopus, and Web of Science from database inception to March 2022 to identify eligible studies reporting the prevalence of NAFLD and the risk of incident cancers among adult individuals (aged ≥18 years). Data from selected studies were extracted, and meta-analysis was performed using random effects models to obtain the pooled prevalence with the 95% CI. The quality of the evidence was assessed with the Newcastle-Ottawa Scale. Results: We identified 11 studies that met our inclusion criteria, involving 222,523 adults and 3 types of cancer: hepatocellular carcinoma (HCC), breast cancer, and other types of extrahepatic cancer. The overall pooled prevalence of NAFLD and cancer was 26% (95% CI 16%-35%), while 25% of people had NAFLD and HCC (95% CI 7%-42%). NAFLD and breast cancer had the highest prevalence out of the 3 forms of cancer at 30% (95% CI 14%-45%), while the pooled prevalence for NAFLD and other cancers was 21% (95% CI 12%-31%). Conclusions: The review suggests that people with NAFLD may be at an increased risk of cancer that might not affect not only the liver but also other organs, such as the breast and bile duct. The findings serve as important evidence for policymakers to evaluate and recommend measures to reduce the prevalence of NAFLD through lifestyle and environmental preventive approaches. Trial Registration: PROSPERO CRD42022321946; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=321946 %M 37467012 %R 10.2196/40653 %U https://www.i-jmr.org/2023/1/e40653 %U https://doi.org/10.2196/40653 %U http://www.ncbi.nlm.nih.gov/pubmed/37467012 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45677 %T Evaluation of Social Isolation Trajectories and Incident Cardiovascular Disease Among Middle-Aged and Older Adults in China: National Cohort Study %A Guo,Lan %A Wang,Wanxin %A Shi,Jingman %A Zheng,Xinyu %A Hua,Yilin %A Lu,Ciyong %+ School of Public Health, Sun Yat-sen University, No 74 Zhongshan 2nd, Guangzhou, 510080, China, 86 87332477, luciyong@mail.sysu.edu.cn %K social isolation trajectories %K cardiovascular disease %K CVD %K cohort study %K middle-aged and older adults %K China %K social isolation %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although the association between social isolation and the risk of subsequent cardiovascular disease (CVD) is well documented, most studies have only assessed social isolation at a single time point, and few studies have considered the association using repeatedly measured social isolation. Objective: This study aimed to examine the association between social isolation trajectories and incident CVD in a large cohort of middle-aged and older adults. Methods: This study used data from 4 waves (wave 1, wave 2, wave 3, and wave 4) of the China Health and Retirement Longitudinal Study. We defined the exposure period as from June 2011 to September 2015 (from wave 1 to wave 3) and the follow-up period as from September 2015 to March 2019 (wave 4). On the basis of the inclusion and exclusion criteria, our final analytic sample included 8422 individuals who had no CVD in the China Health and Retirement Longitudinal Study in waves 1 to 3 and were fully followed up in wave 4. Social isolation was ascertained using an extensively used questionnaire at 3 consecutive, biennial time points from waves 1 to 3, and individuals were assigned to 3 predefined social isolation trajectories based on their scores at each wave (consistently low, fluctuating, and consistently high). Incident CVD included self-reported physician-diagnosed heart disease and stroke combined. Cox proportional hazard models estimated the associations of social isolation trajectories with risks of incident CVD, adjusting for demographics, health behaviors, and health conditions. Results: Of the 8422 participants (mean age 59.76, SD 10.33 years at baseline), 4219 (50.09%) were male. Most of the participants (5267/8422, 62.54%) had consistently low social isolation over time and 16.62% (1400/8422) of the participants had consistently high social isolation over the exposure period. During the 4-year follow-up, 746 incident CVDs occurred (heart disease: 450 cases and stroke: 336 cases). Compared with individuals with consistently low social isolation, those with fluctuating social isolation (adjusted hazard ratio 1.27, 95% CI 1.01-1.59) and consistently high social isolation (adjusted hazard ratio 1.45, 95% CI 1.13-1.85) had higher risks for incident CVD after adjusting for demographics (ie, age, sex, residence, and educational level), health behaviors (ie, smoking status and drinking status), and health conditions (ie, BMI; history of diabetes, hypertension, dyslipidemia, chronic kidney disease; use of diabetes medications, hypertension medications, and lipid-lowering therapy; and depressive symptoms scores). Conclusions: In this cohort study, middle-aged and older adults with fluctuating and consistently high social isolation exposure had higher risks of the onset of CVD than those without the exposure. The findings suggest that routine social isolation screenings and efforts to improve social connectedness merit increased attention for preventing CVD among middle-aged and older adults. %M 37389914 %R 10.2196/45677 %U https://publichealth.jmir.org/2023/1/e45677 %U https://doi.org/10.2196/45677 %U http://www.ncbi.nlm.nih.gov/pubmed/37389914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45061 %T mHealth Intervention for Promoting Hypertension Self-management Among African American Patients Receiving Care at a Community Health Center: Formative Evaluation of the FAITH! Hypertension App %A Brewer,LaPrincess C %A Jones,Clarence %A Slusser,Joshua P %A Pasha,Maarya %A Lalika,Mathias %A Chacon,Megan %A Takawira,Patricia %A Shanedling,Stanton %A Erickson,Paul %A Woods,Cynthia %A Krogman,Ashton %A Ferdinand,Daphne %A Underwood,Paul %A Cooper,Lisa A %A Patten,Christi A %A Hayes,Sharonne N %+ Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 1st St S.W., Rochester, MN, 55905, United States, 1 507 266 1376, brewer.laprincess@mayo.edu %K African Americans %K hypertension %K telemedicine %K health promotion %K community health workers %K community-based participatory research %K mobile phone %K mobile health %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: African American individuals are at a higher risk of premature death from cardiovascular diseases than White American individuals, with disproportionate attributable risk from uncontrolled hypertension. Given their high use among African American individuals, mobile technologies, including smartphones, show promise in increasing reliable health information access. Culturally tailored mobile health (mHealth) interventions may promote hypertension self-management among this population. Objective: This formative study aimed to assess the feasibility of integrating an innovative mHealth intervention into clinical and community settings to improve blood pressure (BP) control among African American patients. Methods: A mixed methods study of African American patients with uncontrolled hypertension was conducted over 2 consecutive phases. In phase 1, patients and clinicians from 2 federally qualified health centers (FQHCs) in the Minneapolis-St Paul, Minnesota area, provided input through focus groups to refine an existing culturally tailored mHealth app (Fostering African-American Improvement in Total Health! [FAITH!] App) for promoting hypertension self-management among African American patients with uncontrolled hypertension (renamed as FAITH! Hypertension App). Phase 2 was a single-arm pre-post intervention pilot study assessing feasibility and patient satisfaction. Patients receiving care at an FQHC participated in a 10-week intervention using the FAITH! Hypertension App synchronized with a wireless BP monitor and community health worker (CHW) support to address social determinants of health–related social needs. The multimedia app consisted of a 10-module educational series focused on hypertension and cardiovascular risk factors with interactive self-assessments, medication and BP self-monitoring, and social networking. Primary outcomes were feasibility (app engagement and satisfaction) and preliminary efficacy (change in BP) at an immediate postintervention assessment. Results: In phase 1, thirteen African American patients (n=9, 69% aged ≥50 years and n=10, 77% women) and 16 clinicians (n=11, 69% aged ≥50 years; n=14, 88% women; and n=10, 63% African American) participated in focus groups. Their feedback informed app modifications, including the addition of BP and medication tracking, BP self-care task reminders, and culturally sensitive contexts. In phase 2, sixteen African American patients were enrolled (mean age 52.6, SD 12.3 years; 12/16, 75% women). Overall, 38% (6/16) completed ≥50% of the 10 education modules, and 44% (7/16) completed the postintervention assessment. These patients rated the intervention a 9 (out of 10) on its helpfulness in hypertension self-management. Qualitative data revealed that they viewed the app as user-friendly, engaging, and informative, and CHWs were perceived as providing accountability and support. The mean systolic and diastolic BPs of the 7 patients decreased by 6.5 mm Hg (P=.15) and 2.8 mm Hg (P=.78), respectively, at the immediate postintervention assessment. Conclusions: A culturally tailored mHealth app reinforced by CHW support may improve hypertension self-management among underresourced African American individuals receiving care at FQHCs. A future randomized efficacy trial of this intervention is warranted. Trial Registration: ClinicalTrials.gov NCT04554147; https://clinicaltrials.gov/ct2/show/NCT04554147 %M 37115658 %R 10.2196/45061 %U https://formative.jmir.org/2023/1/e45061 %U https://doi.org/10.2196/45061 %U http://www.ncbi.nlm.nih.gov/pubmed/37115658 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47911 %T Reducing Premature Coronary Artery Disease in Malaysia by Early Identification of Familial Hypercholesterolemia Using the Familial Hypercholesterolemia Case Ascertainment Tool (FAMCAT): Protocol for a Mixed Methods Evaluation Study %A Ramli,Anis Safura %A Qureshi,Nadeem %A Abdul-Hamid,Hasidah %A Kamal,Aisyah %A Kanchau,Johanes Dedi %A Shahuri,Nur Syahirah %A Akyea,Ralph Kwame %A Silva,Luisa %A Condon,Laura %A Abdul-Razak,Suraya %A Al-Khateeb,Alyaa %A Chua,Yung-An %A Mohamed-Yassin,Mohamed-Syarif %A Baharudin,Noorhida %A Badlishah-Sham,Siti Fatimah %A Abdul Aziz,Aznida Firzah %A Mohd Kasim,Noor Alicezah %A Sheikh Abdul Kadir,Siti Hamimah %A Kai,Joe %A Leonardi-Bee,Jo %A Nawawi,Hapizah %+ Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, 47000, Malaysia, 60 193844503, anis014@uitm.edu.my %K mixed methods evaluation %K study protocol %K familial hypercholesterolemia %K diagnostic accuracy %K qualitative methods %K FAMCAT %K Simon Broome criteria %K Dutch Lipid Clinic Criteria %K genetic diagnosis %K primary care %K Malaysia %D 2023 %7 2.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Familial hypercholesterolemia (FH) is predominantly caused by mutations in the 4 FH candidate genes (FHCGs), namely, low-density lipoprotein receptor (LDLR), apolipoprotein B-100 (APOB-100), proprotein convertase subtilisin/kexin type 9 (PCSK9), and the LDL receptor adaptor protein 1 (LDLRAP1). It is characterized by elevated low-density lipoprotein cholesterol (LDL-c) levels leading to premature coronary artery disease. FH can be clinically diagnosed using established clinical criteria, namely, Simon Broome (SB) and Dutch Lipid Clinic Criteria (DLCC), and can be identified using the Familial Hypercholesterolemia Case Ascertainment Tool (FAMCAT), a primary care screening tool. Objective: This study aims to (1) compare the detection rate of genetically confirmed FH and diagnostic accuracy between the FAMCAT, SB, and DLCC in the Malaysian primary care setting; (2) identify the genetic mutation profiles, including novel variants, in individuals with suspected FH in primary care; (3) explore the experience, concern, and expectation of individuals with suspected FH who have undergone genetic testing in primary care; and (4) evaluate the clinical utility of a web-based FH Identification Tool that includes the FAMCAT, SB, and DLCC in the Malaysian primary care setting. Methods: This is a mixed methods evaluation study conducted in 11 Ministry of Health primary care clinics located at the central administrative region of Malaysia. In Work stream 1, the diagnostic accuracy study design is used to compare the detection rate and diagnostic accuracy of the FAMCAT, SB, and DLCC against molecular diagnosis as the gold standard. In Work stream 2, the targeted next-generation sequencing of the 4 FHCGs is used to identify the genetic mutation profiles among individuals with suspected FH. In Work stream 3a, a qualitative semistructured interview methodology is used to explore the experience, concern, and expectation of individuals with suspected FH who have undergone genetic testing. Lastly, in Work stream 3b, a qualitative real-time observation of primary care physicians using the “think-aloud” methodology is applied to evaluate the clinical utility of a web-based FH Identification Tool. Results: The recruitment for Work stream 1, and blood sampling and genetic analysis for Work stream 2 were completed in February 2023. Data collection for Work stream 3 was completed in March 2023. Data analysis for Work streams 1, 2, 3a, and 3b is projected to be completed by June 2023, with the results of this study anticipated to be published by December 2023. Conclusions: This study will provide evidence on which clinical diagnostic criterion is the best to detect FH in the Malaysian primary care setting. The full spectrum of genetic mutations in the FHCGs including novel pathogenic variants will be identified. Patients’ perspectives while undergoing genetic testing and the primary care physicians experience in utilizing the web-based tool will be established. These findings will have tremendous impact on the management of patients with FH in primary care and subsequently reduce their risk of premature coronary artery disease. International Registered Report Identifier (IRRID): DERR1-10.2196/47911 %M 37137823 %R 10.2196/47911 %U https://www.researchprotocols.org/2023/1/e47911 %U https://doi.org/10.2196/47911 %U http://www.ncbi.nlm.nih.gov/pubmed/37137823 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45521 %T Using the New “Life’s Essential 8” Metrics to Evaluate Trends in Cardiovascular Health Among US Adults From 2005 to 2018: Analysis of Serial Cross-sectional Studies %A Li,Cheng %A Li,Yanzhi %A Zhao,Min %A Zhang,Cheng %A Bovet,Pascal %A Xi,Bo %+ Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China, 86 88382141, xibo2007@126.com %K trends %K cardiovascular health %K primordial prevention %K adult %K nutrition examination %K survey %K diet %K physical activity %K data collection %K cross-sectional %D 2023 %7 8.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The recently published “Life’s Essential 8” (LE8) by the American Heart Association has overcome some limitations in evaluating cardiovascular health (CVH) in the previous “Life’s Simple 7.” Objective: We aimed to examine the secular trends in CVH, as assessed by the LE8, in US adults from 2005 to 2018. Methods: Using cross-sectional data from the National Health and Nutrition Examination Survey between 2005-2006 and 2017-2018, we calculated the age-standardized mean scores of overall CVH and each of the LE8 components, where a higher score (range 0-100 points) means a better health status. A total of 21,667 adults aged 20-79 years were included in this analysis. Results: The overall CVH did not significantly change between 2005-2006 and 2017-2018 (65.5, 95% CI 63.9-67.1 to 65.0, 95% CI 62.8-67.1; P=.82). The individual metrics did not significantly change for diet (41.0, 95% CI 38.0-43.9 to 41.5, 95% CI 36.5-46.6; P=.94), physical activity (57.5, 95% CI 53.0-61.9 to 53.0, 95% CI 48.7-57.3; P=.26), and blood pressure (68.4, 95% CI 65.2-71.5 to 68.6, 95% CI 65.3-71.9, P=.35), improved for nicotine exposure (64.7, 95% CI 61.1-68.4 to 71.9, 95% CI 67.7-76.2; P<.001), sleep health (83.7, 95% CI 81.6-85.7 to 84.1, 95% CI 81.2-87.1; P=.006), and blood lipids (61.6, 95% CI 59.1-64.0 to 67.0, 95% CI 63.5-70.4; P<.001), and worsened for BMI (63.4, 95% CI 59.7-67.1 to 56.2, 95% CI 52.5-59.9; P<.001) and blood glucose (83.9, 95% CI 82.4-85.4 to 77.4, 95% CI 74.5-80.3; P<.001). Conclusions: According to the LE8, the overall CVH did not change among US adults from 2005 to 2018, as well as 3 components (diet, physical activity, and blood pressure). Other metrics such as nicotine exposure, blood lipids, and sleep health improved, while BMI and blood glucose deteriorated over time. %M 37155232 %R 10.2196/45521 %U https://publichealth.jmir.org/2023/1/e45521 %U https://doi.org/10.2196/45521 %U http://www.ncbi.nlm.nih.gov/pubmed/37155232 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44939 %T Efficacy of Mobile-Based Cognitive Behavioral Therapy on Lowering Low-density Lipoprotein Cholesterol Levels in Patients With Atherosclerotic Cardiovascular Disease: Multicenter, Prospective Randomized Controlled Trial %A Li,DuanBin %A Xu,Tian %A Xie,DaQi %A Wang,MiaoYun %A Sun,ShuPing %A Wang,Min %A Zhang,SiSi %A Yang,XinRui %A Zhang,ZhongNan %A Wang,Shen %A Kuang,Ming %A Tang,Jia %A Liu,HongYing %A Hong,XuLin %A Fu,GuoSheng %A Zhang,WenBin %+ Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Shangcheng District, Zhejiang Province, Hangzhou, 310020, China, 86 0571 86006491, 3313011@zju.edu.cn %K mobile-based cognitive behavioral therapy %K low-density lipoprotein cholesterol %K atherosclerotic cardiovascular disease %K self-efficacy %K quality of life %D 2023 %7 12.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Elevated low-density lipoprotein cholesterol (LDL-C) is an established risk factor for atherosclerotic cardiovascular disease (ASCVD). However, low adherence to medication and lifestyle management has limited the benefits of lowering lipid levels. Cognitive behavioral therapy (CBT) has been proposed as a promising solution. Objective: This trial aimed to evaluate the efficacy of mobile-based CBT interventions in lowering LDL-C levels in patients with ASCVD. Methods: This multicenter, prospective, randomized controlled trial enrolled 300 patients with ASCVD, who were randomly assigned to the mobile-based CBT intervention group and the control group in a ratio of 1:1. The intervention group received CBT for ASCVD lifestyle interventions delivered by WeChat MiniApp: “CBT ASCVD.” The control group only received routine health education during each follow-up. The linear regression and logistic regression analyses were used to determine the effects of a mobile-based CBT intervention on LDL-C, triglyceride, C-reactive protein, the score of General Self-Efficacy Scale (GSE), quality of life index (QL-index), and LDL-C up-to-standard rate (<1.8 mmol/L) at the first, third, and sixth months. Results: Finally, 296 participants completed the 6-month follow-up (CBT group: n=148; control group: n=148). At baseline, the mean LDL-C level was 2.48 (SD 0.90) mmol/L, and the LDL-C up-to-standard rate (<1.8 mmol/L) was 21.3%. Mobile-based CBT intervention significantly increased the reduction of LDL-C change (%) at the 6-month follow-up (β=–10.026, 95% CI –18.111 to –1.940). In addition, this benefit remained when baseline LDL-C <1.8 mmol/L (β=–24.103, 95% CI –43.110 to –5.095). Logistic regression analysis showed that mobile-based CBT intervention moderately increased the LDL-C up-to-standard rates (<1.8 mmol/L) in the sixth month (odds ratio 1.579, 95% CI 0.994-2.508). For GSE and QL-index, mobile-based CBT intervention significantly increased the change of scores (%) at the 1-, 3-, and 6-month follow-up (all P values <.05). Conclusions: In patients with ASCVD, mobile-based CBT is effective in reducing LDL-C levels (even for those who already had a standard LDL-C) and can improve self-efficacy and quality of life. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100046775; https://www.chictr.org.cn/showproj.aspx?proj=127140 %M 37043273 %R 10.2196/44939 %U https://www.jmir.org/2023/1/e44939 %U https://doi.org/10.2196/44939 %U http://www.ncbi.nlm.nih.gov/pubmed/37043273 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43134 %T Compliance Challenges in a Longitudinal COVID-19 Cohort Using Wearables for Continuous Monitoring: Observational Study %A Mekhael,Mario %A Ho,Chan %A Noujaim,Charbel %A Assaf,Ala %A Younes,Hadi %A El Hajjar,Abdel Hadi %A Chaudhry,Humza A %A Lanier,Brennan %A Chouman,Nour %A Makan,Noor %A Shan,Botao %A Zhang,Yichi %A Dagher,Lilas %A Kreidieh,Omar %A Marrouche,Nassir %A Donnellan,Eoin %+ Tulane University School of Medicine, 1324 Tulane Avenue, 1324 Tulane Ave, Suite A128, New Orleans, LA, 70112, United States, 1 504 988 3072, nmarrouche@tulane.edu %K COVID-19 %K digital health %K wearables %K compliance %K cardiovascular health %K heart disease %K wearable device %K biometric %K remote monitoring %D 2023 %7 5.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The WEAICOR (Wearables to Investigate the Long Term Cardiovascular and Behavioral Impacts of COVID-19) study was a prospective observational study that used continuous monitoring to detect and analyze biometrics. Compliance to wearables was a major challenge when conducting the study and was crucial for the results. Objective: The aim of this study was to evaluate patients’ compliance to wearable wristbands and determinants of compliance in a prospective COVID-19 cohort. Methods: The Biostrap (Biostrap USA LLC) wearable device was used to monitor participants’ biometric data. Compliance was calculated by dividing the total number of days in which transmissions were sent by the total number of days spent in the WEAICOR study. Univariate correlation analyses were performed, with compliance and days spent in the study as dependent variables and age, BMI, sex, symptom severity, and the number of complications or comorbidities as independent variables. Multivariate linear regression was then performed, with days spent in the study as a dependent variable, to assess the power of different parameters in determining the number of days patients spent in the study. Results: A total of 122 patients were included in this study. Patients were on average aged 41.32 years, and 46 (38%) were female. Age was found to correlate with compliance (r=0.23; P=.01). In addition, age (r=0.30; P=.001), BMI (r=0.19; P=.03), and the severity of symptoms (r=0.19; P=.03) were found to correlate with days spent in the WEAICOR study. Per our multivariate analysis, in which days spent in the study was a dependent variable, only increased age was a significant determinant of compliance with wearables (adjusted R2=0.1; β=1.6; P=.01). Conclusions: Compliance is a major obstacle in remote monitoring studies, and the reasons for a lack of compliance are multifactorial. Patient factors such as age, in addition to environmental factors, can affect compliance to wearables. %M 36763647 %R 10.2196/43134 %U https://www.jmir.org/2023/1/e43134 %U https://doi.org/10.2196/43134 %U http://www.ncbi.nlm.nih.gov/pubmed/36763647 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e39097 %T The Impact and Perception of England’s Web-Based Heart Age Test of Cardiovascular Disease Risk: Mixed Methods Study %A Riley,Victoria %A Gidlow,Christopher %A Fedorowicz,Sophia %A Lagord,Catherine %A Thompson,Katherine %A Woolner,Joshua %A Taylor,Rosie %A Clark,Jade %A Lloyd-Harris,Andrew %+ Centre for Health and Development, Staffordshire University, Ashley Building, Leek Road, Stoke-on-Trent, ST4 2DF, United Kingdom, 44 01782294330 ext 4430, c.gidlow@staffs.ac.uk %K heart age %K cardiovascular disease %K CVD prevention %K web-based risk assessment %K CVD risk %K qualitative research %K cross-sectional design %K cardiology %K risk assessment %K cardiovascular risk %K heart health %K user perception %K risk knowledge %K engagement %K web-based %D 2023 %7 6.2.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: It is well documented that individuals struggle to understand cardiovascular disease (CVD) percentage risk scores, which led to the development of heart age as a means of communicating risk. Developed for clinical use, its application in raising public awareness of heart health as part of a self-directed digital test has not been considered previously. Objective: This study aimed to understand who accesses England’s heart age test (HAT) and its effect on user perception, knowledge, and understanding of CVD risk; future behavior intentions; and potential engagement with primary care services. Methods: There were 3 sources of data: routinely gathered data on all individuals accessing the HAT (February 2015 to June 2020); web-based survey, distributed between January 2021 and March 2021; and interviews with a subsample of survey respondents (February 2021 to March 2021). Data were used to describe the test user population and explore knowledge and understanding of CVD risk, confidence in interpreting and controlling CVD risk, and effect on future behavior intentions and potential engagement with primary care. Interviews were analyzed using reflexive thematic analysis. Results: Between February 2015 and June 2020, the HAT was completed approximately 5 million times, with more completions by men (2,682,544/4,898,532, 54.76%), those aged between 50 to 59 years (1,334,195/4,898,532, 27.24%), those from White ethnic background (3,972,293/4,898,532, 81.09%), and those living in the least deprived 20% of areas (707,747/4,898,532, 14.45%). The study concluded with 819 survey responses and 33 semistructured interviews. Participants stated that they understood the meaning of high estimated heart age and self-reported at least some improvement in the understanding and confidence in understanding and controlling CVD risk. Negative emotional responses were provoked among users when estimated heart age did not equate to their previous risk perceptions. The limited information needed to complete it or the production of a result when physiological risk factor information was missing (ie, blood pressure and cholesterol level) led some users to question the credibility of the test. However, most participants who were interviewed mentioned that they would recommend or had already recommended the test to others, would use it again in the future, and would be more likely to take up the offer of a National Health Service Health Check and self-reported that they had made or intended to make changes to their health behavior or felt encouraged to continue to make changes to their health behavior. Conclusions: England’s web-based HAT has engaged large number of people in their heart health. Improvements to England’s HAT, noted in this paper, may enhance user satisfaction and prevent confusion. Future studies to understand the long-term benefit of the test on behavioral outcomes are warranted. %M 36745500 %R 10.2196/39097 %U https://cardio.jmir.org/2023/1/e39097 %U https://doi.org/10.2196/39097 %U http://www.ncbi.nlm.nih.gov/pubmed/36745500 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42190 %T Association of Uncontrolled Hypertension or Diabetes Mellitus With Major Adverse Cardiovascular Events and Mortality in South Korea: Population-Based Cohort Study %A Oh,Sung-Hee %A Kim,Dohyang %A Hwang,Jinseub %A Kang,Jae-Heon %A Kwon,Yeongkeun %A Kwon,Jin-Won %+ BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea, 82 53 950 8580, jwkwon@knu.ac.kr %K prevention and control %K cardiovascular diseases %K diabetes mellitus %K hypertension %K extended Cox regression %K cohort study %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Managing hypertension (HT) and diabetes mellitus (DM) is crucial to preventing cardiovascular diseases. Few studies have investigated the incidence and risk of cardiovascular diseases or mortality in uncontrolled HT or DM in the Asian population. Epidemiological studies of cardiovascular disease should be conducted with continuous consideration of the changing disease risk profiles, lifestyles, and socioeconomic status over time. Objective: We aimed to examine the association of uncontrolled HT or DM with the incidence of cardiovascular events or deaths from any cause. Methods: This population-based retrospective study was conducted using data from the Korean National Health Insurance Service–National Health Screening Cohort, including patients aged 40-79 years who participated in national screening from 2002 to 2003 and were followed up until 2015. The health screening period from 2002 to 2013 was stratified into 6 index periods in 2-year cycles, and the follow-up period from 2004 to 2015 was stratified accordingly into 6 subsequent 2-year periods. The incidence rates and hazard ratio (HR) for major adverse cardiovascular events (MACE) and death from any cause were estimated according to HT or DM control status. Extended Cox models with time-dependent variables updated every 2 years, including sociodemographic characteristics, blood pressure (BP), fasting blood glucose (FBG), medication prescription, and adherence, were used. Results: Among the total cohort of 440,249 patients, 155,765 (35.38%) were in the uncontrolled HT or DM group. More than 60% of the patients with HT or DM who were prescribed medications did not achieve the target BP or FBG. The incidence of MACE was 10.8-15.5 and 9.6-13.3 per 1000 person-years in the uncontrolled DM and uncontrolled HT groups, respectively, and increased with age. In the uncontrolled HT and DM group, the incidence of MACE was high (15.2-17.5 per 1000 person-years) at a relatively young age and showed no age-related trend. Adjusted HR for MACE were 1.28 (95% CI 1.23-1.32) for the uncontrolled DM group, 1.32 (95% CI 1.29-1.35) for the uncontrolled HT group, and 1.54 (95% CI 1.47-1.60) for the uncontrolled HT and DM group. Adjusted HR for death from any cause were 1.05 (95% CI 1.01-1.10) for the uncontrolled DM group, 1.13 (95% CI 1.10-1.16) for the uncontrolled HT group, and 1.17 (95% CI 1.12-1.23) for the uncontrolled HT and DM group. Conclusions: This up-to-date evidence of cardiovascular epidemiology in South Korea serves as the basis for planning public health policies to prevent cardiovascular diseases. The high uncontrolled rates of HT or DM, regardless of medication prescription, have led us to suggest the need for a novel system for effective BP or glycemic control, such as a community-wide management program using mobile health technology. %M 36735297 %R 10.2196/42190 %U https://publichealth.jmir.org/2023/1/e42190 %U https://doi.org/10.2196/42190 %U http://www.ncbi.nlm.nih.gov/pubmed/36735297 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42051 %T Assessing and Promoting Cardiovascular Health for Adolescent Women: User-Centered Design Approach %A Bradley,Kolbi %A Arconada Alvarez,Santiago J %A Gilmore,Amanda K %A Greenleaf,Morgan %A Herbert,Aayahna %A Kottke,Melissa J %A Parsell,Maren %A Patterson,Sierra %A Smith,Tymirra %A Sotos-Prieto,Mercedes %A Zeichner,Elizabeth %A Gooding,Holly C %+ Department of Pediatrics, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta, GA, 30303, United States, 1 4047781429, holly.gooding@emory.edu %K adolescent %K heart disease %K mHealth %K digital health intervention %K user-centered design %K cardiovascular disease %K CVD %K women's health %K risk assessment %K young adults %K assessment tool %D 2022 %7 19.