TY - JOUR AU - Yang, Li-Tan AU - Wu, Chi-Han AU - Lee, Jen-Kuang AU - Wang, Wei-Jyun AU - Chen, Ying-Hsien AU - Huang, Ching-Chang AU - Hung, Chi-Sheng AU - Chiang, Kuang-Chien AU - Ho, Yi-Lwun AU - Wu, Hui-Wen PY - 2025/4/23 TI - Effects of a Cloud-Based Synchronous Telehealth Program on Valvular Regurgitation Regression: Retrospective Study JO - J Med Internet Res SP - e68929 VL - 27 KW - mitral regurgitation KW - tricuspid regurgitation KW - telehealth KW - telemedicine KW - cardiac remodeling N2 - Background: Telemedicine has been associated with better cardiovascular outcomes, but its effects on the regression of mitral regurgitation (MR) and tricuspid regurgitation (TR) remain unknown. Objective: This study aimed to evaluate whether telemedicine could facilitate the regression of MR and TR compared to usual care and whether it was associated with better survival. Methods: This retrospective cohort study enrolled consecutive patients with moderate or greater MR or TR from 2010 through 2020, excluding those with concomitant aortic stenosis, aortic regurgitation, or mitral stenosis greater than mild severity. All patients underwent follow-up transthoracic echocardiography (TTE) at least 3 months apart. Patients receiving telehealth services for at least two weeks within 90 days of baseline TTE were categorized as the telehealth group; the remainder constituted the nontelehealth group. Telemedicine participants transmitted daily biometric data?blood pressure, pulse rate, blood glucose, electrocardiogram, and oxygen saturation?to a cloud-based platform for timely monitoring. Experienced case managers regularly contacted patients and initiated immediate action for concerning measurements. The primary endpoint was MR or TR regression from ?moderate to 80%). At 8 weeks, the mean group differences in changes in the SCHFI subscale scores favored the intervention over the control group: maintenance (Cohen d=0.19, 95% CI ?0.65 to 1.02), symptom perception (Cohen d=0.33, 95% CI ?0.51 to 1.17), and self-care management (Cohen d=0.25, 95% CI ?0.55 to 1.04). The greatest improvements in terms of effect size were observed in self-efficacy (Cohen d=0.68) and health beliefs about medication adherence (Cohen d=0.63) and self-monitoring adherence (Cohen d=0.94). There were no adverse events due to the intervention. Conclusions: iCardia4HF was found to be feasible, acceptable, and safe. A larger trial with a longer follow-up duration is warranted to examine its efficacy among patients with HF. Trial Registration: ClinicalTrials.gov NCT03642275; https://clinicaltrials.gov/study/NCT03642275 UR - https://www.jmir.org/2025/1/e55586 UR - http://dx.doi.org/10.2196/55586 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55586 ER - TY - JOUR AU - Ceugniez, Maxime AU - Devanne, Hervé AU - Hermand, Eric PY - 2025/1/8 TI - Reliability and Accuracy of the Fitbit Charge 4 Photoplethysmography Heart Rate Sensor in Ecological Conditions: Validation Study JO - JMIR Mhealth Uhealth SP - e54871 VL - 13 KW - photoplethysmography KW - physical activity KW - ecological conditions KW - accuracy KW - reliability KW - Fitbit Charge 4 KW - Fitbit KW - exercise KW - ecological KW - wrist-worn device KW - device KW - sensor KW - wearables KW - usefulness KW - variability KW - sensitivity KW - heart rate KW - heart rate sensor N2 - Background: Wrist-worn photoplethysmography (PPG) sensors allow for continuous heart rate (HR) measurement without the inconveniences of wearing a chest belt. Although green light PPG technology reduces HR measurement motion artifacts, only a limited number of studies have investigated the reliability and accuracy of wearables in non?laboratory-controlled conditions with actual specific and various physical activity movements. Objective: The purpose of this study was to (1) assess the reliability and accuracy of the PPG-based HR sensor of the Fitbit Charge 4 (FC4) in ecological conditions and (2) quantify the potential variability caused by the nature of activities. Methods: We collected HR data from participants who performed badminton, tennis, orienteering running, running, cycling, and soccer while simultaneously wearing the FC4 and the Polar H10 chest belt (criterion sensor). Skin tone was assessed with the Fitzpatrick Skin Scale. Once data from the FC4 and criterion data were synchronized, accuracy and reliability analyses were performed, using intraclass correlation coefficients (ICCs), Lin concordance correlation coefficients (CCCs), mean absolute percentage errors (MAPEs), and Bland-Altman tests. A linear univariate model was also used to evaluate the effect of skin tone on bias. All analyses were stratified by activity and pooled activity types (racket sports and running sports). Results: A total of 77.5 hours of HR recordings from 26 participants (age: mean 21.1, SD 5.8 years) were analyzed. The highest reliability was found for running sports, with ICCs and CCCs of 0.90 and 0.99 for running and 0.80 and 0.93 for orienteering running, respectively, whereas the ICCs and CCCs were 0.37 and 0.78, 0.42 and 0.88, 0.65 and 0.97, and 0.49 and 0.81 for badminton, tennis, cycling, and soccer, respectively. We found the highest accuracy for running (bias: 0.1 beats per minute [bpm]; MAPE 1.2%, SD 4.6%) and the lowest for badminton (bias: ?16.5 bpm; MAPE 16.2%, SD 14.4%) and soccer (bias: ?16.5 bpm; MAPE 17.5%, SD 20.8%). Limit of agreement (LOA) width and artifact rate followed the same trend. No effect of skin tone was observed on bias. Conclusions: LOA width, bias, and MAPE results found for racket sports and soccer suggest a high sensitivity to motion artifacts for activities that involve ?sharp? and random arm movements. In this study, we did not measure arm motion, which limits our results. However, whereas individuals might benefit from using the FC4 for casual training in aerobic sports, we cannot recommend the use of the FC4 for specific purposes requiring high reliability and accuracy, such as research purposes. UR - https://mhealth.jmir.org/2025/1/e54871 UR - http://dx.doi.org/10.2196/54871 ID - info:doi/10.2196/54871 ER - TY - JOUR AU - Handra, Julia AU - James, Hannah AU - Mbilinyi, Ashery AU - Moller-Hansen, Ashley AU - O'Riley, Callum AU - Andrade, Jason AU - Deyell, Marc AU - Hague, Cameron AU - Hawkins, Nathaniel AU - Ho, Kendall AU - Hu, Ricky AU - Leipsic, Jonathon AU - Tam, Roger PY - 2024/12/30 TI - The Role of Machine Learning in the Detection of Cardiac Fibrosis in Electrocardiograms: Scoping Review JO - JMIR Cardio SP - e60697 VL - 8 KW - machine learning KW - cardiac fibrosis KW - electrocardiogram KW - ECG KW - detection KW - ML KW - cardiovascular disease KW - review N2 - 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. UR - https://cardio.jmir.org/2024/1/e60697 UR - http://dx.doi.org/10.2196/60697 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60697 ER - TY - JOUR AU - Eze, E. Chinwe AU - Dorsch, P. Michael AU - Coe, B. Antoinette AU - Lester, A. Corey AU - Buis, R. Lorraine AU - Farris, B. Karen PY - 2024/12/23 TI - Behavioral Factors Related to Participation in Remote Blood Pressure Monitoring Among Adults With Hypertension: Cross-Sectional Study JO - JMIR Form Res SP - e56954 VL - 8 KW - remote blood pressure monitoring KW - telemonitoring KW - hypertension KW - blood pressure KW - technology KW - health behaviors KW - quantitative KW - cross-sectional study KW - United States KW - lack of awareness KW - health information KW - health provider KW - electronic communication channels KW - adult KW - aging KW - mobile phone N2 - Background: Remote blood pressure (BP) monitoring (RBPM) or BP telemonitoring is beneficial in hypertension management. People with hypertension involved in telemonitoring of BP often have better BP control than those in usual care. However, most reports on RBPM are from intervention studies. Objective: This study aimed to assess participant characteristics and technology health behaviors associated with RBPM participation in a wider population with hypertension. This study will help us understand the predictors of RBPM participation and consider how to increase it. Methods: This was a quantitative, cross-sectional survey study of people with hypertension in the United States. The inclusion criteria included people aged ?18 years with a hypertension diagnosis or who self-reported they have hypertension, had a prescription of at least one hypertension medication, understood the English language, and were willing to participate. The survey included demographics, technology health behaviors, and RBPM participation questions. The survey was self-administered on the Qualtrics platform and followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) checklist. The primary dependent variable was participation in RBPM. Results: In total, 507 people with hypertension participated in the survey. The mean age for all respondents was 60 (SD 14.7) years. The respondents were mostly female (306/507, 60.4%), non-Hispanic (483/507, 95.3%), and White (429/507, 84.6%). A little over half of the respondents reported having had hypertension for 5 years or more (287/507, 56.6%). About one-third of participants were aware of RBPM (165/507, 32.5%), and 11.8% (60/507) were enrolled in RBPM. The mean age of those engaging in RBPM and non-RBPM was 46.2 (SD 14.7) and 62 (SD 13.7) years, respectively. The most common reasons for not participating in RBPM were because their health provider did not ask the participant to participate (247/447, 55.3%) and their lack of awareness of RBPM (190/447, 42.5%). Most respondents in the RBPM group measure their BP at home (55/60, 91.7%), and 61.7% (37/60) engage in daily BP measurement, compared with 62.6% (280/447) and 25.1% (112/447), respectively, among the non-RBPM group. A greater number of those in the RBPM group reported tracking their BP measurements with mobile health (mHealth; 37/60, 61.7%) than those in the non-RBPM group (70/447, 15.6%). The electronic health records or patient portal was the most common channel of RBPM communication between the respondents and their health care providers. The significant predictors of participation in RBPM were RBPM awareness (adjusted odds ratio [AOR] 34.65, 95% CI 11.35?150.31; P<.001) and sharing health information electronically with a health provider (AOR 4.90, 95% CI 1.39?21.64; P=.01) among all participants. However, the significant predictor of participation in RBPM among participants who were aware of RBPM was sharing health information electronically with a health provider (AOR 6.99, 95% CI 1.62?47.44; P=.007). Conclusions: Participation in RBPM is likely to increase with increased awareness, health providers? recommendations, and tailoring RBPM services to patients? preferred electronic communication channels. UR - https://formative.jmir.org/2024/1/e56954 UR - http://dx.doi.org/10.2196/56954 ID - info:doi/10.2196/56954 ER - TY - JOUR AU - Feng, Y. Kent AU - Short, A. Sarah AU - Saeb, Sohrab AU - Carroll, K. Megan AU - Olivier, B. Christoph AU - Simard, P. Edgar AU - Swope, Susan AU - Williams, Donna AU - Eckstrand, Julie AU - Pagidipati, Neha AU - Shah, H. Svati AU - Hernandez, F. Adrian AU - Mahaffey, W. Kenneth PY - 2024/12/20 TI - Resting Heart Rate and Associations With Clinical Measures From the Project Baseline Health Study: Observational Study JO - J Med Internet Res SP - e60493 VL - 26 KW - resting heart rate KW - wearable devices KW - remote monitoring KW - physiology KW - PBHS KW - Project Baseline Health Study KW - Verily Study Watch KW - heart rate KW - observational study KW - cohort study KW - wearables KW - electrocardiogram KW - regression analyses KW - socioeconomic status KW - medical condition KW - vital signs KW - laboratory assessments KW - physical function KW - electronic health KW - eHealth N2 - Background: Though widely used, resting heart rate (RHR), as measured by a wearable device, has not been previously evaluated in a large cohort against a variety of important baseline characteristics. Objective: This study aimed to assess the validity of the RHR measured by a wearable device compared against the gold standard of ECG (electrocardiography), and assess the relationships between device-measured RHR and a broad range of clinical characteristics. Methods: The Project Baseline Health Study (PHBS) captured detailed demographic, occupational, social, lifestyle, and clinical data to generate a deeply phenotyped cohort. We selected an analysis cohort within it, which included participants who had RHR determined by both ECG and the Verily Study Watch (VSW). We examined the correlation between these simultaneous RHR measures and assessed the relationship between VSW RHR and a range of baseline characteristics, including demographic, clinical, laboratory, and functional assessments. Results: From the overall PBHS cohort (N=2502), 875 (35%) participants entered the analysis cohort (mean age 50.9, SD 16.5 years; n=519, 59% female and n=356, 41% male). The mean and SD of VSW RHR was 66.6 (SD 11.2) beats per minute (bpm) for female participants and 64.4 (SD 12.3) bpm for male participants. There was excellent reliability between the two measures of RHR (ECG and VSW) with an intraclass correlation coefficient of 0.946. On univariate analyses, female and male participants had similar baseline characteristics that trended with higher VSW RHR: lack of health care insurance (both P<.05), higher BMI (both P<.001), higher C-reactive protein (both P<.001), presence of type 2 diabetes mellitus (both P<.001) and higher World Health Organization Disability Assessment Schedule (WHODAS) 2.0 score (both P<.001) were associated with higher RHR. On regression analyses, within each domain of baseline characteristics (demographics and socioeconomic status, medical conditions, vitals, physical function, laboratory assessments, and patient-reported outcomes), different characteristics were associated with VSW RHR in female and male participants. Conclusions: RHR determined by the VSW had an excellent correlation with that determined by ECG. Participants with higher VSW RHR had similar trends in socioeconomic status, medical conditions, vitals, laboratory assessments, physical function, and patient-reported outcomes irrespective of sex. However, within each domain of baseline characteristics, different characteristics were most associated with VSW RHR in female and male participants. Trial Registration: ClinicalTrials.gov NCT03154346; https://clinicaltrials.gov/study/NCT03154346 UR - https://www.jmir.org/2024/1/e60493 UR - http://dx.doi.org/10.2196/60493 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60493 ER - TY - JOUR AU - Zheng, Yaguang AU - Adhikari, Samrachana AU - Li, Xiyue AU - Zhao, Yunan AU - Mukhopadhyay, Amrita AU - Hamo, E. Carine AU - Stokes, Tyrel AU - Blecker, Saul PY - 2024/12/5 TI - Association Between Video-Based Telemedicine Visits and Medication Adherence Among Patients With Heart Failure: Retrospective Cross-Sectional Study JO - JMIR Cardio SP - e56763 VL - 8 KW - telemedicine KW - medication adherence KW - heart failure KW - systolic dysfunction KW - medical therapy KW - telehealth KW - remote monitoring KW - self-management N2 - Background: Despite the exponential growth in telemedicine visits in clinical practice due to the COVID-19 pandemic, it remains unknown if telemedicine visits achieved similar adherence to prescribed medications as in-person office visits for patients with heart failure. Objective: Our study examined the association between telemedicine visits (vs in-person visits) and medication adherence in patients with heart failure. Methods: This was a retrospective cross-sectional study of adult patients with a diagnosis of heart failure or an ejection fraction of ?40% using data between April 1 and October 1, 2020. This period was used because New York University approved telemedicine visits for both established and new patients by April 1, 2020. The time zero window was between April 1 and October 1, 2020, then each identified patient was monitored for up to 180 days. Medication adherence was measured by the mean proportion of days covered (PDC) within 180 days, and categorized as adherent if the PDC was ?0.8. Patients were included in the telemedicine exposure group or in-person group if all encounters were video visits or in-person office visits, respectively. Poisson regression and logistic regression models were used for the analyses. Results: A total of 9521 individuals were included in this analysis (telemedicine visits only: n=830 in-person office visits only: n=8691). Overall, the mean age was 76.7 (SD 12.4) years. Most of the patients were White (n=6996, 73.5%), followed by Black (n=1060, 11.1%) and Asian (n=290, 3%). Over half of the patients were male (n=5383, 56.5%) and over half were married or living with partners (n=4914, 51.6%). Most patients? health insurance was covered by Medicare (n=7163, 75.2%), followed by commercial insurance (n=1687, 17.7%) and Medicaid (n=639, 6.7%). Overall, the average PDC was 0.81 (SD 0.286) and 71.3% (6793/9521) of patients had a PDC?0.8. There was no significant difference in mean PDC between the telemedicine and in-person office groups (mean 0.794, SD 0.294 vs mean 0.812, SD 0.285) with a rate ratio of 0.99 (95% CI 0.96-1.02; P=.09). Similarly, there was no significant difference in adherence rates between the telemedicine and in-person office groups (573/830, 69% vs 6220/8691, 71.6%), with an odds ratio of 0.94 (95% CI 0.81-1.11; P=.12). The conclusion remained the same after adjusting for covariates (eg, age, sex, race, marriage, language, and insurance). Conclusions: We found similar rates of medication adherence among patients with heart failure who were being seen via telemedicine or in-person visits. Our findings are important for clinical practice because we provide real-world evidence that telemedicine can be an approach for outpatient visits for patients with heart failure. As telemedicine is more convenient and avoids transportation issues, it may be an alternative way to maintain the same medication adherence as in-person visits for patients with heart failure. UR - https://cardio.jmir.org/2024/1/e56763 UR - http://dx.doi.org/10.2196/56763 ID - info:doi/10.2196/56763 ER - TY - JOUR AU - Spethmann, Sebastian AU - Hindricks, Gerhard AU - Koehler, Kerstin AU - Stoerk, Stefan AU - Angermann, E. Christiane AU - Böhm, Michael AU - Assmus, Birgit AU - Winkler, Sebastian AU - Möckel, Martin AU - Mittermaier, Mirja AU - Lelgemann, Monika AU - Reuter, Daniel AU - Bosch, Ralph AU - Albrecht, Alexander AU - von Haehling, Stephan AU - Helms, M. Thomas AU - Sack, Stefan AU - Bekfani, Tarek AU - Gröschel, Wolfgang Jan AU - Koehler, Magdalena AU - Melzer, Christoph AU - Wintrich, Jan AU - Zippel-Schultz, Bettina AU - Ertl, Georg AU - Vogelmeier, Claus AU - Dagres, Nikolaos AU - Zernikow, Jasmin AU - Koehler, Friedrich PY - 2024/12/4 TI - Telemonitoring for Chronic Heart Failure: Narrative Review of the 20-Year Journey From Concept to Standard Care in Germany JO - J Med Internet Res SP - e63391 VL - 26 KW - telemedicine KW - e-counseling KW - heart decompensation KW - Europe KW - patient care management N2 - Background: Chronic heart failure (CHF) is a major cause of morbidity and mortality worldwide, placing a significant burden on health care systems. The concept of telemedicine for CHF was first introduced in the late 1990s, and since 2010, studies have demonstrated its potential to improve patient outcomes and reduce health care costs. Over the following decade, technological advancements and changes in health care policy led to the development of more sophisticated telemedicine solutions for CHF, including remote patient management through invasive or noninvasive telemonitoring devices, mobile apps, and virtual consultations. Years of public funding in Germany have generated evidence that remote patient management improves outcomes for patients with CHF, such as quality of life, and reduces hospital admissions. Based on these data, the Federal Joint Committee (Gemeinsamer Bundesausschuss; G-BA) decided, independently of the current European Society of Cardiology recommendations, to incorporate telemedicine as a standard digital intervention for high-risk patients with reduced left ventricular ejection fraction in Germany in 2020. Objective: This review aims to illustrate the journey from the initial concept through pioneering studies that led to telemedicine?s integration into standard care, and to share current experiences that have positioned Germany as a leader in cardiovascular telemedicine. Methods: We review and discuss existing literature and evidence on the development and implementation of telemonitoring for CHF in Germany over the past 20 years. Relevant studies, reports, and guidelines were identified through a comprehensive search of electronic databases, including PubMed, Google Scholar, and specialized journals focused on CHF telemonitoring. Results: Pioneering studies, such as the TIM-HF2 (Telemedical Interventional Management in Heart Failure II) and IN-TIME (Influence of Home Monitoring on Mortality and Morbidity in Heart Failure Patients with Impaired Left Ventricular Function) trials, demonstrated the effectiveness of remote patient management applications for patients with CHF in Germany and their applicability to current practices involving both invasive and noninvasive methods. Collaborations between researchers and technology developers overcame barriers, leading to sustainable improvements in patient care. Ongoing research on artificial intelligence applications for prioritizing and interpreting individual health data will continue to transform digital health care. Conclusions: The establishment of telemedical care for patients with HF across Europe is likely to benefit from experiences in Germany, where significant improvements have been achieved in the care of patients with HF. UR - https://www.jmir.org/2024/1/e63391 UR - http://dx.doi.org/10.2196/63391 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63391 ER - TY - JOUR AU - Tisdale, Lauren Rebecca AU - Purmal, Colin AU - Kalwani, Neil AU - Sandhu, Alexander AU - Heidenreich, Paul AU - Zulman, Donna AU - Hussain, Tanvir PY - 2024/11/28 TI - Opportunities to Address Specialty Care Deserts and the Digital Divide through the Veterans Health Administration?s Telehealth Hub-and-Spoke Cardiology Clinic: Retrospective Cohort Study JO - J Med Internet Res SP - e53932 VL - 26 KW - telehealth KW - specialty care KW - cardiovascular disease KW - telemedicine KW - cardiology KW - veterans KW - low income KW - digital divide KW - access KW - Veterans Health Administration KW - VA KW - VHA KW - rural KW - clinical resource hub KW - CRH N2 - Background: To address geographic barriers to specialty care access for services such as cardiology, the Veterans Health Administration (VA) has implemented a novel, regionalized telehealth care hub. The Clinical Resource Hub (CRH) model extends care, including cardiology services, to individuals in low-access communities across the region. Little is known, however, about the reach of such programs. Objective: This study aimed to describe the initial CRH program implementation in terms of growth in users and clinical encounters, as well as the association between user characteristics and the use of CRH cardiology care, in VA?s Sierra Pacific region (Northern California, Nevada, and the Pacific Islands). Methods: We compared patients who used CRH cardiology services (CRH users) to those using non-CRH cardiology services (CRH nonusers) in the Sierra Pacific region between July 15, 2021, and March 31, 2023. After characterizing changes in the numbers of CRH users and nonusers and clinical encounters over the study period, we used multivariable logistic regression to estimate the association between patient-level factors and the odds of being a CRH user. Results: There were 804 CRH users over the study period, with 1961 CRH encounters concentrated at 3 main CRH sites. The CRH program comprised a minority of cardiology users and encounters in the region, with 19,583 CRH nonusers with 83,489 encounters. The numbers of CRH patients and encounters both increased at a steady-to-increasing rate over the study period, with increases of 37% (n=292 vs n=213) in users and 64% (n=584 vs n=356) in encounters in the first quarter of 2023 compared with the last quarter of 2022. Among CRH users, 8.3% (67/804) were female and 41.4% (333/804) were aged ?75 years, compared with 4.3% (840/19,583) and 49% (9600/19,583), respectively, among CRH nonusers. The proportions of rural (users: 205/804, 25.5%; nonusers: 4936/19,583, 25.2%), highly disabled (users: 387/804, 48.1%; nonusers: 9246/19,583, 47.2%), and low-income (users: 165/804, 20.5%; nonusers: 3941/19,583, 20.1%) veterans in both groups were similar. In multivariable logistic models, adjusted odds ratios of using CRH were higher for female veterans (1.70, 95% CI 1.29-2.24) and lower for older veterans (aged ?75 years; 0.33, 95% CI 0.23-0.47). Rural veterans also had a higher adjusted odds ratio of using CRH (1.19, 95% CI 1.00-1.42; P=.046). Conclusions: The VA?s Sierra Pacific CRH cardiology program grew substantially in its first 2 years of operation, serving disproportionately more female and rural veterans and similar proportions of highly disabled and low-income veterans compared to conventional VA care. This model appears to be effective for overcoming specialty care access barriers for certain individuals, although targeted efforts may be required to reach older veterans. While this study focuses on a single region, specialty, and health care system, lessons from implementing regionalized telehealth hub models may be applicable to other settings. UR - https://www.jmir.org/2024/1/e53932 UR - http://dx.doi.org/10.2196/53932 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53932 ER - TY - JOUR AU - Craig, William AU - Ohlmann, Suzanne PY - 2024/11/26 TI - The Benefits of Using Active Remote Patient Management for Enhanced Heart Failure Outcomes in Rural Cardiology Practice: Single-Site Retrospective Cohort Study JO - J Med Internet Res SP - e49710 VL - 26 KW - rural KW - remote patient monitoring KW - heart failure KW - heart failure hospitalizations KW - office visits KW - rural health inequalities KW - telehealth N2 - Background: Rural populations have a disproportionate burden of heart failure (HF) morbidity and mortality, associated with socioeconomic and racial inequities. Multiple randomized controlled trials of remote patient monitoring (RPM) using both direct patient contact and device-based monitoring have been conducted to assess improvement in HF outcomes, with mixed results. Objective: We aimed to assess whether a novel digital health care platform designed to proactively assess and manage patients with HF improved patient outcomes by preventing HF re-exacerbations, thus reducing emergency room visits and HF hospitalizations. Methods: This was a single-site, retrospective cohort study using electronic medical record (EMR) data gathered from 2 years prior to RPM initiation and 2 years afterward. In January 2017, this single center began enrolling New York Heart Association (NYHA) class II and class III patients with HF prone to HF exacerbation into an RPM program using the Cordella HF system. By July 2022, 93 total patients had been enrolled in RPM. Of these patients, 87% lived in rural areas. This retrospective review included 40 of the 93 patients enrolled in RPM. These 40 were selected because they had 2 years of established EMR data prior to initiation of RPM and 2 years of post-RPM data; each consented to this Sterling IRB?approved study. Results: We included 40 patients with at least 4 years of follow-up, including 2 years prior to RPM initiation and 2 years after RPM initiation. In the 2 years after RPM initiation, check-up calls increased 519%, medication change calls increased 519%, and total calls increased by 519%. Emergency room visits for HF fell 93%, heart failure hospitalizations fell 83%, and all other cardiovascular hospitalizations fell 50%. Additionally, the total number of office visits declined by 15% after RPM, and unscheduled or urgent office visits declined by 73%. Conclusions: Daily monitoring of trends in vital sign data between engaged patients and a collaborative team of clinicians, incorporated into daily clinical workflow, enhanced patient interactions and allowed timely response or intervention when HF decompensation occurred, resulting in a reduction of outpatient and inpatient clinical use over more than 2 years of follow-up. UR - https://www.jmir.org/2024/1/e49710 UR - http://dx.doi.org/10.2196/49710 UR - http://www.ncbi.nlm.nih.gov/pubmed/39589775 ID - info:doi/10.2196/49710 ER - TY - JOUR AU - Wettstein, Reto AU - Sedaghat-Hamedani, Farbod AU - Heinze, Oliver AU - Amr, Ali AU - Reich, Christoph AU - Betz, Theresa AU - Kayvanpour, Elham AU - Merzweiler, Angela AU - Büsch, Christopher AU - Mohr, Isabell AU - Friedmann-Bette, Birgit AU - Frey, Norbert AU - Dugas, Martin AU - Meder, Benjamin PY - 2024/11/22 TI - A Remote Patient Monitoring System With Feedback Mechanisms Using a Smartwatch: Concept, Implementation, and Evaluation Based on the activeDCM Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e58441 VL - 12 KW - wearable KW - consumer device KW - mobile phone KW - mobile health KW - telemedicine KW - remote patient monitoring KW - usability KW - Health Level 7 Fast Healthcare Interoperability Resources KW - HL7 FHIR KW - cardiology KW - heart failure KW - dilated cardiomyopathy N2 - Background: Technological advances allow for recording and sharing health-related data in a patient-centric way using smartphones and wearables. Secure sharing of such patient-generated data with physicians would enable close management of individual health trajectories, monitoring of risk factors, and asynchronous feedback. However, most remote patient monitoring (RPM) systems currently available are not fully integrated into hospital IT systems or lack a patient-centric design. Objective: The objective of this study was to conceptualize and implement a user-friendly, reusable, interoperable, and secure RPM system incorporating asynchronous feedback mechanisms using a broadly available consumer wearable (Apple Watch). In addition, this study sought to evaluate factors influencing patient acceptance of such systems. Methods: The RPM system requirements were established through focus group sessions. Subsequently, a system concept was designed and implemented using an iterative approach ensuring technical feasibility from the beginning. To assess clinical feasibility, the system was used as part of the activeDCM prospective randomized interventional study focusing on dilated cardiomyopathy. Each patient used the system for at least 12 months. The System Usability Scale was used to measure usability from a subjective patient perspective. In addition, an evaluation was conducted on the objective wearable interaction frequency as well as the completeness of transmitted data classified into sensor-based health data (SHD) and patient-reported outcome measures (PROMs). Descriptive statistics using box plots and bootstrapped multiple linear regression with 95% CIs were used for evaluation analyzing the influence of age, sex, device experience, and intervention group membership. Results: The RPM system comprised 4 interoperable components: patient devices, a data server, a data viewer, and a notification service. The system was evaluated with 95 consecutive patients with dilated cardiomyopathy (28/95, 29% female; mean age 50, SD 12 y) who completed the activeDCM study protocol. The system?s app achieved a mean System Usability Scale score of 78 (SD 17), which was most influenced by device experience. In total, 87% (83/95) of the patients could integrate the use of the app well or very well into their daily routine, and 71% (67/95) saw a benefit of the RPM system for management of their health condition. On average, patients interacted with the wearable on 61% (SD 26%) of days enrolled in the study. SHD were available on average for 78% (SD 23%) of days, and PROM data were available on 64% (SD 27%) of weeks enrolled in the study. Wearable interaction frequency, SHD, and PROM completeness were most influenced by intervention group membership. Conclusions: Our results mark a first step toward integrating RPM systems based on a consumer wearable device for primary patient input into standardized clinical workflows. They can serve as a blueprint for creating a user-friendly, reusable, interoperable, and secure RPM system that can be integrated into patients? daily routines. UR - https://mhealth.jmir.org/2024/1/e58441 UR - http://dx.doi.org/10.2196/58441 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58441 ER - TY - JOUR AU - Saraya, Norah AU - McBride, Jonathon AU - Singh, Karandeep AU - Sohail, Omar AU - Das, Jeet Porag PY - 2024/11/8 TI - Comparison of Auscultation Quality Using Contemporary Digital Stethoscopes JO - JMIR Cardio SP - e54746 VL - 8 KW - auscultation KW - digital stethoscopes KW - valvular heart disease UR - https://cardio.jmir.org/2024/1/e54746 UR - http://dx.doi.org/10.2196/54746 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54746 ER - TY - JOUR AU - Marier-Tétrault, Emmanuel AU - Bebawi, Emmanuel AU - Béchard, Stéphanie AU - Brouillard, Philippe AU - Zuchinali, Priccila AU - Remillard, Emilie AU - Carrier, Zoé AU - Jean-Charles, Loyda AU - Nguyen, Kha John Nam AU - Lehoux, Pascale AU - Pomey, Marie-Pascale AU - Ribeiro, B. Paula A. AU - Tournoux, François PY - 2024/11/6 TI - Remote Patient Monitoring and Digital Therapeutics Enhancing the Continuum of Care in Heart Failure: Nonrandomized Pilot Study JO - JMIR Form Res SP - e53444 VL - 8 KW - heart failure KW - remote patient management KW - telemonitoring KW - digital therapeutics KW - digital health KW - heart KW - therapeutics KW - pilot study KW - patient care KW - medical therapy KW - vitals KW - weight KW - symptoms KW - quality of life KW - medication optimization KW - mobile phone N2 - Background: Heart failure (HF) is the primary cause of hospitalization among Canadian patients aged ?65 years. Care for HF requires regular clinical follow-ups to prevent readmissions and facilitate medical therapy optimization. Multiple barriers lead to therapeutic medical inertia including limited human resources and regional inequities. Remote patient monitoring (RPM) and digital therapeutics (DTx) solutions have been developed to improve HF management, but their adoption remains limited and underexplored. The Continuum project emerged as a collaborative initiative involving a health care center, a software start-up, and an industrial partner. Objective: We aimed to develop and test the feasibility of the Continuum intervention that seamlessly combined an RPM system with a DTx solution for HF within the same software. Methods: A 3-month pre-post pilot study was conducted from October 2020 to June 2021. Patients with HF who owned a smartphone or tablet (having remote patient monitoring [RPM+]), had (1) access to a self-care app where they could enter their vital signs, weight, and HF symptoms and view educational content; (2) daily monitoring of their data by a nurse; and (3) a DTx module with automated HF medication suggestions based on national guidelines, made available to their treating medical team. Bluetooth devices were offered to facilitate data recording. Nurses on RPM monitoring could call patients and arrange appointments with their medical team. Patients without a mobile device or unable to use the app were followed in another group (without remote patient monitoring [RPM?]). Results: In total, 52 patients were enrolled in this study (32 RPM+ and 20 RPM?). Among patients owning a mobile device, only 14% (5/37) could not use the app. In the RPM+ group, 47% (15/32) of the patients used the app for more than 80% (67 days) of the 12-week study period. The use of our digital solution was integrated into the regular nursing workday and only 34 calls had to be made by the nurse during the study period. Only 6% (2/32) of the patients in the RPM+ group experienced at least 1 all-cause hospitalization versus 35% (7/20) of the RPM? ones during the follow-up (6%, 2/32 vs 25%, 5/20 for HF hospitalization) and patients were more likely to have their HF therapy optimized if the DTx solution was available. Quality of life improved in patients compliant with the use of the mobile app (mean score variation +10.6, SD 14.7). Conclusions: This pilot study demonstrated the feasibility of implementing our digital solution, within the specific context of HF. The seamless integration of Continuum into nursing workflow, mobile app accessibility, and adoption by patients, were the 3 main key learning points of this study. Further investigation is required to assess the potential impacts on hospitalizations, drug optimization, and quality of life. Trial Registration: ClinicalTrials.gov NCT05377190; https://clinicaltrials.gov/study/NCT05377190 (pilot study #21.403) UR - https://formative.jmir.org/2024/1/e53444 UR - http://dx.doi.org/10.2196/53444 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53444 ER - TY - JOUR AU - Xu, Dandan AU - Xu, Dongmei AU - Wei, Lan AU - Bao, Zhipeng AU - Liao, Shengen AU - Zhang, Xinyue PY - 2024/11/5 TI - The Effectiveness of Remote Exercise Rehabilitation Based on the ?SCeiP? Model in Homebound Patients With Coronary Heart Disease: Randomized Controlled Trial JO - J Med Internet Res SP - e56552 VL - 26 KW - coronary heart disease KW - exercise rehabilitation KW - promotion strategy KW - home rehabilitation N2 - Background: While exercise rehabilitation is recognized as safe and effective, medium- to long-term compliance among patients with coronary heart disease (CHD) remains low. Therefore, promoting long-term adherence to exercise rehabilitation for these patients warrants significant attention. Objective: This study aims to investigate the impact of remote exercise rehabilitation on time investment and related cognitive levels in homebound patients with CHD. This study utilizes the SCeiP (Self-Evaluation/Condition of Exercise-Effect Perception-Internal Drive-Persistence Behavior) model, alongside WeChat and exercise bracelets. Methods: A total of 147 patients who underwent percutaneous coronary intervention in the cardiovascular department of a grade III hospital in Jiangsu Province from June 2022 to March 2023 were selected as study participants through convenience sampling. The patients were randomly divided into an experimental group and a control group. The experimental group received an exercise rehabilitation promotion strategy based on the ?SCeiP? model through WeChat and exercise bracelets, while the control group followed rehabilitation training according to a standard exercise rehabilitation guide. The days and duration of exercise, levels of cardiac rehabilitation cognition, exercise planning, and exercise input were analyzed before the intervention and at 1 month and 3 months after the intervention. Results: A total of 81 men (55.1%) and 66 women (44.9%) were recruited for the study. The completion rate of exercise days was significantly higher in the experimental group compared with the control group at both 1 month (t145=5.429, P<.001) and 3 months (t145=9.113, P<.001) after the intervention. Similarly, the completion rate of exercise duration was significantly greater in the experimental group (t145=3.471, P=.001) than in the control group (t145=5.574, P<.001). The levels of autonomy, exercise planning, and exercise input in the experimental group were significantly higher than those in the control group at both 1 month and 3 months after the intervention (P<.001). Additionally, the experimental group exhibited a significant reduction in both process anxiety and outcome anxiety scores (P<.001). Repeated measures ANOVA revealed significant differences in the trends of cognitive function related to cardiac rehabilitation between the 2 patient groups over time: autonomy, F1,145(time×group)=9.055 (P<.001); process anxiety, F1,145(time×group)=30.790 (P<.001); and outcome anxiety, F1,145(time×group)=28.186 (P<.001). As expected, the scores for exercise planning (t145=2.490, P=.01 and t145=3.379, P<.001, respectively) and exercise input (t145=2.255, P=.03 and t145=3.817, P<.001, respectively) consistently demonstrated superiority in the experimental group compared with the control group at both 1 and 3 months after the intervention. Interestingly, we observed that the levels of exercise planning and exercise input in both groups initially increased and then slightly decreased over time, although both remained higher than the preintervention levels (P<.001). Conclusions: The remote health intervention based on the ?SCeiP? model effectively enhances exercise compliance, exercise planning, exercise input, and cognitive levels during cardiac rehabilitation in patients with CHD. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300069463; https://www.chictr.org.cn/showproj.html?proj=192461 UR - https://www.jmir.org/2024/1/e56552 UR - http://dx.doi.org/10.2196/56552 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56552 ER - TY - JOUR AU - Jin, Xiaorong AU - Zhang, Yimei AU - Zhou, Min AU - Zhang, Xiong AU - Mei, Qian AU - Bai, Yangjuan AU - Wei, Wei AU - Ma, Fang PY - 2024/10/31 TI - Experiences With mHealth Use Among Patient-Caregiver Dyads With Chronic Heart Failure: Qualitative Study JO - J Med Internet Res SP - e57115 VL - 26 KW - chronic heart failure KW - informal caregiver KW - mHealth KW - experience KW - dyad N2 - Background: Chronic heart failure has become a serious threat to the health of the global population, and self-management is key to treating chronic heart failure. The emergence of mobile health (mHealth) provides new ideas for the self-management of chronic heart failure in which the informal caregiver plays an important role. Current research has mainly studied the experiences with using mHealth among patients with chronic heart failure from the perspective of individual patients, and there is a lack of research from the dichotomous perspective. Objective: The aim of this study was to explore the experiences with mHealth use among patients with chronic heart failure and their informal caregivers from a dichotomous perspective. Methods: This descriptive phenomenological study from a post-positivist perspective used a dyadic interview method, and face-to-face semistructured interviews were conducted with patients with chronic heart failure and their informal caregivers. Data were collected and managed using NVivo 12 software, and data analysis used thematic analysis to identify and interpret participants? experiences and perspectives. The thematic analysis included familiarizing ourselves with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. Results: A total of 14 dyads of patients with chronic heart failure and their informal caregivers (13 men and 15 women) participated in this study, including 3 couples and 11 parent-child pairs. We constructed 4 key themes and their subthemes related to the experiences with mHealth use: (1) opposing experiences with mHealth as human interaction or trauma (great experience with mHealth use; trauma), (2) supplement instead of replacement (it is useful but better as a reference; offline is unavoidable sometimes), (3) both agreement and disagreement over who should be the adopter of mHealth (achieving consensus regarding who should adopt mHealth; conflict occurs when considering patients as the adopter of mHealth), (4) for better mHealth (applying mHealth with caution; suggestions for improved mHealth). Conclusions: This study reported that the experiences with mHealth use among patients with chronic heart failure and their informal caregivers were mixed, and it highlighted the human touch of mHealth and the importance of network security. These results featured mHealth as a complement to offline hospitals rather than a replacement. In the context of modern or changing Chinese culture, we encourage patients to use mHealth by themselves and their informal caregivers to provide help when necessary. In addition, we need to use mHealth carefully, and future mHealth designs should focus more on ease of use and be oriented more toward older adults. UR - https://www.jmir.org/2024/1/e57115 UR - http://dx.doi.org/10.2196/57115 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57115 ER - TY - JOUR AU - Gibson, Irene AU - Neubeck, Lis AU - Corcoran, Marissa AU - Morland, Chris AU - Donovan, Steve AU - Jones, Jennifer AU - Costello, Caroline AU - Hynes, Lisa AU - Harris, Aisling AU - Harrahill, Mary AU - Lillis, Mary AU - Atrey, Alison AU - Ski, F. Chantal AU - Savickas, Vilius AU - Byrne, Molly AU - Murphy, W. Andrew AU - McEvoy, William John AU - Wood, David AU - Jennings, Catriona PY - 2024/10/23 TI - Development of a Digital Health Intervention for the Secondary Prevention of Cardiovascular Disease (INTERCEPT): Co-Design and Usability Testing Study JO - JMIR Hum Factors SP - e63707 VL - 11 KW - cardiovascular disease KW - secondary prevention KW - digital health KW - intervention development KW - co-design KW - usability testing KW - mobile health KW - usability KW - design KW - conline workshop KW - social support KW - behavioral change KW - self-monitoring N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e63707 UR - http://dx.doi.org/10.2196/63707 UR - http://www.ncbi.nlm.nih.gov/pubmed/39441626 ID - info:doi/10.2196/63707 ER - TY - JOUR AU - McCullough, May Julie Elizabeth AU - Sinclair, Marlene AU - Gillender, Jonathan AU - McCrossan, Brian AU - Slater, F. Paul AU - Browne, Rosie AU - Casey, Frank PY - 2024/10/22 TI - Touching Technology?Parents? Experiences of Remote Consultations for Children With Severe Congenital Cardiac Conditions: Quasi-Experimental Cohort Study JO - JMIR Pediatr Parent SP - e54598 VL - 7 KW - congenital heart disease KW - pediatric cardiology KW - pediatric cardiologist KW - pediatric KW - parent KW - digital health KW - digital technology KW - digital intervention KW - telemedicine KW - telehealth KW - virtual care KW - virtual health KW - virtual medicine KW - remote consultation KW - telephone consultation KW - video consultation KW - remote patient monitoring KW - technology acceptance KW - videoconferencing consultations N2 - Background: Remote consultations (RCs) using videoconferencing was recommended by the General Medical Council as the method for clinicians to provide patient consultations during the COVID-19 pandemic. Facilitating this while providing high-quality care depends on the usability and acceptability of the technology. Objective: This project aimed to investigate parents? experiences of using videoconferencing technology for real-time RCs with children who had congenital heart defects during the COVID-19 pandemic lockdown. Methods: This study?s design was quasi-experimental and was underpinned by the Unified Theory of Acceptance and Use of Technology model that seeks to explain and predict an individual?s intention to use a technology. Parents were informed of this study by the medical team, posters were made available in the wards and clinics, and leaflets were left for browsing. Clinician screening of potential participants led to the identification of 33 children and parents who were enrolled on this study. The intervention was a web-based RC by medical staff using a secure, interactive videoconferencing platform (Pexip). Each child and their mother or father received 8 RCs with the same specialist doctor or nurse. Measurements were taken using web-based questionnaires pre and post consultation at the first, middle, and last events; questions were focused on the acceptability, usability, and clinical applicability of RCs. Parents? experiences were explored using recorded interviews and analyzed thematically. Results: In total, 29 children aged 4?1052 (mean 95, SD 191.14) days completed the project, receiving a total of 189 RCs as part of their routine care. Parents? prior experience of consultation via videoconference was low; however, as time progressed, their use and acceptance of the technology increased. The intervention was warmly received by all parents who found the face-to-face component particularly useful for discussion with their child?s medical team. Furthermore, parents noted the savings on time, money, and childcare. Conclusions: While in-person consultations are considered the gold standard of patient care, increasing pressures on health services and staff reduce availability. Given the ease of access and additional benefits experienced by parents and their children, it is proposed that hybrid models of consultation and care provision are equal, if not superior, to in-person consultations in the management of children with severe congenital heart defects while reducing costs and pressure on the health service and parents. UR - https://pediatrics.jmir.org/2024/1/e54598 UR - http://dx.doi.org/10.2196/54598 ID - info:doi/10.2196/54598 ER - TY - JOUR AU - Zhou, You AU - Li, Si-Jia AU - Huang, Ren-Qian AU - Ma, Hao-Ming AU - Wang, Ao-Qi AU - Tang, Xing-Yi AU - Pei, Run-Yuan AU - Piao, Mei-Hua PY - 2024/10/22 TI - Behavior Change Techniques Used in Self-Management Interventions Based on mHealth Apps for Adults With Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e54978 VL - 26 KW - hypertension KW - mHealth KW - app KW - behavior change technique KW - systematic review KW - meta-analysis KW - mobile phone N2 - Background: Hypertension has become an important global public health challenge. Mobile health (mHealth) intervention is a viable strategy to improve outcomes for patients with hypertension. However, evidence on the effect of mHealth app interventions on self-management in patients with hypertension is yet to be updated, and the active ingredients promoting behavior change in interventions remain unclear. Objective: We aimed to evaluate the effect of mHealth app self-management interventions on blood pressure (BP) management and investigate the use of behavior change techniques (BCTs) in mHealth app interventions. Methods: We conducted a literature search in 6 electronic databases from January 2009 to October 2023 for studies reporting the application of mHealth apps in self-management interventions. The Cochrane Risk of Bias (version 2) tool for randomized controlled trials was used to assess the quality of the studies. BCTs were coded according to the Taxonomy of BCTs (version 1). The extracted data were analyzed using RevMan5.4 software (Cochrane Collaboration). Results: We reviewed 20 studies, of which 16 were included in the meta-analysis. In total, 21 different BCTs (mean 8.7, SD 3.8 BCTs) from 12 BCT categories were reported in mHealth app interventions. The most common BCTs were self-monitoring of outcomes of behavior, feedback on outcomes of behavior, instruction on how to perform the behavior, and pharmacological support. The mHealth app interventions resulted in a ?5.78 mm Hg (95% CI ?7.97 mm Hg to ?3.59 mm Hg; P<.001) reduction in systolic BP and a ?3.28 mm Hg (95% CI ?4.39 mm Hg to ?2.17 mm Hg; P<.001) reduction in diastolic BP. The effect of interventions on BP reduction was associated with risk factors, such as hypertension, that were addressed by the mHealth app intervention (multiple risk factors vs a single risk factor: ?6.50 mm Hg, 95% CI ?9.00 mm Hg to ?3.99 mm Hg vs ?1.54 mm Hg, 95% CI ?4.15 mm Hg to 1.06 mm Hg; P=.007); the presence of a theoretical foundation (with vs without behavior change theory: ?10.06 mm Hg, 95% CI ?16.42 mm Hg to ?3.70 mm Hg vs ?4.13 mm Hg, 95% CI ?5.50 to ?2.75 mm Hg; P=.07); intervention duration (3 vs ?6 months: ?8.87 mm Hg, 95% CI ?10.90 mm Hg to ?6.83 mm Hg vs ?5.76 mm Hg, 95% CI ?8.74 mm Hg to ?2.77 mm Hg; P=.09); and the number of BCTs (?11 vs <11 BCTs: ?9.68 mm Hg, 95% CI ?13.49 mm Hg to ?5.87 mm Hg vs ?2.88 mm Hg, 95% CI ?3.90 mm Hg to ?1.86 mm Hg; P<.001). Conclusions: The self-management interventions based on mHealth apps were effective strategies for lowering BP in patients with hypertension. The effect of interventions was influenced by factors related to the study?s intervention design and BCT. UR - https://www.jmir.org/2024/1/e54978 UR - http://dx.doi.org/10.2196/54978 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54978 ER - TY - JOUR AU - Po, Hui-Wen AU - Chu, Ying-Chien AU - Tsai, Hui-Chen AU - Lin, Chen-Liang AU - Chen, Chung-Yu AU - Ma, Huei-Ming Matthew PY - 2024/9/13 TI - Efficacy of Remote Health Monitoring in Reducing Hospital Readmissions Among High-Risk Postdischarge Patients: Prospective Cohort Study JO - JMIR Form Res SP - e53455 VL - 8 KW - telemonitoring KW - discharge planning KW - case manager KW - hospital readmission KW - telehealth KW - remote healthcare KW - high-risk KW - post-discharge KW - respiratory disease KW - respiratory diseases KW - cardiovascular disease KW - cardiovascular diseases KW - case management KW - patient education KW - readmission KW - health status tracking KW - care guidance KW - medical advice KW - male KW - men KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - home monitoring KW - physiological signal KW - physiological signals KW - mobile phone N2 - Background: Patients with respiratory or cardiovascular diseases often experience higher rates of hospital readmission due to compromised heart-lung function and significant clinical symptoms. Effective measures such as discharge planning, case management, home telemonitoring follow-up, and patient education can significantly mitigate hospital readmissions. Objective: This study aimed to determine the efficacy of home telemonitoring follow-up in reducing hospital readmissions, emergency department (ED) visits, and total hospital days for high-risk postdischarge patients. Methods: This prospective cohort study was conducted between July and October 2021. High-risk patients were screened for eligibility and enrolled in the study. The intervention involved implementing home digital monitoring to track patient health metrics after discharge, with the aim of reducing hospital readmissions and ED visits. High-risk patients or their primary caregivers received education on using communication measurement tools and recording and uploading data. Before discharge, patients were familiarized with these tools, which they continued to use for 4 weeks after discharge. A project manager monitored the daily uploaded health data, while a weekly video appointment with the program coordinator monitored the heart and breathing sounds of the patients, tracked health status changes, and gathered relevant data. Care guidance and medical advice were provided based on symptoms and physiological signals. The primary outcomes of this study were the number of hospital readmissions and ED visits within 3 and 6 months after intervention. The secondary outcomes included the total number of hospital days and patient adherence to the home monitoring protocol. Results: Among 41 eligible patients, 93% (n=38) were male, and 46% (n=19) were aged 41-60 years, while 46% (n=19) were aged 60 years or older. The study revealed that home digital monitoring significantly reduced hospitalizations, ED visits, and total hospital stay days at 3 and 6 months after intervention. At 3 months after intervention, average hospitalizations decreased from 0.45 (SD 0.09) to 0.19 (SD 0.09; P=.03), and average ED visits decreased from 0.48 (SD 0.09) to 0.06 (SD 0.04; P<.001). Average hospital days decreased from 6.61 (SD 2.25) to 1.94 (SD 1.15; P=.08). At 6 months after intervention, average hospitalizations decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.01), and average ED visits decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.02). Average hospital days decreased from 7.48 (SD 2.32) to 6.03 (SD 3.12; P=.73). Conclusions: By integrating home telemonitoring with regular follow-up, our research demonstrates a viable approach to reducing hospital readmissions and ED visits, ultimately improving patient outcomes and reducing health care costs. The practical application of telemonitoring in a real-world setting showcases its potential as a scalable solution for chronic disease management. UR - https://formative.jmir.org/2024/1/e53455 UR - http://dx.doi.org/10.2196/53455 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53455 ER - TY - JOUR AU - Mir, Hassan AU - Cullen, J. Katelyn AU - Mosleh, Karen AU - Setrak, Rafi AU - Jolly, Sanjit AU - Tsang, Michael AU - Rutledge, Gregory AU - Ibrahim, Quazi AU - Welsford, Michelle AU - Mercuri, Mathew AU - Schwalm, JD AU - Natarajan, K. Madhu PY - 2024/9/6 TI - Smartphone App for Prehospital ECG Transmission in ST-Elevation Myocardial Infarction Activation: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e55506 VL - 13 KW - ST-elevation myocardial infarction KW - m-health KW - cardiac systems of care KW - knowledge mobilization KW - digital health KW - smartphone technology KW - technology KW - STEMI KW - Canada KW - implementation KW - mobile phone N2 - Background: Timely diagnosis and treatment for ST-elevation myocardial infarction (STEMI) requires a coordinated response from multiple providers. Rapid intervention is key to reducing mortality and morbidity. Activation of the cardiac catheterization laboratory may occur through verbal communication and may also involve the secure sharing of electrocardiographic images between frontline health care providers and interventional cardiologists. To improve this response, we developed a quick, easy-to-use, privacy-compliant smartphone app, that is SMART AMI-ACS (Strategic Management of Acute Reperfusion and Therapies in Acute Myocardial Infarction Acute Coronary Syndromes), for real-time verbal communication and sharing of electrocardiographic images among health care providers in Ontario, Canada. The app further provides information about diagnosis, management, and risk calculators for patients presenting with acute coronary syndrome. Objective: This study aims to integrate the app into workflow processes to improve communication for STEMI activation, resulting in decreased treatment times, improved patient outcomes, and reduced unnecessary catheterization laboratory activation and transfer. Methods: Implementation of the app will be guided by the Reach, Effectiveness, Acceptability, Implementation, and Maintenance (RE-AIM) framework to measure impact. The study will use quantitative registry data already being collected through the SMART AMI project (STEMI registry), the use of the SMART AMI app, and quantitative and qualitative survey data from physicians. Survey questions will be based on the Consolidated Framework for Implementation Research. Descriptive quantitative analysis and thematic qualitative analysis of survey results will be conducted. Continuous variables will be described using either mean and SD or median and IQR values at pre- and postintervention periods by the study sites. Categorical variables, such as false activation, will be described as frequencies (percentages). For each outcome, an interrupted time series regression model will be fitted to evaluate the impact of the app. Results: The primary outcomes of this study include the usability, acceptability, and functionality of the app for physicians. This will be measured using electronic surveys to identify barriers and facilitators to app use. Other key outcomes will measure the implementation of the app by reviewing the timing-of-care intervals, false ?avoidable? catheterization laboratory activation rates, and uptake and use of the app by physicians. Prospective evaluation will be conducted between April 1, 2022, and March 31, 2023. However, for the timing- and accuracy-of-care outcomes, registry data will be compared from January 1, 2019, to March 31, 2023. Data analysis is expected to be completed in Fall 2024, with the completion of a paper for publication anticipated by the end of 2024. Conclusions: Smartphone technology is well integrated into clinical practice and widely accessible. The proposed solution being tested is secure and leverages the accessibility of smartphones. Emergency medicine physicians can use this app to quickly, securely, and accurately transmit information ensuring faster and more appropriate decision-making for STEMI activation. Trial Registration: ClinicalTrials.gov NCT05290389; https://clinicaltrials.gov/study/NCT05290389 International Registered Report Identifier (IRRID): DERR1-10.2196/55506 UR - https://www.researchprotocols.org/2024/1/e55506 UR - http://dx.doi.org/10.2196/55506 UR - http://www.ncbi.nlm.nih.gov/pubmed/39240681 ID - info:doi/10.2196/55506 ER - TY - JOUR AU - Pohl, Petra AU - Klerfors, Karoline AU - Kjörk, K. Emma PY - 2024/9/3 TI - Evaluation of a Digital Previsit Tool for Identifying Stroke-Related Health Problems Before a Follow-Up Visit (Part 1): Survey Study JO - JMIR Hum Factors SP - e55852 VL - 11 KW - e-health KW - stroke KW - Strokehälsa KW - follow-up KW - previsit KW - person-centred care KW - health literacy KW - digital tool KW - shared decision-making KW - survey KW - mobile phone N2 - Background: Stroke may lead to various disabilities, and a structured follow-up visit is strongly recommended within a few months after an event. To facilitate this visit, the digital previsit tool ?Strokehealth? was developed for patients to fill out in advance. The concept Strokehälsa (or Strokehealth) was initially developed in-house as a Windows application, later incorporated in 1177.se. Objective: The study?s primary objective was to use a patient satisfaction survey to evaluate the digital previsit tool Strokehealth when used before a follow-up visit, with a focus on feasibility and relevance from the perspective of people with stroke. Our secondary objective was to explore the extent to which the previsit tool identified stroke-related health problems. Methods: Between November 2020 and June 2021, a web-based survey was sent to patients who were scheduled for a follow-up visit after discharge from a stroke unit and had recently filled in the previsit tool. The survey covered demographic characteristics, internet habits, and satisfaction rated using 5 response options. Descriptive statistics were used to present data from both the previsit tool and the survey. We also compared the characteristics of those who completed the previsit tool and those who did not, using nonparametric statistics. Free-text responses were thematically analyzed. Results: All patients filling out the previsit tool (80/171; age: median 67, range 32-91 years) were community-dwelling. Most had experienced a mild stroke and reported a median of 2 stroke-related health problems (range 0-8), and they were significantly younger than nonresponders (P<.001). The survey evaluating the previsit tool was completed by 73% (58/80; 39 men). The majority (48/58, 83%) reported using the internet daily. Most respondents (56/58, 97%) were either satisfied (n=15) or very satisfied (n=41) with how well the previsit tool captured their health problems. The highest level of dissatisfaction was related to the response options in Strokehealth (n=5). Based on the free-text answers to the survey, we developed 4 themes. First, Strokehealth was perceived to provide a structure that ensured that issues would be emphasized and considered. Second, user-friendliness and accessibility were viewed as acceptable, although respondents suggested improvements. Third, participants raised awareness about being approached digitally for communication and highlighted the importance of how to be approached. Fourth, their experiences with Strokehealth were influenced by their perceptions of the explanatory texts, the response options, and the possibility of elaborating on their answers in free text. Conclusions: People with stroke considered the freely available previsit tool Strokehealth feasible for preparing in advance for a follow-up visit. Despite high satisfaction with how well the tool captured their health problems, participants indicated that additional free-text responses and revised information could enhance usability. Improvements need to be considered in parallel with qualitative data to ensure that the tool meets patient needs. Trial Registration: Researchweb 275135; https://www.researchweb.org/is/vgr/project/275135 UR - https://humanfactors.jmir.org/2024/1/e55852 UR - http://dx.doi.org/10.2196/55852 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55852 ER - TY - JOUR AU - Klassen, A. Stephen AU - Jabbar, Jesica AU - Osborne, Jenna AU - Iannarelli, J. Nathaniel AU - Kirby, S. Emerson AU - O'Leary, D. Deborah AU - Locke, Sean PY - 2024/8/20 TI - Examining the Light Heart Mobile Device App for Assessing Human Pulse Interval and Heart Rate Variability: Validation Study JO - JMIR Form Res SP - e56921 VL - 8 KW - pulse interval KW - mobile app KW - validation KW - mHealth KW - mHealth app KW - app mobile device KW - mobile device app KW - pulse KW - heart KW - heart rate KW - validation study KW - biomarker KW - psychological KW - physiological KW - pulse rate KW - young adults KW - youth KW - linear correlation KW - heart rate variability KW - examining KW - examine KW - validity KW - psychological health KW - physiological health KW - interval data KW - mobile phone N2 - Background: Pulse interval is a biomarker of psychological and physiological health. Pulse interval can now be assessed using mobile phone apps, which expands researchers? ability to assess pulse interval in the real world. Prior to implementation, measurement accuracy should be established. Objective: This investigation evaluated the validity of the Light Heart mobile app to measure pulse interval and pulse rate variability in healthy young adults. Methods: Validity was assessed by comparing the pulse interval and SD of normal pulse intervals obtained by Light Heart to the gold standard, electrocardiogram (ECG), in 14 young healthy individuals (mean age 24, SD 5 years; n=9, 64% female) in a seated posture. Results: Mean pulse interval (Light Heart: 859, SD 113 ms; ECG: 857, SD 112 ms) demonstrated a strong positive linear correlation (r=0.99; P<.001) and strong agreement (intraclass correlation coefficient=1.00, 95% CI 0.99-1.00) between techniques. The Bland-Altman plot demonstrated good agreement for the mean pulse interval measured with Light Heart and ECG with evidence of fixed bias (?1.56, SD 1.86; 95% CI ?5.2 to 2.1 ms), suggesting that Light Heart overestimates pulse interval by a small margin. When Bland-Altman plots were constructed for each participant?s beat-by-beat pulse interval data, all participants demonstrated strong agreement between Light Heart and ECG with no evidence of fixed bias between measures. Heart rate variability, assessed by SD of normal pulse intervals, demonstrated strong agreement between techniques (Light Heart: mean 73, SD 23 ms; ECG: mean 73, SD 22 ms; r=0.99; P<.001; intraclass correlation coefficient=0.99, 95% CI 0.97-1.00). Conclusions: This study provides evidence to suggest that the Light Heart mobile app provides valid measures of pulse interval and heart rate variability in healthy young adults. UR - https://formative.jmir.org/2024/1/e56921 UR - http://dx.doi.org/10.2196/56921 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56921 ER - TY - JOUR AU - Urien, Marie Jean AU - Berthelot, Emmanuelle AU - Raphael, Pierre AU - Moine, Thomas AU - Lopes, Emilie Marie AU - Assayag, Patrick AU - Jourdain, Patrick PY - 2024/8/13 TI - Evaluation of a New Telemedicine System for Early Detection of Cardiac Instability in Patients With Chronic Heart Failure: Real-Life Out-of-Hospital Study JO - JMIR Cardio SP - e52648 VL - 8 KW - telemedicine system KW - follow-up KW - detection KW - heart failure KW - chronic heart failure KW - CHF KW - heart disease KW - ambulatory patient KW - ambulatory patients KW - home-based KW - TwoCan Pulse KW - telecardiology KW - cardiology KW - e-device KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - effectiveness KW - real-life setting KW - remote monitoring KW - virtual monitoring KW - France KW - men KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older man KW - ageing KW - aging N2 - Background: For a decade, despite results from many studies, telemedicine systems have suffered from a lack of recommendations for chronic heart failure (CHF) care because of variable study results. Another limitation is the hospital-based architecture of most telemedicine systems. Some systems use an algorithm based on daily weight, transcutaneous oxygen measurement, and heart rate to detect and treat acute heart failure (AHF) in patients with CHF as early on as possible. Objective: The aim of this study is to determine the efficacy of a telemonitoring system in detecting clinical destabilization in real-life settings (out-of-hospital management) without generating too many false positive alerts. Methods: All patients self-monitoring at home using the system after a congestive AHF event treated at a cardiology clinic in France between March 2020 and March 2021 with at least 75% compliance on daily measurements were included retrospectively. New-onset AHF was defined by the presence of at least 1 of the following criteria: transcutaneous oxygen saturation loss, defined as a transcutaneous oxygen measurement under 90%; rise of cardiac frequency above 110 beats per minute; weight gain of at least 2 kg; and symptoms of congestive AHF, described over the phone. An AHF alert was generated when the criteria reached our definition of new-onset acute congestive heart failure (HF). Results: A total of 111 consecutive patients (n=70 men) with a median age of 76.60 (IQR 69.5-83.4) years receiving the telemonitoring system were included. Thirty-nine patients (35.1%) reached the HF warning level, and 28 patients (25%) had confirmed HF destabilization during follow-up. No patient had AHF without being detected by the telemonitoring system. Among incorrect AHF alerts (n=11), 5 patients (45%) had taken inaccurate measurements, 3 patients (27%) had supraventricular arrhythmia, 1 patient (9%) had a pulmonary bacterial infection, and 1 patient (9%) contracted COVID-19. A weight gain of at least 2 kg within 4 days was significantly associated with a correct AHF alert (P=.004), and a heart rate of more than 110 beats per minute was more significantly associated with an incorrect AHF alert (P=.007). Conclusions: This single-center study highlighted the efficacy of the telemedicine system in detecting and quickly treating cardiac instability complicating the course of CHF by detecting new-onset AHF as well as supraventricular arrhythmia, thus helping cardiologists provide better follow-up to ambulatory patients. UR - https://cardio.jmir.org/2024/1/e52648 UR - http://dx.doi.org/10.2196/52648 UR - http://www.ncbi.nlm.nih.gov/pubmed/39137030 ID - info:doi/10.2196/52648 ER - TY - JOUR AU - Carter, Carter Jocelyn A. AU - Swack, Natalia AU - Isselbacher, Eric AU - Donelan, Karen AU - Thorndike, Anne PY - 2024/8/8 TI - Feasibility, Acceptability, and Preliminary Effectiveness of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Pilot Randomized Controlled Trial JO - JMIR Cardio SP - e59948 VL - 8 KW - heart failure KW - heart KW - cardiology KW - failure KW - clinical pilot trial KW - digital platform KW - home KW - digital health KW - remote monitoring KW - monitoring KW - home-based care KW - community health workers KW - social needs care KW - randomized controlled trial KW - controlled trials KW - feasibility KW - usability KW - acceptability KW - social needs N2 - Background: Heart failure (HF) is a burdensome condition and a leading cause of 30-day hospital readmissions in the United States. Clinical and social factors are key drivers of hospitalization. These 2 strategies, digital platforms and home-based social needs care, have shown preliminary effectiveness in improving adherence to clinical care plans and reducing acute care use in HF. Few studies, if any, have tested combining these 2 strategies in a single intervention. Objective: This study aims to perform a pilot randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of a 30-day digitally-enabled community health worker (CHW) intervention in HF. Methods: Adults hospitalized with a diagnosis of HF at an academic hospital were randomly assigned to receive digitally-enabled CHW care (intervention; digital platform +CHW) or CHW-enhanced usual care (control; CHW only) for 30 days after hospital discharge. Primary outcomes were feasibility (use of the platform) and acceptability (willingness to use the platform in the future). Secondary outcomes assessed preliminary effectiveness (30-day readmissions, emergency department visits, and missed clinic appointments). Results: A total of 56 participants were randomized (control: n=31; intervention: n=25) and 47 participants (control: n=28; intervention: n=19) completed all trial activities. Intervention participants who completed trial activities wore the digital sensor on 78% of study days with mean use of 11.4 (SD 4.6) hours/day, completed symptom questionnaires on 75% of study days, used the blood pressure monitor 1.1 (SD 0.19) times/day, and used the digital weight scale 1 (SD 0.13) time/day. Of intervention participants, 100% responded very or somewhat true to the statement ?If I have access to the [platform] moving forward, I will use it.? Some (n=9, 47%) intervention participants indicated they required support to use the digital platform. A total of 19 (100%) intervention participants and 25 (89%) control participants had ?5 CHW interactions during the 30-day study period. All intervention (n=19, 100%) and control (n=26, 93%) participants who completed trial activities indicated their CHW interactions were ?very satisfying.? In the full sample (N=56), fewer participants in the intervention group were readmitted 30 days after hospital discharge compared to the control group (n=3, 12% vs n=8, 26%; P=.12). Both arms had similar rates of missed clinic appointments and emergency department visits. Conclusions: This pilot trial of a digitally-enabled CHW intervention for HF demonstrated feasibility, acceptability, and a clinically relevant reduction in 30-day readmissions among participants who received the intervention. Additional investigation is needed in a larger trial to determine the effect of this intervention on HF home management and clinical outcomes. Trial Registration: Clinicaltrials.gov NCT05130008; https://clinicaltrials.gov/study/NCT05130008 International Registered Report Identifier (IRRID): RR2-10.2196/55687 UR - https://cardio.jmir.org/2024/1/e59948 UR - http://dx.doi.org/10.2196/59948 UR - http://www.ncbi.nlm.nih.gov/pubmed/38959294 ID - info:doi/10.2196/59948 ER - TY - JOUR AU - Gaur, Pooja AU - Temple, S. Dorota AU - Hegarty-Craver, Meghan AU - Boyce, D. Matthew AU - Holt, R. Jonathan AU - Wenger, F. Michael AU - Preble, A. Edward AU - Eckhoff, P. Randall AU - McCombs, S. Michelle AU - Davis-Wilson, C. Hope AU - Walls, J. Howard AU - Dausch, E. David PY - 2024/8/7 TI - Continuous Monitoring of Heart Rate Variability in Free-Living Conditions Using Wearable Sensors: Exploratory Observational Study JO - JMIR Form Res SP - e53977 VL - 8 KW - heart rate variability KW - physiological monitoring KW - wearable sensors KW - smartwatch KW - PPG KW - photoplethysmography KW - monitoring KW - physiological KW - heart rate KW - wearable KW - wearables KW - sensor KW - sensors KW - observation study KW - wearable devices KW - devices KW - remote monitoring KW - community KW - data platform KW - data collection KW - health risk N2 - Background: Wearable physiological monitoring devices are promising tools for remote monitoring and early detection of potential health changes of interest. The widespread adoption of such an approach across communities and over long periods of time will require an automated data platform for collecting, processing, and analyzing relevant health information. Objective: In this study, we explore prospective monitoring of individual health through an automated data collection, metrics extraction, and health anomaly analysis pipeline in free-living conditions over a continuous monitoring period of several months with a focus on viral respiratory infections, such as influenza or COVID-19. Methods: A total of 59 participants provided smartwatch data and health symptom and illness reports daily over an 8-month window. Physiological and activity data from photoplethysmography sensors, including high-resolution interbeat interval (IBI) and step counts, were uploaded directly from Garmin Fenix 6 smartwatches and processed automatically in the cloud using a stand-alone, open-source analytical engine. Health risk scores were computed based on a deviation in heart rate and heart rate variability metrics from each individual?s activity-matched baseline values, and scores exceeding a predefined threshold were checked for corresponding symptoms or illness reports. Conversely, reports of viral respiratory illnesses in health survey responses were also checked for corresponding changes in health risk scores to qualitatively assess the risk score as an indicator of acute respiratory health anomalies. Results: The median average percentage of sensor data provided per day indicating smartwatch wear compliance was 70%, and survey responses indicating health reporting compliance was 46%. A total of 29 elevated health risk scores were detected, of which 12 (41%) had concurrent survey data and indicated a health symptom or illness. A total of 21 influenza or COVID-19 illnesses were reported by study participants; 9 (43%) of these reports had concurrent smartwatch data, of which 6 (67%) had an increase in health risk score. Conclusions: We demonstrate a protocol for data collection, extraction of heart rate and heart rate variability metrics, and prospective analysis that is compatible with near real-time health assessment using wearable sensors for continuous monitoring. The modular platform for data collection and analysis allows for a choice of different wearable sensors and algorithms. Here, we demonstrate its implementation in the collection of high-fidelity IBI data from Garmin Fenix 6 smartwatches worn by individuals in free-living conditions, and the prospective, near real-time analysis of the data, culminating in the calculation of health risk scores. To our knowledge, this study demonstrates for the first time the feasibility of measuring high-resolution heart IBI and step count using smartwatches in near real time for respiratory illness detection over a long-term monitoring period in free-living conditions. UR - https://formative.jmir.org/2024/1/e53977 UR - http://dx.doi.org/10.2196/53977 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53977 ER - TY - JOUR AU - Chen, Wenfei AU - Chen, Jiana AU - Jiang, Shaojun AU - Wang, Chunhua AU - Zhang, Jinhua PY - 2024/7/29 TI - Web-Based Warfarin Management (Alfalfa App) Versus Traditional Warfarin Management: Multicenter Prospective Cohort Study JO - J Med Internet Res SP - e46319 VL - 26 KW - warfarin KW - telemedicine KW - smart phone application KW - anti-coagulation management KW - management KW - cohort study KW - application KW - chronic disease KW - support KW - effectiveness KW - online model KW - patient management N2 - Background: Poor anticoagulation management of warfarin may lead to patient admission, prolonged hospital stays, and even death due to anticoagulation-related adverse events. Traditional non?web-based outpatient clinics struggle to provide ideal anticoagulation management services for patients, and there is a need to explore a safer, more effective, and more convenient mode of warfarin management. Objective: This study aimed to compare differences in the quality