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death among women in the United States. A considerable number of young women already have risk factors for CVD. Awareness of CVD and its risk factors is critical to preventing CVD, yet younger women are less aware of CVD prevalence, its risk factors, and preventative behaviors compared to older women. Objective: The purpose of this study is to assess CVD awareness among adolescent and young adult women and develop a lifestyle-based cardiovascular risk assessment tool for the promotion of CVD awareness among this population. Methods: This study used a 3-phase iterative design process with young women and health care practitioners from primary care and reproductive care clinics in Atlanta, Georgia. In phase 1, we administered a modified version of the American Heart Association Women’s Health Survey to young women, aged 15-24 years (n=67), to assess their general CVD awareness. In phase 2, we interviewed young women, aged 13-21 years (n=10), and their health care practitioners (n=10), to solicit suggestions for adapting the Healthy Heart Score, an existing adult cardiovascular risk assessment tool, for use with this age group. We also aimed to learn more about the barriers and challenges to health behavior change within this population and the clinical practices that serve them. In phase 3, we used the findings from the first 2 phases to create a prototype of a new online cardiovascular risk assessment tool designed specifically for young women. We then used an iterative user-centered design process to collect feedback from approximately 105 young women, aged 13-21 years, as we adapted the tool. Results: Only 10.5% (7/67) of the young women surveyed correctly identified CVD as the leading cause of death among women in the United States. Few respondents reported having discussed their personal risk (4/67, 6%) or family history of CVD (8/67, 11.9%) with a health care provider. During the interviews, young women reported better CVD awareness and knowledge after completing the adult risk assessment tool and suggested making the tool more teen-friendly by incorporating relevant foods and activity options. Health care practitioners emphasized shortening the assessment for easier use within practice and discussed other barriers adolescents may face in adopting heart-healthy behaviors. The result of the iterative design process was a youth-friendly prototype of a cardiovascular risk assessment tool. Conclusions: Adolescent and young adult women demonstrate low awareness of CVD. This study illustrates the potential value of a cardiovascular risk assessment tool adapted for use with young women and showcases the importance of user-centered design when creating digital health interventions. %M 36534450 %R 10.2196/42051 %U https://formative.jmir.org/2022/12/e42051 %U https://doi.org/10.2196/42051 %U http://www.ncbi.nlm.nih.gov/pubmed/36534450 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37385 %T The Development and Evaluation of “Life Age”—a Primary Prevention and Population-Focused Risk Communication Tool: Feasibility Study With a Single-Arm Repeated Measures Design %A Olusan,Adeogo Akinwale %A Barr,Suzanne %A Cobain,Mark %A Whelan,Holly %+ Department of Cardiology, Belfast Health and Social Care (HSC) Trust, 274 Grosvenor Road,, Belfast, BT12 6BA, United Kingdom, 44 7423161441, aakinwale@yahoo.co.uk %K Life Age %K Heart Age %K cardiovascular risk %K lifestyle change %K psychosocial well-being %K population focused risk communication tool %K health promotion %K risk perception %K premature mortality %K risk communication %D 2022 %7 24.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Communicating cardiovascular risk to the general population requires forms of communication that can enhance risk perception and stimulate lifestyle changes associated with reduced cardiovascular risk. Objective: The aim of this study was to evaluate the motivational potential of a novel lifestyle risk assessment (“Life Age”) based on factors predictive of both premature mortality and psychosocial well-being. Methods: A feasibility study with a single-arm repeated measures design was conducted to evaluate the potential efficacy of Life Age on motivating lifestyle changes. Participants were recruited via social media, completed a web-based version of the Life Age questionnaire at baseline and at follow-up (8 weeks), and received 23 e-newsletters based on their Life Age results along with a mobile tracker. Participants’ estimated Life Age scores were analyzed for evidence of lifestyle changes made. Quantitative feedback of participants was also assessed. Results: In total, 18 of 27 participants completed the two Life Age tests. The median baseline Life Age was 1 year older than chronological age, which was reduced to –1.9 years at follow-up, representing an improvement of 2.9 years (P=.02). There were also accompanying improvements in Mediterranean diet score (P=.001), life satisfaction (P=.003), and sleep (P=.05). Quantitative feedback assessment indicated that the Life Age tool was easy to understand, helpful, and motivating. Conclusions: This study demonstrated the potential benefit of a novel Life Age tool in generating a broad set of lifestyle changes known to be associated with clinical risk factors, similar to “Heart Age.” This was achieved without the recourse to expensive biomarker tests. However, the results from this study suggest that the motivated lifestyle changes improved both healthy lifestyle risks and psychosocial well-being, consistent with the approach of Life Age in merging the importance of a healthy lifestyle and psychosocial well-being. Further evaluation using a larger randomized controlled trial is required to fully evaluate the impact of the Life Age tool on lifestyle changes, cardiovascular disease prevention, and overall psychosocial well-being. %M 36279163 %R 10.2196/37385 %U https://formative.jmir.org/2022/10/e37385 %U https://doi.org/10.2196/37385 %U http://www.ncbi.nlm.nih.gov/pubmed/36279163 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 2 %P e31302 %T Home Telemonitoring and a Diagnostic Algorithm in the Management of Heart Failure in the Netherlands: Cost-effectiveness Analysis %A Albuquerque de Almeida,Fernando %A Corro Ramos,Isaac %A Al,Maiwenn %A Rutten-van Mölken,Maureen %+ Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, Netherlands, 351 918795283, albuquerquedealmeida@eshpm.eur.nl %K discrete event simulation %K cost-effectiveness %K early warning systems %K home telemonitoring %K diagnostic algorithm %K heart failure %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Heart failure is a major health concern associated with significant morbidity, mortality, and reduced quality of life in patients. Home telemonitoring (HTM) facilitates frequent or continuous assessment of disease signs and symptoms, and it has shown to improve compliance by involving patients in their own care and prevent emergency admissions by facilitating early detection of clinically significant changes. Diagnostic algorithms (DAs) are predictive mathematical relationships that make use of a wide range of collected data for calculating the likelihood of a particular event and use this output for prioritizing patients with regard to their treatment. Objective: This study aims to assess the cost-effectiveness of HTM and a DA in the management of heart failure in the Netherlands. Three interventions were analyzed: usual care, HTM, and HTM plus a DA. Methods: A previously published discrete event simulation model was used. The base-case analysis was performed according to the Dutch guidelines for economic evaluation. Sensitivity, scenario, and value of information analyses were performed. Particular attention was given to the cost-effectiveness of the DA at various levels of diagnostic accuracy of event prediction and to different patient subgroups. Results: HTM plus the DA extendedly dominates HTM alone, and it has a deterministic incremental cost-effectiveness ratio compared with usual care of €27,712 (currency conversion rate in purchasing power parity at the time of study: €1=US $1.29; further conversions are not applicable in cost-effectiveness terms) per quality-adjusted life year. The model showed robustness in the sensitivity and scenario analyses. HTM plus the DA had a 96.0% probability of being cost-effective at the appropriate €80,000 per quality-adjusted life year threshold. An optimal point for the threshold value for the alarm of the DA in terms of its cost-effectiveness was estimated. New York Heart Association class IV patients were the subgroup with the worst cost-effectiveness results versus usual care, while HTM plus the DA was found to be the most cost-effective for patients aged <65 years and for patients in New York Heart Association class I. Conclusions: Although the increased costs of adopting HTM plus the DA in the management of heart failure may seemingly be an additional strain on scarce health care resources, the results of this study demonstrate that, by increasing patient life expectancy by 1.28 years and reducing their hospitalization rate by 23% when compared with usual care, the use of this technology may be seen as an investment, as HTM plus the DA in its current form extendedly dominates HTM alone and is cost-effective compared with usual care at normally accepted thresholds in the Netherlands. %M 35925670 %R 10.2196/31302 %U https://cardio.jmir.org/2022/2/e31302 %U https://doi.org/10.2196/31302 %U http://www.ncbi.nlm.nih.gov/pubmed/35925670 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e34717 %T Estimating Cardiorespiratory Fitness Without Exercise Testing or Physical Activity Status in Healthy Adults: Regression Model Development and Validation %A Sloan,Robert %A Visentini-Scarzanella,Marco %A Sawada,Susumu %A Sui,Xuemei %A Myers,Jonathan %+ Department of Social and Behavioral Medicine, Kagoshima University Graduate Medical School, 8-35-1 Sakuragaoka, Kagoshima, Japan, 81 99 275 5751, rsloan@m.kufm.kagoshima-u.ac.jp %K nonexercise estimated cardiorespiratory fitness %K public health %K surveillance %K epidemiology %K electronic health record %K EHR %K fitness %K cardiorespiratory %K physical activity %K regression model %K nonexercise equation %D 2022 %7 6.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Low cardiorespiratory fitness (CRF) is an independent predictor of morbidity and mortality. Most health care settings use some type of electronic health record (EHR) system. However, many EHRs do not have CRF or physical activity data collected, thereby limiting the types of investigations and analyses that can be done. Objective: This study aims to develop a nonexercise equation to estimate and classify CRF (in metabolic equivalent tasks) using variables commonly available in EHRs. Methods: Participants were 42,676 healthy adults (female participants: n=9146, 21.4%) from the Aerobics Center Longitudinal Study examined from 1974 to 2005. The nonexercise estimated CRF was based on sex, age, measured BMI, measured resting heart rate, measured resting blood pressure, and smoking status. A maximal treadmill test measured CRF. Results: After conducting nonlinear feature augmentation, separate linear regression models were used for male and female participants to calculate correlation and regression coefficients. Cross-classification of actual and estimated CRF was performed using low CRF categories (lowest quintile, lowest quartile, and lowest tertile). The multiple correlation coefficient (R) was 0.70 (mean deviation 1.33) for male participants and 0.65 (mean deviation 1.23) for female participants. The models explained 48.4% (SE estimate 1.70) and 41.9% (SE estimate 1.56) of the variance in CRF for male and female participants, respectively. Correct category classification for low CRF (lowest tertile) was found in 77.2% (n=25,885) of male participants and 74.9% (n=6,850) of female participants. Conclusions: The regression models developed in this study provided useful estimation and classification of CRF in a large population of male and female participants. The models may provide a practical method for estimating CRF derived from EHRs for population health research. %M 35793133 %R 10.2196/34717 %U https://publichealth.jmir.org/2022/7/e34717 %U https://doi.org/10.2196/34717 %U http://www.ncbi.nlm.nih.gov/pubmed/35793133 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35065 %T A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study %A Buss,Vera Helen %A Varnfield,Marlien %A Harris,Mark %A Barr,Margo %+ Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 7, Surgical, Treatment and Rehabilitation Service, 296 Herston Road, Herston, 4029, Australia, 61 732533603, vera.buss@csiro.au %K mobile health %K behavior change intervention %K primary prevention %K health promotion %K cardiovascular disease %K diabetes mellitus, type 2 %K mobile phone %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective: This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods: The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results: The target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects. Conclusions: We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing. %M 35536603 %R 10.2196/35065 %U https://humanfactors.jmir.org/2022/2/e35065 %U https://doi.org/10.2196/35065 %U http://www.ncbi.nlm.nih.gov/pubmed/35536603 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e32348 %T Relations Between BMI Trajectories and Habitual Physical Activity Measured by a Smartwatch in the Electronic Cohort of the Framingham Heart Study: Cohort Study %A Hammond,Michael M %A Zhang,Yuankai %A Pathiravasan,Chathurangi H. %A Lin,Honghuang %A Sardana,Mayank %A Trinquart,Ludovic %A Benjamin,Emelia J %A Borrelli,Belinda %A Manders,Emily S %A Fusco,Kelsey %A Kornej,Jelena %A Spartano,Nicole L %A Kheterpal,Vik %A Nowak,Christopher %A McManus,David D %A Liu,Chunyu %A Murabito,Joanne M %+ Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 715 Albany St., Boston, MA, 02118, United States, 1 508 935 3461, murabito@bu.edu %K mobile health %K BMI %K smartwatch %K physical activity %K cardiovascular diseases %K cardiology %K digital health %K mHealth %K mobile health apps %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: The prevalence of obesity is rising. Most previous studies that examined the relations between BMI and physical activity (PA) measured BMI at a single timepoint. The association between BMI trajectories and habitual PA remains unclear. Objective: This study assesses the relations between BMI trajectories and habitual step-based PA among participants enrolled in the electronic cohort of the Framingham Heart Study (eFHS). Methods: We used a semiparametric group-based modeling to identify BMI trajectories from eFHS participants who attended research examinations at the Framingham Research Center over 14 years. Daily steps were recorded from the smartwatch provided at examination 3. We excluded participants with <30 days or <5 hours of smartwatch wear data. We used generalized linear models to examine the association between BMI trajectories and daily step counts. Results: We identified 3 trajectory groups for the 837 eFHS participants (mean age 53 years; 57.8% [484/837] female). Group 1 included 292 participants whose BMI was stable (slope 0.005; P=.75), group 2 included 468 participants whose BMI increased slightly (slope 0.123; P<.001), and group 3 included 77 participants whose BMI increased greatly (slope 0.318; P<.001). The median follow-up period for step count was 516 days. Adjusting for age, sex, wear time, and cohort, participants in groups 2 and 3 took 422 (95% CI –823 to –21) and 1437 (95% CI –2084 to –790) fewer average daily steps, compared with participants in group 1. After adjusting for metabolic and social risk factors, group 2 took 382 (95% CI –773 to 10) and group 3 took 1120 (95% CI –1766 to –475) fewer steps, compared with group 1. Conclusions: In this community-based eFHS, participants whose BMI trajectory increased greatly over time took significantly fewer steps, compared with participants with stable BMI trajectories. Our findings suggest that greater weight gain may correlate with lower levels of step-based physical activity. %M 35476038 %R 10.2196/32348 %U https://cardio.jmir.org/2022/1/e32348 %U https://doi.org/10.2196/32348 %U http://www.ncbi.nlm.nih.gov/pubmed/35476038 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e34704 %T A Web-Based Health Application to Translate Nutrition Therapy for Cardiovascular Risk Reduction in Primary Care (PortfolioDiet.app): Quality Improvement and Usability Testing Study %A Kavanagh,Meaghan E %A Chiavaroli,Laura %A Glenn,Andrea J %A Heijmans,Genevieve %A Grant,Shannan M %A Chow,Chi-Ming %A Josse,Robert G %A Malik,Vasanti S %A Watson,William %A Lofters,Aisha %A Holmes,Candice %A Rackal,Julia %A Srichaikul,Kristie %A Sherifali,Diana %A Snelgrove-Clarke,Erna %A Udell,Jacob A %A Juni,Peter %A Booth,Gillian L %A Farkouh,Michael E %A Leiter,Lawrence A %A Kendall,Cyril W C %A Jenkins,David J A %A Sievenpiper,John L %+ Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 5th floor, room 5334, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada, 1 416 867 3732, john.sievenpiper@utoronto.ca %K portfolio diet %K dietary portfolio %K nutrition therapy %K dietary application %K eHealth %K usability testing %K quality improvement %K mobile phone %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for PCs and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure that the PortfolioDiet.app meets the needs of its target end users. Objective: The main objective of this project is to undertake user testing to inform modifications to the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI). Methods: We undertook a 2-phase QI project from February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, and dietitians, as well as nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for 7 days. In phase 1, a mixed-form questionnaire was administered to evaluate the users’ perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative and qualitative data, including 2 open-ended questions. The responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale was used to assess the usability of the updated PortfolioDiet.app, with a score higher than 70 being considered acceptable. Results: A total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. In phase 1, the PortfolioDiet.app increased users’ perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Limitations identified by users included challenges navigating to resources and profile settings, limited information on plant sterols, inaccuracies in points, timed-logout frustration, request for step-by-step pop-up windows, and request for a mobile app version; when looking at positive feedback, the recipe section was the most commonly praised feature. Between the project phases, 6 modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average System Usability Scale score was 85.39 (SD 11.47), with 100 being the best possible. Conclusions: By undertaking user testing of the PortfolioDiet.app, its limitations and strengths were able to be identified, informing modifications to the application, which resulted in a clinical tool that better meets users’ needs. The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. Although further refinements to the PortfolioDiet.app will continue to be made before its evaluation in a clinical trial, the result of this QI project is an improved clinical tool. %M 35451981 %R 10.2196/34704 %U https://humanfactors.jmir.org/2022/2/e34704 %U https://doi.org/10.2196/34704 %U http://www.ncbi.nlm.nih.gov/pubmed/35451981 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e34142 %T The Impact of Health Literacy–Sensitive Design and Heart Age in a Cardiovascular Disease Prevention Decision Aid: Randomized Controlled Trial and End-User Testing %A Bonner,Carissa %A Batcup,Carys %A Ayre,Julie %A Cvejic,Erin %A Trevena,Lyndal %A McCaffery,Kirsten %A Doust,Jenny %+ School of Public Health, Faculty of Medicine and Health, University of Sydney, Rm 128A, Edward Ford Building A27, Sydney, 2006, Australia, 61 293517125, carissa.bonner@sydney.edu.au %K decision aids %K shared decision-making %K risk communication %K heart age %K cardiovascular disease prevention %K behavior change %K health literacy %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Shared decision-making is an essential principle for the prevention of cardiovascular disease (CVD), where asymptomatic people consider lifelong medication and lifestyle changes. Objective: This study aims to develop and evaluate the first literacy-sensitive CVD prevention decision aid (DA) developed for people with low health literacy, and investigate the impact of literacy-sensitive design and heart age. Methods: We developed a standard DA based on international standards. The standard DA was based on our existing general practitioner DA. The literacy-sensitive DA included simple language, supporting images, white space, and a lifestyle action plan. The control DA used Heart Foundation materials. A randomized trial included 859 people aged 45-74 years using a 3 (DA: standard, literacy-sensitive, control) ×2 (heart age: heart age + percentage risk, percentage risk only) factorial design, with outcomes including prevention intentions and behaviors, gist and verbatim knowledge of risk, credibility, emotional response, and decisional conflict. We iteratively improved the literacy-sensitive version based on end-user testing interviews with 20 people with varying health literacy levels. Results: Immediately after the intervention (n=859), there were no differences in any outcome among the DA groups. The heart age group was less likely to have a positive emotional response, perceived the message as less credible, and had higher gist and verbatim knowledge of heart age risk but not percentage risk. After 4 weeks (n=596), the DA group had better gist knowledge of percentage risk than the control group. The literacy-sensitive DA group had higher fruit consumption, and the standard DA group had better verbatim knowledge of percentage risk. Verbatim knowledge was higher for heart age than for percentage risk among those who received both. Conclusions: The literacy-sensitive DA resulted in increased knowledge of CVD risk and increased fruit consumption in participants with varying health literacy levels and CVD risk results. Adding heart age did not increase lifestyle change intentions or behavior but did affect psychological outcomes, consistent with previous findings. This tool will be integrated with additional resources to improve other lifestyle outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000806965; https://tinyurl.com/226yhk8a %M 35436208 %R 10.2196/34142 %U https://cardio.jmir.org/2022/1/e34142 %U https://doi.org/10.2196/34142 %U http://www.ncbi.nlm.nih.gov/pubmed/35436208 %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 %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e34946 %T Changes in Blood Lipid Levels After a Digitally Enabled Cardiometabolic Preventive Health Program: Pre-Post Study in an Adult Dutch General Population Cohort %A Castela Forte,José %A Gannamani,Rahul %A Folkertsma,Pytrik %A Kumaraswamy,Sridhar %A Mount,Sarah %A van Dam,Sipko %A Hoogsteen,Jan %+ Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713GZ, Netherlands, 31 628218360, jose@ancora.health %K cholesterol %K lifestyle intervention %K prevention %K hypercholesterolemia %K digital health %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Despite widespread education, many individuals fail to follow basic health behaviors such as consuming a healthy diet and exercising. Positive changes in lifestyle habits are associated with improvements in multiple cardiometabolic health risk factors, including lipid levels. Digital lifestyle interventions have been suggested as a viable complement or potential alternative to conventional health behavior change strategies. However, the benefit of digital preventive interventions for lipid levels in a preventive health context remains unclear. Objective: This observational study aimed to determine how the levels of lipids, namely total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, non-HDL cholesterol, and triglycerides, changed over time in a Dutch general population cohort undergoing a digital preventive health program. Moreover, we looked to establish associations between lifestyle factors at baseline and lipid levels. Methods: We included 348 adults from the Dutch general population who underwent a digitally enabled preventive health program at Ancora Health between January 2020 and October 2021. Upon enrollment, participants underwent a baseline assessment involving a comprehensive lifestyle questionnaire, a blood biochemistry panel, physical measurements, and cardiopulmonary fitness measurements. Thereafter, users underwent a lifestyle coaching program and could access the digital application to register and track health behaviors, weight, and anthropometric data at any time. Lipid levels were categorized as normal, elevated, high, and clinical dyslipidemia according to accepted international standards. If at least one lipid marker was high or HDL was low, participants received specific coaching and advice for cardiometabolic health. We retrospectively analyzed the mean and percentage changes in lipid markers in users who were remeasured after a cardiometabolic health–focused intervention, and studied the association between baseline user lifestyle characteristics and having normal lipid levels. Results: In our cohort, 199 (57.2%) participants had dyslipidemia at baseline, of which 104 participants were advised to follow a cardiometabolic health–focused intervention. Eating more amounts of favorable food groups and being more active were associated with normal lipid profiles. Among the participants who underwent remeasurement 9 months after intervention completion, 57% (17/30), 61% (19/31), 56% (15/27), 82% (9/11), and 100% (8/8) showed improvements at remeasurement for total, LDL, HDL, and non-HDL cholesterol, and triglycerides, respectively. Moreover, between 35.3% and 77.8% showed a return to normal levels. In those with high lipid levels at baseline, total cholesterol decreased by 0.5 mmol/L (7.5%), LDL cholesterol decreased by 0.39 mmol/L (10.0%), non-HDL cholesterol decreased by 0.44 mmol/L (8.3%), triglycerides decreased by 0.97 mmol/L (32.0%), and HDL increased by 0.17 mmol/L (15.6%), after the intervention. Conclusions: A cardiometabolic screening program in a general population cohort identified a significant portion of individuals with subclinical and clinical lipid levels. Individuals who, after screening, actively engaged in a cardiometabolic health–focused lifestyle program improved their lipid levels. %M 35319473 %R 10.2196/34946 %U https://cardio.jmir.org/2022/1/e34946 %U https://doi.org/10.2196/34946 %U http://www.ncbi.nlm.nih.gov/pubmed/35319473 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e31501 %T The Effect of Wearable Tracking Devices on Cardiorespiratory Fitness Among Inactive Adults: Crossover Study %A Larsen,Lisbeth Hoejkjaer %A Lauritzen,Maja Hedegaard %A Sinkjaer,Mikkel %A Kjaer,Troels W %+ Department of Neurology, Zealand University Hospital, Sygehusvej 10, Roskilde, 4000, Denmark, 45 41558592, lisbla@regionsjaelland.dk %K activity tracking %K cardiorespiratory fitness %K mHealth %K mobile health %K motivation %K physical activity %K self-monitoring %K wearable %K cardio %K fitness %K cardiorespiratory %K behavior change %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Modern lifestyle is associated with a high prevalence of physical inactivity. Objective: This study aims to investigate the effect of a wearable tracking device on cardiorespiratory fitness among inactive adults and to explore if personal characteristics and health outcomes can predict adoption of the device. Methods: In total, 62 inactive adults were recruited for this study. A control period (4 weeks) was followed by an intervention period (8 weeks) where participants were instructed to register and follow their physical activity (PA) behavior on a wrist-worn tracking device. Data collected included estimated cardiorespiratory fitness, body composition, blood pressure, perceived stress levels, and self-reported adoption of using the tracking device. Results: In total, 50 participants completed the study (mean age 48, SD 13 years, 84% women). Relative to the control period, participants increased cardiorespiratory fitness by 1.52 mL/kg/minute (95% CI 0.82-2.22; P<.001), self-reported PA by 140 minutes per week (95% CI 93.3-187.1; P<.001), daily step count by 982 (95% CI 492-1471; P<.001), and participants’ fat percentage decreased by 0.48% (95% CI –0.84 to –0.13; P=.009). No difference was observed in blood pressure (systolic: 95% CI –2.16 to 3.57, P=.63; diastolic: 95% CI –0.70 to 2.55; P=.27) or perceived stress (95% CI –0.86 to 1.78; P=.49). No associations were found between adoption of the wearable tracking device and age, gender, personality, or education. However, participants with a low perceived stress at baseline were more likely to rate the use of a wearable tracking device highly motivating. Conclusions: Tracking health behavior using a wearable tracking device increases PA resulting in an improved cardiorespiratory fitness among inactive adults. %M 35289763 %R 10.2196/31501 %U https://cardio.jmir.org/2022/1/e31501 %U https://doi.org/10.2196/31501 %U http://www.ncbi.nlm.nih.gov/pubmed/35289763 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e26184 %T Home Telemonitoring of Arterial Hypertension With Antihypertensive Treatment Titration: Protocol for a Randomized Controlled Prospective Trial (HOROSCOPE Study) %A Ben Hafaiedh,Sonia %A Ben Daya,Yosra %A Radoui,Amina Hadjer %A Bouchoucha,Mohamed %A Razgallah,Rabie %A Nouira,Semir %+ Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, Rue du 1ier juin 1955, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia, 216 73106046, semir.nouira@rns.tn %K telemonitoring %K arterial hypertension %K primary care %K ambulatory blood pressure monitoring %K randomized controlled trial %D 2022 %7 1.