of anticoagulation management and clinical adverse events between a web-based management model (via a smartphone app) and the conventional non?web-based outpatient management model. Methods: This study is a prospective cohort research that includes multiple national centers. Patients meeting the nadir criteria were split into a web-based management group using the Alfalfa app or a non?web-based management group with traditional outpatient management, and they were then monitored for a 6-month follow-up period to collect coagulation test results and clinical events. The effectiveness and safety of the 2 management models were assessed by the following indicators: time in therapeutic range (TTR), bleeding events, thromboembolic events, all-cause mortality events, cumulative event rates, and the distribution of the international normalized ratio (INR). Results: This national multicenter cohort study enrolled 522 patients between June 2019 and May 2021, with 519 (99%) patients reaching the follow-up end point, including 260 (50%) in the non?web-based management group and 259 (50%) in the web-based management group. There were no observable differences in baseline characteristics between the 2 patient groups. The web-based management group had a significantly higher TTR than the non?web-based management group (82.4% vs 71.6%, P<.001), and a higher proportion of patients received effective anticoagulation management (81.2% vs 63.5%, P<.001). The incidence of minor bleeding events in the non?web-based management group was significantly higher than that in the web-based management group (12.1% vs 6.6%, P=.048). Between the 2 groups, there was no statistically significant difference in the incidence of severe bleeding and thromboembolic and all-cause death events. In addition, compared with the non?web-based management group, the web-based management group had a lower proportion of INR in the extreme subtreatment range (17.6% vs 21.3%) and severe supertreatment range (0% vs 0.8%) and a higher proportion in the treatment range (50.4% vs 43.1%), with statistical significance. Conclusions: Compared with traditional non?web-based outpatient management, web-based management via the Alfalfa app may be more beneficial because it can enhance patient anticoagulation management quality, lower the frequency of small bleeding events, and improve INR distribution. UR - https://www.jmir.org/2024/1/e46319 UR - http://dx.doi.org/10.2196/46319 UR - http://www.ncbi.nlm.nih.gov/pubmed/39073869 ID - info:doi/10.2196/46319 ER - TY - JOUR AU - Razjouyan, Javad AU - Orkaby, R. Ariela AU - Horstman, J. Molly AU - Goyal, Parag AU - Intrator, Orna AU - Naik, D. Aanand PY - 2024/6/27 TI - The Frailty Trajectory?s Additional Edge Over the Frailty Index: Retrospective Cohort Study of Veterans With Heart Failure JO - JMIR Aging SP - e56345 VL - 7 KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - frailty KW - frailty index KW - frailty trajectory KW - frail KW - weak KW - weakness KW - heart failure KW - HF KW - cardiovascular disease KW - CVD KW - congestive heart failure KW - CHF KW - myocardial infarction KW - MI KW - unstable angina KW - angina KW - cardiac arrest KW - atherosclerosis KW - cardiology KW - cardiac KW - cardiologist KW - cardiologists UR - https://aging.jmir.org/2024/1/e56345 UR - http://dx.doi.org/10.2196/56345 ID - info:doi/10.2196/56345 ER - TY - JOUR AU - Huecker, Martin AU - Schutzman, Craig AU - French, Joshua AU - El-Kersh, Karim AU - Ghafghazi, Shahab AU - Desai, Ravi AU - Frick, Daniel AU - Thomas, Jeremy Jarred PY - 2024/6/26 TI - Accurate Modeling of Ejection Fraction and Stroke Volume With Mobile Phone Auscultation: Prospective Case-Control Study JO - JMIR Cardio SP - e57111 VL - 8 KW - ejection fraction KW - stroke volume KW - auscultation KW - digital health KW - telehealth KW - acoustic recording KW - acoustic recordings KW - acoustic KW - mHealth KW - mobile health KW - mobile phone KW - mobile phones KW - heart failure KW - heart KW - cardiac KW - cardiology KW - health care costs KW - audio KW - echocardiographic KW - echocardiogram KW - ultrasonography KW - echocardiography KW - accuracy KW - monitoring KW - telemonitoring KW - recording KW - recordings KW - ejection KW - machine learning KW - algorithm KW - algorithms N2 - Background: Heart failure (HF) contributes greatly to morbidity, mortality, and health care costs worldwide. Hospital readmission rates are tracked closely and determine federal reimbursement dollars. No current modality or technology allows for accurate measurement of relevant HF parameters in ambulatory, rural, or underserved settings. This limits the use of telehealth to diagnose or monitor HF in ambulatory patients. Objective: This study describes a novel HF diagnostic technology using audio recordings from a standard mobile phone. Methods: This prospective study of acoustic microphone recordings enrolled convenience samples of patients from 2 different clinical sites in 2 separate areas of the United States. Recordings were obtained at the aortic (second intercostal) site with the patient sitting upright. The team used recordings to create predictive algorithms using physics-based (not neural networks) models. The analysis matched mobile phone acoustic data to ejection fraction (EF) and stroke volume (SV) as evaluated by echocardiograms. Using the physics-based approach to determine features eliminates the need for neural networks and overfitting strategies entirely, potentially offering advantages in data efficiency, model stability, regulatory visibility, and physical insightfulness. Results: Recordings were obtained from 113 participants. No recordings were excluded due to background noise or for any other reason. Participants had diverse racial backgrounds and body surface areas. Reliable echocardiogram data were available for EF from 113 patients and for SV from 65 patients. The mean age of the EF cohort was 66.3 (SD 13.3) years, with female patients comprising 38.3% (43/113) of the group. Using an EF cutoff of ?40% versus >40%, the model (using 4 features) had an area under the receiver operating curve (AUROC) of 0.955, sensitivity of 0.952, specificity of 0.958, and accuracy of 0.956. The mean age of the SV cohort was 65.5 (SD 12.7) years, with female patients comprising 34% (38/65) of the group. Using a clinically relevant SV cutoff of <50 mL versus >50 mL, the model (using 3 features) had an AUROC of 0.922, sensitivity of 1.000, specificity of 0.844, and accuracy of 0.923. Acoustics frequencies associated with SV were observed to be higher than those associated with EF and, therefore, were less likely to pass through the tissue without distortion. Conclusions: This work describes the use of mobile phone auscultation recordings obtained with unaltered cellular microphones. The analysis reproduced the estimates of EF and SV with impressive accuracy. This technology will be further developed into a mobile app that could bring screening and monitoring of HF to several clinical settings, such as home or telehealth, rural, remote, and underserved areas across the globe. This would bring high-quality diagnostic methods to patients with HF using equipment they already own and in situations where no other diagnostic and monitoring options exist. UR - https://cardio.jmir.org/2024/1/e57111 UR - http://dx.doi.org/10.2196/57111 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57111 ER - TY - JOUR AU - Vögeli, Benjamin AU - Arenja, Nisha AU - Schütz, Narayan AU - Nef, Tobias AU - Buluschek, Philipp AU - Saner, Hugo PY - 2024/5/31 TI - Evaluation of Ambient Sensor Systems for the Early Detection of Heart Failure Decompensation in Older Patients Living at Home Alone: Protocol for a Prospective Cohort Study JO - JMIR Res Protoc SP - e55953 VL - 13 KW - heart failure KW - home telemonitoring KW - digital health KW - biomarker KW - ambient sensor system N2 - Background: The results of telemedicine intervention studies in patients with heart failure (HF) to reduce rehospitalization rate and mortality by early detection of HF decompensation are encouraging. However, the benefits are lower than expected. A possible reason for this could be the fact that vital signs, including blood pressure, heart rate, heart rhythm, and weight changes, may not be ideal indicators of the early stages of HF decompensation but are more sensitive for acute events triggered by ischemic episodes or rhythm disturbances. Preliminary results indicate a potential role of ambient sensor?derived digital biomarkers in this setting. Objective: The aim of this study is to identify changes in ambient sensor system?derived digital biomarkers with a high potential for early detection of HF decompensation. Methods: This is a prospective interventional cohort study. A total of 24 consecutive patients with HF aged 70 years and older, living alone, and hospitalized for HF decompensation will be included. Physical activity in the apartment and toilet visits are quantified using a commercially available, passive, infrared motion sensing system (DomoHealth SA). Heart rate, respiration rate, and toss-and-turns in bed are recorded by using a commercially available Emfit QS device (Emfit Ltd), which is a contact-free piezoelectric sensor placed under the participant?s mattress. Sensor data are visualized on a dedicated dashboard for easy monitoring by health professionals. Digital biomarkers are evaluated for predefined signs of HF decompensation, including particularly decreased physical activity; time spent in bed; increasing numbers of toilet visits at night; and increasing heart rate, respiration rate, and motion in bed at night. When predefined changes in digital biomarkers occur, patients will be called in for clinical evaluation, and N-terminal pro b-type natriuretic peptide measurement (an increase of >30% considered as significant) will be performed. The sensitivity and specificity of the different biomarkers and their combinations for the detection of HF decompensation will be calculated. Results: The study is in the data collection phase. Study recruitment started in February 2024. Data analysis is scheduled to start after all data are collected. As of manuscript submission, 5 patients have been recruited. Results are expected to be published by the end of 2025. Conclusions: The results of this study will add to the current knowledge about opportunities for telemedicine to monitor older patients with HF living at home alone by evaluating the potential of ambient sensor systems for this purpose. Timely recognition of HF decompensation could enable proactive management, potentially reducing health care costs associated with preventable emergency presentations or hospitalizations. Trial Registration: ClinicalTrials.gov NCT06126848; https://clinicaltrials.gov/study/NCT06126848 International Registered Report Identifier (IRRID): PRR1-10.2196/55953 UR - https://www.researchprotocols.org/2024/1/e55953 UR - http://dx.doi.org/10.2196/55953 UR - http://www.ncbi.nlm.nih.gov/pubmed/38820577 ID - info:doi/10.2196/55953 ER - TY - JOUR AU - Mittal, Ajay AU - Elkaldi, Yasmine AU - Shih, Susana AU - Nathu, Riken AU - Segal, Mark PY - 2024/5/27 TI - Mobile Electrocardiograms in the Detection of Subclinical Atrial Fibrillation in High-Risk Outpatient Populations: Protocol for an Observational Study JO - JMIR Res Protoc SP - e52647 VL - 13 KW - mobile ECG KW - digital health KW - cardiology KW - ECG KW - electrocardiogram KW - atrial fibrillation KW - outpatient KW - randomized KW - controlled trial KW - controlled trials KW - smartphone KW - mobile health KW - app KW - apps KW - feasibility KW - effectiveness KW - KardiaMobile single-lead ECGs KW - mobile phone N2 - Background: Single-lead, smartphone-based mobile electrocardiograms (ECGs) have the potential to provide a noninvasive, rapid, and cost-effective means of screening for atrial fibrillation (AFib) in outpatient settings. AFib has been associated with various comorbid diseases that prompt further investigation and screening methodologies for at-risk populations. A simple 30-second sinus rhythm strip from the KardiaMobile ECG (AliveCor) can provide an effective screen for cardiac rhythm abnormalities. Objective: The aim of this study is to demonstrate the feasibility of performing Kardia-enabled ECG recordings routinely in outpatient settings in high-risk populations and its potential use in uncovering previous undiagnosed cases of AFib. Specific aim 1 is to determine the feasibility and accuracy of performing routine cardiac rhythm sampling in patients deemed at high risk for AFib. Specific aim 2 is to determine whether routine rhythm sampling in outpatient clinics with high-risk patients can be used cost-effectively in an outpatient clinic without increasing the time it takes for the patient to be seen by a physician. Methods: Participants were recruited across 6 clinic sites across the University of Florida Health Network: University of Florida Health Nephrology, Sleep Center, Ophthalmology, Urology, Neurology, and Pre-Surgical. Participants, aged 18-99 years, who agreed to partake in the study were given a consent form and completed a questionnaire regarding their past medical history and risk factors for cardiovascular disease. Single-lead, 30-second ECGs were taken by the KardiaMobile ECG device. If patients are found to have newly diagnosed AFib, the attending physician is notified, and a 12-lead ECG or standard ECG equivalent will be ordered. Results: As of March 1, 2024, a total of 2339 participants have been enrolled. Of the data collected thus far, the KardiaMobile rhythm strip reported 381 abnormal readings, which are pending analysis from a cardiologist. A total of 78 readings were labeled as possible AFib, 159 readings were labeled unclassified, and 49 were unreadable. Of note, the average age of participants was 61 (SD 10.25) years, and the average self-reported weight was 194 (SD 14.26) pounds. Additionally, 1572 (67.25%) participants report not regularly seeing a cardiologist. Regarding feasibility, the average length of enrolling a patient into the study was 3:30 (SD 0.5) minutes after informed consent was completed, and medical staff across clinic sites (n=25) reported 9 of 10 level of satisfaction with the impact of the screening on clinic flow. Conclusions: Preliminary data show promise regarding the feasibility of using KardiaMobile ECGs for the screening of AFib and prevention of cardiological disease in vulnerable outpatient populations. The use of a single-lead mobile ECG strip can serve as a low-cost, effective AFib screen for implementation across free clinics attempting to provide increased health care accessibility. International Registered Report Identifier (IRRID): DERR1-10.2196/52647 UR - https://www.researchprotocols.org/2024/1/e52647 UR - http://dx.doi.org/10.2196/52647 UR - http://www.ncbi.nlm.nih.gov/pubmed/38801762 ID - info:doi/10.2196/52647 ER - TY - JOUR AU - Zakiyah, Neily AU - Marulin, Dita AU - Alfaqeeh, Mohammed AU - Puspitasari, Melyani Irma AU - Lestari, Keri AU - Lim, Keat Ka AU - Fox-Rushby, Julia PY - 2024/4/30 TI - Economic Evaluations of Digital Health Interventions for Patients With Heart Failure: Systematic Review JO - J Med Internet Res SP - e53500 VL - 26 KW - digital health KW - telemonitoring KW - telehealth KW - heart failure KW - cost-effectiveness KW - systematic review KW - mobile phone N2 - Background: Digital health interventions (DHIs) have shown promising results in enhancing the management of heart failure (HF). Although health care interventions are increasingly being delivered digitally, with growing evidence on the potential cost-effectiveness of adopting them, there has been little effort to collate and synthesize the findings. Objective: This study?s objective was to systematically review the economic evaluations that assess the adoption of DHIs in the management and treatment of HF. Methods: A systematic review was conducted using 3 electronic databases: PubMed, EBSCOhost, and Scopus. Articles reporting full economic evaluations of DHIs for patients with HF published up to July 2023 were eligible for inclusion. Study characteristics, design (both trial based and model based), input parameters, and main results were extracted from full-text articles. Data synthesis was conducted based on the technologies used for delivering DHIs in the management of patients with HF, and the findings were analyzed narratively. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. The reporting quality of the included studies was evaluated using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Results: Overall, 27 economic evaluations were included in the review. The economic evaluations were based on models (13/27, 48%), trials (13/27, 48%), or a combination approach (1/27, 4%). The devices evaluated included noninvasive remote monitoring devices (eg, home telemonitoring using digital tablets or specific medical devices that enable transmission of physiological data), telephone support, mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems. Most of the studies (24/27, 89%) used cost-utility analysis. The majority of the studies (25/27, 93%) were conducted in high-income countries, particularly European countries (16/27, 59%) such as the United Kingdom and the Netherlands. Mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems yielded cost-effective results or even emerged as dominant strategies. However, conflicting results were observed, particularly in noninvasive remote monitoring devices and telephone support. In 15% (4/27) of the studies, these DHIs were found to be less costly and more effective than the comparators (ie, dominant), while 33% (9/27) reported them to be more costly but more effective with incremental cost-effectiveness ratios below the respective willingness-to-pay thresholds (ie, cost-effective). Furthermore, in 11% (3/27) of the studies, noninvasive remote monitoring devices and telephone support were either above the willingness-to-pay thresholds or more costly than, yet as effective as, the comparators (ie, not cost-effective). In terms of reporting quality, the studies were classified as good (20/27, 74%), moderate (6/27, 22%), or excellent (1/27, 4%). Conclusions: Despite the conflicting results, the main findings indicated that, overall, DHIs were more cost-effective than non-DHI alternatives. Trial Registration: PROSPERO CRD42023388241; https://tinyurl.com/2p9axpmc UR - https://www.jmir.org/2024/1/e53500 UR - http://dx.doi.org/10.2196/53500 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687991 ID - info:doi/10.2196/53500 ER - TY - JOUR AU - Raes, Sarah AU - Prezzi, Andrea AU - Willems, Rik AU - Heidbuchel, Hein AU - Annemans, Lieven PY - 2024/4/19 TI - Investigating the Cost-Effectiveness of Telemonitoring Patients With Cardiac Implantable Electronic Devices: Systematic Review JO - J Med Internet Res SP - e47616 VL - 26 KW - systematic review KW - cost-effectiveness KW - telemonitoring KW - cardiac device KW - implantable cardioverter-defibrillator KW - ICD KW - pacemaker KW - monitoring KW - patient management KW - effectiveness KW - cost KW - quality of life KW - cardiac implantable electronic device KW - cardiac N2 - Background: Telemonitoring patients with cardiac implantable electronic devices (CIEDs) can improve their care management. However, the results of cost-effectiveness studies are heterogeneous. Therefore, it is still a matter of debate whether telemonitoring is worth the investment. Objective: This systematic review aims to investigate the cost-effectiveness of telemonitoring patients with CIEDs, focusing on its key drivers, and the impact of the varying perspectives. Methods: A systematic review was performed in PubMed, Web of Science, Embase, and EconLit. The search was completed on July 7, 2022. Studies were included if they fulfilled the following criteria: patients had a CIED, comparison with standard care, and inclusion of health economic evaluations (eg, cost-effectiveness analyses and cost-utility analyses). Only complete and peer-reviewed studies were included, and no year limits were applied. The exclusion criteria included studies with partial economic evaluations, systematic reviews or reports, and studies without standard care as a control group. Besides general study characteristics, the following outcome measures were extracted: impact on total cost or income, cost or income drivers, cost or income drivers per patient, cost or income drivers as a percentage of the total cost impact, incremental cost-effectiveness ratios, or cost-utility ratios. Quality was assessed using the Consensus Health Economic Criteria checklist. Results: Overall, 15 cost-effectiveness analyses were included. All studies were performed in Western countries, mainly Europe, and had primarily a male participant population. Of the 15 studies, 3 (20%) calculated the incremental cost-effectiveness ratio, 1 (7%) the cost-utility ratio, and 11 (73%) the health and cost impact of telemonitoring. In total, 73% (11/15) of the studies indicated that telemonitoring of patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy ICDs was cost-effective and cost-saving, both from a health care and patient perspective. Cost-effectiveness results for telemonitoring of patients with pacemakers were inconclusive. The key drivers for cost reduction from a health care perspective were hospitalizations and scheduled in-office visits. Hospitalization costs were reduced by up to US $912 per patient per year. Scheduled in-office visits included up to 61% of the total cost reduction. Key drivers for cost reduction from a patient perspective were loss of income, cost for scheduled in-office visits and transport. Finally, of the 15 studies, 8 (52%) reported improved quality of life, with statistically significance in only 1 (13%) study (P=.03). Conclusions: From a health care and patient perspective, telemonitoring of patients with an ICD or a cardiac resynchronization therapy ICD is a cost-effective and cost-saving alternative to standard care. Inconclusive results were found for patients with pacemakers. However, telemonitoring can lead to a decrease in providers? income, mainly due to a lack of reimbursement. Introducing appropriate reimbursement could make telemonitoring sustainable for providers while still being cost-effective from a health care payer perspective. Trial Registration: PROSPERO CRD42022322334; https://tinyurl.com/puunapdr UR - https://www.jmir.org/2024/1/e47616 UR - http://dx.doi.org/10.2196/47616 UR - http://www.ncbi.nlm.nih.gov/pubmed/38640471 ID - info:doi/10.2196/47616 ER - TY - JOUR AU - Han, Yunmin AU - Sung, Hoyong AU - Kim, Geonhui AU - Ryu, Yeun AU - Yoon, Jiyeon AU - Kim, Soo Yeon PY - 2024/4/18 TI - Effects of a Web-based Weight Management Education Program on Various Factors for Overweight and Obese Women: Randomized Controlled Trial JO - JMIR Cardio SP - e42402 VL - 8 KW - weight loss KW - obesity KW - health education KW - self-management KW - health promotion KW - tailored feedback KW - web-based intervention KW - behavior change N2 - Background: Mediated diet and exercise methods yield effective short-term weight loss but are costly and hard to manage. However, web-based programs can serve many participants, offering ease of access and cost-efficiency. Objective: This study aimed to compare the effectiveness of a web-based weight management program through web-based education alone (MINE) or combined with tailored video feedback (MINE Plus) with a control (CO) group. Methods: This intervention included 60 Korean women with overweight and obesity (BMI?23 kg/m2) aged 19 years to 39 years old. We randomly allocated 60 participants to each of 3 groups: (1) MINE group (web-based education video and self-monitoring app), (2) MINE Plus group (web-based education video, self-monitoring app, and 1:1 tailored video feedback), and (3) CO group (only self-monitoring app). Web-based education included nutrition, physical activity, psychological factors, medical knowledge for weight loss, goal setting, and cognitive and behavioral strategies. Tailored feedback aimed to motivate and provide solutions via weekly 10-minute real-time video sessions. The intervention lasted 6 weeks, followed by a 6-week observation period to assess the education's lasting effects, with evaluations at baseline, 6 weeks, and 12 weeks. A generalized linear mixed model was used to evaluate time and group interactions. Results: In the intention-to-treat analysis including all 60 participants, there were significant differences in weight change at 6 weeks in the MINE and MINE Plus groups, with mean weight changes of ?0.74 (SD 1.96) kg (P=.03) and ?1.87 (SD 1.8) kg (P<.001), respectively, while no significant change was observed in the CO group, who had a mean weight increase of 0.03 (SD 1.68) kg (P=.91). After 12 weeks, changes in body weight were ?1.65 (SD 2.64) kg in the MINE group, ?1.59 (SD 2.79) kg in the MINE Plus group, and 0.43 (SD 1.42) kg in the CO group. There was a significant difference between the MINE and MINE Plus groups (P<.001). Significant group × time effects were found for body weight in the MINE and CO groups (P<.001) and in the MINE Plus and CO groups (P<.001), comparing baseline and 12 weeks. Regarding physical activity and psychological factors, only body shape satisfaction and health self-efficacy were associated with improvements in the MINE and MINE Plus groups (P<.001). Conclusions: This study found that the group receiving education and tailored feedback showed significant weight loss and improvements in several psychological factors, though there were differences in the sustainability of the effects. Trial Registration: Korea Disease Control and Prevention Agency (KDCA) KCT0007780: https://cris.nih.go.kr/cris/search/detailSearch.do/22861 UR - https://cardio.jmir.org/2024/1/e42402 UR - http://dx.doi.org/10.2196/42402 UR - http://www.ncbi.nlm.nih.gov/pubmed/38635975 ID - info:doi/10.2196/42402 ER - TY - JOUR AU - Wang, Xuzhi AU - Zhang, Yuankai AU - Pathiravasan, H. Chathurangi AU - Ukonu, C. Nene AU - Rong, Jian AU - Benjamin, J. Emelia AU - McManus, D. David AU - Larson, G. Martin AU - Vasan, S. Ramachandran AU - Hamburg, M. Naomi AU - Murabito, M. Joanne AU - Liu, Chunyu AU - Mitchell, F. Gary PY - 2024/4/8 TI - Association of Arterial Stiffness With Mid- to Long-Term Home Blood Pressure Variability in the Electronic Framingham Heart Study: Cohort Study JO - JMIR Cardio SP - e54801 VL - 8 KW - arterial stiffness KW - mobile health KW - mHealth KW - blood pressure KW - blood pressure variability KW - risk factors N2 - 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. UR - https://cardio.jmir.org/2024/1/e54801 UR - http://dx.doi.org/10.2196/54801 UR - http://www.ncbi.nlm.nih.gov/pubmed/38587880 ID - info:doi/10.2196/54801 ER - TY - JOUR AU - Ahn, Hyo-Jeong AU - Choi, Eue-Keun AU - Lee, So-Ryoung AU - Kwon, Soonil AU - Song, Hee-Seok AU - Lee, Young-Shin AU - Oh, Seil PY - 2024/3/21 TI - Three-Day Monitoring of Adhesive Single-Lead Electrocardiogram Patch for Premature Ventricular Complex: Prospective Study for Diagnosis Validation and Evaluation of Burden Fluctuation JO - J Med Internet Res SP - e46098 VL - 26 KW - premature ventricular complex KW - single-lead electrocardiogram KW - wearable device KW - extended monitor KW - electrocardiogram KW - EKG KW - ECG KW - wearable KW - heart KW - cardiology KW - cardiovascular N2 - Background: Wearable electrocardiogram (ECG) monitoring devices are used worldwide. However, data on the diagnostic yield of an adhesive single-lead ECG patch (SEP) to detect premature ventricular complex (PVC) and the optimal duration of wearing an SEP for PVC burden assessment are limited. Objective: We aimed to validate the diagnostic yield of an SEP (mobiCARE MC-100, Seers Technology) for PVC detection and evaluate the PVC burden variation recorded by the SEP over a 3-day monitoring period. Methods: This is a prospective study of patients with documented PVC on a 12-lead ECG. Patients underwent simultaneous ECG monitoring with the 24-hour Holter monitor and SEP on the first day. On the subsequent second and third days, ECG monitoring was continued using only SEP, and a 3-day extended monitoring was completed. The diagnostic yield of SEP for PVC detection was evaluated by comparison with the results obtained on the first day of Holter monitoring. The PVC burden monitored by SEP for 3 days was used to assess the daily and 6-hour PVC burden variations. The number of patients additionally identified to reach PVC thresholds of 10%, 15%, and 20% during the 3-day extended monitoring by SEP and the clinical factors associated with the higher PVC burden variations were explored. Results: The recruited data of 134 monitored patients (mean age, 54.6 years; males, 45/134, 33.6%) were analyzed. The median daily PVC burden of these patients was 2.4% (IQR 0.2%-10.9%), as measured by the Holter monitor, and 3.3% (IQR 0.3%-11.7%), as measured in the 3-day monitoring by SEP. The daily PVC burden detected on the first day of SEP was in agreement with that of the Holter monitor: the mean difference was ?0.07%, with 95% limits of agreement of ?1.44% to 1.30%. A higher PVC burden on the first day was correlated with a higher daily (R2=0.34) and 6-hour burden variation (R2=0.48). Three-day monitoring by SEP identified 29% (12/42), 18% (10/56), and 7% (4/60) more patients reaching 10%, 15%, and 20% of daily PVC burden, respectively. Younger age was additionally associated with the identification of clinically significant PVC burden during the extended monitoring period (P=.02). Conclusions: We found that the mobiCARE MC-100 SEP accurately detects PVC with comparable diagnostic yield to the 24-hour Holter monitor. Performing 3-day PVC monitoring with SEP, especially among younger patients, may offer a pragmatic alternative for identifying more individuals exceeding the clinically significant PVC burden threshold. UR - https://www.jmir.org/2024/1/e46098 UR - http://dx.doi.org/10.2196/46098 UR - http://www.ncbi.nlm.nih.gov/pubmed/38512332 ID - info:doi/10.2196/46098 ER - TY - JOUR AU - Hofner, Michael AU - Hurnaus, Patrick AU - DiStefano, Dan AU - Philip, Shaji AU - Kim, Sarah AU - Shaw, Julie AU - Waring, Chander Avantika PY - 2024/3/13 TI - Outcomes of an Asynchronous Care Model for Chronic Conditions in a Diverse Population: 12-Month Retrospective Chart Review Study JO - JMIR Diabetes SP - e53835 VL - 9 KW - asynchronous KW - blood pressure KW - cardiology KW - chronic disease KW - cohort KW - diabetes mellitus therapy KW - diabetes KW - diabetics KW - eHealth KW - e-health KW - HbA1c KW - health disparities KW - heart KW - hemoglobin A1c KW - hypertension therapy KW - hypertension KW - hypertensive KW - remote care KW - retrospective KW - telehealth KW - telemedicine KW - virtual care N2 - Background: Diabetes and hypertension are some of the most prevalent and costly chronic conditions in the United States. However, outcomes continue to lag behind targets, creating further risk of long-term complications, morbidity, and mortality for people living with these conditions. Furthermore, racial and ethnic disparities in glycemic and hypertension control persist. Flexible telehealth programs leveraging asynchronous care allow for increased provider access and more convenient follow-up, ultimately improving critical health outcomes across demographic groups. Objective: We aim to evaluate the 12-month clinical outcomes of participants in the 9amHealth web-based clinic for diabetes and hypertension. We hypothesized that participation in the 9amHealth program would be associated with significant improvements in glycemic and blood pressure (BP) control across a diverse group of individuals. Methods: We enrolled 95 patients in a completely web-based care clinic for diabetes and hypertension who received nutrition counseling, health coaching, and asynchronous physician consultations for medication prescribing. Patients received standard or cellular-connected glucose meters and BP cuffs in order to share data. Laboratory tests were completed either with at-home phlebotomy draws or a self-administered test kit. Patients? first and last hemoglobin A1c (HbA1c) and BP results over the 12-month period were compared, and analyses were repeated across race and ethnicity groups. Results: Among all 95 patients, the average HbA1c decreased by ?1.0 (from 8.2% to 7.2%; P<.001) over 12 months of program participation. In those with a baseline HbA1c >8%, the average HbA1c decreased by ?2.1 (from 10.2% to 8.1%; P<.001), and in those with a baseline HbA1c >9%, the average HbA1c decreased by ?2.8 (from 11% to 8.2%; P<.001). Among participants who identified as a race or ethnicity other than White, the HbA1c decreased by ?1.2 (from 8.6% to 7.4%, P=.001). Further examination of subgroups confirmed HbA1c lowering within each race or ethnicity group. In the overall population, the average systolic BP decreased by 17.7 mm Hg (P=.006) and the average diastolic BP decreased by 14.3 mm Hg (P=.002). Among participants self-identifying as a race or ethnicity other than White, the results similarly showed a decrease in BP (average reduction in systolic BP of 10 mm Hg and in diastolic BP of 9 mm Hg). Conclusions: A fully web-based model leveraging all-asynchronous physician review and prescribing, combined with synchronous and asynchronous coaching and nutrition support, was associated with clinically meaningful improvement in HbA1c and BP control over a 12-month period among a diverse group of individuals. Further studies should prospectively evaluate the effectiveness of such models among larger populations, assess the longer-term sustainability of these outcomes, and explore financial models to make these types of programs broadly accessible. UR - https://diabetes.jmir.org/2024/1/e53835 UR - http://dx.doi.org/10.2196/53835 UR - http://www.ncbi.nlm.nih.gov/pubmed/38363585 ID - info:doi/10.2196/53835 ER - TY - JOUR AU - Keogh, Alison AU - Brennan, Carol AU - Johnston, William AU - Dickson, Jane AU - Leslie, J. Stephen AU - Burke, David AU - Megyesi, Peter AU - Caulfield, Brian PY - 2024/3/1 TI - Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study JO - JMIR Form Res SP - e52442 VL - 8 KW - digital health KW - heart failure KW - cardiology KW - self-care KW - behavior change KW - eHealth KW - mHealth KW - mobile health KW - mobile app KW - mobile phone KW - elderly KW - self-management KW - digital tools KW - digital tool KW - human-centered design KW - app KW - apps KW - applications KW - wearables KW - wearable KW - Fitbit KW - usability KW - adherence KW - feasibility KW - congestive heart failure KW - cardiac failure KW - myocardial failure KW - heart decompensation N2 - Background: Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centered design development of a digital tool to support self-care of HF, the next step was to pilot the tool over a period of time to establish people?s acceptance of it in practice. Objective: This study aims to conduct an observational pilot study to examine the usability, adherence, and feasibility of a digital health tool for HF within the Irish health care system. Methods: A total of 19 participants with HF were provided with a digital tool comprising a mobile app and the Fitbit Charge 4 and Aria Air smart scales for a period of 6 months. Changes to their self-care were assessed before and after the study with the 9-item European HF Self-care Behavior Scale (EHFScBS) and the Minnesota Living with HF Questionnaire (MLwHFQ) using a Wilcoxon signed rank test. After the study, 3 usability questionnaires were implemented and descriptively analyzed: the System Usability Scale (SUS), Wearable Technology Motivation Scale (WTMS), and Comfort Rating Scale (CRS). Participants also undertook a semistructured interview regarding their experiences with the digital tool. Interviews were analyzed deductively using the Theoretical Domains Framework. Results: Participants wore their devices for an average of 86.2% of the days in the 6-month testing period ranging from 40.6% to 98%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (P=.10 and P=.70, respectively, where P>.03, after a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (IQR 55.0-60.0; range 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (median 6.0, IQR 5.0-7.0; range 1.0-7.0), whereas the Fitbit was considered very comfortable as demonstrated by the low CRS results (median 0.0, IQR 0.0-0.0; range 0.0-2.0). According to participant interviews, the digital tool supported self-management through increased knowledge, improved awareness, decision-making, and confidence in their own data, and improving their social support through a feeling of comfort in being watched. Conclusions: The digital health tool demonstrated high levels of adherence and acceptance among participants. Although the SUS results suggest low usability, this may be explained by participants uncertainty that they were using it fully, rather than it being unusable, especially given the experiences documented in their interviews. The digital tool targeted key self-management behaviors and feelings of social support. However, a number of changes to the tool, and the health service, are required before it can be implemented at scale. A full-scale feasibility trial conducted at a wider level is required to fully determine its potential effectiveness and wider implementation needs. UR - https://formative.jmir.org/2024/1/e52442 UR - http://dx.doi.org/10.2196/52442 UR - http://www.ncbi.nlm.nih.gov/pubmed/38427410 ID - info:doi/10.2196/52442 ER - TY - JOUR AU - Tegegne, Kassaw Teketo AU - Tran, Ly-Duyen AU - Nourse, Rebecca AU - Gurrin, Cathal AU - Maddison, Ralph PY - 2024/2/21 TI - Daily Activity Lifelogs of People With Heart Failure: Observational Study JO - JMIR Form Res SP - e51248 VL - 8 KW - heart failure KW - self-management KW - lifelogs KW - daily activity KW - wearable camera KW - E-Myscéal KW - activities of daily living KW - ADL KW - intervention KW - self-report method KW - wearable KW - chronic condition N2 - Background: Globally, heart failure (HF) affects more than 64 million people, and attempts to reduce its social and economic burden are a public health priority. Interventions to support people with HF to self-manage have been shown to reduce hospitalizations, improve quality of life, and reduce mortality rates. Understanding how people self-manage is imperative to improve future interventions; however, most approaches to date, have used self-report methods to achieve this. Wearable cameras provide a unique tool to understand the lived experiences of people with HF and the daily activities they undertake, which could lead to more effective interventions. However, their potential for understanding chronic conditions such as HF is unclear. Objective: This study aimed to determine the potential utility of wearable cameras to better understand the activities of daily living in people living with HF. Methods: The ?Seeing is Believing (SIB)? study involved 30 patients with HF who wore wearable cameras for a maximum of 30 days. We used the E-Myscéal web-based lifelog retrieval system to process and analyze the wearable camera image data set. Search terms for 7 daily activities (physical activity, gardening, shopping, screen time, drinking, eating, and medication intake) were developed and used for image retrieval. Sensitivity analysis was conducted to compare the number of images retrieved using different search terms. Temporal patterns in daily activities were examined, and differences before and after hospitalization were assessed. Results: E-Myscéal exhibited sensitivity to specific search terms, leading to significant variations in the number of images retrieved for each activity. The highest number of images returned were related to eating and drinking, with fewer images for physical activity, screen time, and taking medication. The majority of captured activities occurred before midday. Notably, temporal differences in daily activity patterns were observed for participants hospitalized during this study. The number of medication images increased after hospital discharge, while screen time images decreased. Conclusions: Wearable cameras offer valuable insights into daily activities and self-management in people living with HF. E-Myscéal efficiently retrieves relevant images, but search term sensitivity underscores the need for careful selection. UR - https://formative.jmir.org/2024/1/e51248 UR - http://dx.doi.org/10.2196/51248 UR - http://www.ncbi.nlm.nih.gov/pubmed/38381484 ID - info:doi/10.2196/51248 ER - TY - JOUR AU - Muehlensiepen, Felix AU - Hoffmann, Josephine Marie AU - Nübel, Jonathan AU - Ignatyev, Yury AU - Heinze, Martin AU - Butter, Christian AU - Haase-Fielitz, Anja PY - 2024/2/20 TI - Acceptance of Telemedicine by Specialists and General Practitioners in Cardiology Care: Cross-Sectional Survey Study JO - JMIR Form Res SP - e49526 VL - 8 KW - acceptance KW - adoption KW - cardiac KW - cardiology KW - cross sectional KW - health services research KW - heart KW - preference KW - survey KW - telecardiology KW - telehealth KW - telemedicine N2 - Background: In the coming years, telemedicine will play a key role in health care. Especially in rural areas with weak infrastructure, telemedicine could be crucial to providing adequate and personalized medical care. Objective: We investigated the acceptance and preferences of telemedicine among cardiologists, internists, and general practitioners. In addition, we aimed to identify knowledge, explore factors that influence the decision to adopt or reject this technology, and create starting points for demand-oriented further research. Methods: We conducted a web-based survey between May 2021 and February 2022. The 34-item questionnaire covered a wide range of questions regarding knowledge, acceptance, and use of telemedicine in cardiology care. Participants (cardiologists, internists, and general practitioners) were contacted through their professional email addresses, through a QR code published in a regional health journal, and through X (formerly known as Twitter). After exclusion of questionnaires with missed values, multidimensional scaling and k-means clustering were performed. Participants were divided into 3 clusters (C1, C2, and C3) based on their attitudes toward telecardiology. C1 uses telemedicine for personal health and clinical practice; C2 shows reluctance; C3 uses telemedicine mainly clinically. Results: We contacted 929 physicians. Of those 12.1% (112/929) completed the questionnaires. Participants were 56% male (54/97), 29% female (28/97), and 2% (2/97) diverse (median age 50 years). About 16% (18/112) of the respondents currently use telemedicine daily, 14.3% (16/112) 3-4 times a week, and 43% (48/112) did not use telemedicine at all. Overall, 35.1% (34/97) rated their knowledge of telemedicine as very good or good. Most of the respondents replied that telemedicine could support cardiology care in monitoring of blood pressure and electrocardiograms (57/97, 58.8%, both), consultation (57/97, 58.8%), and extending follow-up time (59/97, 60.8%). Reported barriers to implementation were mostly administration (26/97, 26.8%), inadequate reimbursement (25/97, 25.8%), and the purchase of technology equipment (23/97, 23.7%). Attitudes toward telemedicine in clinical practice were closely related to the number of patients being treated per annual quarter: C3 (median 1350, IQR 1000-1500) versus C1 (median 750, IQR 300-1200) and C2 (median 500, IQR 105-825). The differences between clinical caseloads of C1-C3 members were significant: C1 versus C2 (P=.03), C1 versus C3 (P=.02), and C2 versus C3 (P<.001). Most participants (87/112, 77.7%) would like to expand telemedicine approaches in the future. In the field of cardiology, the participants reported a high suitability of telemedicine. The willingness to train in telemedicine is high to very high for > 50% of the participants. Conclusions: Our results indicate generally moderate use but positive attitudes toward telemedicine among participating physicians with a higher clinical caseload. The lack of a structural framework seems to be a barrier to the effective implementation of telecardiology. UR - https://formative.jmir.org/2024/1/e49526 UR - http://dx.doi.org/10.2196/49526 UR - http://www.ncbi.nlm.nih.gov/pubmed/38376898 ID - info:doi/10.2196/49526 ER - TY - JOUR AU - Meng, Guangxia AU - McAiney, Carrie AU - McKillop, Ian AU - Perlman, M. Christopher AU - Tsao, Shu-Feng AU - Chen, Helen PY - 2024/2/16 TI - Factors That Influence Patient Satisfaction With the Service Quality of Home-Based Teleconsultation During the COVID-19 Pandemic: Cross-Sectional Survey Study JO - JMIR Cardio SP - e51439 VL - 8 KW - teleconsultation KW - secondary stroke prevention KW - telemedicine KW - service quality KW - patient satisfaction N2 - Background: Ontario stroke prevention clinics primarily held in-person visits before the COVID-19 pandemic and then had to shift to a home-based teleconsultation delivery model using telephone or video to provide services during the pandemic. This change may have affected service quality and patient experiences. Objective: This study seeks to understand patient satisfaction with Ontario stroke prevention clinics? rapid shift to a home-based teleconsultation delivery model used during the COVID-19 pandemic. The research question explores explanatory factors affecting patient satisfaction. Methods: Using a cross-sectional service performance model, we surveyed patients who received telephone or video consultations at 2 Ontario stroke prevention clinics in 2021. This survey included closed- and open-ended questions. We used logistic regression and qualitative content analysis to understand factors affecting patient satisfaction with the quality of home-based teleconsultation services. Results: The overall response rate to the web survey was 37.2% (128/344). The quantitative analysis was based on 110 responses, whereas the qualitative analysis included 97 responses. Logistic regression results revealed that responsiveness (adjusted odds ratio [AOR] 0.034, 95% CI 0.006-0.188; P<.001) and empathy (AOR 0.116, 95% CI 0.017-0.800; P=.03) were significant factors negatively associated with low satisfaction (scores of 1, 2, or 3 out of 5). The only characteristic positively associated with low satisfaction was when survey consent was provided by the substitute decision maker (AOR 6.592, 95% CI 1.452-29.927; P=.02). In the qualitative content analysis, patients with both low and high global satisfaction scores shared the same factors of service dissatisfaction (assurance, reliability, and empathy). The main subcategories associated with dissatisfaction were missing clinical activities, inadequate communication, administrative process issues, and absence of personal connection. Conversely, the high-satisfaction group offered more positive feedback on assurance, reliability, and empathy, as well as on having a competent clinician, appropriate patient selection, and excellent communication and empathy skills. Conclusions: The insights gained from this study can be considered when designing home-based teleconsultation services to enhance patient experiences in stroke prevention care. UR - https://cardio.jmir.org/2024/1/e51439 UR - http://dx.doi.org/10.2196/51439 UR - http://www.ncbi.nlm.nih.gov/pubmed/38363590 ID - info:doi/10.2196/51439 ER - TY - JOUR AU - Chai, R. Peter AU - Kaithamattam, J. Jenson AU - Chung, Michelle AU - Tom, J. Jeremiah AU - Goodman, R. Georgia AU - Hasdianda, Adrian Mohammad AU - Carnes, Christopher Tony AU - Vaduganathan, Muthiah AU - Scirica, M. Benjamin AU - Schnipper, L. Jeffrey PY - 2024/2/15 TI - Formative Perceptions of a Digital Pill System to Measure Adherence to Heart Failure Pharmacotherapy: Mixed Methods Study JO - JMIR Cardio SP - e48971 VL - 8 KW - behavioral interventions KW - cardiac treatment KW - digital pill system KW - heart failure medication KW - heart failure KW - ingestible sensors KW - medication adherence N2 - Background: Heart failure (HF) affects 6.2 million Americans and is a leading cause of hospitalization. The mainstay of the management of HF is adherence to pharmacotherapy. Despite the effectiveness of HF pharmacotherapy, effectiveness is closely linked to adherence. Measuring adherence to HF pharmacotherapy is difficult; most clinical measures use indirect strategies such as calculating pharmacy refill data or using self-report. While helpful in guiding treatment adjustments, indirect measures of adherence may miss the detection of suboptimal adherence and co-occurring structural barriers associated with nonadherence. Digital pill systems (DPSs), which use an ingestible radiofrequency emitter to directly measure medication ingestions in real-time, represent a strategy for measuring and responding to nonadherence in the context of HF pharmacotherapy. Previous work has demonstrated the feasibility of using DPSs to measure adherence in other chronic diseases, but this strategy has yet to be leveraged for individuals with HF. Objective: We aim to explore through qualitative interviews the facilitators and barriers to using DPS technology to monitor pharmacotherapy adherence among patients with HF. Methods: We conducted individual, semistructured qualitative interviews and quantitative assessments between April and August 2022. A total of 20 patients with HF who were admitted to the general medical or cardiology service at an urban quaternary care hospital participated in this study. Participants completed a qualitative interview exploring the overall acceptability of and willingness to use DPS technology for adherence monitoring and perceived barriers to DPS use. Quantitative assessments evaluated HF history, existing medication adherence strategies, and attitudes toward technology. We analyzed qualitative data using applied thematic analysis and NVivo software (QSR International). Results: Most participants (12/20, 60%) in qualitative interviews reported a willingness to use the DPS to measure HF medication adherence. Overall, the DPS was viewed as useful for increasing accountability and reinforcing adherence behaviors. Perceived barriers included technological issues, a lack of need, additional costs, and privacy concerns. Most were open to sharing adherence data with providers to bolster clinical care and decision-making. Reminder messages following detected nonadherence were perceived as a key feature, and customization was desired. Suggested improvements are primarily related to the design and usability of the Reader (a wearable device). Conclusions: Overall, individuals with HF perceived the DPS to be an acceptable and useful tool for measuring medication adherence. Accurate, real-time ingestion data can guide adherence counseling to optimize adherence management and inform tailored behavioral interventions to support adherence among patients with HF. UR - https://cardio.jmir.org/2024/1/e48971 UR - http://dx.doi.org/10.2196/48971 UR - http://www.ncbi.nlm.nih.gov/pubmed/38358783 ID - info:doi/10.2196/48971 ER - TY - JOUR AU - Gerhardy, Benjamin AU - Sivapathan, Shanthosh AU - Orde, Sam AU - Morgan, Lucy PY - 2024/2/12 TI - Simultaneous Cardiopulmonary Exercise Testing and Echocardiography for Investigation of Cardiopulmonary Dysfunction in Outpatients: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e52076 VL - 13 KW - cardiopulmonary KW - echocardiography KW - exercise KW - cardiopulmonary exercise test N2 - Background: Cardiopulmonary dysfunction is a complex process with a broad range of etiologies. Investigations performed either at rest or those that only assess the function of a single organ (heart or lungs) are often insufficient. A simultaneous cardiopulmonary exercise test with stress echocardiography is a new approach to assessing cardiopulmonary dysfunction as it provides anatomical and functional imaging simultaneously while under increasing stress. To date, the application of cardiopulmonary exercise test-stress echocardiography (CPET-SE) has been broad and without structure, and its effect on patient outcomes is unclear. Objective: The objective of this scoping review is to explore and analyze the evidence regarding the role of simultaneous CPET-SE in investigating cardiopulmonary dysfunction in outpatients. It will include any published study in which adult (older than or equal to 18 years of age) patients have completed a CPET-SE for the investigation of cardiopulmonary dysfunction. Methods: This review will follow the Arksey and O?Malley framework, supported by the Joanna Briggs Institute methodology for scoping reviews. It will use the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Data sources will include MEDLINE, Scopus, Embase, and Cochrane (including reviews, trials, and protocols) electronic databases, with no date range defined. The search will be limited to the English language with no restrictions regarding pathology. Secondary references of the included sources will also be assessed by a hand search for suitability. A 2-person title-abstract screen and data charting process will be used. Independent experts will be used for