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the availability of effective treatment, the control of hypertension remains insufficient. Telemonitoring in the management of hypertension would be an effective way to improve blood pressure control. Objective: The aim of our study will be to evaluate the effects of telemonitoring with antihypertensive treatment titration on blood pressure control in Tunisian patients with hypertension. Methods: Our trial will be a prospective, rater-blinded randomized controlled trial carried out with primary care physicians in the Sahel region of Tunisia. Patients will be eligible for enrollment if they are aged over 35 years, are newly diagnosed with hypertension, or are known to be poorly controlled on antihypertensive therapy. Participants will be randomly assigned in a 1:1 ratio to the telemonitoring arm or usual care arm. The telemonitoring arm will involve a weekly telephone call for the collection of the home blood pressure measurements, therapeutic education, and treatment compliance assessment as well as a monthly call for treatment titration and a side effect check. Randomization will be done via the use of an interactive web responsive system, and patients will be stratified by investigation center. Neither participants nor investigators will be masked to the group assignments. The primary outcome will be the change in mean 24-hour systolic blood pressure from baseline to the 6-month follow-up in the 2 groups. All randomized patients who attend the follow-up visit at 6 months and have no missing data for the primary outcome will be included in the analysis. Results: Recruitment to the trial started in July 2020. The study was initiated with 17 primary care physicians. We expect the inclusion period to last for approximately 6 months. We expect to complete data collection by the end of 2021 and plan to disseminate the results subsequently. Conclusions: The HOROSCOPE (Home Telemonitoring of Arterial Hypertension With Antihypertensive Treatment Titration: Randomized Controlled Prospective Trial) study will provide important new evidence that could shed some light on the feasibility and impact of telemonitoring and self-monitoring in a Tunisian population of patients with hypertension who consult primary care physicians. Trial Registration: ClinicalTrials.gov NCT04607239; https://clinicaltrials.gov/ct2/show/NCT04607239 International Registered Report Identifier (IRRID): DERR1-10.2196/26184 %M 35230254 %R 10.2196/26184 %U https://www.researchprotocols.org/2022/3/e26184 %U https://doi.org/10.2196/26184 %U http://www.ncbi.nlm.nih.gov/pubmed/35230254 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e32918 %T Supporting People With Type 2 Diabetes in the Effective Use of Their Medicine Through Mobile Health Technology Integrated With Clinical Care to Reduce Cardiovascular Risk: Protocol for an Effectiveness and Cost-effectiveness Randomized Controlled Trial %A Farmer,Andrew %A Jones,Louise %A Newhouse,Nikki %A Kenning,Cassandra %A Williams,Nicola %A Chi,Yuan %A Bartlett,Y Kiera %A Plumpton,Catrin %A McSharry,Jenny %A Cholerton,Rachel %A Holmes,Emily %A Robinson,Stephanie %A Allen,Julie %A Gudgin,Bernard %A Velardo,Carmelo %A Rutter,Heather %A Horne,Rob %A Tarassenko,Lionel %A Williams,Veronika %A Locock,Louise %A Rea,Rustam %A Yu,Ly-Mee %A Hughes,Dyfrig %A Bower,Peter %A French,David %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 1865 617942, andrew.farmer@phc.ox.ac.uk %K diabetes %K SMS text messages %K cardiovascular risk prevention %K medication adherence %K digital health %K randomized controlled trial %D 2022 %7 21.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Type 2 diabetes is a common lifelong condition that affects over 400 million people worldwide. The use of effective medications and active self-management can reduce the risk of serious complications. However, people often have concerns when starting new medications and face difficulties in taking their medications regularly. Support provided by brief messages delivered through mobile phone–based SMS text messages can be effective in some long-term conditions. We have identified promising behavior change techniques (BCTs) to promote medication adherence in this population via a systematic review and developed SMS text messages that target these BCTs. Feasibility work has shown that these messages have fidelity to intended BCTs, are acceptable to patients, and are successful in changing the intended determinants of medication adherence. We now plan to test this intervention on a larger scale in a clinical trial. Objective: The aim of this trial is to determine the effectiveness and cost-effectiveness of this intervention for reducing cardiovascular risk in people with type 2 diabetes by comparing it with usual care. Methods: The trial will be a 12-month, multicenter, individually randomized controlled trial in primary care and will recruit adults (aged ≥35 years) with type 2 diabetes in England. Consenting participants will be randomized to receive short SMS text messages intended to affect a change in medication adherence 3 to 4 times per week in addition to usual care. The aim is to test the effectiveness and cost-effectiveness of the intervention when it is added to usual care. The primary clinical outcome will be a composite cardiovascular risk measure. Data including patient-reported measures will be collected at baseline, at 13 and 26 weeks, and at the end of the 12-month follow-up period. With 958 participants (479 in each group), the trial is powered at 92.5% to detect a 4–percentage point difference in cardiovascular risk. The analysis will follow a prespecified plan. A nested quantitative and qualitative process analysis will be used to examine the putative mechanisms of behavior change and wider contextual influences. A health economic analysis will be used to assess the cost-effectiveness of the intervention. Results: The trial has completed the recruitment phase and is in the follow-up phase. The publication of results is anticipated in 2024. Conclusions: This trial will provide evidence regarding the effectiveness and cost-effectiveness of this intervention for people with type 2 diabetes. Trial Registration: ISRCTN Registry ISRCTN15952379; https://www.isrctn.com/ISRCTN15952379 International Registered Report Identifier (IRRID): DERR1-10.2196/32918 %M 35188478 %R 10.2196/32918 %U https://www.researchprotocols.org/2022/2/e32918 %U https://doi.org/10.2196/32918 %U http://www.ncbi.nlm.nih.gov/pubmed/35188478 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 2 %P e30483 %T Disease Progression of Hypertrophic Cardiomyopathy: Modeling Using Machine Learning %A Pičulin,Matej %A Smole,Tim %A Žunkovič,Bojan %A Kokalj,Enja %A Robnik-Šikonja,Marko %A Kukar,Matjaž %A Fotiadis,Dimitrios I %A Pezoulas,Vasileios C %A Tachos,Nikolaos S %A Barlocco,Fausto %A Mazzarotto,Francesco %A Popović,Dejana %A Maier,Lars S %A Velicki,Lazar %A Olivotto,Iacopo %A MacGowan,Guy A %A Jakovljević,Djordje G %A Filipović,Nenad %A Bosnić,Zoran %+ Faculty of Computer and Information Science, University of Ljubljana, Večna pot 113, Ljubljana, 1000, Slovenia, 386 1 479 8226, matej.piculin@fri.uni-lj.si %K hypertrophic cardiomyopathy %K disease progression %K machine learning %K artificial intelligence %K AI %K ML %K cardiomyopathy %K cardiovascular disease %K sudden cardiac death %K SCD %K prediction %K prediction model %K validation %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Cardiovascular disorders in general are responsible for 30% of deaths worldwide. Among them, hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease that is present in about 1 of 500 young adults and can cause sudden cardiac death (SCD). Objective: Although the current state-of-the-art methods model the risk of SCD for patients, to the best of our knowledge, no methods are available for modeling the patient's clinical status up to 10 years ahead. In this paper, we propose a novel machine learning (ML)-based tool for predicting disease progression for patients diagnosed with HCM in terms of adverse remodeling of the heart during a 10-year period. Methods: The method consisted of 6 predictive regression models that independently predict future values of 6 clinical characteristics: left atrial size, left atrial volume, left ventricular ejection fraction, New York Heart Association functional classification, left ventricular internal diastolic diameter, and left ventricular internal systolic diameter. We supplemented each prediction with the explanation that is generated using the Shapley additive explanation method. Results: The final experiments showed that predictive error is lower on 5 of the 6 constructed models in comparison to experts (on average, by 0.34) or a consortium of experts (on average, by 0.22). The experiments revealed that semisupervised learning and the artificial data from virtual patients help improve predictive accuracies. The best-performing random forest model improved R2 from 0.3 to 0.6. Conclusions: By engaging medical experts to provide interpretation and validation of the results, we determined the models' favorable performance compared to the performance of experts for 5 of 6 targets. %M 35107432 %R 10.2196/30483 %U https://medinform.jmir.org/2022/2/e30483 %U https://doi.org/10.2196/30483 %U http://www.ncbi.nlm.nih.gov/pubmed/35107432 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e33188 %T Predictors of Smartphone and Tablet Use Among Patients With Hypertension: Secondary Analysis of Health Information National Trends Survey Data %A Eze,Chinwe E %A West,Brady T %A Dorsch,Michael P %A Coe,Antoinette B %A Lester,Corey A %A Buis,Lorraine R %A Farris,Karen %+ College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, MI, 48109-1065, United States, 1 7346806587, ceeze@umich.edu %K hypertension %K mHealth %K remote monitoring %K telemonitoring %K smartphones %K tablets %K text messaging %K Health Information National Trends Survey %K mobile health %K digital health %K mobile phone %D 2022 %7 24.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Uncontrolled hypertension leads to significant morbidity and mortality. The use of mobile health technology, such as smartphones, for remote blood pressure (BP) monitoring has improved BP control. An increase in BP control is more significant when patients can remotely communicate with their health care providers through technologies and receive feedback. Little is known about the predictors of remote BP monitoring among hypertensive populations. Objective: The objective of this study is to quantify the predictors of smartphone and tablet use in achieving health goals and communicating with health care providers via SMS text messaging among hypertensive patients in the United States. Methods: This study was a cross-sectional, secondary analysis of the 2017 and 2018 Health Information National Trends Survey 5, cycles 1 and 2 data. A total of 3045 respondents answered “Yes” to the question “Has a doctor or other healthcare provider ever told you that you had high blood pressure or hypertension?”, which defined the subpopulation used in this study. We applied the Health Information National Trends Survey full sample weight to calculate the population estimates and 50 replicate weights to calculate the SEs of the estimates. We used design-adjusted descriptive statistics to describe the characteristics of respondents who are hypertensive based on relevant survey items. Design-adjusted multivariable logistic regression models were fitted to estimate predictors of achieving health goals with the help of smartphone or tablet and sending or receiving an SMS text message to or from a health care provider in the last 12 months. Results: An estimated 36.9%, SE 0.9% (183,285,150/497,278,883) of the weighted adult population in the United States had hypertension. The mean age of the hypertensive population was 58.3 (SE 0.48) years. Electronic communication with the doctor or doctor’s office through email or internet (odds ratio 2.93, 95% CI 1.85-4.63; P<.001) and having a wellness app (odds ratio 1.82, 95% CI 1.16-2.86; P=.02) were significant predictors of using SMS text message communication with a health care professional, adjusting for other demographic and technology-related variables. The odds of achieving health-related goals with the help of a tablet or smartphone declined significantly with older age (P<.001) and ownership of basic cellphones (P=.04). However, they increased significantly with being a woman (P=.045) or with being married (P=.03), having a wellness app (P<.001), using devices other than smartphones or tablets to monitor health (P=.008), making health treatment decisions (P=.048), and discussing with a provider (P=.02) with the help of a tablet or smartphone. Conclusions: Intervention measures accounting for age, gender, marital status, and the patient’s technology-related health behaviors are required to increase smartphone and tablet use in self-care and SMS text message communication with health care providers. %M 35072647 %R 10.2196/33188 %U https://www.jmir.org/2022/1/e33188 %U https://doi.org/10.2196/33188 %U http://www.ncbi.nlm.nih.gov/pubmed/35072647 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e25384 %T Encouraging Behavior Changes and Preventing Cardiovascular Diseases Using the Prevent Connect Mobile Health App: Conception and Evaluation of App Quality %A Agher,Dahbia %A Sedki,Karima %A Despres,Sylvie %A Albinet,Jean-Pierre %A Jaulent,Marie-Christine %A Tsopra,Rosy %+ Inserm, University Sorbonne Paris Nord, Sorbonne University, Laboratory of Medical Informatics and Knowledge Engineering in e-Health, LIMICS, 15 Rue de l'école de Médecine, Paris, 75006, France, 33 0619260049, agherdahbia2@gmail.com %K digital health %K mHealth, mobile application %K IT %K technology %K prevention %K cardiovascular risk factor %K behavior change %K primary care %D 2022 %7 20.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiovascular diseases are a major cause of death worldwide. Mobile health apps could help in preventing cardiovascular diseases by improving modifiable risk factors such as eating habits, physical activity levels, and alcohol or tobacco consumption. Objective: The aim of this study was to design a mobile health app, Prevent Connect, and to assess its quality for (1) assessing patient behavior for 4 cardiovascular risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and (2) suggesting personalized recommendations and mobile health interventions for risky behaviors. Methods: The knowledge base of the app is based on French national recommendations for healthy eating, physical activity, and limiting alcohol and tobacco consumption. It contains a list of patient behaviors and related personalized recommendations and digital health interventions. The interface was designed according to usability principles. Its quality was assessed by a panel of 52 users in a 5-step process: completion of the demographic form, visualization of a short presentation of the app, testing of the app, completion of the user version of the Mobile App Rating Scale (uMARS), and an open group discussion. Results: This app assesses patient behaviors through specific questionnaires about 4 risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and suggests personalized recommendations and digital health interventions for improving behavior. The app was deemed to be of good quality, with a mean uMARS quality score of 4 on a 5-point Likert scale. The functionality and information content of the app were particularly appreciated, with a mean uMARS score above 4. Almost all the study participants appreciated the navigation system and found the app easy to use. More than three-quarters of the study participants found the app content relevant, concise, and comprehensive. The aesthetics and the engagement of the app were also appreciated (uMARS score, 3.7). Overall, 80% (42/52) of the study participants declared that the app helped them to become aware of the importance of addressing health behavior, and 65% (34/52) said that the app helped motivate them to change lifestyle habits. Conclusions: The app assessed the risky behaviors of the patients and delivered personalized recommendations and digital health interventions for multiple risk factors. The quality of the app was considered to be good, but the impact of the app on behavior changes is yet to be demonstrated and will be assessed in further studies. %M 35049508 %R 10.2196/25384 %U https://www.jmir.org/2022/1/e25384 %U https://doi.org/10.2196/25384 %U http://www.ncbi.nlm.nih.gov/pubmed/35049508 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e29434 %T Machine Learning for Cardiovascular Outcomes From Wearable Data: Systematic Review From a Technology Readiness Level Point of View %A Naseri Jahfari,Arman %A Tax,David %A Reinders,Marcel %A van der Bilt,Ivo %+ Pattern Recognition and Bioinformatics, Delft University of Technology, van Mourik Broekmanweg 6, Delft, 2628 XE, Netherlands, 31 152786052, a.naserijahfari@tudelft.nl %K mHealth %K wearable %K machine learning %K cardiovascular disease %K digital health %K review %K mobile phone %D 2022 %7 19.1.2022 %9 Review %J JMIR Med Inform %G English %X Background: Wearable technology has the potential to improve cardiovascular health monitoring by using machine learning. Such technology enables remote health monitoring and allows for the diagnosis and prevention of cardiovascular diseases. In addition to the detection of cardiovascular disease, it can exclude this diagnosis in symptomatic patients, thereby preventing unnecessary hospital visits. In addition, early warning systems can aid cardiologists in timely treatment and prevention. Objective: This study aims to systematically assess the literature on detecting and predicting outcomes of patients with cardiovascular diseases by using machine learning with data obtained from wearables to gain insights into the current state, challenges, and limitations of this technology. Methods: We searched PubMed, Scopus, and IEEE Xplore on September 26, 2020, with no restrictions on the publication date and by using keywords such as “wearables,” “machine learning,” and “cardiovascular disease.” Methodologies were categorized and analyzed according to machine learning–based technology readiness levels (TRLs), which score studies on their potential to be deployed in an operational setting from 1 to 9 (most ready). Results: After the removal of duplicates, application of exclusion criteria, and full-text screening, 55 eligible studies were included in the analysis, covering a variety of cardiovascular diseases. We assessed the quality of the included studies and found that none of the studies were integrated into a health care system (TRL<6), prospective phase 2 and phase 3 trials were absent (TRL<7 and 8), and group cross-validation was rarely used. These issues limited these studies’ ability to demonstrate the effectiveness of their methodologies. Furthermore, there seemed to be no agreement on the sample size needed to train these studies’ models, the size of the observation window used to make predictions, how long participants should be observed, and the type of machine learning model that is suitable for predicting cardiovascular outcomes. Conclusions: Although current studies show the potential of wearables to monitor cardiovascular events, their deployment as a diagnostic or prognostic cardiovascular clinical tool is hampered by the lack of a realistic data set and proper systematic and prospective evaluation. %M 35044316 %R 10.2196/29434 %U https://medinform.jmir.org/2022/1/e29434 %U https://doi.org/10.2196/29434 %U http://www.ncbi.nlm.nih.gov/pubmed/35044316 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e25444 %T An Open-Source Privacy-Preserving Large-Scale Mobile Framework for Cardiovascular Health Monitoring and Intervention Planning With an Urban African American Population of Young Adults: User-Centered Design Approach %A Clifford,Gari %A Nguyen,Tony %A Shaw,Corey %A Newton,Brittney %A Francis,Sherilyn %A Salari,Mohsen %A Evans,Chad %A Jones,Camara %A Akintobi,Tabia Henry %A Taylor Jr,Herman %+ Cardiovascular Research Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, United States, 1 404 752 1545, htaylor@msm.edu %K agile design %K cardiovascular disease %K community-based participatory research %K exposome %K user-centered design %K minority health %K African American %K mobile phone %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular diseases (CVDs) are the leading cause of death worldwide and are increasingly affecting younger populations, particularly African Americans in the southern United States. Access to preventive and therapeutic services, biological factors, and social determinants of health (ie, structural racism, resource limitation, residential segregation, and discriminatory practices) all combine to exacerbate health inequities and their resultant disparities in morbidity and mortality. These factors manifest early in life and have been shown to impact health trajectories into adulthood. Early detection of and intervention in emerging risk offers the best hope for preventing race-based differences in adult diseases. However, young-adult populations are notoriously difficult to recruit and retain, often because of a lack of knowledge of personal risk and a low level of concern for long-term health outcomes. Objective: This study aims to develop a system design for the MOYO mobile platform. Further, we seek to addresses the challenge of primordial prevention in a young, at-risk population (ie, Southern-urban African Americans). Methods: Urban African Americans, aged 18 to 29 years (n=505), participated in a series of co-design sessions to develop MOYO prototypes (ie, HealthTech Events). During the sessions, participants were orientated to the issues of CVD risk health disparities and then tasked with wireframing prototype screens depicting app features that they considered desirable. All 297 prototype screens were subsequently analyzed using NVivo 12 (QSR International), a qualitative analysis software. Using the grounded theory approach, an open-coding method was applied to a subset of data, approximately 20% (5/25), or 5 complete prototypes, to identify the dominant themes among the prototypes. To ensure intercoder reliability, 2 research team members analyzed the same subset of data. Results: Overall, 9 dominant design requirements emerged from the qualitative analysis: customization, incentive motivation, social engagement, awareness, education, or recommendations, behavior tracking, location services, access to health professionals, data user agreements, and health assessment. This led to the development of a cross-platform app through an agile design process to collect standardized health surveys, narratives, geolocated pollution, weather, food desert exposure data, physical activity, social networks, and physiology through point-of-care devices. A Health Insurance Portability and Accountability Act–compliant cloud infrastructure was developed to collect, process, and review data, as well as generate alerts to allow automated signal processing and machine learning on the data to produce critical alerts. Integration with wearables and electronic health records via fast health care interoperability resources was implemented. Conclusions: The MOYO mobile platform provides a comprehensive health and exposure monitoring system that allows for a broad range of compliance, from passive background monitoring to active self-reporting. These study findings support the notion that African Americans should be meaningfully involved in designing technologies that are developed to improve CVD outcomes in African American communities. %M 35014970 %R 10.2196/25444 %U https://formative.jmir.org/2022/1/e25444 %U https://doi.org/10.2196/25444 %U http://www.ncbi.nlm.nih.gov/pubmed/35014970 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e31316 %T Effects of Urban Green Space on Cardiovascular and Respiratory Biomarkers in Chinese Adults: Panel Study Using Digital Tracking Devices %A Yang,Lin %A Chan,Ka Long %A Yuen,John W M %A Wong,Frances K Y %A Han,Lefei %A Ho,Hung Chak %A Chang,Katherine K P %A Ho,Yuen Shan %A Siu,Judy Yuen-Man %A Tian,Linwei %A Wong,Man Sing %+ School of Nursing, The Hong Kong Polytechnic University, Hung Hom Campus, GH519, Hong Kong, Hong Kong, 852 2766 6419, frances.wong@polyu.edu.hk %K green space %K biomarker %K cardiovascular disease %K respiratory disease %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: The health benefits of urban green space have been widely reported in the literature; however, the biological mechanisms remain unexplored, and a causal relationship cannot be established between green space exposure and cardiorespiratory health. Objective: Our aim was to conduct a panel study using personal tracking devices to continuously collect individual exposure data from healthy Chinese adults aged 50 to 64 years living in Hong Kong. Methods: A panel of cardiorespiratory biomarkers was tested each week for a period of 5 consecutive weeks. Data on weekly exposure to green space, air pollution, and the physical activities of individual participants were collected by personal tracking devices. The effects of green space exposure measured by the normalized difference vegetation index (NDVI) at buffer zones of 100, 250, and 500 meters on a panel of cardiorespiratory biomarkers were estimated by a generalized linear mixed-effects model, with adjustment for confounding variables of sociodemographic characteristics, exposure to air pollutants and noise, exercise, and nutrient intake. Results: A total of 39 participants (mean age 56.4 years, range 50-63 years) were recruited and followed up for 5 consecutive weeks. After adjustment for sex, income, occupation, physical activities, dietary intake, noise, and air pollution, significant negative associations with the NDVI for the 250-meter buffer zone were found in total cholesterol (–21.6% per IQR increase in NDVI, 95% CI –32.7% to –10.6%), low-density lipoprotein (–14.9%, 95% CI –23.4% to –6.4%), glucose (–11.2%, 95% CI –21.9% to –0.5%), and high-sensitivity C-reactive protein (–41.3%, 95% CI –81.7% to –0.9%). Similar effect estimates were found for the 100-meter and 250-meter buffer zones. After adjustment for multiple testing, the effect estimates of glucose and high-sensitivity C-reactive protein were no longer significant. Conclusions: The health benefits of green space can be found in some metabolic and inflammatory biomarkers. Further studies are warranted to establish the causal relationship between green space and cardiorespiratory health. %M 34967754 %R 10.2196/31316 %U https://cardio.jmir.org/2021/2/e31316 %U https://doi.org/10.2196/31316 %U http://www.ncbi.nlm.nih.gov/pubmed/34967754 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e32351 %T The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data %A Montgomery,Robert M %A Boucher,Eliane M %A Honomichl,Ryan D %A Powell,Tyler A %A Guyton,Sharelle L %A Bernecker,Samantha L %A Stoeckl,Sarah Elizabeth %A Parks,Acacia C %+ Happify Health, 51 E 12th St 5th floor, New York, NY, 10003, United States, 1 917 261 6933, robmontgomery@happify.com %K digital mental health %K digital health %K mobile apps %K mobile health %K internet-based intervention %K happiness %K subjective well-being %K anxiety %K cardiovascular health %K high blood pressure %K high cholesterol %K diabetes %K cardiovascular disease risk %K real-world data %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions. Objective: The objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2). Methods: Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks’ exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time. Results: Both hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well. Conclusions: This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD. %M 34806986 %R 10.2196/32351 %U https://cardio.jmir.org/2021/2/e32351 %U https://doi.org/10.2196/32351 %U http://www.ncbi.nlm.nih.gov/pubmed/34806986 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e27299 %T A Sustainable Community-Based Model of Noncommunicable Disease Risk Factor Surveillance (Shraddha-Jagrithi Project): Protocol for a Cohort Study %A Menon,Jaideep %A Numpeli,Mathews %A Kunjan,Sajeev P %A Karimbuvayilil,Beena V %A Sreedevi,Aswathy %A Panniyamakkal,Jeemon %A Suseela,Rakesh P %A Thachathodiyil,Rajesh %A Banerjee,Amitava %+ Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Amrita Institute of Medical Sciences, Ponekkara PO, Angamaly 683572, Kochi, 682041, India, 91 04842457470, menon7jc@gmail.com %K non-communicable diseases %K surveillance %K accredited social health activist %K panchayat (village) %K primary health centre %K spoke and hub %K non-communicable diseases %K cardiovascular %K public health %K hypertension %K health services %K health center %K diabetes %D 2021 %7 22.