consultation including an academic librarian and clinicians. The Covidence software will be used for article screening. Results: This scoping review will provide a unified and detailed description of the applications of CPET-SE in investigating cardiopulmonary dysfunction. This will provide a platform for future research harnessing this investigatory method. The results will be presented in both tabular and graphical formats to ensure clarity. The results of this scoping review will be submitted to a relevant peer-reviewed academic journal for publication. Conclusions: The CPET-SE is a powerful tool for investigating cardiopulmonary dysfunction but remains in its infancy with a patchwork approach to indications, data reporting, and interpretation. This scoping review will unify the literature and provide a platform for future researchers and the development of a comprehensive application guideline. Trial Registration: Open Science Framework; https://osf.io/98r3e International Registered Report Identifier (IRRID): PRR1-10.2196/52076 UR - https://www.researchprotocols.org/2024/1/e52076 UR - http://dx.doi.org/10.2196/52076 UR - http://www.ncbi.nlm.nih.gov/pubmed/38345834 ID - info:doi/10.2196/52076 ER - TY - JOUR AU - Kokkonen, Jorma AU - Mustonen, Pirjo AU - Heikkilä, Eija AU - Leskelä, Riikka-Leena AU - Pennanen, Paula AU - Krühn, Kati AU - Jalkanen, Arto AU - Laakso, Jussi-Pekka AU - Kempers, Jari AU - Väisänen, Sami AU - Torkki, Paulus PY - 2024/2/7 TI - Effectiveness of Telemonitoring in Reducing Hospitalization and Associated Costs for Patients With Heart Failure in Finland: Nonrandomized Pre-Post Telemonitoring Study JO - JMIR Mhealth Uhealth SP - e51841 VL - 12 KW - cost KW - Finland KW - heart failure KW - hospital KW - resource use KW - telemonitoring N2 - Background: Many patients with chronic heart failure (HF) experience a reduced health status, leading to readmission after hospitalization despite receiving conventional care. Telemonitoring approaches aim to improve the early detection of HF decompensations and prevent readmissions. However, knowledge about the impact of telemonitoring on preventing readmissions and related costs remains scarce. Objective: This study assessed the effectiveness of adding a telemonitoring solution to the standard of care (SOC) for the prevention of hospitalization and related costs in patients with HF in Finland. Methods: We performed a nonrandomized pre-post telemonitoring study to estimate health care costs and resource use during 6 months on SOC followed by 6 months on SOC with a novel telemonitoring solution. The telemonitoring solution consisted of a digital platform for patient-reported symptoms and daily weight and blood pressure measurements, automatically generated alerts triggering phone calls with secondary care nurses, and rapid response to alerts by treating physicians. Telemonitoring solution data were linked to patient register data on primary care, secondary care, and hospitalization. The patient register of the Southern Savonia Social and Health Care Authority (Essote) was used. Eligible patients had at least 1 hospital admission within the last 12 months and self-reported New York Heart Association class II-IV from the central hospital in the Southern Savonia region. Results: Out of 50 recruited patients with HF, 43 completed the study and were included in the analysis. The hospitalization-related cost decreased (49%; P=.03) from ?2189 (95% CI ?1384-?2994; a currency exchange rate of EUR ?1=US $1.10589 is applicable) during SOC to ?1114 (95% CI ?425-?1803) during telemonitoring. The number of patients with at least 1 hospitalization due to HF was reduced by 70% (P=.002) from 20 (47%) out of 43patients during SOC to 6 (14%) out of 43 patients in telemonitoring. The estimated mean total health care cost per patient was ?3124 (95% CI ?2212-?4036) during SOC and ?2104 (95% CI ?1313-?2895) during telemonitoring, resulting in a 33% reduction (P=.07) in costs with telemonitoring. Conclusions: The results suggest that the telemonitoring solution can reduce hospital-related costs for patients with HF with a recent hospital admission. UR - https://mhealth.jmir.org/2024/1/e51841 UR - http://dx.doi.org/10.2196/51841 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324366 ID - info:doi/10.2196/51841 ER - TY - JOUR AU - Carter, Jocelyn AU - Swack, Natalia AU - Isselbacher, Eric AU - Donelan, Karen AU - Thorndike, Anne PY - 2024/2/6 TI - Feasibility, Acceptability, and Preliminary Effectiveness of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e55687 VL - 13 KW - heart failure KW - digital platform KW - remote monitoring KW - home-based care KW - health worker KW - social needs care KW - community health worker N2 - Background: Interventions focused on remote monitoring and social needs care have shown promise in improving clinical outcomes for patients with heart failure (HF). However, patient willingness to use technology as well as concerns about access in underresourced settings have limited digital platform implementation and adoption. There is little research in HF populations examining the effect of a combined digital and social needs care intervention that could enhance patient engagement in digital platform use while closing gaps in care related to social determinants of health. Here, we describe the protocol for a clinical trial of a digitally enabled community health worker intervention designed for patients with HF. Objective: This study aims to describe the protocol for a randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of an intervention that combines remote monitoring with a digital platform and community health worker (CHW) social needs care for patients with HF who are transitioning from hospital to home. Given the elevated morbidity and mortality, identifying comprehensive and patient-centered interventions at the time of hospital care transitions that can improve clinical outcomes, impact cost, and augment the quality of care for this cohort is a priority. Methods: This trial randomized adult inpatient participants (n=50) with a diagnosis of HF receiving care at a single academic health care institution to the 30-day intervention (digital platform+CHW pairing+usual care) or the 30-day control (CHW pairing+usual care) arms. All study participants completed baseline questionnaires and 30-day exit interviews and questionnaires. The primary outcomes will be acceptability, feasibility, and preliminary effectiveness. Results: This clinical trial opened for enrollment in September 2022 and was completed in June 2023. Initial results are expected to be published in the spring of 2024, and analysis is currently underway. Feasibility outcome measures will include the use rates of the biometric sensor (average hours per day), the digital blood pressure monitor (average times per day), the weight scale (average times per day), and the completion of the symptoms questionnaire (average times per day). The acceptability outcome will be measured by the patients? response to the truthfulness of the statement that they would be willing to use the digital platform in the future (response options: very true, somewhat true, or not true). Preliminary effectiveness will be measured by tracking 30-day clinical outcomes (hospital readmissions, emergency room visits, and missed primary care and cardiology appointments). Conclusions: The results of this investigation are expected to contribute to our understanding of the use of digital interventions and the implementation of supportive home-based social needs care to enhance engagement and the potential effectiveness of clinically focused digital platforms. These results may inform the construction of a future multi-institutional trial designed to test the true effectiveness of this intervention in HF. Trial Registration: ClinicalTrials.gov NCT05130008; https://clinicaltrials.gov/study/NCT05130008 International Registered Report Identifier (IRRID): DERR1-10.2196/55687 UR - https://www.researchprotocols.org/2024/1/e55687 UR - http://dx.doi.org/10.2196/55687 UR - http://www.ncbi.nlm.nih.gov/pubmed/38216543 ID - info:doi/10.2196/55687 ER - TY - JOUR AU - Dhruva, S. Sanket AU - Raitt, H. Merritt AU - Munson, Scott AU - Moore, J. Hans AU - Steele, Pamela AU - Rosman, Lindsey AU - Whooley, A. Mary PY - 2023/11/21 TI - Barriers and Facilitators Associated With Remote Monitoring Adherence Among Veterans With Pacemakers and Implantable Cardioverter-Defibrillators: Qualitative Cross-Sectional Study JO - JMIR Cardio SP - e50973 VL - 7 KW - cardiac implantable electronic device KW - electrophysiology KW - pacemaker KW - remote monitoring KW - veterans KW - adherence N2 - Background: The Heart Rhythm Society strongly recommends remote monitoring (RM) of cardiovascular implantable electronic devices (CIEDs) because of the clinical outcome benefits to patients. However, many patients do not adhere to RM and, thus, do not achieve these benefits. There has been limited study of patient-level barriers and facilitators to RM adherence; understanding patient perspectives is essential to developing solutions to improve adherence. Objective: We sought to identify barriers and facilitators associated with adherence to RM among veterans with CIEDs followed by the Veterans Health Administration. Methods: We interviewed 40 veterans with CIEDs regarding their experiences with RM. Veterans were stratified into 3 groups based on their adherence to scheduled RM transmissions over the past 2 years: 6 fully adherent (?95%), 25 partially adherent (?65% but <95%), and 9 nonadherent (<65%). As the focus was to understand challenges with RM adherence, partially adherent and nonadherent veterans were preferentially weighted for selection. Veterans were mailed a letter stating they would be called to understand their experiences and perspectives of RM and possible barriers, and then contacted beginning 1 week after the letter was mailed. Interviews were structured (some questions allowing for open-ended responses to dive deeper into themes) and focused on 4 predetermined domains: knowledge of RM, satisfaction with RM, reasons for nonadherence, and preferences for health care engagement. Results: Of the 44 veterans contacted, 40 (91%) agreed to participate. The mean veteran age was 75.3 (SD 7.6) years, and 98% (39/40) were men. Veterans had been implanted with their current CIED for an average of 4.4 (SD 2.8) years. A total of 58% (23/40) of veterans recalled a discussion of home monitoring, and 45% (18/40) reported a good understanding of RM; however, when asked to describe RM, their understanding was sometimes incomplete or not correct. Among the 31 fully or partially adherent veterans, nearly all were satisfied with RM. Approximately one-third recalled ever being told the results of a remote transmission. Among partially or nonadherent veterans, only one-fourth reported being contacted by a Department of Veterans Affairs health care professional regarding not having sent a remote transmission; among those who had troubleshooted to ensure they could send remote transmissions, they often relied on the CIED manufacturer for help (this experience was nearly always positive). Most nonadherent veterans felt more comfortable engaging in RM if they received more information or education. Most veterans were interested in being notified of a successful remote transmission and learning the results of their remote transmissions. Conclusions: Veterans with CIEDs often had limited knowledge about RM and did not recall being contacted about nonadherence. When they were contacted and troubleshooted, the experience was positive. These findings provide opportunities to optimize strategies for educating and engaging patients in RM. UR - https://cardio.jmir.org/2023/1/e50973 UR - http://dx.doi.org/10.2196/50973 UR - http://www.ncbi.nlm.nih.gov/pubmed/37988153 ID - info:doi/10.2196/50973 ER - TY - JOUR AU - Nicmanis, Mitchell AU - Chur-Hansen, Anna AU - Linehan, Karen PY - 2023/11/1 TI - The Information Needs and Experiences of People Living With Cardiac Implantable Electronic Devices: Qualitative Content Analysis of Reddit Posts JO - JMIR Cardio SP - e46296 VL - 7 KW - implantable cardioverter defibrillator KW - pacemaker KW - cardiac resynchronization therapy KW - social media KW - patients KW - peer support KW - content analysis KW - experiences N2 - Background: Cardiac implantable electronic devices (CIEDs) are used to treat a range of cardiovascular diseases and can lead to substantial clinical improvements. However, studies evaluating patients? experiences of living with these devices are sparse and have focused mainly on implantable cardioverter defibrillators. In addition, there has been limited evaluation of how people living with a CIED use social media to gain insight into their condition. Objective: This study aims to analyze posts from web-based communities called subreddits on the website Reddit, intended for people living with a CIED, to characterize the informational needs and experiences of patients. Methods: Reddit was systematically searched for appropriate subreddits, and we found 1 subreddit that could be included in the analysis. A Python-based web scraping script using the Reddit application programming interface was used to extract posts from this subreddit. Each post was individually screened for relevancy, and a register of participants? demographic information was created. Conventional qualitative content analysis was used to inductively classify the qualitative data collected into codes, subcategories, and overarching categories. Results: Of the 484 posts collected using the script, 186 were excluded, resulting in 298 posts from 196 participants being included in the analysis. The median age of the participants who reported this was 33 (IQR 22.0-39.5; range 17-72) years, and the majority had a permanent pacemaker. The content analysis yielded 5 overarching categories: use of the subreddit by participants, questions and experiences related to the daily challenges of living with a CIED, physical sequelae of CIED implantation, psychological experiences of living with a CIED, and questions and experiences related to health care while living with a CIED. These categories provided insight into the diverse experiences and informational needs of participants living with a CIED. The data predominantly represented the experiences of younger and more physically active participants. Conclusions: Social media provides a platform through which people living with a CIED can share information and provide support to their peers. Participants generally sought information about the experiences of others living with a CIED. This was often done to help overcome a range of challenges faced by participants, including the need to adapt to living with a CIED, difficulties with navigating health care, psychological difficulties, and various aversive physical sequelae. These challenges may be particularly difficult for younger and physically active people. Health care professionals may leverage peer support and other aid to help people overcome the challenges they face while living with a CIED. UR - https://cardio.jmir.org/2023/1/e46296 UR - http://dx.doi.org/10.2196/46296 UR - http://www.ncbi.nlm.nih.gov/pubmed/37766632 ID - info:doi/10.2196/46296 ER - TY - JOUR AU - Auener, L. Stefan AU - van Dulmen, A. Simone AU - Atsma, Femke AU - van der Galiën, Onno AU - Bellersen, Louise AU - van Kimmenade, Roland AU - Westert, P. Gert AU - Jeurissen, T. Patrick P. PY - 2023/10/18 TI - Characteristics Associated With Telemonitoring Use Among Patients With Chronic Heart Failure: Retrospective Cohort Study JO - J Med Internet Res SP - e43038 VL - 25 KW - heart failure KW - telemonitoring KW - remote monitoring KW - eHealth KW - chronic heart failure KW - heart KW - disease KW - patient KW - self-management KW - prevention KW - utilization KW - Netherlands KW - hospital KW - treatment N2 - Background: Chronic heart failure (HF) is a chronic disease affecting more than 64 million people worldwide, with an increasing prevalence and a high burden on individual patients and society. Telemonitoring may be able to mitigate some of this burden by increasing self-management and preventing use of the health care system. However, it is unknown to what degree telemonitoring has been adopted by hospitals and if the use of telemonitoring is associated with certain patient characteristics. Insight into the dissemination of this technology among hospitals and patients may inform strategies for further adoption. Objective: We aimed to explore the use of telemonitoring among hospitals in the Netherlands and to identify patient characteristics associated with the use of telemonitoring for HF. Methods: We performed a retrospective cohort study based on routinely collected health care claim data in the Netherlands. Descriptive analyses were used to gain insight in the adoption of telemonitoring for HF among hospitals in 2019. We used logistic multiple regression analyses to explore the associations between patient characteristics and telemonitoring use. Results: Less than half (31/84, 37%) of all included hospitals had claims for telemonitoring, and 20% (17/84) of hospitals had more than 10 patients with telemonitoring claims. Within these 17 hospitals, a total of 7040 patients were treated for HF in 2019, of whom 5.8% (409/7040) incurred a telemonitoring claim. Odds ratios (ORs) for using telemonitoring were higher for male patients (adjusted OR 1.90, 95% CI 1.50-2.41) and patients with previous hospital treatment for HF (adjusted OR 1.76, 95% CI 1.39-2.24). ORs were lower for higher age categories and were lowest for the highest age category, that is, patients older than 80 years (OR 0.30, 95% CI 0.21-0.44) compared to the reference age category (18-59 years). Socioeconomic status, degree of multimorbidity, and excessive polypharmacy were not associated with the use of telemonitoring. Conclusions: The use of reimbursed telemonitoring for HF was limited up to 2019, and our results suggest that large variation exists among hospitals. A lack of adoption is therefore not only due to a lack of diffusion among hospitals but also due to a lack of scaling up within hospitals that already deploy telemonitoring. Future studies should therefore focus on both kinds of adoption and how to facilitate these processes. Older patients, female patients, and patients with no previous hospital treatment for HF were less likely to use telemonitoring for HF. This shows that some patient groups are not served as much by telemonitoring as other patient groups. The underlying mechanism of the reported associations should be identified in order to gain a deeper understanding of telemonitoring use among different patient groups. UR - https://www.jmir.org/2023/1/e43038 UR - http://dx.doi.org/10.2196/43038 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851505 ID - info:doi/10.2196/43038 ER - TY - JOUR AU - Nakrys, Marius AU - Valinskas, Sarunas AU - Aleknavicius, Kasparas AU - Jonusas, Justinas PY - 2023/10/17 TI - Pilot Investigation of Blood Pressure Control Using a Mobile App (Cardi.Health): Retrospective Chart Review Study JO - JMIR Cardio SP - e48454 VL - 7 KW - mobile app KW - Cardi.Health KW - blood pressure KW - engagement KW - app KW - pilot study KW - hypertension KW - effective KW - blood pressure control KW - self-monitoring KW - medication KW - management KW - users KW - use N2 - Background: The high prevalence of hypertension necessitates effective, scalable interventions for blood pressure (BP) control. Self-monitoring has shown improved adherence to medication and better BP management. Mobile apps offer a promising approach with their increasing popularity and potential for large-scale implementation. Studies have demonstrated associations between mobile app interventions and lowered BP, yet real-world data on app effectiveness and engagement remain limited. Objective: In this study, we analyzed real-world user data from the Cardi.Health mobile app, which is aimed at helping its users monitor and control their BP. Our goal was to find out whether there is an association between the use of the mobile app and a decrease in BP. Additionally, the study explored how engagement with the app may influence this outcome. Methods: This was a retrospective chart review study. The initial study population comprised 4407 Cardi.Health users who began using the app between January 2022 and April 2022. After applying inclusion criteria, the final study cohort comprised 339 users with elevated BP at the baseline. The sample consisted of 108 (31.9%) men and 231 (68.1%) women (P=.04). This retrospective chart review study obtained permission from the Biomedical Research Alliance of New York Institutional Review Board (June 2022, registration ID 22-08-503-939). Results: The study?s main findings were that there is a possible relationship between use of the Cardi.Health mobile app and a decrease in systolic BP. Additionally, there was a significant association between active use of the app and systolic BP decrease (?21=5.311; P=.02). Finally, active users had an almost 2 times greater chance of reducing systolic BP by 5 mm Hg or more over 4 weeks (odds ratio 1.932, 95% CI 1.074-3.528; P=.03). Conclusions: This study shows a possible relationship between Cardi.Health mobile app use and decreased BP. Additionally, engagement with the app may be related to better results?active use was associated with an almost 2-fold increase in the odds of reducing BP by 5 or more mm Hg. UR - https://cardio.jmir.org/2023/1/e48454 UR - http://dx.doi.org/10.2196/48454 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847544 ID - info:doi/10.2196/48454 ER - TY - JOUR AU - Yang, Li-Tan AU - Lee, Jen-Kuang AU - Tsai, Chieh-Mei AU - Chen, Ying-Hsien AU - Huang, Ching-Chang AU - Wu, Hui-Wen AU - Su, Chin-Hua AU - Lee, Chien-Chang AU - Hung, Chi-Sheng AU - Ho, Yi-Lwun PY - 2023/9/26 TI - Effect of Telehealth Services on Mitral and Tricuspid Regurgitation Progression: Retrospective Study JO - J Med Internet Res SP - e47947 VL - 25 KW - mitral regurgitation KW - tricuspid regurgitation KW - telehealth KW - telemedicine KW - point-of-care ultrasound KW - cardiovascular health KW - heart disease KW - cardiac KW - cardiology KW - patience care KW - patient-reported outcome KW - remote monitoring KW - health management N2 - Background: Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common cardiac conditions with high mortality risks, which can be improved through early intervention. Telehealth services, which allow for remote monitoring of patient conditions, have been proven to improve the health management of chronic diseases, but the effects on MR and TR progression are unknown. Objective: This study aimed to explore whether patients receiving telehealth services have less MR and TR progression compared with a control group. We also aimed to identify the determinants of MR and TR progression. Methods: This single-center retrospective study conducted at the National Taiwan University Hospital compared MR and TR progression (defined as either progression to moderate or greater MR and TR or MR and TR progression by ?2 grades during the study period) between the telehealth and control groups. Patients had a minimum of 2 transthoracic echocardiograms at least 6 months apart; baseline mild-moderate MR and TR or lower; and no prior surgeries on the mitral or tricuspid valve. Telehealth patients were defined as those who received telehealth services for at least 28 days within 3 months of baseline. Basic demographics, baseline blood pressure measurements, prescribed medication, and Charlson Comorbidity Index components were obtained for all patients. Results: A total of 1081 patients (n=226 in the telehealth group and n=855 in the control group) were included in the study analyses. The telehealth group showed significantly lower baseline systolic blood pressure (P<.001), higher Charlson Comorbidity Index (P=.02), higher prevalence of prior myocardial infarction (P=.01) and heart failure (P<.001), higher beta-blocker (P=.03) and diuretic (P=.04) use, and lower nitrate use (P=.04). Both groups showed similar cardiac remodeling conditions at baseline. Telehealth was found to be neutral for both MR (hazard ratio 1.10, 95% CI 0.80-1.52; P=.52) and TR (hazard ratio 1.27, 95% CI 0.92-1.74; P=.14) progression. Determinants for moderate or greater MR progression included older age, female sex, diuretic use, larger left atrial dimension, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, and lower left ventricular ejection fraction. Determinants of moderate or greater TR progression included older age, female sex, diuretic use, presence of atrial fibrillation, LA dimension, left ventricular end-systolic dimension, and lower left ventricular ejection fraction; statin use was found to be protective. Conclusions: This is the first study to assess the association between telehealth services and the progression of MR and TR. Telehealth patients, who had more comorbidities, displayed similar MR and TR progression versus control patients, indicating that telehealth may slow MR and TR progression. Determinants of MR and TR progression included easy-to-measure traditional echo parameters of cardiac function, older age, female sex, and atrial fibrillation, which can be incorporated into a telehealth platform and advanced alert system, improving patient outcomes through personalized care. UR - https://www.jmir.org/2023/1/e47947 UR - http://dx.doi.org/10.2196/47947 UR - http://www.ncbi.nlm.nih.gov/pubmed/37751276 ID - info:doi/10.2196/47947 ER - TY - JOUR AU - Kwun, Ju-Seung AU - Lee, Hoon Jang AU - Park, Eun Bo AU - Park, Sung Jong AU - Kim, Jeong Hyeon AU - Kim, Sun-Hwa AU - Jeon, Ki-Hyun AU - Cho, Hyoung-won AU - Kang, Si-Hyuck AU - Lee, Wonjae AU - Youn, Tae-Jin AU - Chae, In-Ho AU - Yoon, Chang-Hwan PY - 2023/9/18 TI - Diagnostic Value of a Wearable Continuous Electrocardiogram Monitoring Device (AT-Patch) for New-Onset Atrial Fibrillation in High-Risk Patients: Prospective Cohort Study JO - J Med Internet Res SP - e45760 VL - 25 KW - arrhythmias KW - atrial fibrillation KW - wearable electronic device KW - patch electrocardiogram monitor KW - electrocardiogram KW - adult KW - AT-Patch KW - heart failure KW - mobile phone N2 - Background: While conventional electrocardiogram monitoring devices are useful for detecting atrial fibrillation, they have considerable drawbacks, including a short monitoring duration and invasive device implantation. The use of patch-type devices circumvents these drawbacks and has shown comparable diagnostic capability for the early detection of atrial fibrillation. Objective: We aimed to determine whether a patch-type device (AT-Patch) applied to patients with a high risk of new-onset atrial fibrillation defined by the congestive heart failure, hypertension, age ?75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex scale (CHA2DS2-VASc) score had increased detection rates. Methods: In this nonrandomized multicenter prospective cohort study, we enrolled 320 adults aged ?19 years who had never experienced atrial fibrillation and whose CHA2DS2-VASc score was ?2. The AT-Patch was attached to each individual for 11 days, and the data were analyzed for arrhythmic events by 2 independent cardiologists. Results: Atrial fibrillation was detected by the AT-Patch in 3.4% (11/320) of patients, as diagnosed by both cardiologists. Interestingly, when participants with or without atrial fibrillation were compared, a previous history of heart failure was significantly more common in the atrial fibrillation group (n=4/11, 36.4% vs n=16/309, 5.2%, respectively; P=.003). When a CHA2DS2-VASc score ?4 was combined with previous heart failure, the detection rate was significantly increased to 24.4%. Comparison of the recorded electrocardiogram data revealed that supraventricular and ventricular ectopic rhythms were significantly more frequent in the new-onset atrial fibrillation group compared with nonatrial fibrillation group (3.4% vs 0.4%; P=.001 and 5.2% vs 1.2%; P<.001), respectively. Conclusions: This study detected a moderate number of new-onset atrial fibrillations in high-risk patients using the AT-Patch device. Further studies will aim to investigate the value of early detection of atrial fibrillation, particularly in patients with heart failure as a means of reducing adverse clinical outcomes of atrial fibrillation. Trial Registration: ClinicalTrials.gov NCT04857268; https://classic.clinicaltrials.gov/ct2/show/NCT04857268 UR - https://www.jmir.org/2023/1/e45760 UR - http://dx.doi.org/10.2196/45760 UR - http://www.ncbi.nlm.nih.gov/pubmed/37721791 ID - info:doi/10.2196/45760 ER - TY - JOUR AU - Estrella, Tony AU - Alfonso, Carla AU - Ramos-Castro, Juan AU - Alsina, Aitor AU - Capdevila, Lluis PY - 2023/8/24 TI - A Serious Game to Self-Regulate Heart Rate Variability as a Technique to Manage Arousal Level Through Cardiorespiratory Biofeedback: Development and Pilot Evaluation Study JO - JMIR Serious Games SP - e46351 VL - 11 KW - serious game KW - heart rate variability KW - biofeedback KW - mobile health KW - mHealth KW - app KW - mobile phone N2 - Background: Heart rate variability biofeedback (HRVB) is an established intervention for increasing heart rate variability (HRV) in the clinical context. Using this technique, participants become aware of their HRV through real-time feedback and can self-regulate it. Objective: The aim of this study was 2-fold: first, to develop a serious game that applies the HRVB technique to teach participants to self-regulate HRV and, second, to test the app with participants in a pilot study. Methods: An HRVB app called the FitLab Game was developed for this study. To play the game, users must move the main character up and down the screen, avoiding collisions with obstacles. The wavelength that users must follow to avoid these obstacles is based on the user?s basal heart rate and changes in instantaneous heart rate. To test the FitLab Game, a total of 16 participants (mean age 23, SD 0.69 years) were divided into a control group (n=8) and an experimental group (n=8). A 2 × 2 factorial design was used in each session. Participants in the experimental condition were trained in breathing techniques. Results: Changes in the frequency and time domain parameters of HRV and the game?s performance features were evaluated. Significant changes in the average RR intervals and root mean square of differences between adjacent RR intervals (RMSSD) were found between the groups (P=.02 and P=.04, respectively). Regarding performance, both groups showed a tendency to increase the evaluated outcomes from baseline to the test condition. Conclusions: The results may indicate that playing different levels leads to an improvement in the game?s final score by repeated training. The tendency of changes in HRV may reflect a higher activation of the mental system of attention and control in the experimental group versus the control group. In this context, learning simple, voluntary strategies through a serious game can aid the improvement of self-control and arousal management. The FitLab Game appears to be a promising serious game owing to its ease of use, high engagement, and enjoyability provided by the instantaneous feedback. UR - https://games.jmir.org/2023/1/e46351 UR - http://dx.doi.org/10.2196/46351 UR - http://www.ncbi.nlm.nih.gov/pubmed/37616033 ID - info:doi/10.2196/46351 ER - TY - JOUR AU - Zhong, Wen AU - Liu, Rui AU - Cheng, Hongxin AU - Xu, Lin AU - Wang, Lu AU - He, Chengqi AU - Wei, Quan PY - 2023/7/28 TI - Longer-Term Effects of Cardiac Telerehabilitation on Patients With Coronary Artery Disease: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e46359 VL - 11 KW - cardiac telerehabilitation KW - coronary artery disease KW - CAD KW - cardiac rehabilitation KW - CR KW - long-term effect KW - meta-analysis N2 - Background: Cardiac telerehabilitation offers a flexible and accessible model for patients with coronary artery disease (CAD), effectively transforming the traditional cardiac rehabilitation (CR) approach. Objective: This systematic review and meta-analysis aimed to evaluate the long-term effectiveness of cardiac telerehabilitation. Methods: We searched randomized controlled trials (RCTs) in 7 electronic databases: PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the China National Knowledge Infrastructure, and WANFANG. The primary outcome focused on cardiopulmonary fitness. For secondary outcomes, we examined cardiovascular risk factors (blood pressure, BMI, and serum lipids), psychological scales of depression and anxiety, quality of life (QoL), cardiac telerehabilitation adherence, and adverse events. Results: In total, 10 RCTs fulfilled the predefined criteria, which were reviewed in our meta-analysis. The results showed that after cardiac telerehabilitation, there was a significant difference in the improvement in long-term peak oxygen uptake compared to center-based CR (mean difference [MD] 1.61, 95% CI 0.38-2.85, P=.01), particularly after 6-month rehabilitation training (MD 1.87, 95% CI 0.34-3.39, P=.02). The pooled effect size of the meta-analysis indicated that there were no significant differences in the reduction in cardiovascular risk factor control. There was also no practical demonstration of anxiety scores or depression scores. However, cardiac telerehabilitation demonstrated an improvement in the long-term QoL of patients (MD 0.92, 95% CI 0.06-1.78, P=.04). In addition, the study reported a high completion rate (80%) for cardiac telerehabilitation interventions. The incidence of adverse events was also low during long-term follow-up. Conclusions: Cardiac telerehabilitation proves to be more effective in improving cardiopulmonary fitness and QoL during the long-term follow-up for patients with CAD. Our study highlights monitoring-enabled and patient-centered telerehabilitation programs, which play a vital role in the recovery and development of CAD and in the long-term prognosis of patients. UR - https://mhealth.jmir.org/2023/1/e46359 UR - http://dx.doi.org/10.2196/46359 UR - http://www.ncbi.nlm.nih.gov/pubmed/37505803 ID - info:doi/10.2196/46359 ER - TY - JOUR AU - Xu, Jianing AU - Qu, Mingyu AU - Dong, Xuejie AU - Chen, Yihe AU - Yin, Hongfan AU - Qu, Fangge AU - Zhang, Lin PY - 2023/7/26 TI - Tele-Instruction Tool for Multiple Lay Responders Providing Cardiopulmonary Resuscitation in Telehealth Emergency Dispatch Services: Mixed Methods Study JO - J Med Internet Res SP - e46092 VL - 25 KW - cardiac arrest KW - lay responder KW - teamwork KW - telehealth KW - telephone-assisted cardiopulmonary resuscitation N2 - Background: Telephone-assisted cardiopulmonary resuscitation (T-CPR) has proven to be a crucial intervention in enhancing the ability of lay responders to perform cardiopulmonary resuscitation (CPR) during telehealth emergency services. While the majority of established T-CPR protocols primarily focus on guiding individual rescuers, there is a lack of emphasis on instructing and coordinating multiple lay responders to perform resuscitation collaboratively. Objective: This study aimed to develop an innovative team-based tele-instruction tool to efficiently organize and instruct multiple lay responders on the CPR process and to evaluate the effectiveness and feasibility of the tool. Methods: We used a mixed methods design in this study. We conducted a randomized controlled simulation trial to conduct the quantitative analysis. The intervention groups used the team-based tele-instruction tool for team resuscitation, while the control groups did not have access to the tool. Baseline resuscitation was performed during the initial phase (phase I test). Subsequently, all teams watched a team-based CPR education training video and finished a 3-person practice session with teaching followed by a posttraining test (phase II test). In the qualitative analysis, we randomly selected an individual from each team and 4 experts in emergency medical services to conduct semistructured interviews. The purpose of these interviews was to evaluate the effectiveness and feasibility of this tool. Results: The team-based tele-instruction tool significantly improved the quality of chest compression in both phase I and phase II tests. The average compression rates were more appropriate in the intervention groups compared to the control groups (median 104.5, IQR 98.8-111.8 min?1 vs median 112, IQR 106-120.8 min?1; P=.04 in phase I and median 117.5, IQR 112.3-125 min?1 vs median 111, IQR 105.3-119 min?1; P=.03 in phase II). In the intervention group, there was a delay in the emergency response time compared to that in the control group (time to first chest compression: median 20, IQR 15-24.8 seconds vs median 25, IQR 20.5-40.3 seconds; P=.03; time to open the airway: median 48, IQR 36.3-62 seconds vs median 73.5, IQR 54.5-227.8 seconds; P=.01). However, this delay was partially mitigated after the phase II test. The qualitative results confirmed the compatibility and generalizability of the team-based tele-instruction tool, demonstrating its ability to effectively guide multiple lay responders through teamwork and effective communication with telecommunicators. Conclusions: The use of the team-based tele-instruction tool offers an effective solution to enhance the quality of chest compression among multiple lay responders. This tool facilitated the organization of resuscitation teams by dispatchers and enabled efficient cooperation. Further assessment of the widespread adoption and practical application of the team-based tele-instruction tools in real-life rescue scenarios within the telehealth emergency services system is warranted. UR - https://www.jmir.org/2023/1/e46092 UR - http://dx.doi.org/10.2196/46092 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494107 ID - info:doi/10.2196/46092 ER - TY - JOUR AU - Zepeda-Echavarria, Alejandra AU - van de Leur, R. Rutger AU - van Sleuwen, Meike AU - Hassink, J. Rutger AU - Wildbergh, X. Thierry AU - Doevendans, A. Pieter AU - Jaspers, Joris AU - van Es, René PY - 2023/7/7 TI - Electrocardiogram Devices for Home Use: Technological and Clinical Scoping Review JO - JMIR Cardio SP - e44003 VL - 7 KW - electrocardiogram KW - mobile ECG KW - home use ECG KW - wearables KW - medical devices KW - ECG clinical validation, ECG technical characteristics N2 - Background: Electrocardiograms (ECGs) are used by physicians to record, monitor, and diagnose the electrical activity of the heart. Recent technological advances have allowed ECG devices to move out of the clinic and into the home environment. There is a great variety of mobile ECG devices with the capabilities to be used in home environments. Objective: This scoping review aimed to provide a comprehensive overview of the current landscape of mobile ECG devices, including the technology used, intended clinical use, and available clinical evidence. Methods: We conducted a scoping review to identify studies concerning mobile ECG devices in the electronic database PubMed. Secondarily, an internet search was performed to identify other ECG devices available in the market. We summarized the devices? technical information and usability characteristics based on manufacturer data such as datasheets and user manuals. For each device, we searched for clinical evidence on the capabilities to record heart disorders by performing individual searches in PubMed and ClinicalTrials.gov, as well as the Food and Drug Administration (FDA) 510(k) Premarket Notification and De Novo databases. Results: From the PubMed database and internet search, we identified 58 ECG devices with available manufacturer information. Technical characteristics such as shape, number of electrodes, and signal processing influence the capabilities of the devices to record cardiac disorders. Of the 58 devices, only 26 (45%) had clinical evidence available regarding their ability to detect heart disorders such as rhythm disorders, more specifically atrial fibrillation. Conclusions: ECG devices available in the market are mainly intended to be used for the detection of arrhythmias. No devices are intended to be used for the detection of other cardiac disorders. Technical and design characteristics influence the intended use of the devices and use environments. For mobile ECG devices to be intended to detect other cardiac disorders, challenges regarding signal processing and sensor characteristics should be solved to increase their detection capabilities. Devices recently released include the use of other sensors on ECG devices to increase their detection capabilities. UR - https://cardio.jmir.org/2023/1/e44003 UR - http://dx.doi.org/10.2196/44003 UR - http://www.ncbi.nlm.nih.gov/pubmed/37418308 ID - info:doi/10.2196/44003 ER - TY - JOUR AU - Zaman, Sameer AU - Padayachee, Yorissa AU - Shah, Moulesh AU - Samways, Jack AU - Auton, Alice AU - Quaife, M. Nicholas AU - Sweeney, Mark AU - Howard, P. James AU - Tenorio, Indira AU - Bachtiger, Patrik AU - Kamalati, Tahereh AU - Pabari, A. Punam AU - Linton, F. Nick W. AU - Mayet, Jamil AU - Peters, S. Nicholas AU - Barton, Carys AU - Cole, D. Graham AU - Plymen, M. Carla PY - 2023/6/23 TI - Smartphone-Based Remote Monitoring in Heart Failure With Reduced Ejection Fraction: Retrospective Cohort Study of Secondary Care Use and Costs JO - JMIR Cardio SP - e45611 VL - 7 KW - heart failure KW - remote monitoring KW - smartphone care KW - telemonitoring KW - self-management KW - admission prevention KW - cohort study KW - hospitalization KW - noninvasive KW - smartphone KW - vital signs KW - diagnosis N2 - Background: Despite effective therapies, the economic burden of heart failure with reduced ejection fraction (HFrEF) is driven by frequent hospitalizations. Treatment optimization and admission avoidance rely on frequent symptom reviews and monitoring of vital signs. Remote monitoring (RM) aims to prevent admissions by facilitating early intervention, but the impact of noninvasive, smartphone-based RM of vital signs on secondary health care use and costs in the months after a new diagnosis of HFrEF is unknown. Objective: The purpose of this study is to conduct a secondary care health use and health-economic evaluation for patients with HFrEF using smartphone-based noninvasive RM and compare it with matched controls receiving usual care without RM. Methods: We conducted a retrospective study of 2 cohorts of newly diagnosed HFrEF patients, matched 1:1 for demographics, socioeconomic status, comorbidities, and HFrEF severity. They are (1) the RM group, with patients using the RM platform for >3 months and (2) the control group, with patients referred before RM was available who received usual heart failure care without RM. Emergency department (ED) attendance, hospital admissions, outpatient use, and the associated costs of this secondary care activity were extracted from the Discover data set for a 3-month period after diagnosis. Platform costs were added for the RM group. Secondary health care use and costs were analyzed using Kaplan-Meier event analysis and Cox proportional hazards modeling. Results: A total of 146 patients (mean age 63 years; 42/146, 29% female) were included (73 in each group). The groups were well-matched for all baseline characteristics except hypertension (P=.03). RM was associated with a lower hazard of ED attendance (hazard ratio [HR] 0.43; P=.02) and unplanned admissions (HR 0.26; P=.02). There were no differences in elective admissions (HR 1.03, P=.96) or outpatient use (HR 1.40; P=.18) between the 2 groups. These differences were sustained by a univariate model controlling for hypertension. Over a 3-month period, secondary health care costs were approximately 4-fold lower in the RM group than the control group, despite the additional cost of RM itself (mean cost per patient GBP £465, US $581 vs GBP £1850, US $2313, respectively; P=.04). Conclusions: This retrospective cohort study shows that smartphone-based RM of vital signs is feasible for HFrEF. This type of RM was associated with an approximately 2-fold reduction in ED attendance and a 4-fold reduction in emergency admissions over just 3 months after a new diagnosis with HFrEF. Costs were significantly lower in the RM group without increasing outpatient demand. This type of RM could be adjunctive to standard care to reduce admissions, enabling other resources to help patients unable to use RM. UR - https://cardio.jmir.org/2023/1/e45611 UR - http://dx.doi.org/10.2196/45611 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351921 ID - info:doi/10.2196/45611 ER - TY - JOUR AU - Nishizaki, Yuji AU - Kuroki, Haruo AU - Ishii, So AU - Ohtsu, Shigeyuki AU - Watanabe, Chizuru AU - Nishizawa, Hiroto AU - Nagao, Masashi AU - Nojima, Masanori AU - Watanabe, Ryo AU - Sato, Daisuke AU - Sato, Kensuke AU - Kawata, Yumi AU - Wada, Hiroo AU - Toyoda, Goichiro AU - Ohbayashi, Katsumi PY - 2023/6/8 TI - Determining Optimal Intervals for In-Person Visits During Video-Based Telemedicine Among Patients With Hypertension: Cluster Randomized Controlled Trial JO - JMIR Cardio SP - e45230 VL - 7 KW - hypertension KW - Japan KW - lost productivity time KW - patient satisfaction KW - telemedicine N2 - Background: Introducing telemedicine in outpatient treatment may improve patient satisfaction and convenience. However, the optimal in-person visit interval for video-based telemedicine among patients with hypertension remains unreported in Japan. Objective: We determined the optimal in-person visit interval for video-based telemedicine among patients with hypertension. Methods: This was a cluster randomized controlled noninferiority trial. The target sites were 8 clinics in Japan that had a telemedicine system, and the target patients were individuals with essential hypertension. Among patients receiving video-based telemedicine, those who underwent in-person visits at 6-month intervals were included in the intervention group, and those who underwent in-person visits at 3-month intervals were included in the control group. The follow-up period of the participants was 6 months. The primary end point of the study was the change in systolic blood pressure, and the secondary end points were the rate of treatment continuation after 6 months, patient satisfaction, health economic evaluation, and safety evaluation. Results: Overall, 64 patients were enrolled. Their mean age was 54.5 (SD 10.3) years, and 60.9% (39/64) of patients were male. For the primary end point, the odds ratio for the estimated difference in the change in systolic blood pressure between the 2 groups was 1.18 (90% CI ?3.68 to 6.04). Notably, the criteria for noninferiority were met. Patient satisfaction was higher in the intervention group than in the control group. Furthermore, the indirect costs indicated that lost productivity was significantly lesser in the intervention group than in the control group. Moreover, the treatment continuation rate did not differ between the intervention and control groups, and there were no adverse events in either group. Conclusions: Blood pressure control status and safety did not differ between the intervention and control groups. In-person visits at 6-month intervals may cause a societal cost reduction and improve patient satisfaction during video-based telemedicine. Trial Registration: UMIN Clinical Trials Registry (UMIN-CTR) UMIN000040953; https://tinyurl.com/2p8devm9 UR - https://cardio.jmir.org/2023/1/e45230 UR - http://dx.doi.org/10.2196/45230 UR - http://www.ncbi.nlm.nih.gov/pubmed/37161483 ID - info:doi/10.2196/45230 ER - TY - JOUR AU - Ashikaga, Kohei AU - Doi, Shunichi AU - Yoneyama, Kihei AU - Suzuki, Norio AU - Kuwata, Shingo AU - Koga, Masashi AU - Takeichi, Naoya AU - Watanabe, Satoshi AU - Izumo, Masaki AU - Kida, Keisuke AU - Akashi, J. Yoshihiro PY - 2023/5/17 TI - Efficacy and Safety of Home-Based Cardiac Telemonitoring Rehabilitation in Patients After Transcatheter Aortic Valve Implantation: Single-Center Usability and Feasibility Study JO - JMIR Rehabil Assist Technol SP - e45247 VL - 10 KW - transcatheter aortic valve implantation KW - telerehabilitation KW - cardiac rehabilitation KW - remote KW - telemonitoring N2 - Background: No consensus exists on the efficacy of home-based cardiac rehabilitation (CR) in patients who have undergone transcatheter aortic valve implantation (TAVI). Additionally, there are no reports on home-based cardiac telemonitoring rehabilitation (HBTR) in patients after TAVI. Objective: We aimed to investigate the efficacy of HBTR in patients who have undergone TAVI. Methods: This single-center preliminary study introduced HBTR to patients after TAVI, and the efficacy outcomes of the rehabilitation method were compared to that of a historical control cohort. The historical control cohort (control group) consisted of 6 consecutive patients who underwent ordinary outpatient CR after TAVI from February 2016 to March 2020. Patients who participated in the HBTR program were only recruited after the TAVI procedure and before discharge between April 2021 and May 2022. In the first 2 weeks after TAVI, patients underwent outpatient CR and were trained using telemonitoring rehabilitation systems. Thereafter, patients underwent HBTR twice a week for 12 weeks. The control group performed standard outpatient CR at least once a week for 12 to 16 weeks. Efficacy was assessed using peak oxygen uptake (VO2) prior to and after CR. Results: Eleven patients were included in the HBTR group. All patients underwent 24 HBTR sessions during the 12-week training period, and no adverse events were observed. The control group participants performed 19 (SD 7) sessions during the training period, and no adverse events were observed. Participants in the HBTR and control groups had a mean age of 80.4 (SD 6.0) years and 79.0 (SD 3.9) years, respectively. In the HBTR group, preintervention and postintervention peak VO2 values were 12.0 (SD 1.7) mL/min/kg and 14.3 (SD 2.7) mL/min/kg (P=.03), respectively. The peak VO2 changes in the HBTR and control groups were 2.4 (SD 1.4) mL/min/kg and 1.3 (SD 5.0) mL/min/kg (P=.64), respectively. Conclusions: Home-based CR using a telemonitoring system is a safe outpatient rehabilitation method. Its efficacy is not inferior to that of standard CR in patients who have undergone TAVI. Trial Registration: Japan Registry of Clinical Trials jRCTs032200122; https://jrct.niph.go.jp/latest-detail/jRCTs032200122 UR - https://rehab.jmir.org/2023/1/e45247 UR - http://dx.doi.org/10.2196/45247 UR - http://www.ncbi.nlm.nih.gov/pubmed/37195764 ID - info:doi/10.2196/45247 ER - TY - JOUR AU - Zoodsma, S. Ruben AU - Bosch, Rian AU - Alderliesten, Thomas AU - Bollen, W. Casper AU - Kappen, H. Teus AU - Koomen, Erik AU - Siebes, Arno AU - Nijman, Joppe PY - 2023/5/16 TI - Continuous Data-Driven Monitoring in Critical Congenital Heart Disease: Clinical Deterioration Model Development JO - JMIR Cardio SP - e45190 VL - 7 KW - artificial intelligence KW - aberration detection KW - clinical deterioration KW - classification model KW - paediatric intensive care KW - pediatric intensive care KW - congenital heart disease KW - cardiac monitoring KW - machine learning KW - peri-operative KW - perioperative KW - surgery N2 - Background: Critical congenital heart disease (cCHD)?requiring cardiac intervention in the first year of life for survival?occurs globally in 2-3 of every 1000 live births. In the critical perioperative period, intensive multimodal monitoring at a pediatric intensive care unit (PICU) is warranted, as their organs?especially the brain?may be severely injured due to hemodynamic and respiratory events. These 24/7 clinical data streams yield large quantities of high-frequency data, which are challenging in terms of interpretation due to the varying and dynamic physiology innate to cCHD. Through advanced data science algorithms, these dynamic data can be condensed into comprehensible information, reducing the cognitive load on the medical team and providing data-driven monitoring support through automated detection of clinical deterioration, which may facilitate timely intervention. Objective: This study aimed to develop a clinical deterioration detection algorithm for PICU patients with cCHD. Methods: Retrospectively, synchronous per-second data of cerebral regional oxygen saturation (rSO2) and 4 vital parameters (respiratory rate, heart rate, oxygen saturation, and invasive mean blood pressure) in neonates with cCHD admitted to the University Medical Center Utrecht, the Netherlands, between 2002 and 2018 were extracted. Patients were stratified based on mean oxygen saturation during admission to account for physiological differences between acyanotic and cyanotic cCHD. Each subset was used to train our algorithm in classifying data as either stable, unstable, or sensor dysfunction. The algorithm was designed to detect combinations of parameters abnormal to the stratified subpopulation and significant deviations from the patient?s unique baseline, which were further analyzed to distinguish clinical improvement from deterioration. Novel data were used for testing, visualized in detail, and internally validated by pediatric