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: India has a massive noncommunicable disease (NCD) burden, at an enormous cost to the individual, family, society, and health system at large, despite which prevention and surveillance are relatively neglected. If diagnosed early and treated adequately, risk factors for atherosclerotic cardiovascular disease would help decrease the mortality and morbidity burden. Surveillance for NCDs, creating awareness, positive lifestyle changes, and treatment are the proven measures known to prevent the progression of the disease. India is in a stage of rapid epidemiological transition, with the state of Kerala being at the forefront, pointing us towards likely disease burden and outcomes for the rest of the country in the future. A previous study done by the same investigators in a population of >100,000 revealed poor awareness, treatment of NCDs, and poor adherence to medicines in individuals with CVD. Objective: This study aimed at assessing a sustainable, community-based surveillance model for NCDs with corporate support fully embedded in the public health system. Methods: Frontline health workers will check all individuals in the target group (≥age 30 years) with further follow-up and treatment planned in a “spoke and hub” model using the public health system of primary health centers as spokes to the hubs of taluk or district hospitals. All data entry done by frontline health workers will be on a tablet PC, ensuring rapid acquisition and transfer of participant health details to primary health centers for further follow-up and treatment. Results: The model will be evaluated based on the utilization rate of various services offered at all tier levels. The proportions of the target population screened, eligible individuals who reached the spoke or hub centers for risk stratification and care, and community-level control for hypertension and diabetes in annual surveys will be used as indicator variables. The model ensures diagnosis and follow-up treatment at no cost to the individual entirely through the tiered public health system of the state and country. Conclusions: Surveillance for NCDs is an essential facet of health care presently lacking in India. Atherosclerotic cardiovascular disease has a long gestation period in progression to the symptomatic phase of the disease, during which timely preventive and lifestyle measures would help prevent disease progression if implemented. Unfortunately, several asymptomatic individuals have never tested their plasma glucose, serum lipid levels, or blood pressure and are unaware of their disease status. Our model, implemented through the public health system using frontline health workers, would ensure individuals aged≥30 years at risk of disease are identified, and necessary lifestyle modifications and treatments are given. In addition, the surveillance at the community level would help create a general awareness of NCDs and lead to healthier lifestyle habits. Trial Registration: Clinical Trial Registry India CTRI/2018/07/014856; https://tinyurl.com/4saydnxf International Registered Report Identifier (IRRID): DERR1-10.2196/27299 %M 34677141 %R 10.2196/27299 %U https://www.researchprotocols.org/2021/10/e27299 %U https://doi.org/10.2196/27299 %U http://www.ncbi.nlm.nih.gov/pubmed/34677141 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e33252 %T Values of Importance to Patients With Cardiovascular Disease as a Foundation for eHealth Design and Evaluation: Mixed Methods Study %A Bente,Britt E %A Wentzel,Jobke %A Groeneveld,Rik GH %A IJzerman,Renée VH %A de Buisonjé,David R %A Breeman,Linda D %A Janssen,Veronica R %A Kraaijenhagen,Roderik %A Pieterse,Marcel E %A Evers,Andrea WM %A van Gemert-Pijnen,Julia EWC %+ Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 53 489 9660, b.e.bente@utwente.nl %K patient values %K health behavior %K lifestyle %K mobile app %K user-centered design %K eHealth %K cardiovascular disease %K behavior %K app %K design %K cardiovascular %K evaluation %K platform %K support %K intervention %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: eHealth interventions are developed to support and facilitate patients with lifestyle changes and self-care tasks after being diagnosed with a cardiovascular disease (CVD). Creating long-lasting effects on lifestyle change and health outcomes with eHealth interventions is challenging and requires good understanding of patient values. Objective: The aim of the study was to identify values of importance to patients with CVD to aid in designing a technological lifestyle platform. Methods: A mixed method design was applied, combining data from usability testing with an additional online survey study, to validate the outcomes of the usability tests. Results: A total of 11 relevant patient values were identified, including the need for security, support, not wanting to feel anxious, tailoring of treatment, and personalized, accessible care. The validation survey shows that all values but one (value 9: To have extrinsic motivation to accomplish goals or activities [related to health/lifestyle]) were regarded as important/very important. A rating of very unimportant or unimportant was given by less than 2% of the respondents (value 1: 4/641, 0.6%; value 2: 10/641, 1.6%; value 3: 9/641, 1.4%; value 4: 5/641, 0.8%; value 5: 10/641, 1.6%; value 6: 4/641, 0.6%; value 7: 10/639, 1.6%; value 8: 4/639, 0.6%; value 10: 3/636, 0.5%; value 11: 4/636, 0.6%) to all values except but one (value 9: 56/636, 8.8%). Conclusions: There is a high consensus among patients regarding the identified values reflecting goals and themes central to their lives, while living with or managing their CVD. The identified values can serve as a foundation for future research to translate and integrate these values into the design of the eHealth technology. This may call for prioritization of values, as not all values can be met equally. %M 34677130 %R 10.2196/33252 %U https://cardio.jmir.org/2021/2/e33252 %U https://doi.org/10.2196/33252 %U http://www.ncbi.nlm.nih.gov/pubmed/34677130 %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 %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28669 %T Multiscale Biology of Cardiovascular Risk in Psoriasis: Protocol for a Case-Control Study %A Kaiser,Hannah %A Kvist-Hansen,Amanda %A Becker,Christine %A Wang,Xing %A McCauley,Benjamin D %A Krakauer,Martin %A Gørtz,Peter Michael %A Henningsen,Kristoffer Mads Aaris %A Zachariae,Claus %A Skov,Lone %A Hansen,Peter Riis %+ Department of Dermatology and Allergy, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 15, Hellerup, 2900, Denmark, 45 38673144, amanda.kvist-hansen@regionh.dk %K cardiovascular disease %K psoriasis %K study protocol %K cardiovascular imaging %K proteomics %K lipidomics %K microbiome %K mass cytometry %K bioinformatics %K system biology %D 2021 %7 28.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with psoriasis have increased risk of cardiovascular disease (CVD) independent of traditional risk factors. The molecular mechanisms underlying the psoriasis-CVD connection are not fully understood. Advances in high-throughput molecular profiling technologies and computational analysis techniques offer new opportunities to improve the understanding of disease connections. Objective: We aim to characterize the complexity of cardiovascular risk in patients with psoriasis by integrating deep phenotypic data with systems biology techniques to perform comprehensive multiomic analyses and construct network models of the two interacting diseases. Methods: The study aims to include 120 adult patients with psoriasis (60 with prior atherosclerotic CVD and 60 without CVD). Half of the patients are already receiving systemic antipsoriatic treatment. All patients complete a questionnaire, and a medical interview is conducted to collect medical history and information on, for example, socioeconomics, mental health, diet, and physical exercise. Participants are examined clinically with assessment of the Psoriasis Area and Severity Index and undergo imaging by transthoracic echocardiography, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT), and carotid artery ultrasonography. Skin swabs are collected for analysis of microbiome metagenomics; skin biopsies and blood samples are collected for transcriptomic profiling by RNA sequencing; skin biopsies are collected for immunohistochemistry; plasma samples are collected for analyses of proteomics, lipidomics, and metabolomics; blood samples are collected for high-dimensional mass cytometry; and feces samples are collected for gut microbiome metagenomics. Bioinformatics and systems biology techniques are utilized to analyze the multiomic data and to integrate data into a network model of CVD in patients with psoriasis. Results: Recruitment was completed in September 2020. Preliminary results of 18F-FDG-PET/CT data have recently been published, where vascular inflammation was reduced in the ascending aorta (P=.046) and aortic arch (P=.04) in patients treated with statins and was positively associated with inflammation in the visceral adipose tissue (P<.001), subcutaneous adipose tissue (P=.007), pericardial adipose tissue (P<.001), spleen (P=.001), and bone marrow (P<.001). Conclusions: This systems biology approach with integration of multiomics and clinical data in patients with psoriasis with or without CVD is likely to provide novel insights into the biological mechanisms underlying these diseases and their interplay that can impact future treatment. International Registered Report Identifier (IRRID): DERR1-10.2196/28669 %M 34581684 %R 10.2196/28669 %U https://www.researchprotocols.org/2021/9/e28669 %U https://doi.org/10.2196/28669 %U http://www.ncbi.nlm.nih.gov/pubmed/34581684 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e29061 %T Digital Technology Tools to Examine Patient Adherence to a Prescription-Only Omega-3 Polyunsaturated Fatty Acid Therapy To Mitigate Cardiovascular Risk: Protocol for a Prospective Observational Study and Preliminary Demographic Analysis %A Arutyunov,Gregory P %A Arutyunov,Alexander G %A Ageev,Fail T %A Fofanova,Tatiana V %+ Pirogov Russian National Research Medical University, Department of Internal Medicine, Ostrovityanova Street, Moscow, 117997, Russian Federation, 7 9103281989, arut@ossn.ru %K omega-3-acid ethyl esters %K myocardial infarction %K hypertriglyceridemia %K adherence %K compliance %K persistence %K mHealth %K eHealth %K patient-reported outcomes %D 2021 %7 30.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sustained adherence and persistence with prescription medications is considered essential to achieve maximal treatment benefit for patients with major chronic, noncommunicable diseases such as hyperlipidemia and lipid-associated cardiovascular disease. It is widely documented, however, that many patients with these conditions have poor long-term adherence to their treatments. The population of Russia is affected by poor adherence in the same ways as populations elsewhere and continues to have high rates of cardiovascular disease. Objective: The purpose of this study was to examine patient adherence to a prescription-only preparation of highly purified omega-3 polyunsaturated fatty acids (1.2 to 1 eicosapentaenoic acid to docosahexaenoic ratio, 90% purity) in a large sample of patients at risk for cardiovascular diseases using digital technology to monitor patient behavior and as an outreach facility for patient education and engagement. Methods: We conducted a 6-month prospective observational study (DIAPAsOn) at >100 centers in the Russian Federation. A bespoke electronic data capture and patient engagement system were developed with a well-established Russian technology supplier that enables information obtained during clinic visits to be supplemented by remote patient self-reporting. Other aspects of the program included raising patients' awareness about their condition via educational materials available in personal patient accounts in the electronic system. Results: From an initial cohort of 3000 patients, a safety population of 2572 patients (age: mean 60 years) with an equal proportion of men and women has been characterized. There was widespread concomitant cardiovascular pathology and commensurate use of multiple classes of cardiovascular medication, notably lipid-modifying and antihypertensive drugs. The program was completed by 1975 patients, of whom 780 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for secondary prevention after myocardial infarction and 1195 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for hypertriglyceridemia. Data collection and analysis have been completed. Conclusions: DIAPAsOn will provide insights into patient adherence with prescription-grade omega-3 polyunsaturated fatty acid therapy and perspectives on the role of mobile technology in monitoring and encouraging adherence to therapy. %M 34459746 %R 10.2196/29061 %U https://www.researchprotocols.org/2021/8/e29061 %U https://doi.org/10.2196/29061 %U http://www.ncbi.nlm.nih.gov/pubmed/34459746 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e23765 %T Health Information Technology Use Among Persons With Self-reported Atherosclerotic Cardiovascular Disease: Analysis of the 2011-2018 National Health Interview Survey %A Nwokeji,Uchenna %A Spaulding,Erin M %A Shan,Rongzi %A Turkson-Ocran,Ruth-Alma %A Baptiste,Diana %A Koirala,Binu %A Plante,Timothy B %A Martin,Seth S %A Commodore-Mensah,Yvonne %+ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 525 N. Wolfe Street, Room #419, Baltimore, MD, 21205, United States, 1 410 614 1529, ycommod1@jhu.edu %K health information technology %K cardiovascular disease %K digital health %K eHealth %K mobile phone %D 2021 %7 13.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality in the United States. Health information technologies (HITs) have recently emerged as a viable intervention to mitigate the burden of ASCVD. Approximately 60% of US adults report searching the internet for health information; however, previous research has not examined the prevalence of general technology or HIT use among adults with and without ASCVD. In addition, social determinants in HIT use among adults with ASCVD are not well understood. Objective: The aim of this study was to evaluate the prevalence and social determinants of HIT use among US adults with versus without self-reported ASCVD. Methods: We pooled cross-sectional data from the 2011-2018 National Health Interview Survey (NHIS) to examine the general technology and HIT use among adults aged ≥18 years with and without self-reported ASCVD (coronary heart disease, stroke, or both). General technology use was defined as mobile phone ownership, internet use, and computer use. HIT use was defined as looking up health information on the internet, filling a web-based prescription, scheduling a medical appointment on the internet, communicating with a health care provider by email, or using web-based group chats to learn about health topics. We evaluated sociodemographic differences in HIT use among respondents by using Poisson regression. Analyses were weighted according to NHIS standards. Results: A total sample of 256,117 individuals were included, of which 2194 (0.9%) reported prior ASCVD. Among adults with prior ASCVD, the mean age was 70.6 (SD 11.5) years, and 47.4% (1048/2194) of the adults were females. General technology use differed between participants with and without prior ASCVD, with 36.0% (614/1826) and 76.2% (157,642/213,816) indicating internet usage and 24.6% (374/1575) and 60.7% (107,742/184,557) indicating using a computer every day, respectively. Similarly, adults with ASCVD were less likely to use HIT than those without ASCVD (515/2194, 25.1% vs 123,966/253,923, 51.0%; P<.001). Among adults with prior ASCVD, social determinants that were associated with HIT use included younger age, higher education, higher income, being employed, and being married. Conclusions: HIT use was low among adults with a history of ASCVD, which may represent a barrier to delivering care via emerging HIT. Given the associations with social determinants such as income, education, and employment, targeted strategies and policies are needed to eliminate barriers to impact HIT usage. %M 34397391 %R 10.2196/23765 %U https://www.jmir.org/2021/8/e23765 %U https://doi.org/10.2196/23765 %U http://www.ncbi.nlm.nih.gov/pubmed/34397391 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e25548 %T Efficacy and Safety of Text Messages Targeting Adherence to Cardiovascular Medications in Secondary Prevention: TXT2HEART Colombia Randomized Controlled Trial %A Bermon,Anderson %A Uribe,Ana Fernanda %A Pérez-Rivero,Paula Fernanda %A Prieto-Merino,David %A Saaibi,Jose Federico %A Silva,Federico Arturo %A Canon,Diana Ivonne %A Castillo-Gonzalez,Karol Melissa %A Cáceres-Rivera,Diana Isabel %A Guio,Elizabeth %A Meneses-Castillo,Karen Janneth %A Castillo-Meza,Alberto %A Atkins,Louise %A Horne,Robert %A Murray,Elizabeth %A Serrano,Norma Cecilia %A Free,Caroline %A Casas,Juan Pablo %A Perel,Pablo %+ Research Center, Fundación Cardiovascular de Colombia, Calle 155A #23-58, Floridablanca, 681001, Colombia, 57 3002053041, andebermon@gmail.com %K randomized controlled trial %K Colombia %K text messaging %K cardiovascular disease %K secondary prevention %D 2021 %7 28.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS text messaging intervention was recently developed based on behavior change techniques to increase adherence to pharmacological treatment among patients with a history of ASCVD. Objective: This study aims to evaluate the efficacy and safety of an SMS text messaging intervention to improve adherence to cardiovascular medications in patients with ASCVD. Methods: A randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular events, such as acute myocardial infarction, unstable angina, cerebrovascular disease, or peripheral artery disease, in one center in Colombia was conducted. Patients randomized to the intervention arm were assigned to receive SMS text messages daily for the first 4 weeks, 5 SMS text messages on week 5, 3 SMS text messages each in weeks 6 and 7, and 1 SMS text message weekly from week 8 until week 52. In contrast, patients in the control arm received a monthly SMS text message reminding them of the next study appointment and the importance of the study, requesting information about changes in their phone number, and thanking them for participating in the study. The primary endpoint was the change in low-density lipoprotein cholesterol (LDL-C) levels, whereas the secondary endpoints were the changes in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure, medication adherence, cardiac and noncardiac mortality, and hospitalization. Linear regression analyses and bivariate tests were performed. Results: Of the 930 randomized patients, 805 (86.5%) completed follow-up and were analyzed for the primary endpoint. There was no evidence that the intervention changed the primary outcome (LDL-C levels; P=.41) or any of the secondary outcomes evaluated (all P>.05). There was also no evidence that the intervention was associated with adverse events. Conclusions: In this study, there was no evidence that a behavior modification intervention delivered by SMS text messaging improved LDL-C levels, blood pressure levels, or adherence at 12 months. More research is needed to evaluate whether different SMS text messaging strategies, including personalized messages and different timings, are effective; future studies should include mixed methods to better understand why, for whom, and in which context (eg, health system or social environment) SMS text messaging interventions work (or not) to improve adherence in patients with ASCVD. Trial Registration: ClinicalTrials.gov NCT03098186; https://clinicaltrials.gov/ct2/show/NCT03098186 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028017 %M 34319247 %R 10.2196/25548 %U https://mhealth.jmir.org/2021/7/e25548 %U https://doi.org/10.2196/25548 %U http://www.ncbi.nlm.nih.gov/pubmed/34319247 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e29191 %T Geospatial Analysis of Neighborhood Environmental Stress in Relation to Biological Markers of Cardiovascular Health and Health Behaviors in Women: Protocol for a Pilot Study %A Tamura,Kosuke %A Curlin,Kaveri %A Neally,Sam J %A Vijayakumar,Nithya P %A Mitchell,Valerie M %A Collins,Billy S %A Gutierrez-Huerta,Cristhian %A Troendle,James F %A Baumer,Yvonne %A Osei Baah,Foster %A Turner,Briana S %A Gray,Veronica %A Tirado,Brian A %A Ortiz-Chaparro,Erika %A Berrigan,David %A Mehta,Nehal N %A Vaccarino,Viola %A Zenk,Shannon N %A Powell-Wiley,Tiffany M %+ Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bldg 10-CRC, 5-5330, Bethesda, MD, 20892, United States, 1 3018278660, kosuke.tamura@nih.gov %K wearables %K global positioning system %K ecological momentary assessment %K accelerometer %K biomarkers of stress %K mobile phone %D 2021 %7 22.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Innovative analyses of cardiovascular (CV) risk markers and health behaviors linked to neighborhood stressors are essential to further elucidate the mechanisms by which adverse neighborhood social conditions lead to poor CV outcomes. We propose to objectively measure physical activity (PA), sedentary behavior, and neighborhood stress using accelerometers, GPS, and real-time perceived ecological momentary assessment via smartphone apps and to link these to biological measures in a sample of White and African American women in Washington, DC, neighborhoods. Objective: The primary aim of this study is to test the hypothesis that living in adverse neighborhood social conditions is associated with higher stress-related neural activity among 60 healthy women living in high or low socioeconomic status neighborhoods in Washington, DC. Sub-aim 1 of this study is to test the hypothesis that the association is moderated by objectively measured PA using an accelerometer. A secondary objective is to test the hypothesis that residing in adverse neighborhood social environment conditions is related to differences in vascular function. Sub-aim 2 of this study is to test the hypothesis that the association is moderated by objectively measured PA. The third aim of this study is to test the hypothesis that adverse neighborhood social environment conditions are related to differences in immune system activation. Methods: The proposed study will be cross-sectional, with a sample of at least 60 women (30 healthy White women and 30 healthy Black women) from Wards 3 and 5 in Washington, DC. A sample of the women (n=30) will be recruited from high-income areas in Ward 3 from census tracts within a 15% of Ward 3’s range for median household income. The other participants (n=30) will be recruited from low-income areas in Wards 5 from census tracts within a 15% of Ward 5’s range for median household income. Finally, participants from Wards 3 and 5 will be matched based on age, race, and BMI. Participants will wear a GPS unit and accelerometer and report their stress and mood in real time using a smartphone. We will then examine the associations between GPS-derived neighborhood variables, stress-related neural activity measures, and adverse biological markers. Results: The National Institutes of Health Institutional Review Board has approved this study. Recruitment will begin in the summer of 2021. Conclusions: Findings from this research could inform the development of multilevel behavioral interventions and policies to better manage environmental factors that promote immune system activation or psychosocial stress while concurrently working to increase PA, thereby influencing CV health. International Registered Report Identifier (IRRID): PRR1-10.2196/29191 %M 34292168 %R 10.2196/29191 %U https://www.researchprotocols.org/2021/7/e29191 %U https://doi.org/10.2196/29191 %U http://www.ncbi.nlm.nih.gov/pubmed/34292168 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e27423 %T Availability, Formulation, Labeling, and Price of Low-sodium Salt Worldwide: Environmental Scan %A Yin,Xuejun %A Liu,Hueiming %A Webster,Jacqui %A Trieu,Kathy %A Huffman,Mark D %A Miranda,J Jaime %A Marklund,Matti %A Wu,Jason H Y %A Cobb,Laura K %A Li,Ka Chun %A Pearson,Sallie-Anne %A Neal,Bruce %A Tian,Maoyi %+ The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown NSW, Sydney, 2042, Australia, 61 18610501623, mtian@georgeinstitute.org.cn %K low-sodium salt %K salt substitute %K availability %K formulation %K labeling %K price %K sodium %K salt %K blood pressure %K cardiology %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Regular salt is about 100% sodium chloride. Low-sodium salts have reduced sodium chloride content, most commonly through substitution with potassium chloride. Low-sodium salts have a potential role in reducing the population's sodium intake levels and blood pressure, but their availability in the global market is unknown. Objective: The aim of this study is to assess the availability, formulation, labeling, and price of low-sodium salts currently available to consumers worldwide. Methods: Low-sodium salts were identified through a systematic literature review, Google search, online shopping site searches, and inquiry of key informants. The keywords “salt substitute,” “low-sodium salt,” “potassium salt,” “mineral salt,” and “sodium reduced salt” in six official languages of the United Nations were used for the search. Information about the brand, formula, labeling, and price was extracted and analyzed. Results: A total of 87 low-sodium salts were available in 47 out of 195 (24%) countries worldwide, including 28 high-income countries, 13 upper-middle-income countries, and 6 lower-middle-income countries. The proportion of sodium chloride varied from 0% (sodium-free) to 88% (as percent of weight; regular salt is 100% sodium chloride). Potassium chloride was the most frequent component with levels ranging from 0% to 100% (potassium chloride salt). A total of 43 (49%) low-sodium salts had labels with the potential health risks, and 33 (38%) had labels with the potential health benefits. The median price of low-sodium salts in high-income, upper-middle-income, and lower-middle-income countries was US $15.00/kg (IQR 6.4-22.5), US $2.70/kg (IQR 1.7-5.5), and US $2.90/kg (IQR 0.50-22.2), respectively. The price of low-sodium salts was between 1.1 and 14.6 times that of regular salts. Conclusions: Low-sodium salts are not widely available and are commonly more expensive than regular salts. Policies that promote the availability, affordability, and labeling of low-sodium salts should increase uptake, helping populations reduce blood pressure and prevent cardiovascular diseases. International Registered Report Identifier (IRRID): RR2-10.1111/jch.14054 %M 33985938 %R 10.2196/27423 %U https://publichealth.jmir.org/2021/7/e27423 %U https://doi.org/10.2196/27423 %U http://www.ncbi.nlm.nih.gov/pubmed/33985938 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 1 %P e28392 %T Evaluating the Impact of a Digital Nutrition Platform on Cholesterol Levels in Users With Dyslipidemia: Longitudinal Study %A Hu,Emily A %A Scharen,Jared %A Nguyen,Viet %A Langheier,Jason %+ Zipongo Inc, DBA Foodsmart, 595 Pacific Avenue, Fl 4, San Francisco, CA, 94133, United States, 1 415 800 2311, emily.hu@foodsmart.com %K dyslipidemia %K hyperlipidemia %K lipids %K cholesterol %K digital %K nutrition %K meal planning %K food environment %K food ordering %K food purchasing %D 2021 %7 10.6.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: A strong association exists between consuming a healthy diet and lowering cholesterol levels among individuals with high cholesterol. However, implementing and sustaining a healthy diet in the real world is a major challenge. Digital technologies are at the forefront of changing dietary behavior on a massive scale, as they can reach broad populations. There is a lack of evidence that has examined the benefit of a digital nutrition intervention, especially one that incorporates nutrition education, meal planning, and food ordering, on cholesterol levels among individuals with dyslipidemia. Objective: The aim of this observational longitudinal study was to examine the characteristics of people with dyslipidemia, determine how their status changed over time, and evaluate the changes in total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and triglycerides among individuals with elevated lipids who used Foodsmart, a digital nutrition platform that integrates education, meal planning, and food ordering. Methods: We included 653 adults who used Foodsmart between January 2015 and February 2021, and reported a lipid marker twice. Participants self-reported age, gender, weight, and usual dietary intake in a 53-item food frequency questionnaire, and lipid values could be provided at any time. Dyslipidemia was defined as total cholesterol ≥200 mg/dL, HDL-C ≤40 mg/dL, LDL-C ≥130 mg/dL, or triglycerides ≥150 mg/dL. We retrospectively analyzed distributions of user characteristics and their associations with the likelihood of returning to normal lipid levels. We calculated the mean changes and percent changes in lipid markers among users with elevated lipids. Results: In our total sample, 54.1% (353/653) of participants had dyslipidemia at baseline. Participants with dyslipidemia at baseline were more likely to be older, be male, and have a higher weight and BMI compared with participants who had normal lipid levels. We found that 36.3% (128/353) of participants who had dyslipidemia at baseline improved their lipid levels to normal by the end of follow-up. Using multivariate logistic regression, we found that baseline obesity (odds ratio [OR] 2.57, 95% CI 1.25-5.29; P=.01) and Nutriscore (OR 1.04, 95% CI 1.00-1.09; P=.04) were directly associated with achieving normal lipid levels. Participants with elevated lipid levels saw improvements as follows: HDL-C increased by 38.5%, total cholesterol decreased by 6.8%, cholesterol ratio decreased by 20.9%, LDL-C decreased by 12.9%, non-HDL-C decreased by 7.8%, and triglycerides decreased by 10.8%. Conclusions: This study characterized users of the Foodsmart platform who had dyslipidemia and found that users with elevated lipid levels showed improvements in the levels over time. %M 34110291 %R 10.2196/28392 %U https://cardio.jmir.org/2021/1/e28392 %U https://doi.org/10.2196/28392 %U http://www.ncbi.nlm.nih.gov/pubmed/34110291 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e26605 %T The Association Between Short-term Exposure to Ambient Air Pollution and Patient-Level Home Blood Pressure Among Patients With Chronic Cardiovascular Diseases in a Web-Based Synchronous Telehealth Care Program: Retrospective Study %A Huang,Ching-Chang %A Chen,Ying-Hsien %A Hung,Chi-Sheng %A Lee,Jen-Kuang %A Hsu,Tse-Pin %A Wu,Hui-Wen %A Chuang,Pao-Yu %A Chen,Ming-Fong %A Ho,Yi-Lwun %+ Telehealth Center, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 10002, Taiwan, 886 223123456 ext 63737, ylho@ntu.edu.tw %K ambient air pollution %K blood pressure %K cardiovascular disease %K chronic disease %K climate %K home blood pressure %K particulate matter %K pollution %K remote monitoring %K telehealth care %K telemonitoring %K weather %D 2021 %7 8.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The association between short-term exposure to ambient air pollution and blood pressure has been inconsistent, as reported in the literature. Objective: This study aimed to investigate the relationship between short-term ambient air pollution exposure and patient-level home blood pressure (HBP). Methods: Patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital were enrolled as the study population. HBP was measured by patients or their caregivers. Hourly meteorological data (including temperature, relative humidity, wind speed, and rainfall) and ambient air pollution monitoring data (including CO, NO2, particulate matter with a diameter of <10 µm, particulate matter with a diameter of <2.5 µm, and SO2) during the same time period were obtained from the Central Weather Bureau and the Environmental Protection Administration in Taiwan, respectively. A stepwise multivariate repeated generalized estimating equation model was used to assess the significant factors for predicting systolic and diastolic blood pressure (SBP and DBP). Results: A total of 253 patients and 110,715 HBP measurements were evaluated in this study. On multivariate analysis, demographic, clinical, meteorological factors, and air pollutants significantly affected the HBP (both SBP and DBP). All 5 air pollutants evaluated in this study showed a significant, nonlinear association with both home SBP and DBP. Compared with demographic and clinical factors, environmental factors (meteorological factors and air pollutants) played a minor yet significant role in the regulation of HBP. Conclusions: Short-term exposure to ambient air pollution significantly affects HBP in patients with chronic cardiovascular disease. %M 34100764 %R 10.2196/26605 %U https://publichealth.jmir.org/2021/6/e26605 %U https://doi.org/10.2196/26605 %U http://www.ncbi.nlm.nih.gov/pubmed/34100764 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e29084 %T Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews %A O'Leary,Renee %A Qureshi,Maria Ahmed %A La Rosa,Giusy Rita Maria %A Vernooij,Robin W M %A Odimegwu,Damian Chukwu %A Bertino,Gaetano %A Polosa,Riccardo %+ Center for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia, 89 Torre Biologica 11 piano, Catania, 95123, Italy, 39 3383892673, renee.oleary@eclatrbc.it %K cardiovascular %K e-cigarettes %K ENDS %K respiratory %K tobacco harm reduction %D 2021 %7 27.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, particularly respiratory and cardiovascular effects, have come to differing conclusions. Objective: We conducted two systematic reviews to critically assess and synthesize available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal of the reviews is to promote health literacy in ENDS users with facts on the health effects of ENDS. Methods: These two reviews will be living systematic reviews. The systematic reviews will be initiated through a baseline review. Studies will be evaluated using the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned because of the heterogeneity of data. A search for recently published studies will be conducted every 3 months, and an updated review will be published every 6 months for the duration of the project or possibly longer. Results: The baseline and updated reviews will be published in a peer-reviewed journal. The findings of the reviews will be reported in a white paper for clinicians and a fact sheet for people who use ENDS. Conclusions: The substitution of ENDS for cigarettes is one way to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research. Trial Registration: PROSPERO CRD42021239094; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239094 International Registered Report Identifier (IRRID): DERR1-10.2196/29084 %M 34042601 %R 10.2196/29084 %U https://www.researchprotocols.org/2021/5/e29084 %U https://doi.org/10.2196/29084 %U http://www.ncbi.nlm.nih.gov/pubmed/34042601 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24190 %T Mobile Apps to Improve Medication Adherence in Cardiovascular Disease: Systematic Review and Meta-analysis %A Al-Arkee,Shahd %A Mason,Julie %A Lane,Deirdre A %A Fabritz,Larissa %A Chua,Winnie %A Haque,M Sayeed %A Jalal,Zahraa %+ Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 0121 414 4042, s.k.k.al-arkee@pgr.bham.ac.uk %K mobile health care applications %K medication adherence %K cardiovascular disease %K systematic review %K mobile phone %D 2021 %7 25.5.2021 %9 Review %J J Med Internet Res %G English %X Background: Adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57%, and approximately 9% of all CVD events in Europe are attributable to poor medication adherence. Mobile health technologies, particularly mobile apps, have the potential to improve medication adherence and clinical outcomes. Objective: The objective of this study is to assess the effects of mobile health care apps on medication adherence and health-related outcomes in patients with CVD. This study also evaluates apps’ functionality and usability and the involvement of health care professionals in their use. Methods: Electronic databases (MEDLINE [Ovid], PubMed Central, Cochrane Library, CINAHL Plus, PsycINFO [Ovid], Embase [Ovid], and Google Scholar) were searched for randomized controlled trials (RCTs) to investigate app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane risk of bias tool was used to assess the included studies. Meta-analysis was performed for clinical outcomes and medication adherence, with meta-regression analysis used to evaluate the impact of app intervention duration on medication adherence. Results: This study included 16 RCTs published within the last 6 years. In total, 12 RCTs reported medication adherence as the primary outcome, which is the most commonly self-reported adherence. The duration of the interventions ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. Medication adherence rates showed statistically significant improvements in 9 RCTs when compared with the control, and meta-analysis of the 6 RCTs reporting continuous data showed a significant overall effect in favor of the app intervention (mean difference 0.90, 95% CI 0.03-1.78) with a high statistical heterogeneity (I2=93.32%). Moreover, 9 RCTs assessed clinical outcomes and reported an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. Meta-analysis of these clinical outcomes from 6 RCTs favored app interventions, but none were significant. In the 7 trials evaluating app usability, all were found to be acceptable. There was a great variation in the app characteristics. A total of 10 RCTs involved health care professionals, mainly physicians and nurses, in the app-based interventions. The apps had mixed functionality: 2 used education, 7 delivered reminders, and 7 provided reminders in combination with educational support. Conclusions: Apps tended to increase medication adherence, but interventions varied widely in design, content, and delivery. Apps have an acceptable degree of usability; yet the app characteristics conferring usability and effectiveness are ill-defined. Future large-scale studies should focus on identifying the essential active components of successful apps. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019121385; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=121385 %M 34032583 %R 10.2196/24190 %U https://www.jmir.org/2021/5/e24190 %U https://doi.org/10.2196/24190 %U http://www.ncbi.nlm.nih.gov/pubmed/34032583 %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 %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e19688 %T Effectiveness of Digital Interventions for Reducing Behavioral Risks of Cardiovascular Disease in Nonclinical Adult Populations: Systematic Review of Reviews %A Gold,Natalie %A Yau,Amy %A Rigby,Benjamin %A Dyke,Chris %A Remfry,Elizabeth Alice %A Chadborn,Tim %+ Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, United Kingdom, 44 9767839044, n.gold@lse.ac.uk %K alcohol %K behavior change %K cardiovascular disease %K diet %K digital interventions %K digital medicine %K internet interventions %K mHealth %K mobile interventions %K physical activity %K smoking %K tobacco %K mobile phone %D 2021 %7 14.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions are increasingly being used as a supplement or replacement for face-to-face services as a part of predictive prevention. They may be offered to those who are at high risk of cardiovascular disease and need to improve their diet, increase physical activity, stop smoking, or reduce alcohol consumption. Despite the popularity of these interventions, there is no overall summary and comparison of the effectiveness of different modes of delivery of a digital intervention to inform policy. Objective: This review aims to summarize the effectiveness of digital interventions in improving behavioral and health outcomes related to physical activity, smoking, alcohol consumption, or diet in nonclinical adult populations and to identify the effectiveness of different modes of delivery of digital interventions. Methods: We reviewed articles published in the English language between January 1, 2009, and February 25, 2019, that presented a systematic review with a narrative synthesis or meta-analysis of any study design examining digital intervention effectiveness; data related to adults (≥18 years) in high-income countries; and data on behavioral or health outcomes related to diet, physical activity, smoking, or alcohol, alone or in any combination. Any time frame or comparator was considered eligible. We searched MEDLINE, Embase, PsycINFO, Cochrane Reviews, and gray literature. The AMSTAR-2 tool was used to assess review confidence ratings. Results: We found 92 reviews from the academic literature (47 with meta-analyses) and 2 gray literature items (1 with a meta-analysis). Digital interventions were typically more effective than no intervention, but the effect sizes were small. Evidence on the effectiveness of digital interventions compared with face-to-face interventions was mixed. Most trials reported that intent-to-treat analysis and attrition rates were often high. Studies with long follow-up periods were scarce. However, we found that digital interventions may be effective for up to 6 months after the end of the intervention but that the effects dissipated by 12 months. There were small positive effects of digital interventions on smoking cessation and alcohol reduction; possible effectiveness in combined diet and physical activity interventions; no effectiveness for interventions targeting physical activity alone, except for when interventions were delivered by mobile phone, which had medium-sized effects; and no effectiveness observed for interventions targeting diet alone. Mobile interventions were particularly effective. Internet-based interventions were generally effective. Conclusions: Digital interventions have small positive effects on smoking, alcohol consumption, and in interventions that target a combination of diet and physical activity. Small effects may have been due to the low efficacy of treatment or due to nonadherence. In addition, our ability to make inferences from the literature we reviewed was limited as those interventions were heterogeneous, many reviews had critically low AMSTAR-2 ratings, analysis was typically intent-to-treat, and follow-up times were relatively short. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019126074; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=126074. %M 33988126 %R 10.2196/19688 %U https://www.jmir.org/2021/5/e19688 %U https://doi.org/10.2196/19688 %U http://www.ncbi.nlm.nih.gov/pubmed/33988126 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 1 %P e22296 %T Electronic Health Records–Based Cardio-Oncology Registry for Care Gap Identification and Pragmatic Research: Procedure and Observational Study %A Chandra,Alvin %A Philips,Steven T %A Pandey,Ambarish %A Basit,Mujeeb %A Kannan,Vaishnavi %A Sara,Evan J %A Das,Sandeep R %A Lee,Simon J C %A Haley,Barbara %A Willett,DuWayne L %A Zaha,Vlad G %+ Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8568, United States, 1 214 648 1400, vlad.zaha@utsouthwestern.edu %K electronic health records %K cardio-oncology %K patient registry %K heart failure %K screening %D 2021 %7 12.5.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: Professional society guidelines are emerging for cardiovascular care in cancer patients. However, it is not yet clear how effectively the cancer survivor population is screened and treated for cardiomyopathy in contemporary clinical practice. As electronic health records (EHRs) are now widely used in clinical practice, we tested the hypothesis that an EHR-based cardio-oncology registry can address these questions. Objective: The aim of this study was to develop an EHR-based pragmatic cardio-oncology registry and, as proof of principle, to investigate care gaps in the cardiovascular care of cancer patients. Methods: We generated a programmatically deidentified, real-time EHR-based cardio-oncology registry from all patients in our institutional Cancer Population Registry (N=8275, 2011-2017). We investigated: (1) left ventricular ejection fraction (LVEF) assessment before and after treatment with potentially cardiotoxic agents; and (2) guideline-directed medical therapy (GDMT) for left ventricular dysfunction (LVD), defined as LVEF<50%, and symptomatic heart failure with reduced LVEF (HFrEF), defined as LVEF<50% and Problem List documentation of systolic congestive heart failure or dilated cardiomyopathy. Results: Rapid development of an EHR-based cardio-oncology registry was feasible. Identification of tests and outcomes was similar using the EHR-based cardio-oncology registry and manual chart abstraction (100% sensitivity and 83% specificity for LVD). LVEF was documented prior to initiation of cancer therapy in 19.8% of patients. Prevalence of postchemotherapy LVD and HFrEF was relatively low (9.4% and 2.5%, respectively). Among patients with postchemotherapy LVD or HFrEF, those referred to cardiology had a significantly higher prescription rate of a GDMT. Conclusions: EHR data can efficiently populate a real-time, pragmatic cardio-oncology registry as a byproduct of clinical care for health care delivery investigations. %M 33797396 %R 10.2196/22296 %U https://cardio.jmir.org/2021/1/e22296 %U https://doi.org/10.2196/22296 %U http://www.ncbi.nlm.nih.gov/pubmed/33797396 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26163 %T A Smartphone App (TRIANGLE) to Change Cardiometabolic Risk Behaviors in Women Following Gestational Diabetes Mellitus: Intervention Mapping Approach %A Potzel,Anne Lotte %A Gar,Christina %A Seissler,Jochen %A Lechner,Andreas %+ Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstr. 1, Munich, 80336, Germany, 49 894 400 521 85, andreas.lechner@med.uni-muenchen.de %K mHealth %K diabetes prevention %K health behavior %K cardiometabolic disease %K gestational diabetes mellitus %K smartphone app %K intervention mapping %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is associated with an increased risk for the development of cardiometabolic diseases. Behavioral interventions can reduce this risk, but current solutions insufficiently address the requirements for such a program. The systematic development of a scalable mobile health (mHealth) promotion program for mothers during the first years post-GDM may contribute to solving this problem. Objective: The aim of this project was to systematically plan and develop a theory- and evidence-based mHealth intervention to change cardiometabolic risk behaviors in women during the first 5 years post-GDM that meets women’s expected standards of commercial health apps. Methods: The intervention mapping steps 1 to 4 structured the systematic planning and development of the mHealth program described in this paper. Steps 1 and 2 led to a theory- and evidence-based logic model of change for cardiometabolic health. Based on this model, the prevention program was designed (step 3) and produced (step 4) in cooperation with industrial partners to ensure a high technological standard of the resulting smartphone app for the iPhone (Apple Inc). Step 4 included a user study with women during the first 5 years post-GDM once a beta version of the app (“TRIANGLE”) was available. The user study comprised 2 test rounds of 1 week (n=5) and 4 weeks (n=6), respectively. The tests included validated questionnaires on user acceptance, user logs, and think-alouds with semistructured interviews. Results: The novel TRIANGLE app is among the first self-paced smartphone apps for individual habit change in the 3 lifestyle areas of physical activity, nutrition, and psychosocial well-being. The 3 core features—a challenge system, human coaching, and a library—address 11 behavioral determinants with 39 behavior change methods to support lifestyle changes. Participants in the user study showed a high acceptance, high perceived quality, and high perceived impact of the TRIANGLE app on their health behaviors. Participants tested the app regularly, used it intuitively, and suggested improvements. We then adapted the TRIANGLE app according to the insights from the user study before the full TRIANGLE program production. Conclusions: The intervention mapping approach was feasible to plan and develop an innovative and scalable smartphone solution for women during the first 5 years post-GDM. The resulting TRIANGLE intervention has the potential to support behavior change for cardiometabolic disease prevention. However, the app needs further refinement and testing in clinical trials. Intervention mapping steps 5 (implementation plan) and 6 (evaluation plan) may support the integration of the TRIANGLE intervention into routine care. Trial Registration: German Clinical Trials Register DRKS00012736; https://www.drks.de/DRKS00012736 %M 33973864 %R 10.2196/26163 %U https://mhealth.jmir.org/2021/5/e26163 %U https://doi.org/10.2196/26163 %U http://www.ncbi.nlm.nih.gov/pubmed/33973864 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e28997 %T Influence of Stress, Gender, and Minority Status on Cardiovascular Disease Risk in the Hispanic/Latino Community: Protocol for a Longitudinal Observational Cohort Study %A Poteat,Tonia %A Gallo,Linda C %A Harkness,Audrey %A Isasi,Carmen R %A Matthews,Phoenix %A Schneiderman,Neil %A Thyagarajan,Bharat %A Daviglus,Martha L %A Sotres-Alvarez,Daniela %A Perreira,Krista M %+ Department of Social Medicine, University of North Carolina School of Medicine, MacNider Hall, 333 South Columbia Street, Room 345B, Chapel Hill, NC, 27599, United States, 1 919 445 6364, tonia_poteat@med.unc.edu %K minority stress %K cardiovascular disease %K sexual and gender minorities %K transgender %K intersex %K lesbian %K bisexual %K gay %K Hispanic %K Latino %D 2021 %7 6.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hispanic/Latino sexual and gender minorities (SGM) are the fastest growing ethnic group of SGM in the United States. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among Hispanics/Latinos. SGM inequities in CVD risk have been identified as early as young adulthood, and minority stress has been identified as a potential mediator. Yet, the small number of ethnic or racial minority participants in SGM studies have precluded the examination of the intersections of sexual orientation, gender identity, and race and ethnicity. Objective: Minority stress models conceptualize relationships between stressors in minority groups and health outcomes. In this study, we will (1) examine the influence of sexual orientation and gender identity on CVD risk among all Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants at visit 3 (2021-2024; N~9300); (2) model pathways from sexual orientation and gender identity to CVD risk through stigma, discrimination, and stress in a 1:2 matched subcohort of SGM and non-SGM participants at visit 3 (n~1680); and (3) examine the influence of resilience factors on sexual orientation or gender identity and CVD risk relationships among subcohort participants at visit 3 (n~1680). Methods: This study will leverage existing data from the parent HCHS/SOL study (collected since 2008) while collecting new data on sexual orientation, gender identity, stigma, discrimination, stress, coping, social support, and CVD risk. Data analysis will follow the SGM minority stress model, which states that excess stigma against SGM populations leads to minority stress that increases CVD risk. In this model, coping and social support serve as resilience factors that can mitigate the impact of minority stress on CVD risk. Cross-sectional and longitudinal regression models as well as structural equation models will be used to test these relationships. Results: This study was funded by the National Heart, Lung, and Blood Institute in March 2020. Recruitment is scheduled to begin in the first quarter of 2021 and continue through 2024. Conclusions: Understanding the influence of stigma-induced stress on CVD risk among Hispanic/Latino SGM has significant implications for the development of culturally specific CVD risk reduction strategies. Study findings will be used to build on identified Hispanic/Latino cultural strengths to inform adaptation and testing of family and community acceptance interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/28997 %M 33955843 %R 10.2196/28997 %U https://www.researchprotocols.org/2021/5/e28997 %U https://doi.org/10.2196/28997 %U http://www.ncbi.nlm.nih.gov/pubmed/33955843 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e21061 %T Digital Technology Interventions for Risk Factor Modification in Patients With Cardiovascular Disease: Systematic Review and Meta-analysis %A Akinosun,Adewale Samuel %A Polson,Rob %A Diaz - Skeete,Yohanca %A De Kock,Johannes Hendrikus %A Carragher,Lucia %A Leslie,Stephen %A Grindle,Mark %A Gorely,Trish %+ Department of Nursing and Midwifery, Institute of Health Research and Innovation, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom, 44 07727867360, 18026171@uhi.ac.uk %K digital technologies %K mHealth %K eHealth %K risk factors %K cardiovascular diseases %K telehealth %K cardiac rehabilitation %K behavior %K systematic review %K meta-analysis %K mobile phone %D 2021 %7 3.3.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Approximately 50% of cardiovascular disease (CVD) cases are attributable to lifestyle risk factors. Despite widespread education, personal knowledge, and efficacy, many individuals fail to adequately modify these risk factors, even after a cardiovascular event. Digital technology interventions have been suggested as a viable equivalent and potential alternative to conventional cardiac rehabilitation care centers. However, little is known about the clinical effectiveness of these technologies in bringing about behavioral changes in patients with CVD at an individual level. Objective: The aim of this study is to identify and measure the effectiveness of digital technology (eg, mobile phones, the internet, software applications, wearables, etc) interventions in randomized controlled trials (RCTs) and determine which behavior change constructs are effective at achieving risk factor modification in patients with CVD. Methods: This study is a systematic review and meta-analysis of RCTs designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. Mixed data from studies extracted from selected research databases and filtered for RCTs only were analyzed using quantitative methods. Outcome hypothesis testing was set at 95% CI and P=.05 for statistical significance. Results: Digital interventions were delivered using devices such as cell phones, smartphones, personal computers, and wearables coupled with technologies such as the internet, SMS, software applications, and mobile sensors. Behavioral change constructs such as cognition, follow-up, goal setting, record keeping, perceived benefit, persuasion, socialization, personalization, rewards and incentives, support, and self-management were used. The meta-analyzed effect estimates (mean difference [MD]; standard mean difference [SMD]; and risk ratio [RR]) calculated for outcomes showed benefits in total cholesterol SMD at −0.29 [−0.44, −0.15], P<.001; high-density lipoprotein SMD at –0.09 [–0.19, 0.00], P=.05; low-density lipoprotein SMD at −0.18 [−0.33, −0.04], P=.01; physical activity (PA) SMD at 0.23 [0.11, 0.36], P<.001; physical inactivity (sedentary) RR at 0.54 [0.39, 0.75], P<.001; and diet (food intake) RR at 0.79 [0.66, 0.94], P=.007. Initial effect estimates showed no significant benefit in body mass index (BMI) MD at −0.37 [−1.20, 0.46], P=.38; diastolic blood pressure (BP) SMD at −0.06 [−0.20, 0.08], P=.43; systolic BP SMD at −0.03 [−0.18, 0.13], P=.74; Hemoglobin A1C blood sugar (HbA1c) RR at 1.04 [0.40, 2.70], P=.94; alcohol intake SMD at −0.16 [−1.43, 1.10], P=.80; smoking RR at 0.87 [0.67, 1.13], P=.30; and medication adherence RR at 1.10 [1.00, 1.22], P=.06. Conclusions: Digital interventions may improve healthy behavioral factors (PA, healthy diet, and medication adherence) and are even more potent when used to treat multiple behavioral outcomes (eg, medication adherence plus). However, they did not appear to reduce unhealthy behavioral factors (smoking, alcohol intake, and unhealthy diet) and clinical outcomes (BMI, triglycerides, diastolic and systolic BP, and HbA1c). %M 33656444 %R 10.2196/21061 %U https://mhealth.jmir.org/2021/3/e21061 %U https://doi.org/10.2196/21061 %U http://www.ncbi.nlm.nih.gov/pubmed/33656444 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 1 %P e24473 %T Predicting Cardiovascular Risk Using Social Media Data: Performance Evaluation of Machine-Learning Models %A Andy,Anietie U %A Guntuku,Sharath C %A Adusumalli,Srinath %A Asch,David A %A Groeneveld,Peter W %A Ungar,Lyle H %A Merchant,Raina M %+ Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States, 1 202 486 4095, Anietie.Andy@pennmedicine.upenn.edu %K ASCVD %K machine learning %K natural language processing %K atherosclerotic %K cardiovascular disease %K social media language %K social media %D 2021 %7 19.2.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: Current atherosclerotic cardiovascular disease (ASCVD) predictive models have limitations; thus, efforts are underway to improve the discriminatory power of ASCVD models. Objective: We sought to evaluate the discriminatory power of social media posts to predict the 10-year risk for ASCVD as compared to that of pooled cohort risk equations (PCEs). Methods: We consented patients receiving care in an urban academic emergency department to share access to their Facebook posts and electronic medical records (EMRs). We retrieved Facebook status updates up to 5 years prior to study enrollment for all consenting patients. We identified patients (N=181) without a prior history of coronary heart disease, an ASCVD score in their EMR, and more than 200 words in their Facebook posts. Using Facebook posts from these patients, we applied a machine-learning model to predict 10-year ASCVD risk scores. Using a machine-learning model and a psycholinguistic dictionary, Linguistic Inquiry and Word Count, we evaluated if language from posts alone could predict differences in risk scores and the association of certain words with risk categories, respectively. Results: The machine-learning model predicted the 10-year ASCVD risk scores for the categories <5%, 5%-7.4%, 7.5%-9.9%, and ≥10% with area under the curve (AUC) values of 0.78, 0.57, 0.72, and 0.61, respectively. The machine-learning model distinguished between low risk (<10%) and high risk (>10%) with an AUC of 0.69. Additionally, the machine-learning model predicted the ASCVD risk score with Pearson r=0.26. Using Linguistic Inquiry and Word Count, patients with higher ASCVD scores were more likely to use words associated with sadness (r=0.32). Conclusions: Language used on social media can provide insights about an individual’s ASCVD risk and inform approaches to risk modification. %M 33605888 %R 10.2196/24473 %U http://cardio.jmir.org/2021/1/e24473/ %U https://doi.org/10.2196/24473 %U http://www.ncbi.nlm.nih.gov/pubmed/33605888 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24080 %T Effectiveness of Mobile Health–Based Exercise Interventions for Patients with Peripheral Artery Disease: Systematic Review and Meta-Analysis %A Kim,Mihui %A Kim,Changhwan %A Kim,Eunkyo %A Choi,Mona %+ College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3341, monachoi@yuhs.ac %K peripheral artery disease %K mobile health %K exercise %K adherence %K meta-analysis %D 2021 %7 15.2.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Peripheral artery disease (PAD) affects over 236 million people worldwide, and exercise interventions are commonly used to alleviate symptoms of this condition. However, no previous systematic review has evaluated the effects of mobile health (mHealth)–based exercise interventions for patients with PAD. Objective: This study aimed to assess the effect of mHealth-based exercise interventions on walking performance, functional status, and quality of life in patients with PAD. Methods: A systematic review and meta-analysis were conducted. We searched in seven databases to identify randomized controlled trials of patients with PAD published in English up to December 4, 2020. Studies were included if patients participated in mHealth-based exercise interventions and were assessed for walking performance. We analyzed pooled effect size on walking performance, functional status, and quality of life based on the standardized mean differences between groups. Results: A total of seven studies were selected for the systematic review, and six studies were included in the meta-analysis. The duration of interventions in the included studies was 12 to 48 weeks. In the pooled analysis, when compared with the control groups, the mHealth-based exercise intervention groups were associated with significant improvements in pain-free walking (95% CI 0.13-0.88), maximal walking (95% CI 0.03-0.87), 6-minute walk test (6MWT) distance (95% CI 0.59-1.24), and walking distance (95% CI 0.02-0.49). However, benefits of the interventions on walking speed, stair-climbing ability, and quality of life were not observed. Conclusions: mHealth-based exercise interventions for patients with PAD were beneficial for improving pain-free walking, maximal walking, and 6MWT distance. We found that exercise interventions using mHealth are an important strategy for improving the exercise effectiveness and adherence rate of patients with PAD. Future studies should consider the use of various and suitable functions of mHealth that can increase the adherence rates and improve the effectiveness of exercise. %M 33587042 %R 10.2196/24080 %U http://mhealth.jmir.org/2021/2/e24080/ %U https://doi.org/10.2196/24080 %U http://www.ncbi.nlm.nih.gov/pubmed/33587042 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 1 %P e18834 %T User Engagement With Smartphone Apps and Cardiovascular Disease Risk Factor Outcomes: Systematic Review %A Spaulding,Erin M %A Marvel,Francoise A %A Piasecki,Rebecca J %A Martin,Seth S %A Allen,Jerilyn K %+ Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, United States, 1 603 724 0604, espauld2@jhu.edu %K mHealth %K smartphone %K mobile phone %K engagement %K cardiovascular disease %K health behaviors %K risk factors %D 2021 %7 3.2.2021 %9 Review %J JMIR Cardio %G English %X Background: The use of mobile health (mHealth) interventions, including smartphone apps, for the prevention of cardiovascular disease (CVD) has demonstrated mixed results for obesity, hypercholesterolemia, diabetes, and hypertension management. A major factor attributing to the variation in mHealth study results may be mHealth user engagement. Objective: This systematic review aims to determine if user engagement with smartphone apps for the prevention and management of CVD is associated with improved CVD health behavior change and risk factor outcomes. Methods: We conducted a comprehensive search of PubMed, CINAHL, and Embase databases from 2007 to 2020. Studies were eligible if they assessed whether user engagement with a smartphone app used by an individual to manage his or her CVD risk factors was associated with the CVD health behavior change or risk factor outcomes. For eligible studies, data were extracted on study and sample characteristics, intervention description, app user engagement measures, and the relationship between app user engagement and the CVD risk factor outcomes. App user engagement was operationalized as general usage (eg, number of log-ins or usage days per week) or self-monitoring within the app (eg, total number of entries made in the app). The quality of the studies was assessed. Results: Of the 24 included studies, 17 used a randomized controlled trial design, 4 used a retrospective analysis, and 3 used a single-arm pre- and posttest design. Sample sizes ranged from 55 to 324,649 adults, with 19 studies recruiting participants from a community setting. Most of the studies assessed weight loss interventions, with 6 addressing additional CVD risk factors, including diabetes, sleep, stress, and alcohol consumption. Most of the studies that assessed the relationship between user engagement and reduction in weight (9/13, 69%), BMI (3/4, 75%), body fat percentage (1/2, 50%), waist circumference (2/3, 67%), and hemoglobin A1c (3/5, 60%) found statistically significant results, indicating that greater app user engagement was associated with better outcomes. Of 5 studies, 3 (60%) found a statistically significant relationship between higher user engagement and an increase in objectively measured physical activity. The studies assessing the relationship between user engagement and dietary and diabetes self-care behaviors, blood pressure, and lipid panel components did not find statistically significant results. Conclusions: Increased app user engagement for prevention and management of CVD may be associated with improved weight and BMI; however, only a few studies assessed other outcomes, limiting the evidence beyond this. Additional studies are needed to assess user engagement with smartphone apps targeting other important CVD risk factors, including dietary behaviors, hypercholesterolemia, diabetes, and hypertension. Further research is needed to assess mHealth user engagement in both inpatient and outpatient settings to determine the effect of integrating mHealth interventions into the existing clinical workflow and on CVD outcomes. %M 33533730 %R 10.2196/18834 %U http://cardio.jmir.org/2021/1/e18834/ %U https://doi.org/10.2196/18834 %U http://www.ncbi.nlm.nih.gov/pubmed/33533730 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e20456 %T Readiness for Voice Technology in Patients With Cardiovascular Diseases: Cross-Sectional Study %A Kowalska,Małgorzata %A Gładyś,Aleksandra %A Kalańska-Łukasik,Barbara %A Gruz-Kwapisz,Monika %A Wojakowski,Wojciech %A Jadczyk,Tomasz %+ Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 45-47, Katowice, 40-635, Poland, 48 322523930, tomasz.jadczyk@gmail.com %K voice technology %K smart speaker %K acceptance %K telehealth %K cardiovascular diseases %K chatbot %D 2020 %7 17.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The clinical application of voice technology provides novel opportunities in the field of telehealth. However, patients’ readiness for this solution has not been investigated among patients with cardiovascular diseases (CVD). Objective: This paper aims to evaluate patients’ anticipated experiences regarding telemedicine, including voice conversational agents combined with provider-driven support delivered by phone. Methods: A cross-sectional study enrolled patients with chronic CVD who were surveyed using a validated investigator-designed questionnaire combining 19 questions (eg, demographic data, medical history, preferences for using telehealth services). Prior to the survey, respondents were educated on the telemedicine services presented in the questionnaire while being assisted by a medical doctor. Responses were then collected and analyzed, and multivariate logistic regression was used to identify predictors of willingness to use voice technology. Results: In total, 249 patients (mean age 65.3, SD 13.8 years; 158 [63.5%] men) completed the questionnaire, which showed good repeatability in the validation procedure. Of the 249 total participants, 209 (83.9%) reported high readiness to receive services allowing for remote contact with a cardiologist (176/249, 70.7%) and telemonitoring of vital signs (168/249, 67.5%). The voice conversational agents combined with provider-driven support delivered by phone were shown to be highly anticipated by patients with CVD. The readiness to use telehealth was statistically higher in people with previous difficulties accessing health care (OR 2.920, 95% CI 1.377-6.192) and was most frequent in city residents and individuals reporting a higher education level. The age and sex of the respondents did not impact the intention to use voice technology (P=.20 and P=.50, respectively). Conclusions: Patients with cardiovascular diseases, including both younger and older individuals, declared high readiness for voice technology. %M 33331824 %R 10.2196/20456 %U http://www.jmir.org/2020/12/e20456/ %U https://doi.org/10.2196/20456 %U http://www.ncbi.nlm.nih.gov/pubmed/33331824 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 12 %P e18716 %T Effects of Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients: Observational Study %A Hou,Ying-Hui %A Yang,Feng-Jung %A Lai,I-Chun %A Lin,Shih-Pi %A Wan,Thomas TH %A Chang,Ray-E %+ Institute of Health Policy and Management, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Room 639, Taipei, 100, Taiwan, 886 2 3366 8069, rchang@ntu.edu.tw %K erythropoietin %K cardiovascular disease %K peritoneal dialysis %K diabetes mellitus %D 2020 %7 17.12.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The change in the reimbursement policy of erythropoietin administration to patients receiving peritoneal dialysis by the Taiwan National Health Insurance (NHI) system provided a natural experimental venue to examine whether cardiovascular risk differs when maintaining the hematocrit (Hct) level below or above 30%. Objective: The aim of this study was to analyze the impact of loosening the erythropoietin payment criteria for peritoneal dialysis patients on their cardiovascular outcomes. Methods: Two cohorts of incident peritoneal dialysis patients were identified according to the time before and after relaxation of the NHI’s erythropoietin payment criteria, designated cohort 1 (n=1759) and cohort 2 (n=2981), respectively. The cohorts were matched according to propensity scores (1754 patients in each cohort) and then followed up for cardiovascular events, which were analyzed with Cox regressions. Results: For the composite cardiovascular endpoint, patients in cohort 2 had a significantly lower risk than those in cohort 1. However, subgroup analysis showed that this risk reduction was observed only in patients with diabetes. Conclusions: After loosening erythropoietin payment criteria, reduced cardiovascular risks were observed, particularly for patients with diabetes. These results indicate that it is crucial to maintain an Hct level above 30% to reduce the cardiovascular risk in patients with diabetes undergoing peritoneal dialysis. %M 33331829 %R 10.2196/18716 %U http://medinform.jmir.org/2020/12/e18716/ %U https://doi.org/10.2196/18716 %U http://www.ncbi.nlm.nih.gov/pubmed/33331829 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18567 %T Surveillance of Cardiovascular Risk Factors in the Fifth Military Sector Health Center, Ngaoundéré, Cameroon: Observational Study %A Bell Ngan,Williams %A Essama Eno Belinga,Lawrence %A Essam Nlo'o,Alain Serges Patrick %A Roche,Frederic %A Goethals,Luc %A Mandengue,Samuel Honoré %A Bongue,Bienvenu %+ Autonomic Nervous System Research Laboratory, University of Jean Monnet, 10 rue tréfilerie, Saint-Etienne, France, 33 0681021199, bienvenu.bongue@cetaf.fr %K prevention %K noncommunicable disease %K cardiovascular diseases %K cardiovascular risk %K soldiers %D 2020 %7 26.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Noncommunicable diseases (NCDs) are the leading causes of death worldwide. They were responsible for 40 million of the 57 million deaths recorded worldwide in 2016. In Cameroon, epidemiological studies have been devoted to NCDs and their risk factors. However, none provides specific information on their extent or the distribution of their risk factors within the Cameroonian defense forces. Objective: The objective of our study was to assess the cardiovascular risk of a Cameroonian military population compared with that of its neighboring civilian population. Methods: We conducted a cross-sectional study that involved subjects aged 18 to 58 years, recruited from October 2017 to November 2018 at the Fifth Military Sector Health Center in Ngaoundéré, Cameroon. Data collection and assessment were done according to the World Health Organization (WHO)’s STEPS manual for surveillance of risk factors for chronic NCDs and the Alcohol Use Disorders Identification Test. Five cardiovascular risk factors were assessed: smoking, harmful alcohol consumption, obesity/overweight, hypertension, and diabetes. The risk was considered high in subjects with 3 or more of the factors. Univariate analysis and multivariate logistic regression were carried out according to their indications. Results: Our study sample of 566 participants included 295 soldiers and 271 civilians of the same age group (median age 32 years versus 33 years, respectively; P=.57). The military sample consisted of 31 officers and 264 noncommissioned officers (NCOs). Soldiers were more exposed to behavioral risk factors than civilians, with a prevalence of smoking of 13.9% versus 4.4% (P<.001) and excessive alcohol consumption of 61.7% versus 14.8% (P<.001). They also presented with a higher cardiovascular risk than civilians (odds ratio 2.7, 95% CI 1.50-4.81; P<.001), and among the military participants, the cardiovascular risk was higher for officers than for NCOs (51.6% versus 14.0%, respectively; P<.001). Conclusions: Cameroonian soldiers are particularly exposed to cardiovascular behavioral risk factors and consequently are at higher risk of NCDs. Trial Registration: ClinicalTrials.gov NCT04315441; https://clinicaltrials.gov/ct2/show/NCT04315441 %M 33242013 %R 10.2196/18567 %U http://formative.jmir.org/2020/11/e18567/ %U https://doi.org/10.2196/18567 %U http://www.ncbi.nlm.nih.gov/pubmed/33242013 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e21450 %T A Cardiovascular Health and Wellness Mobile Health Intervention Among Church-Going African Americans: Formative Evaluation of the FAITH! App %A Brewer,LaPrincess C %A Kumbamu,Ashok %A Smith,Christina %A Jenkins,Sarah %A Jones,Clarence %A Hayes,Sharonne N %A Burke,Lora %A Cooper,Lisa A %A Patten,Christi A %+ Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 538 0325, brewer.laprincess@mayo.edu %K mobile health %K eHealth %K community-based participatory research %K health promotion %K African Americans %K mobile phone %D 2020 %7 17.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In light of the scarcity of culturally tailored mobile health (mHealth) lifestyle interventions for African Americans, we designed and pilot tested the Fostering African-American Improvement in Total Health (FAITH!) App in a community-based participatory research partnership with African American churches to promote cardiovascular health and wellness in this population. Objective: This report presents the results of a formative evaluation of the FAITH! App from participants in an intervention pilot study. Methods: We included 2 semistructured focus groups (n=4 and n=5) to explore participants’ views on app functionality, utility, and satisfaction as well as its impact on healthy lifestyle change. Sessions were audio-recorded and transcribed verbatim, and qualitative data were analyzed by using general inductive analysis to generate themes. Results: In total, 6 overarching themes emerged among the 9 participants: overall impression, content usefulness, formatting, implementation, impact, and suggestions for improvement. Underpinning the themes was a high level of agreement that the intervention facilitated healthy behavioral change through cultural tailoring, multimedia education modules, and social networking. Suggestions for improvement were streamlining the app self-monitoring features, prompts to encourage app use, and personalization based on individuals’ cardiovascular risk. Conclusions: This formative evaluation found that the FAITH! App had high reported satisfaction and impact on the health-promoting behaviors of African Americans, thereby improving their overall cardiovascular health. Further development and testing of the app among African Americans is warranted. Trial Registration: ClinicalTrials.gov NCT03084822; https://clinicaltrials.gov/ct2/show/NCT03084822. %M 33200999 %R 10.2196/21450 %U http://formative.jmir.org/2020/11/e21450/ %U https://doi.org/10.2196/21450 %U http://www.ncbi.nlm.nih.gov/pubmed/33200999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21159 %T Primary Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus Using Mobile Health Technology: Systematic Review of the Literature %A Buss,Vera Helen %A Leesong,Stuart %A Barr,Margo %A Varnfield,Marlien %A Harris,Mark %+ Centre for Primary Health Care and Equity, University of New South Wales, Level 3, AGSM Building, UNSW Sydney, Sydney, 2052, Australia, 61 293851547, v.buss@student.unsw.edu.au %K systematic review %K mobile health %K telemedicine %K primary prevention %K cardiovascular diseases %K diabetes mellitus, type 2 %D 2020 %7 29.10.2020 %9 Review %J J Med Internet Res %G English %X Background: Digital technology is an opportunity for public health interventions to reach a large part of the population. Objective: This systematic literature review aimed to assess the effectiveness of mobile health–based interventions in reducing the risk of cardiovascular disease and type 2 diabetes mellitus. Methods: We conducted the systematic search in 7 electronic databases using a predefined search strategy. We included articles published between inception of the databases and March 2019 if they reported on the effectiveness of an intervention for prevention of cardiovascular disease or type 2 diabetes via mobile technology. One researcher performed the search, study selection, data extraction, and methodological quality assessment. The steps were validated by the other members of the research team Results: The search yielded 941 articles for cardiovascular disease, of which 3 met the inclusion criteria, and 732 for type 2 diabetes, of which 6 met the inclusion criteria. The methodological quality of the studies was low, with the main issue being nonblinding of participants. Of the selected studies, 4 used SMS text messaging, 1 used WhatsApp, and the remaining ones used specific smartphone apps. Weight loss and reduction in BMI were the most reported successful outcomes (reported in 4 studies). Conclusions: Evidence on the effectiveness of mobile health-based interventions in reducing the risk for cardiovascular disease and type 2 diabetes is low due to the quality of the studies and the small effects that were measured. This highlights the need for further high-quality research to investigate the potential of mobile health interventions. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019135405; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=135405 %M 33118936 %R 10.2196/21159 %U http://www.jmir.org/2020/10/e21159/ %U https://doi.org/10.2196/21159 %U http://www.ncbi.nlm.nih.gov/pubmed/33118936 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e20488 %T Digital Cardiovascular Biomarker Responses to Transcutaneous Cervical Vagus Nerve Stimulation: State-Space Modeling, Prediction, and Simulation %A Gazi,Asim H %A Gurel,Nil Z %A Richardson,Kristine L S %A Wittbrodt,Matthew T %A Shah,Amit J %A Vaccarino,Viola %A Bremner,J Douglas %A Inan,Omer T %+ School of Electrical and Computer Engineering, Georgia Institute of Technology, North Ave NW, Atlanta, GA, 30332, United States, 1 4693608083, asim.gazi@gatech.edu %K vagus nerve stimulation %K noninvasive %K wearable sensing %K digital biomarkers %K dynamic models %K state space %K biomarker %K cardiovascular %K neuromodulation %K bioelectronic medicine %D 2020 %7 22.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Transcutaneous cervical vagus nerve stimulation (tcVNS) is a promising alternative to implantable stimulation of the vagus nerve. With demonstrated potential in myriad applications, ranging from systemic inflammation reduction to traumatic stress attenuation, closed-loop tcVNS during periods of risk could improve treatment efficacy and reduce ineffective delivery. However, achieving this requires a deeper understanding of biomarker changes over time. Objective: The aim of the present study was to reveal the dynamics of relevant cardiovascular biomarkers, extracted from wearable sensing modalities, in response to tcVNS. Methods: Twenty-four human subjects were recruited for a randomized double-blind clinical trial, for whom electrocardiography and photoplethysmography were used to measure heart rate and photoplethysmogram amplitude responses to tcVNS, respectively. Modeling these responses in state-space, we (1) compared the biomarkers in terms of their predictability and active vs sham differentiation, (2) studied the latency between stimulation onset and measurable effects, and (3) visualized the true and model-simulated biomarker responses to tcVNS. Results: The models accurately predicted future heart rate and photoplethysmogram amplitude values with root mean square errors of approximately one-fifth the standard deviations of the data. Moreover, (1) the photoplethysmogram amplitude showed superior predictability (P=.03) and active vs sham separation compared to heart rate; (2) a consistent delay of greater than 5 seconds was found between tcVNS onset and cardiovascular effects; and (3) dynamic characteristics differentiated responses to tcVNS from the sham stimulation. Conclusions: This work furthers the state of the art by modeling pertinent biomarker responses to tcVNS. Through subsequent analysis, we discovered three key findings with implications related to (1) wearable sensing devices for bioelectronic medicine, (2) the dominant mechanism of action for tcVNS-induced effects on cardiovascular physiology, and (3) the existence of dynamic biomarker signatures that can be leveraged when titrating therapy in closed loop. Trial Registration: ClinicalTrials.gov NCT02992899; https://clinicaltrials.gov/ct2/show/NCT02992899 International Registered Report Identifier (IRRID): RR2-10.1016/j.brs.2019.08.002 %M 32960179 %R 10.2196/20488 %U http://mhealth.jmir.org/2020/9/e20488/ %U https://doi.org/10.2196/20488 %U http://www.ncbi.nlm.nih.gov/pubmed/32960179 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e15156 %T Rams Have Heart, a Mobile App Tracking Activity and Fruit and Vegetable Consumption to Support the Cardiovascular Health of College Students: Development and Usability Study %A Krzyzanowski,Michelle C %A Kizakevich,Paul N %A Duren-Winfield,Vanessa %A Eckhoff,Randall %A Hampton,Joel %A Blackman Carr,Loneke T %A McCauley,Georgia %A Roberson,Kristina B %A Onsomu,Elijah O %A Williams,John %A Price,Amanda Alise %+ RTI International, 3040 Conwallis Rd, Research Triangle Park, NC, 27709, United States, 1 919 485 5648, mkrzyzanowski@rti.org %K exercise %K cardiovascular disease %K diary %K diet %K mHealth %K mobile phone %D 2020 %7 5.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the increasing use of mobile devices to access the internet and as the main computing system of apps, there is a growing market for mobile health apps to provide self-care advice. Their effectiveness with regard to diet and fitness tracking, for example, needs to be examined. The majority of American adults fail to meet daily recommendations for healthy behavior. Testing user engagement with an app in a controlled environment can provide insight into what is effective and not effective in an app focused on improving diet and exercise. Objective: We developed Rams Have Heart, a mobile app, to support a cardiovascular disease (CVD) intervention course. The app tracks healthy behaviors, including fruit and vegetable consumption and physical activity, throughout the day. This paper aimed to present its functionality and evaluated adherence among the African American college student population. Methods: We developed the app using the Personal Health Informatics and Intervention Toolkit, a software framework. Rams Have Heart integrates self-reported health screening with health education, diary tracking, and user feedback modules to acquire data and assess progress. The parent study, conducted at a historically black college and university-designated institution in southeastern United States, consisted of a semester-long intervention administered as an academic course in the fall, for 3 consecutive years. Changes were made after the cohort 1 pilot study, so results only include cohorts 2 and 3, comprising a total of 115 students (n=55 intervention participants and n=54 control participants) aged from 17 to 24 years. Data collected over the study period were transferred using the secure Hypertext Transfer Protocol Secure protocol and stored in a secure Structured Query Language server database accessible only to authorized persons. SAS software was used to analyze the overall app usage and the specific results collected. Results: Of the 55 students in the intervention group, 27 (49%) students in cohort 2 and 25 (45%) in cohort 3 used the Rams Have Heart app at least once. Over the course of the fall semester, app participation dropped off gradually until exam week when most students no longer participated. The average fruit and vegetable intake increased slightly, and activity levels decreased over the study period. Conclusions: Rams Have Heart was developed to allow daily tracking of fruit and vegetable intake and physical activity to support a CVD risk intervention for a student demographic susceptible to obesity, heart disease, and type 2 diabetes. We conducted an analysis of app usage, function, and user results. Although a mobile app provides privacy and flexibility for user participation in a research study, Rams Have Heart did not improve compliance or user outcomes. Health-oriented research studies relying on apps in support of user goals need further evaluation. %M 32755883 %R 10.2196/15156 %U https://mhealth.jmir.org/2020/8/e15156 %U https://doi.org/10.2196/15156 %U http://www.ncbi.nlm.nih.gov/pubmed/32755883 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17351 %T Changing the Health Behavior of Patients With Cardiovascular Disease Through an Electronic Health Intervention in Three Different Countries: Cost-Effectiveness Study in the Do Cardiac Health: Advanced New Generation Ecosystem (Do CHANGE) 2 Randomized Controlled Trial %A Piera-Jiménez,Jordi %A Winters,Marjolein %A Broers,Eva %A Valero-Bover,Damià %A Habibovic,Mirela %A Widdershoven,Jos W M G %A Folkvord,Frans %A Lupiáñez-Villanueva,Francisco %+ Open Evidence Research Group, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 651041515, jpieraj@uoc.edu %K cost-effectiveness %K randomized controlled trial %K RCT %K eHealth %K cardiovascular disease %K engagement %K behavior change %K digital health %D 2020 %7 28.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: During the last few decades, preventing the development of cardiovascular disease has become a mainstay for reducing cardiovascular morbidity and mortality. It has been suggested that interventions should focus more on committed approaches of self-care, such as electronic health techniques. Objective: This study aimed to provide evidence to understand the financial consequences of implementing the “Do Cardiac Health: Advanced New Generation Ecosystem” (Do CHANGE 2) intervention, which was evaluated in a multisite randomized controlled trial to change the health behavior of patients with cardiovascular disease. Methods: The cost-effectiveness analysis of the Do CHANGE 2 intervention was performed with the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing tool, based on a Markov model of five health states. The following two types of costs were considered for both study groups: (1) health care costs (ie, costs associated with the time spent by health care professionals on service provision, including consultations, and associated unplanned hospitalizations, etc) and (2) societal costs (ie, costs attributed to the time spent by patients and informal caregivers on care activities). Results: The Do CHANGE 2 intervention was less costly in Spain (incremental cost was −€2514.90) and more costly in the Netherlands and Taiwan (incremental costs were €1373.59 and €1062.54, respectively). Compared with treatment as usual, the effectiveness of the Do CHANGE 2 program in terms of an increase in quality-adjusted life-year gains was slightly higher in the Netherlands and lower in Spain and Taiwan. Conclusions: In general, we found that the incremental cost-effectiveness ratio strongly varied depending on the country where the intervention was applied. The Do CHANGE 2 intervention showed a positive cost-effectiveness ratio only when implemented in Spain, indicating that it saved financial costs in relation to the effect of the intervention. Trial Registration: ClinicalTrials.gov NCT03178305; https://clinicaltrials.gov/ct2/show/NCT03178305 %M 32720908 %R 10.2196/17351 %U http://www.jmir.org/2020/7/e17351/ %U https://doi.org/10.2196/17351 %U http://www.ncbi.nlm.nih.gov/pubmed/32720908 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17422 %T Evaluation of a Web-Based Self-Management Program for Patients With Cardiovascular Disease: Explorative Randomized Controlled Trial %A Engelen,Marscha M %A van Dulmen,Sandra %A Puijk-Hekman,Saskia %A Vermeulen,Hester %A Nijhuis-van der Sanden,Maria WG %A Bredie,Sebastian JH %A van Gaal,Betsie GI %+ IQ Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, PO Box 9101, Nijmegen, Netherlands, 31 654272129, marscha.engelen@radboudumc.nl %K explorative randomized controlled trial %K cardiovascular diseases %K self-management %K eHealth support programs %K internet %K lifestyle %K nursing %D 2020 %7 24.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based self-management programs have the potential to support patients with cardiovascular disease (CVD) in their self-management (eg, by focusing on behavior change and improving physical activity). The intervention mapping framework was used to develop a web-based program called Vascular View. The Vascular View program contained 6 modules (coping with CVD, setting boundaries, lifestyle, healthy nutrition, being physically active, interaction with health professionals) aiming to increase self-management behavior by tailoring to the perceived problems and (support) needs of patients after CVD. Objective: The aim was to test the effectiveness of Vascular View before embarking on a full-scale randomized clinical trial (RCT) by evaluating the potential effectiveness and effect sizes of the Vascular View program and identifying outcome measures most likely to capture the potential benefits. Methods: An explorative RCT was performed. Both control and intervention groups received care as usual and, in addition, the intervention group received 12 months of access to a web-based self-management program. Assessment occurred at baseline, 6 months, and 12 months. Outcome measures included general patient-reported outcome measurements: Illness Perception Questionnaire (IPQ), Rand-36, Patient Activation Measure, and patient self-efficacy. Module-specific patient-reported outcome measurements were Beliefs about Medicines Questionnaire, International Physical Activity Questionnaire, Dutch Healthy Diet Index, Fagerström Test for Nicotine Dependence (FTND), Alcohol Use Disorders Identification Test, and Perceived Efficacy in Patient-Physician Interaction. Linear mixed models for repeated measures using intention-to-treat and per-protocol analysis were applied to study differences between the patients in the intervention and control groups. Floor and ceiling effects were explored to give insight into the outcome measures most likely to capture the potential benefits. Results: A total of 105 patients in the control group and 103 patients in the intervention group participated in the study. A positive direction of change between baseline and 12 months was shown for most outcome measurements in favor of the intervention group, of which 2 out of 10 outcomes showed a significant effect: attribution of cause of the disease to risk factors and immunity factors (IPQ) and dependency of nicotine (FTND). Floor and ceiling effects were seen in the IPQ, Rand-36, and the self-efficacy questionnaire. Conclusions: No conclusion for the efficacy of the Vascular View program or selection of outcome measurements can be taken yet. A process evaluation will be conducted to gain thorough insight into the working elements of the program, patient needs in eHealth, and the use of the program by patients. This can determine for whom web-based self-management programs will work and help to adapt the program. Trial Registration: Dutch Trial Register NTR5412; https://www.trialregister.nl/trial/5303 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6352 %M 32706708 %R 10.2196/17422 %U http://www.jmir.org/2020/7/e17422/ %U https://doi.org/10.2196/17422 %U http://www.ncbi.nlm.nih.gov/pubmed/32706708 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e16699 %T Preventing Cardiovascular Disease Among Urban African Americans With a Mobile Health App (the MOYO App): Protocol for a Usability Study %A Taylor Jr,Herman A %A Francis,Sherilyn %A Evans,Chad Ray %A Harvey,Marques %A Newton,Brittney A %A Jones,Camara P %A Akintobi,Tabia Henry %A Clifford,Gari %+ Cardiovascular Research Institute, Morehouse School of Medicine, 720 West View Drive, Atlanta, GA, United States, 1 404 752 1978, htaylor@msm.edu %K African Americans %K mHealth %K community-based participatory research %K agile design %K cardiovascular %D 2020 %7 9.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cardiovascular disease (CVD) disparities are a particularly devastating manifestation of health inequity. Despite advancements in prevention and treatment, CVD is still the leading cause of death in the United States. Additionally, research indicates that African American (AA) and other ethnic-minority populations are affected by CVD at earlier ages than white Americans. Given that AAs are the fastest-growing population of smartphone owners and users, mobile health (mHealth) technologies offer the unparalleled potential to prevent or improve self-management of chronic disease among this population. Objective: To address the unmet need for culturally tailored primordial prevention CVD–focused mHealth interventions, the MOYO app was cocreated with the involvement of young people from this priority community. The overall project aims to develop and evaluate the effectiveness of a novel smartphone app designed to reduce CVD risk factors among urban-AAs, 18-29 years of age. Methods: The theoretical underpinning will combine the principles of community-based participatory research and the agile software development framework. The primary outcome goals of the study will be to determine the usability, acceptability, and functionality of the MOYO app, and to build a cloud-based data collection infrastructure suitable for digital epidemiology in a disparity population. Changes in health-related parameters over a 24-week period as determined by both passive (eg, physical activity levels, sleep duration, social networking) and active (eg, use of mood measures, surveys, uploading pictures of meals and blood pressure readings) measures will be the secondary outcome. Participants will be recruited from a majority AA “large city” school district, 2 historically black colleges or universities, and 1 urban undergraduate college. Following baseline screening for inclusion (administered in person), participants will receive the beta version of the MOYO app. Participants will be monitored during a 24-week pilot period. Analyses of varying data including social network dynamics, standard metrics of activity, percentage of time away from a given radius of home, circadian rhythm metrics, and proxies for sleep will be performed. Together with external variables (eg, weather, pollution, and socioeconomic indicators such as food access), these metrics will be used to train machine-learning frameworks to regress them on the self-reported quality of life indicators. Results: This 5-year study (2015-2020) is currently in the implementation phase. We believe that MOYO can build upon findings of classical epidemiology and longitudinal studies like the Jackson Heart Study by adding greater granularity to our knowledge of the exposures and behaviors that affect health and disease, and creating a channel for outreach capable of launching interventions, clinical trials, and enhancements of health literacy. Conclusions: The results of this pilot will provide valuable information about community cocreation of mHealth programs, efficacious design features, and essential infrastructure for digital epidemiology among young AA adults. International Registered Report Identifier (IRRID): DERR1-10.2196/16699 %M 32673258 %R 10.2196/16699 %U https://www.researchprotocols.org/2020/7/e16699 %U https://doi.org/10.2196/16699 %U http://www.ncbi.nlm.nih.gov/pubmed/32673258 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16695 %T Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis %A Indraratna,Praveen %A Tardo,Daniel %A Yu,Jennifer %A Delbaere,Kim %A Brodie,Matthew %A Lovell,Nigel %A Ooi,Sze-Yuan %+ Department of Cardiology, Prince of Wales Hospital, Barker Street, Randwick, Sydney, Australia, 61 293822222, praveen@unsw.edu.au %K mobile phone %K text messaging %K telemedicine %K myocardial ischemia %K heart failure %K hypertension %D 2020 %7 6.7.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide. Mobile phones have become ubiquitous in most developed societies. Smartphone apps, telemonitoring, and clinician-driven SMS allow for novel opportunities and methods in managing chronic CVD, such as ischemic heart disease, heart failure, and hypertension, and in the conduct and support of cardiac rehabilitation. Objective: A systematic review was conducted using seven electronic databases, identifying all relevant randomized control trials (RCTs) featuring a mobile phone intervention (MPI) used in the management of chronic CVD. Outcomes assessed included mortality, hospitalizations, blood pressure (BP), and BMI. Methods: Electronic data searches were performed using seven databases from January 2000 to June 2019. Relevant articles were reviewed and analyzed. Meta-analysis was performed using standard techniques. The odds ratio (OR) was used as a summary statistic for dichotomous variables. A random effect model was used. Results: A total of 26 RCTs including 6713 patients were identified and are described in this review, and 12 RCTs were included in the meta-analysis. In patients with heart failure, MPIs were associated with a significantly lower rate of hospitalizations (244/792, 30.8% vs 287/803, 35.7%; n=1595; OR 0.77, 95% CI 0.62 to 0.97; P=.03; I2=0%). In patients with hypertension, patients exposed to MPIs had a significantly lower systolic BP (mean difference 4.3 mm Hg; 95% CI −7.8 to −0.78 mm Hg; n=2023; P=.02). Conclusions: The available data suggest that MPIs may have a role as a valuable adjunct in the management of chronic CVD. %M 32628615 %R 10.2196/16695 %U https://mhealth.jmir.org/2020/7/e16695 %U https://doi.org/10.2196/16695 %U http://www.ncbi.nlm.nih.gov/pubmed/32628615 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e19200 %T Use of a Machine Learning Program to Correctly Triage Incoming Text Messaging Replies From a Cardiovascular Text–Based Secondary Prevention Program: Feasibility Study %A Lowres,Nicole %A Duckworth,Andrew %A Redfern,Julie %A Thiagalingam,Aravinda %A Chow,Clara K %+ Heart Research Institute, Building D17, Charles Perkins Centre, Sydney, Australia, 61 2 8627 5940, nicole.lowres@sydney.edu.au %K eHealth %K machine learning, secondary prevention, SMS text messaging, cardiovascular, mHealth, digital health, mobile phone %D 2020 %7 16.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: SMS text messaging programs are increasingly being used for secondary prevention, and have been shown to be effective in a number of health conditions including cardiovascular disease. SMS text messaging programs have the potential to increase the reach of an intervention, at a reduced cost, to larger numbers of people who may not access traditional programs. However, patients regularly reply to the SMS text messages, leading to additional staffing requirements to monitor and moderate the patients’ SMS text messaging replies. This additional staff requirement directly impacts the cost-effectiveness and scalability of SMS text messaging interventions. Objective: This study aimed to test the feasibility and accuracy of developing a machine learning (ML) program to triage SMS text messaging replies (ie, identify which SMS text messaging replies require a health professional review). Methods: SMS text messaging replies received from 2 clinical trials were manually coded (1) into “Is staff review required?” (binary response of yes/no); and then (2) into 12 general categories. Five ML models (Naïve Bayes, OneVsRest, Random Forest Decision Trees, Gradient Boosted Trees, and Multilayer Perceptron) and an ensemble model were tested. For each model run, data were randomly allocated into training set (2183/3118, 70.01%) and test set (935/3118, 29.98%). Accuracy for the yes/no classification was calculated using area under the receiver operating characteristics curve (AUC), false positives, and false negatives. Accuracy for classification into 12 categories was compared using multiclass classification evaluators. Results: A manual review of 3118 SMS text messaging replies showed that 22.00% (686/3118) required staff review. For determining need for staff review, the Multilayer Perceptron model had highest accuracy (AUC 0.86; 4.85% false negatives; and 4.63% false positives); with addition of heuristics (specified keywords) fewer false negatives were identified (3.19%), with small increase in false positives (7.66%) and AUC 0.79. Application of this model would result in 26.7% of SMS text messaging replies requiring review (true + false positives). The ensemble model produced the lowest false negatives (1.43%) at the expense of higher false positives (16.19%). OneVsRest was the most accurate (72.3%) for the 12-category classification. Conclusions: The ML program has high sensitivity for identifying the SMS text messaging replies requiring staff input; however, future research is required to validate the models against larger data sets. Incorporation of an ML program to review SMS text messaging replies could significantly reduce staff workload, as staff would not have to review all incoming SMS text messages. This could lead to substantial improvements in cost-effectiveness, scalability, and capacity of SMS text messaging–based interventions. %M 32543439 %R 10.2196/19200 %U http://mhealth.jmir.org/2020/6/e19200/ %U https://doi.org/10.2196/19200 %U http://www.ncbi.nlm.nih.gov/pubmed/32543439 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e14570 %T A Personalized eHealth Intervention for Lifestyle Changes in Patients With Cardiovascular Disease: Randomized Controlled Trial %A Broers,Eva Rosalinde %A Kop,Willem Johan %A Denollet,Johan %A Widdershoven,Jos %A Wetzels,Mart %A Ayoola,Idowu %A Piera-Jimenez,Jordi %A Habibovic,Mirela %+ Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands, 31 13 466 4020, m.habibovic@tilburguniversity.edu %K cardiovascular diseases %K lifestyle %K habits %K eHealth %K mHealth %D 2020 %7 22.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Behavior change methods involving new ambulatory technologies may improve lifestyle and cardiovascular disease outcomes. Objective: This study aimed to provide proof-of-concept analyses of an intervention aiming to increase (1) behavioral flexibility, (2) lifestyle change, and (3) quality of life. The feasibility and patient acceptance of the intervention were also evaluated. Methods: Patients with cardiovascular disease (N=149; mean age 63.57, SD 8.30 years; 50/149, 33.5% women) were recruited in the Do Cardiac Health Advanced New Generation Ecosystem (Do CHANGE) trial and randomized to the Do CHANGE intervention or care as usual (CAU). The intervention involved a 3-month behavioral program in combination with ecological momentary assessment and intervention technologies. Results: The intervention was perceived to be feasible and useful. A significant increase in lifestyle scores over time was found for both groups (F2,146.6=9.99; P<.001), which was similar for CAU and the intervention group (F1,149.9=0.09; P=.77). Quality of life improved more in the intervention group (mean 1.11, SD 0.11) than CAU (mean −1.47, SD 0.11) immediately following the intervention (3 months), but this benefit was not sustained at the 6-month follow-up (interaction: P=.02). No significant treatment effects were observed for behavioral flexibility (F1,149.0=0.48; P=.07). Conclusions: The Do CHANGE 1 intervention was perceived as useful and easy to use. However, no long-term treatment effects were found on the outcome measures. More research is warranted to examine which components of behavioral interventions are effective in producing long-term behavior change. Trial Registration: ClinicalTrials.gov NCT02946281; https://www.clinicaltrials.gov/ct2/show/NCT02946281 %M 32441658 %R 10.2196/14570 %U https://www.jmir.org/2020/5/e14570 %U https://doi.org/10.2196/14570 %U http://www.ncbi.nlm.nih.gov/pubmed/32441658 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 4 %P e16400 %T Low-Density Lipoprotein Cholesterol Target Attainment in Patients With Established Cardiovascular Disease: Analysis of Routine Care Data %A Groenhof,T Katrien J %A Kofink,Daniel %A Bots,Michiel L %A Nathoe,Hendrik M %A Hoefer,Imo E %A Van Solinge,Wouter W %A Lely,A Titia %A Asselbergs,Folkert W %A Haitjema,Saskia %+ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584CX, Netherlands, 31 887569308, t.k.j.groenhof@umcutrecht.nl %K learning health care system %K routine clinical data %K cardiovascular risk management %K LDL-c %D 2020 %7 2.4.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Direct feedback on quality of care is one of the key features of a learning health care system (LHS), enabling health care professionals to improve upon the routine clinical care of their patients during practice. Objective: This study aimed to evaluate the potential of routine care data extracted from electronic health records (EHRs) in order to obtain reliable information on low-density lipoprotein cholesterol (LDL-c) management in cardiovascular disease (CVD) patients referred to a tertiary care center. Methods: We extracted all LDL-c measurements from the EHRs of patients with a history of CVD referred to the University Medical Center Utrecht. We assessed LDL-c target attainment at the time of referral and per year. In patients with multiple measurements, we analyzed LDL-c trajectories, truncated at 6 follow-up measurements. Lastly, we performed a logistic regression analysis to investigate factors associated with improvement of LDL-c at the next measurement. Results: Between February 2003 and December 2017, 250,749 LDL-c measurements were taken from 95,795 patients, of whom 23,932 had a history of CVD. At the time of referral, 51% of patients had not reached their LDL-c target. A large proportion of patients (55%) had no follow-up LDL-c measurements. Most of the patients with repeated measurements showed no change in LDL-c levels over time: the transition probability to remain in the same category was up to 0.84. Sequence clustering analysis showed more women (odds ratio 1.18, 95% CI 1.07-1.10) in the cluster with both most measurements off target and the most LDL-c measurements furthest from the target. Timing of drug prescription was difficult to determine from our data, limiting the interpretation of results regarding medication management. Conclusions: Routine care data can be used to provide feedback on quality of care, such as LDL-c target attainment. These routine care data show high off-target prevalence and little change in LDL-c over time. Registrations of diagnosis; follow-up trajectory, including primary and secondary care; and medication use need to be improved in order to enhance usability of the EHR system for adequate feedback. %M 32238333 %R 10.2196/16400 %U https://medinform.jmir.org/2020/4/e16400 %U https://doi.org/10.2196/16400 %U http://www.ncbi.nlm.nih.gov/pubmed/32238333 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e15057 %T Efficacy of an Electronic Health Management Program for Patients With Cardiovascular Risk: Randomized Controlled Trial %A Yun,Young Ho %A Kang,EunKyo %A Cho,Young Min %A Park,Sang Min %A Kim,Yong-Jin %A Lee,Hae-Young %A Kim,Kyae Hyung %A Lee,Kiheon %A Koo,Hye Yeon %A Kim,Soojeong %A Rhee,YeEun %A Lee,Jihye %A Min,Jeong Hee %A Sim,Jin-Ah %+ Seoul National University College of Medicine, Department of Family Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea, 82 27408417, lawyun@snu.ac.kr %K health %K hypertension %K diabetes %K hypercholesterolemia %K randomized controlled trial %D 2020 %7 22.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In addition to medication, health behavior management is crucial in patients with multiple risks of cardiovascular mortality. Objective: This study aimed to examine the efficacy of a 3-month Smart Management Strategy for Health–based electronic program (Smart Healthing). Methods: A 2-arm randomized controlled trial was conducted to assess the efficacy of Smart Healthing in 106 patients with at least one indicator of poor disease control and who had hypertension, diabetes, or hypercholesterolemia. The intervention group (n=53) took part in the electronic program, which was available in the form of a mobile app and a Web-based PC application. The program covered 4 areas: self-assessment, self-planning, self-learning, and self-monitoring by automatic feedback. The control group (n=53) received basic educational material concerning disease control. The primary outcome was the percentage of participants who achieved their clinical indicator goal after 12 weeks into the program: glycated hemoglobin (HbA1c) <7.0%, systolic blood pressure (SBP) <140 mmHg, or low-density lipoprotein cholesterol <130 mg/dL. Results: The intervention group showed a significantly higher success rate (in comparison with the control group) for achieving each of 3 clinical indicators at the targeted goal levels (P<.05). Only the patients with hypertension showed a significant improvement in SBP from the baseline as compared with the control group (72.7% vs 35.7%; P<.05). There was a significant reduction in HbA1c in the intervention group compared with the control group (difference=0.54%; P≤.05). In the intervention group, 20% of patients with diabetes exhibited a ≥1% decrease in HbA1c (vs 0% among controls; P≤.05). Conclusions: A short-term self-management strategy-based electronic program intervention may improve clinical outcomes among patients with cardiovascular risks. Trial Registration: ClinicalTrials.gov NCT03294044; https://clinicaltrials.gov/ct2/show/NCT03294044 %M 32012053 %R 10.2196/15057 %U https://www.jmir.org/2020/1/e15057 %U https://doi.org/10.2196/15057 %U http://www.ncbi.nlm.nih.gov/pubmed/32012053 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 4 %N 1 %P e14963 %T Using Mobile Health Tools to Assess Physical Activity Guideline Adherence and Smoking Urges: Secondary Analysis of mActive-Smoke %A Shan,Rongzi %A Yanek,Lisa R %A Silverman-Lloyd,Luke G %A Kianoush,Sina %A Blaha,Michael J %A German,Charles A %A Graham,Garth N %A Martin,Seth S %+ Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 591, Baltimore, MD, 21287, United States, 1 4105020469, smart100@jhmi.edu %K physical activity %K smoking %K mHealth %K fitness trackers %K short message service %D 2020 %7 6.1.2020 %9 Original Paper %J JMIR Cardio %G English %X Background: Rates of cigarette smoking are decreasing because of public health initiatives, pharmacological aids, and clinician focus on smoking cessation. However, a sedentary lifestyle increases cardiovascular risk, and therefore, inactive smokers have a particularly enhanced risk of cardiovascular disease. Objective: In this secondary analysis of mActive-Smoke, a 12-week observational study, we investigated adherence to guideline-recommended moderate-to-vigorous physical activity (MVPA) in smokers and its association with the urge to smoke. Methods: We enrolled 60 active smokers (≥3 cigarettes per day) and recorded continuous step counts with the Fitbit Charge HR. MVPA was defined as a cadence of greater than or equal to 100 steps per minute. Participants were prompted to report instantaneous smoking urges via text message 3 times a day on a Likert scale from 1 to 9. We used a mixed effects linear model for repeated measures, controlling for demographics and baseline activity level, to investigate the association between MVPA and urge. Results: A total of 53 participants (mean age 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite, and 38% [20/53] obese) recorded 6 to 12 weeks of data. Data from 3633 person-days were analyzed, with a mean of 69 days per participant. Among all participants, median daily MVPA was 6 min (IQR 2-13), which differed by sex (12 min [IQR 3-20] for men vs 3.5 min [IQR 1-9] for women; P=.004) and BMI (2.5 min [IQR 1-8.3] for obese vs 10 min [IQR 3-15] for nonobese; P=.04). The median total MVPA minutes per week was 80 (IQR 31-162). Only 10% (5/51; 95% CI 4% to 22%) of participants met national guidelines of 150 min per week of MVPA on at least 50% of weeks. Adjusted models showed no association between the number of MVPA minutes per day and mean daily smoking urge (P=.72). Conclusions: The prevalence of MVPA was low in adult smokers who rarely met national guidelines for MVPA. Given the poor physical activity attainment in smokers, more work is required to enhance physical activity in this population. %M 31904575 %R 10.2196/14963 %U https://cardio.jmir.org/2020/1/e14963 %U https://doi.org/10.2196/14963 %U http://www.ncbi.nlm.nih.gov/pubmed/31904575 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14275 %T Investigating the Use of Mobile Health Interventions in Vulnerable Populations for Cardiovascular Disease Management: Scoping Review %A Wali,Sahr %A Hussain-Shamsy,Neesha %A Ross,Heather %A Cafazzo,Joseph %+ Centre for Global eHealth Innovation, Techna Institute, University Health Network, TGH/RFE Bldg, 4th Fl, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada, 1 416 340 3200, sahr.wali@mail.utoronto.ca %K mobile health %K health services %K indigenous %K low- and middle-income countries %K cardiovascular disease %K self-care %D 2019 %7 7.10.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Cardiovascular disease (CVD) has grown to become one of the leading causes of mortality worldwide. The advancements of CVD-related treatments have led to a decline in CVD prevalence among individuals in high-income countries (HICs). However, these improvements do not reflect the state of individuals in low- and middle-income countries (LMICs) and vulnerable subgroup populations in HICs, such as the Indigenous. To help minimize the health disparities in these populations, technology-based interventions have been offered as a potential solution, but there is concern regarding if they will be effective, or even needed, as these tools have been designed for use in HICs. Objective: The objective of this study was to explore how mobile health (mHealth) interventions currently assist individuals in Indigenous communities and LMICs with CVD management. Methods: A scoping review guided by the methods outlined by Arksey and O’Malley was conducted. A comprehensive search was completed by 2 reviewers in 5 electronic databases using keywords related to mobile health, cardiovascular disease, self-care, Indigenous communities, and LMICs. Studies were screened over 2 rounds and critically reviewed using a descriptive-analytical narrative method. Descriptive data were categorized into thematic groups reflecting the major findings related to the study objective. Results: We identified a total of 11 original articles and 11 review papers that met the criteria for this scoping review. The majority of the studies included a telemonitoring- and text messaging (short message service, SMS)–related feature associated with the intervention. The use of SMS was the most common approach to effectively promote disease management among individuals in both LMICs and Indigenous communities. However, customizing for cultural considerations within the design of the intervention was highlighted as a pivotal component to encourage CVD management. Specifically, individuals emphasized that the inclusion of collaborative partnerships with community members would strengthen the effectiveness of the intervention by ensuring it was designed with the appropriate context. Conclusions: Technology-based interventions used within Indigenous communities and LMICs have shown their potential to assist individuals with managing their condition. Although the literature available regarding this topic is limited, this review outlines key components to promote the effective use of these tools in the context of these vulnerable populations. %M 31593547 %R 10.2196/14275 %U https://mhealth.jmir.org/2019/10/e14275 %U https://doi.org/10.2196/14275 %U http://www.ncbi.nlm.nih.gov/pubmed/31593547 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e13166 %T The Cost-Effectiveness of Digital Health Interventions on the Management of Cardiovascular Diseases: Systematic Review %A Jiang,Xinchan %A Ming,Wai-Kit %A You,Joyce HS %+ School of Pharmacy, The Chinese University of Hong Kong, 8/F, Lo Kwee-Seong Integrated Biomedical Sciences Building, CUHK, Shatin, NT, China (Hong Kong), 852 39436830, joyceyou@cuhk.edu.hk %K telemedicine %K cardiovascular diseases %K stroke %K heart failure %K myocardial infarction %K heart attack %K cost-effectiveness %K medical economics %K decision modeling %K systematic review %D 2019 %7 17.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: With the advancement in information technology and mobile internet, digital health interventions (DHIs) are improving the care of cardiovascular diseases (CVDs). The impact of DHIs on cost-effective management of CVDs has been examined using the decision analytic model–based health technology assessment approach. Objective: The aim of this study was to perform a systematic review of the decision analytic model–based studies evaluating the cost-effectiveness of DHIs on the management of CVDs. Methods: A literature review was conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature Complete, PsycINFO, Scopus, Web of Science, Center for Review and Dissemination, and Institute for IEEE Xplore between 2001 and 2018. Studies were included if the following criteria were met: (1) English articles, (2) DHIs that promoted or delivered clinical interventions and had an impact on patients’ cardiovascular conditions, (3) studies that were modeling works with health economic outcomes of DHIs for CVDs, (4) studies that had a comparative group for assessment, and (5) full economic evaluations including a cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, and cost-consequence analysis. The primary outcome collected was the cost-effectiveness of the DHIs, presented by incremental cost per additional quality-adjusted life year (QALY). The quality of each included study was evaluated using the Consolidated Health Economic Evaluation Reporting Standards. Results: A total of 14 studies met the defined criteria and were included in the review. Among the included studies, heart failure (7/14, 50%) and stroke (4/14, 29%) were two of the most frequent CVDs that were managed by DHIs. A total of 9 (64%) studies were published between 2015 and 2018 and 5 (36%) published between 2011 and 2014. The time horizon was ≤1 year in 3 studies (21%), >1 year in 10 studies (71%), and 1 study (7%) did not declare the time frame. The types of devices or technologies used to deliver the health interventions were short message service (1/14, 7%), telephone support (1/14, 7%), mobile app (1/14, 7%), video conferencing system (5/14, 36%), digital transmission of physiologic data (telemonitoring; 5/14, 36%), and wearable medical device (1/14, 7%). The DHIs gained higher QALYs with cost saving in 43% (6/14) of studies and gained QALYs at a higher cost at acceptable incremental cost-effectiveness ratio (ICER) in 57% (8/14) of studies. The studies were classified as excellent (0/14, 0%), good (9/14, 64%), moderate (4/14, 29%), and low (1/14, 7%) quality. Conclusions: This study is the first systematic review of decision analytic model–based cost-effectiveness analyses of DHIs in the management of CVDs. Most of the identified studies were published recently, and the majority of the studies were good quality cost-effectiveness analyses with an adequate duration of time frame. All the included studies found the DHIs to be cost-effective. %M 31210136 %R 10.2196/13166 %U http://www.jmir.org/2019/6/e13166/ %U https://doi.org/10.2196/13166 %U http://www.ncbi.nlm.nih.gov/pubmed/31210136 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 5 %P e13571 %T The Impact of Treatment Adherence for Patients With Diabetes and Hypertension on Cardiovascular Disease Risk: Protocol for a Retrospective Cohort Study, 2008-2018 %A Su,Min %A Haldane,Victoria %A Upshur,Ross %A Sullivan,Frank %A Légaré,France %A Greiver,Michelle %A Wei,Xiaolin %+ Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada, 1 416 978 2020, xiaolin.wei@utoronto.ca %K treatment adherence %K cardiovascular disease %K primary care %D 2019 %7 31.05.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death globally and in Canada. Diabetes and hypertension are major risk factors for CVD events. Despite the increasing availability of effective treatments, the majority of diabetic and hypertensive patients do not have adequate blood pressure and glycemic control. One of the major contributors is poor treatment adherence. Objective: This study aims to evaluate the impact of treatment adherence for patients with both diabetes and hypertension on acute severe CVD events and intermediate clinical outcomes in Canadian primary care settings. Methods: We will conduct a population-based retrospective cohort study of patients living with both diabetes and hypertension in Ontario, Canada, between January 1, 2008, and March 31, 2018. The Social Cognitive Theory will be used as a conceptual framework by which to frame the reciprocal relationship between treatment adherence, personal factors, and environmental determinants and how this interplay impacts CVD events and clinical outcomes. Data will be derived from the Diabetes Action Canada National Data Repository. A time-varying Cox proportional hazards model will be used to estimate the impacts of treatment adherence on CVD morbidity and mortality. Multivariable linear regression models and hierarchical regression models will be used to estimate the associations between treatment adherence of different medication categories and intermediate clinical outcomes. Our primary outcome is the association between treatment adherence and the risk of acute severe CVD events, including CVD mortality. The secondary outcome is the association between treatment adherence and intermediate clinical outcomes including diastolic and systolic blood pressures, glycated hemoglobin, low-density lipoprotein cholesterol, and total cholesterol. Owing to data limitation, we use medication prescriptions as a proxy to estimate treatment adherence. We assume that a patient adhered to medications if she or he had any prescription record in the 4 preceding quarters and 1 quarter after each quarter of interest. Acute severe CVD events are defined based on the World Health Organization’s Monitoring Trends and Determinants in Cardiovascular Disease Project, including acute coronary heart disease, stroke, and heart failure. As causes of death are not available, the number of CVD deaths will be computed using the most recent systolic blood pressure distributions and the population attributable risks related to systolic blood pressure level. Results: The project was funded by Diabetes Action Canada (reference number: 503854) and approved by the University of Toronto Research Ethics Board (reference number: 36065). The project started in June 2018 and is expected to be finished by September 2019. Conclusions: The findings will be helpful in identifying the challenges of treatment adherence for diabetic and hypertensive patients in primary care settings. This will also help to develop intervention strategies to promote treatment adherence for patients with multi-morbidities. International Registered Report Identifier (IRRID): DERR1-10.2196/13571 %M 31152529 %R 10.2196/13571 %U http://www.researchprotocols.org/2019/5/e13571/ %U https://doi.org/10.2196/13571 %U http://www.ncbi.nlm.nih.gov/pubmed/31152529 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e10465 %T User Preferences and Persona Design for an mHealth Intervention to Support Adherence to Cardiovascular Disease Medication in Singapore: A Multi-Method Study %A Haldane,Victoria %A Koh,Joel Jun Kai %A Srivastava,Aastha %A Teo,Krichelle Wei Qi %A Tan,Yao Guo %A Cheng,Rui Xiang %A Yap,Yi Cheng %A Ong,Pei-Shi %A Van Dam,Rob M %A Foo,Jie Min %A Müller-Riemenschneider,Falk %A Koh,Gerald Choon-Huat %A Foong,Pin Sym %A Perel,Pablo %A Legido-Quigley,Helena %+ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, ON,, Canada, 1 416 978 4326, v.haldane@mail.utoronto.ca %K personas %K biopsychosocial personas %K qualitative %K ASCVD %K adherence %K patient perspectives %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile health (mHealth) has gained popularity globally, including for its use in a variety of health interventions, particularly through short message service (SMS) text messaging. However, there are challenges to the use of mHealth, particularly among older users who have a large heterogeneity in usability and accessibility barriers when using technology. Objective: In order to better understand and conceptualize the diversity of users and give insight into their particular needs, we turned to persona creation. Personas are user archetypes created through data generated from multi-method inquiry with actual target users. Personas are an appropriate yet largely underutilized component of current mHealth research. Methods: Leveraging data from a multi-method study conducted in Singapore with an ethnically diverse population including Chinese, Malay, and Indian participants, we used a proforma to analyze data from the qualitative component (ie, 20 in-depth interviews) and quantitative component (ie, 100 interviewer-guided surveys). We then identified key characteristics, including technology use and preferences as well as adherence factors, to synthesize five personas reflective of persons over the age of 40 years in Singapore with atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk factors, such as hypertension. Results: We present five personas typologized as (1) The Quiet Analog, (2) The Busy Grandparent, (3) The Socializer, (4) The Newly Diagnosed, and (5) The Hard-to-Reach. We report on four key characteristics: health care access, medication adherence, mobile phone technology usage (ie, ownership, access, and utilization), and interest in mHealth. Finally, we provide insights into how these personas may be used in the design and implementation of an mHealth intervention. Our work demonstrates how multi-method data can create biopsychosocial personas that can be used to explore and address the diversity in behaviors, preferences, and needs in user groups. Conclusions: With wider adoption of mHealth, it is important that we consider user-centered design techniques and design thinking in order to create meaningful, patient-centered interventions for adherence to medications. Future research in this area should include greater exploration of how these five personas can be used to better understand how and when is best to deliver mHealth interventions in Singapore and beyond. %M 31140445 %R 10.2196/10465 %U http://mhealth.jmir.org/2019/5/e10465/ %U https://doi.org/10.2196/10465 %U http://www.ncbi.nlm.nih.gov/pubmed/31140445 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12191 %T Examining Development Processes for Text Messaging Interventions to Prevent Cardiovascular Disease: Systematic Literature Review %A Ricci-Cabello,Ignacio %A Bobrow,Kirsten %A Islam,Sheikh Mohammed Shariful %A Chow,Clara K %A Maddison,Ralph %A Whittaker,Robyn %A Farmer,Andrew J %+ Balearic Islands Health Research Institute, Carretera de Valldemossa, 79, Hospital Universitari Son Espases, Edifici S., Palma de Mallorca, 07120, Spain, 34 697750971, nacho.ricci.cabello@gmail.com %K systematic review %K cardiovascular disease %K telemedicine %K text messaging %K methods %D 2019 %7 29.03.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Interventions delivered by mobile phones have the potential to prevent cardiovascular disease (CVD) by supporting behavior change toward healthier lifestyles and treatment adherence. To allow replication and adaptation of these interventions across settings, it is important to fully understand how they have been developed. However, the development processes of these interventions have not previously been systematically examined. Objective: This study aimed to systematically describe and compare the development process of text messaging interventions identified in the Text2PreventCVD systematic review. Methods: We extracted data about the development process of the 9 interventions identified in the Text2PreventCVD systematic review. Data extraction, which was guided by frameworks for the development of complex interventions, considered the following development stages: intervention planning, design, development, and pretesting. Following data extraction, we invited the developers of the interventions to contribute to our study by reviewing the accuracy of the extracted data and providing additional data not reported in the available publications. Results: A comprehensive description of the development process was available for 5 interventions. Multiple methodologies were used for the development of each intervention. Intervention planning involved gathering information from stakeholder consultations, literature reviews, examination of relevant theory, and preliminary qualitative research. Intervention design involved the use of behavior change theories and behavior change techniques. Intervention development involved (1) generating message content based on clinical guidelines and expert opinions; (2) conducting literature reviews and primary qualitative research to inform decisions about message frequency, timing, and level of tailoring; and (3) gathering end-user feedback concerning message readability, intervention acceptability, and perceived utility. Intervention pretesting involved pilot studies with samples of 10 to 30 participants receiving messages for a period ranging from 1 to 4 weeks. Conclusions: The development process of the text messaging interventions examined was complex and comprehensive, involving multiple studies to guide decisions about the scope, content, and structure of the interventions. Additional research is needed to establish whether effective messaging systems can be adapted from work already done or whether this level of development is needed for application in other conditions and settings. %M 30924790 %R 10.2196/12191 %U http://mhealth.jmir.org/2019/3/e12191/ %U https://doi.org/10.2196/12191 %U http://www.ncbi.nlm.nih.gov/pubmed/30924790 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e9017 %T American Heart Association’s Cholesterol CarePlan as a Smartphone-Delivered Web App for Patients Prescribed Cholesterol-Lowering Medication: Protocol for an Observational Feasibility Study %A Woringer,Maria %A Dharmayat,Kanika I %A Greenfield,Geva %A Bottle,Alex %A Ray,Kausik K %+ Imperial College London, Department of Primary Care and Public Health, Reynolds Building, St Dunstan's Road, London, W6 8RP, United Kingdom, 44 02075940789, m.woringer@imperial.ac.uk %K behavioral change %K cholesterol %K lifestyle %K mHealth %K medication adherence %D 2019 %7 24.01.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adoption of healthy lifestyle and compliance with cholesterol-lowering medication reduces the risk of cardiovascular disease (CVD). The use of digital tools and mobile technology may be important for sustaining positive behavioral change. Objective: The primary objective of this study is to evaluate the feasibility and acceptability of administering the Cholesterol CarePlan Web app developed by the American Heart Association aimed at improving lifestyle and medication adherence among patients prescribed cholesterol-lowering medication. The secondary objective is to assess the Web app’s efficacy. Methods: A prospective, observational feasibility study will be conducted to demonstrate whether the Web app may be successfully taken up by patients and will be associated with improved clinical and behavioral outcomes. The study will aim to recruit 180 study participants being prescribed cholesterol-lowering medication for at least 30 days across 14 general practices in London, England. Potentially eligible patients will be invited to use the Web app on a smartphone and visit general practice for three 20-minute clinical assessments of blood pressure, height, weight, smoking, and nonfasting cholesterol over 24 weeks. The feasibility of administering the Web app will be judged by recruitment and dropout statistics and the sociodemographic and comorbidity profile of consenting study participants, consenting nonparticipants, and all potentially eligible patients. Acceptability will be assessed using patients’ readiness to embrace new technologies, the usability of the Web app, and patient satisfaction. The efficacy of the Web app will be assessed by changes in medication adherence and clinical risk factors by levels of the Web app compliance. Results: This study is currently funded by the American Heart Association. Initial study recruitment will take place between February and July 2018 followed by patient follow-up. Patient level data will be obtained in January 2019. Data analysis will be completed by February 2019. Results will be submitted for publication in March 2019. Conclusions: The potential of an app to improve patients’ lifestyle and management of cholesterol may inform the design of a randomized controlled trial and the delivery of more effective CVD prevention programs. International Registered Report Identifier (IRRID): PRR1-10.2196/9017 %M 30679150 %R 10.2196/resprot.9017 %U https://www.researchprotocols.org/2019/1/e9017/ %U https://doi.org/10.2196/resprot.9017 %U http://www.ncbi.nlm.nih.gov/pubmed/30679150 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e11124 %T The Mediating Role of Perceived Social Support Between Physical Activity Habit Strength and Depressive Symptoms in People Seeking to Decrease Their Cardiovascular Risk: Cross-Sectional Study %A Storm,Vera %A Reinwand,Dominique Alexandra %A Wienert,Julian %A Tan,Shu-Ling %A Lippke,Sonia %+ Institute of Sport and Exercise Sciences, Department of Sport and Exercise Psychology, University of Münster, Horstmarer Landweg 62b, Münster, 48149, Germany, 49 251 83 31805, vera.storm@uni-muenster.de %K physical activity %K habit %K social support %K depressive symptoms %K cardiac diseases %D 2018 %7 14.11.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Regular physical activity treatment has been advocated for the prevention and rehabilitation of patients at risk of cardiovascular diseases and depressive symptoms. How physical activity is related to depressive symptoms is widely discussed. Objective: The aim of this internet-based study was to investigate the role of perceived social support in the relationship between physical activity habit strength and depressive symptoms. Methods: In total, 790 participants (mean 50.9 years, SD 12.2, range 20-84 years) who were interested in reducing their cardiovascular risk were recruited in Germany and the Netherlands. Data collection was conducted via an internet-based questionnaire addressing physical activity habit strength, depressive symptoms, and perceived social support. Cross-sectional data analysis was done with SPSS version 24 using the Macro PROCESS version 2 16.3 by Hayes with bootstrapping (10,000 samples), providing 95% CIs. Results: Physical activity habit strength was negatively related to depressive symptoms (r=–.13, P=.006), but this interrelation disappeared when controlling for perceived social support (beta=–.14, SE 0.09, P=.11). However, there was an indirect relationship between physical activity habit strength and depressive symptoms, which was mediated via perceived social support (beta=–.13; SE 0.04, 95% CI –0.21 to 0.06). The negative relationship between physical activity habit strength and depressive symptoms was fully mediated by perceived social support. Conclusions: We suggest that physical activity treatment in people interested in reducing their cardiovascular risk should also embed social support to target depressive symptoms. Internet-based interventions and electronic health may provide a good option for doing so. Trial Registration: ClinicalTrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/73Y9RfdiY) %M 30429112 %R 10.2196/11124 %U http://mental.jmir.org/2018/4/e11124/ %U https://doi.org/10.2196/11124 %U http://www.ncbi.nlm.nih.gov/pubmed/30429112 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 11 %P e11289 %T The Ready to Reduce Risk (3R) Study for a Group Educational Intervention With Telephone and Text Messaging Support to Improve Medication Adherence for the Primary Prevention of Cardiovascular Disease: Protocol for a Randomized Controlled Trial %A Byrne,Jo L %A Dallosso,Helen M %A Rogers,Stephen %A Gray,Laura J %A Waheed,Ghazala %A Patel,Prashanth %A Gupta,Pankaj %A Doherty,Yvonne %A Davies,Melanie %A Khunti,Kamlesh %+ Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, United Kingdom, 44 116 258 4005, kk22@leicester.ac.uk %K medication adherence %K cardiovascular diseases %K primary prevention %K educational intervention %K telephone support %K text messaging support %D 2018 %7 12.11.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Poor adherence to cardiovascular medications is associated with worse clinical outcomes. Evidence for effective education interventions that address medication adherence for the primary prevention of cardiovascular disease is lacking. The Ready to Reduce Risk (3R) study aims to investigate whether a complex intervention, involving group education plus telephone and text messaging follow-up support, can improve medication adherence and reduce cardiovascular risk. Objective: This protocol paper details the design and rationale for the development of the 3R intervention and the study methods used. Methods: This is an open and pragmatic randomized controlled trial with 12 months of follow-up. We recruited participants from primary care and randomly assigned them at a 1:1 frequency, stratified by sex and age, to either a control group (usual care from a general practitioner) or an intervention group involving 2 facilitated group education sessions with telephone and text messaging follow-up support, with a theoretical underpinning and using recognized behavioral change techniques. The primary outcome was medication adherence to statins. The primary measure was an objective, novel, urine-based biochemical measure of medication adherence. We also used the 8-item Morisky Medication Adherence Scale to assess medication adherence. Secondary outcomes were changes in total cholesterol, blood pressure, high-density lipoprotein, total cholesterol to high-density lipoprotein ratio, body mass index, waist to hip ratio, waist circumference, smoking behavior, physical activity, fruit and vegetable intake, patient activation level, quality of life, health status, health and medication beliefs, and overall cardiovascular disease risk score. We also considered process outcomes relating to acceptability and feasibility of the 3R intervention. Results: We recruited 212 participants between May 2015 and March 2017. The 12-month follow-up data collection clinics were completed in April 2018, and data analysis will commence once all study data have been collected and verified. Conclusions: This study will identify a potentially clinically useful and effective educational intervention for the primary prevention of cardiovascular disease. Medication adherence to statins is being assessed using a novel urine assay as an objective measure, in conjunction with other validated measures. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN16863160; http://www.isrctn.com/ISRCTN16863160 (Archived by WebCite at http://www.webcitation.org/734PqfdQw) International Registered Report Identifier (IRRID): DERR1-10.2196/11289 %M 30425027 %R 10.2196/11289 %U http://www.researchprotocols.org/2018/11/e11289/ %U https://doi.org/10.2196/11289 %U http://www.ncbi.nlm.nih.gov/pubmed/30425027 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e8 %T MedFit App, a Behavior-Changing, Theoretically Informed Mobile App for Patient Self-Management of Cardiovascular Disease: User-Centered Development %A Duff,Orlaith %A Walsh,Deirdre %A Malone,Shauna %A McDermott,Lauri %A Furlong,Brona %A O'Connor,Noel %A Moran,Kieran %A Woods,Catherine %+ School of Health and Human Performance, Dublin City University, Glasnevin,, Dublin, 9, Ireland, 353 17008011, kieran.moran@dcu.ie %K app development %K cardiac rehabilitation %K telemedicine %K exercise %K mHealth %K focus groups %K usability testing %D 2018 %7 27.04.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The MedFit app is designed to facilitate participation of people with cardiovascular disease (CVD) in an exercise-based rehabilitation program remotely. This paper details the development for the MedFit app. Objective: The aim of this research was to develop a behavior change, theoretically informed exercise rehabilitation mobile app for adults with CVD by following the early stages of the formative research: development and feasibility testing. Methods: Adhering to the mobile health (mHealth) development evaluation framework, the stages of the formative research process including (1) development and (2) feasibility were undertaken. The content and format of the MedFit app were developed based on (1) theory, (2) usability testing, and (3) content design. Results: A systematic review of the literature was undertaken to identify the most appropriate theories from which to develop the app. This led to the creation of the MedFit app. The app went through iterative rounds of usability focus group testing with adults with CVD to provide feedback on the app. This process was framed by the unified theory of acceptance and use of technology model. Feedback was then translated into feasible technical improvements to be executed through close collaboration with the technical team, who adapted and made modifications to the app based on this codesign process. Conclusions: The formative research process of the app development involved theoretical underpinning, usability testing, and content design. mHealth interventions may play a key role in the future of health care, potentially addressing the barriers to participation in cardiac rehabilitation. This work will provide guidance for future research aiming to develop mobile apps by incorporating a best practice framework for mHealth intervention development and a user-centered design approach. %M 30684426 %R 10.2196/formative.9550 %U http://formative.jmir.org/2018/1/e8/ %U https://doi.org/10.2196/formative.9550 %U http://www.ncbi.nlm.nih.gov/pubmed/30684426 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e10 %T Food Addiction Support: Website Content Analysis %A McKenna,Rebecca A %A Rollo,Megan E %A Skinner,Janelle A %A Burrows,Tracy L %+ School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 249215514, tracy.burrows@newcastle.edu.au %K food addiction %K self-help groups %K social support %D 2018 %7 24.04.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Food addiction has a long history; however, there has been a substantial increase in published literature and public media focus in the past decade. Food addiction has previously demonstrated an overlap with overweight and obesity, a risk for cardiovascular disease. This increased focus has led to the establishment of numerous support options for addictive eating behaviors, yet evidence-based support options are lacking. Objective: This study aimed to evaluate the availability and content of support options, accessible online, for food addiction. Methods: A standardized Web search was conducted using 4 search engines to identify current support availability for food addiction. Through use of a comprehensive data extraction sheet, 2 reviewers independently extracted data related to the program or intervention characteristics, and support fidelity including fundamentals, support modality, social support offered, program or intervention origins, member numbers, and program or intervention evaluation. Results: Of the 800 records retrieved, 13 (1.6%, 13/800) websites met the inclusion criteria. All 13 websites reported originating in the United States, and 1 website reported member numbers. The use of credentialed health professionals was reported by only 3 websites, and 5 websites charged a fee-for-service. The use of the 12 steps or traditions was evident in 11 websites, and 9 websites described the use of food plans. In total, 6 websites stated obligatory peer support, and 11 websites featured spirituality as a main theme of delivery. Moreover, 12 websites described phone meetings as the main program delivery modality, with 7 websites stating face-to-face delivery and 4 opting for online meetings. Newsletters (n=5), closed social media groups (n=5), and retreat programs (n=5) were the most popular forms of social support. Conclusions: This is the first review to analyze online support options for food addiction. Very few online support options include health professionals, and a strengthening argument is forming for an increase in support options for food addiction. This review forms part of this argument by showing a lack of evidence-based options. By reviewing current support availability, it can provide a guide toward the future development of evidence-based support for food addiction. %M 31758778 %R 10.2196/cardio.8718 %U http://cardio.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/cardio.8718 %U http://www.ncbi.nlm.nih.gov/pubmed/31758778 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 3 %P e73 %T Impact of Medication Adherence on Mortality and Cardiovascular Morbidity: Protocol for a Population-Based Cohort Study %A Giner-Soriano,Maria %A Sotorra Figuerola,Gerard %A Cortés,Jordi %A Pera Pujadas,Helena %A Garcia-Sangenis,Ana %A Morros,Rosa %+ Medicines Research Unit, Institut Universitari d’Investigació en Atenció Primària Jordi Gol, Gran Via de les Corts Catalanes 587, àtic, Barcelona, 08007, Spain, 34 934824110, mginer@idiapjgol.info %K cardiovascular diseases %K coronary heart disease %K acute coronary syndrome %K adherence %K aspirin %K statins %K beta-blockers %K angiotensin-converting enzyme inhibitors %K angiotensin-receptor blockers %D 2018 %7 09.03.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels, such as coronary heart disease (CHD), cerebrovascular disease, and peripheral artery disease. CVD is the leading threat to global health, whether measured by mortality, morbidity, or economic cost. Long-term administration of aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers improves survival in patients with stablished coronary heart disease. Nevertheless, adherence to prescribed medication is poor for long-term drug treatment. Objective: We aim to assess the relationship between adherences to the four pharmacological groups recommended for secondary prevention and the clinical outcomes of cardiovascular morbidity and mortality in patients with established CHD according to the level of adherence to these drugs in a population of incident cases of acute coronary syndrome (ACS). Methods: Population-based cohort study of patients with a first episode of ACS during 2006-2015 in the Information System for Research in Primary Care (SIDIAP) database. We will estimate adherence to these drugs. The primary endpoint is a composite of all-cause mortality, ACS, and ischaemic stroke. Bivariate analyses will be performed estimating odds ratios for categorical variables and mean differences for continuous variables. Hazard ratios for adherences will be calculated for outcome events using Cox proportional hazard regression models, and proportionality of hazards assumption will be tested. Results: We expect to estimate adherence to all four study treatments, the incidence of MACE, and to analyze if this incidence is associated with the level of drug adherence. Conclusions: We expect to find that adherent patients have a lower risk of the primary endpoints compared with nonadherent patients. Trial Registration: This study protocol was classified as EPA-OD by the AEMPS (IJG-EST-2017-01-2017-01, 07/04/2017) and registered in the EU PAS register (EUPAS19017, 09/05/2017). %M 29523501 %R 10.2196/resprot.8121 %U http://www.researchprotocols.org/2018/3/e73/ %U https://doi.org/10.2196/resprot.8121 %U http://www.ncbi.nlm.nih.gov/pubmed/29523501 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 8 %N 2 %P e6643 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2016 %7 ..2016 %9 %J Online J Public Health Inform %G English %X In the modern era, with high-throughput technology and large data size, associational studies are actively being generated. Some have statistical and clinical validity and utility, or at least have biologically plausible relationships, while others may not. Recently, the potential effect of birth month on lifetime disease risks was studied in a phenome-wide model. We evaluated the associations between birth month and 5 cardiovascular diseases in an independent dataset of 8,346 patients from Canada in 1977-2014. We compared the predictiveness of birth month vs. sex (or age) by various statistical measures, and also examined the event rate over birth months by sex. Hypertension and coronary heart disease were most prevalent in those who were born in January and April, respectively, as observed in the original paper. Other outcomes showed weak or opposite associations. Time-trends of blood pressures and of event rates by sex demonstrate inconsistent patterns, implying high randomness. As scientific importance/meaningfulness and clinical implications and practical usefulness can be different, readers would want to read the original and new papers together for more objective interpretations of the potential impacts of birth month on personal and public health. %M 27752296 %R 10.5210/ojphi.v8i2.6643 %U %U https://doi.org/10.5210/ojphi.v8i2.6643 %U http://www.ncbi.nlm.nih.gov/pubmed/27752296