intensivists. Results: A retrospective query yielded 4600 hours and 209 hours of per-second data in 78 and 10 neonates for, respectively, training and testing purposes. During testing, stable episodes occurred 153 times, of which 134 (88%) were correctly detected. Unstable episodes were correctly noted in 46 of 57 (81%) observed episodes. Twelve expert-confirmed unstable episodes were missed in testing. Time-percentual accuracy was 93% and 77% for, respectively, stable and unstable episodes. A total of 138 sensorial dysfunctions were detected, of which 130 (94%) were correct. Conclusions: In this proof-of-concept study, a clinical deterioration detection algorithm was developed and retrospectively evaluated to classify clinical stability and instability, achieving reasonable performance considering the heterogeneous population of neonates with cCHD. Combined analysis of baseline (ie, patient-specific) deviations and simultaneous parameter-shifting (ie, population-specific) proofs would be promising with respect to enhancing applicability to heterogeneous critically ill pediatric populations. After prospective validation, the current?and comparable?models may, in the future, be used in the automated detection of clinical deterioration and eventually provide data-driven monitoring support to the medical team, allowing for timely intervention. UR - https://cardio.jmir.org/2023/1/e45190 UR - http://dx.doi.org/10.2196/45190 UR - http://www.ncbi.nlm.nih.gov/pubmed/37191988 ID - info:doi/10.2196/45190 ER - TY - JOUR AU - Calvo-López, Margarita AU - Arranz Tolós, Raquel AU - Marin Expósito, Josefa AU - Gruosso, Domenico AU - Andrea, Rut AU - Roque, Mercè AU - Falces, Carles AU - Yago, Gemma AU - Saura Araguas, Judith AU - Pastor, Nuria AU - Sitges, Marta AU - Sanz-de la Garza, Maria PY - 2023/4/24 TI - Cardio4Health Study, a Cardiac Telerehabilitation Pilot Program Aimed at Patients After an Ischemic Event: Cross-sectional Study JO - JMIR Cardio SP - e44179 VL - 7 KW - cardiac rehabilitation KW - web-based platform KW - telemedicine KW - remote care KW - ischemic heart disease N2 - Background: Center-based cardiac rehabilitation programs (CRPs) reduce morbidity and mortality after an ischemic cardiac event; however, they are widely underused. Home-based CRP has emerged as an alternative to improve patient adherence; however, its safety and efficacy remain unclear, especially for older patients and female patients. Objective: This study aimed to develop a holistic home-based CRP for patients with ischemic heart disease and evaluate its safety and impact on functional capacity, adherence to a healthy lifestyle, and quality of life. Methods: The 8-week home-based CRP included patients of both sexes, with no age limit, who had overcome an acute myocardial infarction in the previous 3 months, had a left ventricular ejection fraction of ?40%, and had access to a tablet or mobile device. The CRP was developed using a dedicated platform designed explicitly for this purpose and included 3 weekly exercise sessions combining tailored aerobic and strength training and 2 weekly educational session focused on lifestyle habits, therapeutic adherence, and patient empowerment. Results: We initially included 62 patients, of whom 1 was excluded for presenting with ventricular arrhythmias during the initial stress test, 5 were excluded because of incompatibility, and 6 dropped out because of a technological barrier. Ultimately, 50 patients completed the program: 85% (42/50) were male, with a mean age of 58.9 (SD 10.3) years, a mean left ventricular ejection fraction of 52.1% (SD 6.72%), and 25 (50%) New York Heart Association functional class I and 25 (50%) New York Heart Association II-III. The CRP significantly improved functional capacity (+1.6 metabolic equivalent tasks), muscle strength (arm curl test +15.5% and sit-to-stand test +19.7%), weekly training volume (+803 metabolic equivalent tasks), adherence to the Mediterranean diet, emotional state (anxiety), and quality of life. No major complications occurred, and adherence was excellent (>80%) in both the exercise and educational sessions. In the subgroup analysis, CRP showed equivalent beneficial effects irrespective of sex and age. In addition, patient preferences for CRP approaches were equally distributed, with one-third (14/50, 29%) of the patients preferring a face-to-face CRP, one-third (17/50, 34%) preferring a telematic CRP, and one-third (18/50, 37%) preferring a hybrid approach. Regarding CRP duration, 63% (31/50) of the patients considered it adequate, whereas the remaining 37% (19/50) preferred a longer program. Conclusions: A holistic telematic CRP dedicated to patients after an ischemic cardiac event, irrespective of sex and age, is safe and, in our population, has achieved positive results in improving maximal aerobic capacity, weekly training volume, muscle strength, quality of life, compliance with diet, and anxiety symptoms. The preference for a center- or home-based CRP approach is diverse among the study population, emphasizing the need for a tailored CRP to improve adherence and completion rates. UR - https://cardio.jmir.org/2023/1/e44179 UR - http://dx.doi.org/10.2196/44179 UR - http://www.ncbi.nlm.nih.gov/pubmed/37093637 ID - info:doi/10.2196/44179 ER - TY - JOUR AU - Ru, Boshu AU - Tan, Xi AU - Liu, Yu AU - Kannapur, Kartik AU - Ramanan, Dheepan AU - Kessler, Garin AU - Lautsch, Dominik AU - Fonarow, Gregg PY - 2023/4/17 TI - Comparison of Machine Learning Algorithms for Predicting Hospital Readmissions and Worsening Heart Failure Events in Patients With Heart Failure With Reduced Ejection Fraction: Modeling Study JO - JMIR Form Res SP - e41775 VL - 7 KW - deep learning KW - machine learning KW - hospital readmission KW - heart failure KW - heart failure with reduced ejection fraction KW - worsening heart failure event KW - Bidirectional Encoder Representations From Transformers KW - BERT KW - clinical registry KW - medical claims KW - real-world data N2 - Background: Heart failure (HF) is highly prevalent in the United States. Approximately one-third to one-half of HF cases are categorized as HF with reduced ejection fraction (HFrEF). Patients with HFrEF are at risk of worsening HF, have a high risk of adverse outcomes, and experience higher health care use and costs. Therefore, it is crucial to identify patients with HFrEF who are at high risk of subsequent events after HF hospitalization. Objective: Machine learning (ML) has been used to predict HF-related outcomes. The objective of this study was to compare different ML prediction models and feature construction methods to predict 30-, 90-, and 365-day hospital readmissions and worsening HF events (WHFEs). Methods: We used the Veradigm PINNACLE outpatient registry linked to Symphony Health?s Integrated Dataverse data from July 1, 2013, to September 30, 2017. Adults with a confirmed diagnosis of HFrEF and HF-related hospitalization were included. WHFEs were defined as HF-related hospitalizations or outpatient intravenous diuretic use within 1 year of the first HF hospitalization. We used different approaches to construct ML features from clinical codes, including frequencies of clinical classification software (CCS) categories, Bidirectional Encoder Representations From Transformers (BERT) trained with CCS sequences (BERT + CCS), BERT trained on raw clinical codes (BERT + raw), and prespecified features based on clinical knowledge. A multilayer perceptron neural network, extreme gradient boosting (XGBoost), random forest, and logistic regression prediction models were applied and compared. Results: A total of 30,687 adult patients with HFrEF were included in the analysis; 11.41% (3184/27,917) of adults experienced a hospital readmission within 30 days of their first HF hospitalization, and nearly half (9231/21,562, 42.81%) of the patients experienced at least 1 WHFE within 1 year after HF hospitalization. The prediction models and feature combinations with the best area under the receiver operating characteristic curve (AUC) for each outcome were XGBoost with CCS frequency (AUC=0.595) for 30-day readmission, random forest with CCS frequency (AUC=0.630) for 90-day readmission, XGBoost with CCS frequency (AUC=0.649) for 365-day readmission, and XGBoost with CCS frequency (AUC=0.640) for WHFEs. Our ML models could discriminate between readmission and WHFE among patients with HFrEF. Our model performance was mediocre, especially for the 30-day readmission events, most likely owing to limitations of the data, including an imbalance between positive and negative cases and high missing rates of many clinical variables and outcome definitions. Conclusions: We predicted readmissions and WHFEs after HF hospitalizations in patients with HFrEF. Features identified by data-driven approaches may be comparable with those identified by clinical domain knowledge. Future work may be warranted to validate and improve the models using more longitudinal electronic health records that are complete, are comprehensive, and have a longer follow-up time. UR - https://formative.jmir.org/2023/1/e41775 UR - http://dx.doi.org/10.2196/41775 UR - http://www.ncbi.nlm.nih.gov/pubmed/37067873 ID - info:doi/10.2196/41775 ER - TY - JOUR AU - Mekhael, Mario AU - Ho, Chan AU - Noujaim, Charbel AU - Assaf, Ala AU - Younes, Hadi AU - El Hajjar, Hadi Abdel AU - Chaudhry, A. Humza AU - Lanier, Brennan AU - Chouman, Nour AU - Makan, Noor AU - Shan, Botao AU - Zhang, Yichi AU - Dagher, Lilas AU - Kreidieh, Omar AU - Marrouche, Nassir AU - Donnellan, Eoin PY - 2023/4/5 TI - Compliance Challenges in a Longitudinal COVID-19 Cohort Using Wearables for Continuous Monitoring: Observational Study JO - J Med Internet Res SP - e43134 VL - 25 KW - COVID-19 KW - digital health KW - wearables KW - compliance KW - cardiovascular health KW - heart disease KW - wearable device KW - biometric KW - remote monitoring N2 - 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; ?=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. UR - https://www.jmir.org/2023/1/e43134 UR - http://dx.doi.org/10.2196/43134 UR - http://www.ncbi.nlm.nih.gov/pubmed/36763647 ID - info:doi/10.2196/43134 ER - TY - JOUR AU - Chen, Botian AU - Dou, Yuqi AU - Yu, Xue AU - Ma, Defu PY - 2023/3/20 TI - Influence of Internet-Based Health Management on Control of Clinical Parameters in Patients With Hypertension: Four-Year Longitudinal Study JO - J Med Internet Res SP - e42896 VL - 25 KW - hypertension KW - internet-based health management KW - blood pressure control KW - longitudinal study KW - health management KW - primary care KW - online based KW - eHealth KW - telehealth KW - telemedicine N2 - Background: In recent years, more and more studies have shown that internet-based health management can help patients with hypertension control their blood pressure. However, there is a lack of similar research in China. Objective: We designed this study to clarify the impact of long-term internet-based health management on the control of clinical parameters in patients with hypertension. These results are also expected to identify the relevant factors affecting the control of clinical parameters in hypertension more accurately toward developing more targeted health management strategies. Methods: This was a longitudinal study of internet-based health management in the five provinces of northwest China. The inclusion criteria were aged ?18 years and no serious cognitive disease or mental disorder. After collecting the physical examination data of 8567 people in the five northwest provinces in 2013, we conducted online health management (including diet, exercise, and behavior) and follow-up. In the physical examination in 2013, 1008 new patients with hypertension were identified, who were divided into a good blood pressure control group and poor blood pressure control group. Physical examination and a questionnaire survey were conducted every 2 years to understand the changes of health management on the subjects? health-related behaviors. We then analyzed the changes of clinical indicators related to hypertension and the influencing factors related to blood pressure control in patients with hypertension. All statistical analyses were performed using R software (version 4.1.2) and a P value <.05 was considered statistically significant. Results: A total of 8567 people met the inclusion criteria and underwent health management. Self-comparison showed that after 4 years of health management, the smoking cessation rate and amount of exercise significantly increased (both P<.001). The low-density lipoprotein-cholesterol levels also increased (P=.005), whereas the high-density lipoprotein-cholesterol levels decreased (P=.007). The newly discovered patients with hypertension in 2013 were further screened. After 4 years of health management, their smoking cessation rate increased significantly (P=.03) and the amount of exercise increased but not significantly (P=.08). In terms of clinical indicators, the diastolic blood pressure considerably decreased (P<.001) and the systolic blood pressure slightly decreased (P=.13). The correlation analysis of blood pressure control in patients with new-onset hypertension showed that gender (female) and changing relevant factors according to health management behaviors (BMI; cereals and potatoes intake; fish, livestock meat, and eggs intake; fruit intake; and physical activity) were the protective factors of blood pressure control. Conclusions: Internet-based health management has a significant and long-term effect on blood pressure control in patients with hypertension. UR - https://www.jmir.org/2023/1/e42896 UR - http://dx.doi.org/10.2196/42896 UR - http://www.ncbi.nlm.nih.gov/pubmed/36939826 ID - info:doi/10.2196/42896 ER - TY - JOUR AU - Khalid, Ayisha AU - Dong, Quanfang AU - Chuluunbaatar, Enkhzaya AU - Haldane, Victoria AU - Durrani, Hammad AU - Wei, Xiaolin PY - 2023/3/14 TI - Implementation Science Perspectives on Implementing Telemedicine Interventions for Hypertension or Diabetes Management: Scoping Review JO - J Med Internet Res SP - e42134 VL - 25 KW - telemedicine KW - hypertension KW - diabetes KW - implementation science KW - mobile phone N2 - Background: Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions for care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension or diabetes worldwide. Objective: We adopted a comprehensive implementation research perspective to synthesize the barriers to and facilitators of implementing telemedicine interventions for the management of hypertension, diabetes, or both. Methods: We performed a scoping review involving searches in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research. Results: Of the 17,687 records identified, 35 (0.2%) studies were included in our scoping review. We found that facilitators of and barriers to implementation were dispersed across the constructs of the Consolidated Framework for Implementation Research. Barriers related to cost, patient needs and resources (eg, lack of consideration of language needs, culture, and rural residency), and personal attributes of patients (eg, demographics and priorities) were the most common. Facilitators related to the design and packaging of the intervention (eg, user-friendliness), patient needs and resources (eg, personalized information that leveraged existing strengths), implementation climate (eg, intervention embedded into existing infrastructure), knowledge of and beliefs about the intervention (eg, convenience of telemedicine), and other personal attributes (eg, technical literacy) were the most common. Conclusions: Our findings suggest that the successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, execution, engagement, and reflection and evaluation stages of intervention implementation to address challenges at the individual, interpersonal, organizational, and environmental levels. UR - https://www.jmir.org/2023/1/e42134 UR - http://dx.doi.org/10.2196/42134 UR - http://www.ncbi.nlm.nih.gov/pubmed/36917174 ID - info:doi/10.2196/42134 ER - TY - JOUR AU - Leiner, Johannes AU - König, Sebastian AU - Mouratis, Konstantinos AU - Kim, Igor AU - Schmitz, Pia AU - Joshi, Tanvi AU - Schanner, Carolin AU - Wohlrab, Lisa AU - Hohenstein, Sven AU - Pellissier, Vincent AU - Nitsche, Anne AU - Kuhlen, Ralf AU - Hindricks, Gerhard AU - Bollmann, Andreas PY - 2023/3/3 TI - A Digital Infrastructure for Cardiovascular Patient Care Based on Mobile Health Data and Patient-Reported Outcomes: Concept Details of the Helios TeleWear Project Including Preliminary Experiences JO - JMIR Form Res SP - e41115 VL - 7 KW - mHealth KW - wearable KW - patient-reported outcomes KW - electrocardiogram KW - cardiovascular disease KW - atrial fibrillation KW - telemedicine KW - mobile health KW - telehealth N2 - Background: Mobile health (mHealth) approaches are already having a fundamental impact on clinical practice in cardiovascular medicine. A variety of different health apps and wearable devices for capturing health data such as electrocardiograms (ECGs) exist. However, most mHealth technologies focus on distinct variables without integrating patients? quality of life, and the impact on clinical outcome measures of implementing those digital solutions into cardiovascular health care is still to be determined. Objective: Within this document, we describe the TeleWear project, which was recently initiated as an approach for contemporary patient management integrating mobile-collected health data and the standardized mHealth-guided measurement of patient-reported outcomes (PROs) in patients with cardiovascular disease. Methods: The specifically designed mobile app and clinical frontend form the central elements of our TeleWear infrastructure. Because of its flexible framework, the platform allows far-reaching customization with the possibility to add different mHealth data sources and respective questionnaires (patient-reported outcome measures). Results: With initial focus on patients with cardiac arrhythmias, a feasibility study is currently carried out to assess wearable-recorded ECG and PRO transmission and its evaluation by physicians using the TeleWear app and clinical frontend. First experiences made during the feasibility study yielded positive results and confirmed the platform?s functionality and usability. Conclusions: TeleWear represents a unique mHealth approach comprising PRO and mHealth data capturing. With the currently running TeleWear feasibility study, we aim to test and further develop the platform in a real-world setting. A randomized controlled trial including patients with atrial fibrillation that investigates PRO- and ECG-based clinical management based on the established TeleWear infrastructure will evaluate its clinical benefits. Widening the spectrum of health data collection and interpretation beyond the ECG and use of the TeleWear infrastructure in different patient subcohorts with focus on cardiovascular diseases are further milestones of the project with the ultimate goal to establish a comprehensive telemedical center entrenched by mHealth. UR - https://formative.jmir.org/2023/1/e41115 UR - http://dx.doi.org/10.2196/41115 UR - http://www.ncbi.nlm.nih.gov/pubmed/36867450 ID - info:doi/10.2196/41115 ER - TY - JOUR AU - Askman, Sanna AU - Löf, Marie AU - Maddison, Ralph AU - Nourse, Rebecca PY - 2023/2/17 TI - Feasibility and Acceptability of Wearable Cameras to Assess Self-care in People With Heart Failure: Pilot Study JO - JMIR Form Res SP - e40536 VL - 7 KW - heart failure KW - HF KW - life logging KW - self-management KW - cardiovascular disease KW - wearable devices KW - self management KW - self-care N2 - Background: Heart failure (HF) is a common chronic condition that affects over 26 million people worldwide. It is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. People with HF generally do not self-manage their condition well (eg, monitoring symptoms, taking medications regularly, physical activity, etc). A better understanding of self-care activities and what factors may indicate deterioration is warranted. Objective: The aim of this study was to determine the feasibility and acceptability of using wearable cameras to assess self-care activities in people with HF. The study objectives were to (1) explore whether changes in self-care activities could be identified prior to hospitalization and (2) determine the acceptability of wearable cameras to people with HF. Methods: A total of 30 people recently diagnosed with HF wore a camera for a maximum of 30 days; the camera took a photo every 30 seconds in the forward-facing direction. At the end of the study, all 30 participants were presented with 8 statements of acceptability, scored on a 5-point Likert scale. To determine whether camera images could identify changes in self-care activities and lifestyle risk factors before hospitalization, we analyzed images from participants (n=8) who were hospitalized during the 30-day study period. Images from the period immediately prior to hospitalization and a comparison were selected for each participant. Images were manually coded according to 9 different event categories relating to self-care and lifestyle risk factors, and events were compared between the 2 periods. Results: The participants reported high acceptability for wearing the cameras, as most strongly agreed or agreed that they were comfortable to wear (28/30, 93%) and easy to use (30/30, 100%). The results of the camera image analysis showed that participants undertook fewer activities of daily living (P=.008) and were more sedentary (P=.02) prior to being hospitalized, compared to a period nonadjacent to hospitalization. Conclusions: Adults with HF were accepting of using a wearable camera for periods within a 30-day time frame. Wearable cameras were a feasible approach for providing data on selected self-care activities and lifestyle risk factors for HF and offer the potential to be a valuable tool for improving our understanding of self-care. UR - https://formative.jmir.org/2023/1/e40536 UR - http://dx.doi.org/10.2196/40536 UR - http://www.ncbi.nlm.nih.gov/pubmed/36800215 ID - info:doi/10.2196/40536 ER - TY - JOUR AU - Brons, Maaike AU - ten Klooster, Iris AU - van Gemert-Pijnen, Lisette AU - Jaarsma, Tiny AU - Asselbergs, W. Folkert AU - Oerlemans, J. Marish I. F. AU - Koudstaal, Stefan AU - Rutten, H. Frans PY - 2023/1/31 TI - Patterns in the Use of Heart Failure Telemonitoring: Post Hoc Analysis of the e-Vita Heart Failure Trial JO - JMIR Cardio SP - e41248 VL - 7 KW - heart failure KW - telemonitoring KW - adherence KW - eHealth KW - remote monitoring KW - electronic personal health record KW - patient monitoring N2 - Background: Research on the use of home telemonitoring data and adherence to it can provide new insights into telemonitoring for the daily management of patients with heart failure (HF). Objective: We described the use of a telemonitoring platform?including remote patient monitoring of blood pressure, pulse, and weight?and the use of the electronic personal health record. Patient characteristics were assessed in both adherent and nonadherent patients to weight transmissions. Methods: We used the data of the e-Vita HF study, a 3-arm parallel randomized trial performed in stable patients with HF managed in outpatient clinics in the Netherlands. In this study, data were analyzed from the participants in the intervention arm (ie, e-Vita HF platform). Adherence to weight transmissions was defined as transmitting weight ?3 times per week for at least 42 weeks during a year. Results: Data from 150 patients (mean age 67, SD 11 years; n=37, 25% female; n=123, 82% self-assessed New York Heart Association class I-II) were analyzed. One-year adherence to weight transmissions was 74% (n=111). Patients adherent to weight transmissions were less often hospitalized for HF in the 6 months before enrollment in the study compared to those who were nonadherent (n=9, 8% vs n=9, 23%; P=.02). The percentage of patients visiting the personal health record dropped steadily over time (n=140, 93% vs n=59, 39% at one year). With univariable analyses, there was no significant correlation between patient characteristics and adherence to weight transmissions. Conclusions: Adherence to remote patient monitoring was high among stable patients with HF and best for weighing; however, adherence decreased over time. Clinical and demographic variables seem not related to adherence to transmitting weight. Trial Registration: ClinicalTrials.gov NCT01755988; https://clinicaltrials.gov/ct2/show/NCT01755988 UR - https://cardio.jmir.org/2023/1/e41248 UR - http://dx.doi.org/10.2196/41248 UR - http://www.ncbi.nlm.nih.gov/pubmed/36719715 ID - info:doi/10.2196/41248 ER - TY - JOUR AU - Goswami, Aumeya AU - Poole, Lydia AU - Thorlu-Bangura, Zareen AU - Khan, Nushrat AU - Hanif, Wasim AU - Khunti, Kamlesh AU - Gill, Paramjit AU - Sajid, Madiha AU - Blandford, Ann AU - Stevenson, Fiona AU - Banerjee, Amitava AU - Ramasawmy, Mel PY - 2023/1/6 TI - The Use of Digital Health Interventions for Cardiometabolic Diseases Among South Asian and Black Minority Ethnic Groups: Realist Review JO - J Med Internet Res SP - e40630 VL - 25 KW - digital health KW - health inequality KW - cardiometabolic disease KW - cardiometabolic KW - ethnic KW - minority KW - cardiology KW - heart KW - eHealth KW - review KW - realist KW - context-mechanism-outcome KW - South Asia KW - Black KW - migrant KW - systematic search KW - literature search KW - African American KW - CVD KW - cardiovascular KW - diabetes KW - diabetic KW - type 2 KW - mobile phone N2 - Background: Digital health interventions (DHIs) for the prevention and management of cardiometabolic diseases have become increasingly common. However, there is limited evidence for the suitability of these approaches in minority ethnic populations, who are at an increased risk of these diseases. Objective: This study aimed to investigate the use of DHIs for cardiovascular disease and type 2 diabetes among minority ethnic populations in countries with a majority of White, English-speaking populations, focusing on people who identified as South Asian, Black, or African American. Methods: A realist methodology framework was followed. A literature search was conducted to develop context-mechanism-outcome configurations, including the contexts in which DHIs work for the target minority ethnic groups, mechanisms that these contexts trigger, and resulting health outcomes. After systematic searches, a qualitative analysis of the included studies was conducted using deductive and inductive coding. Results: A total of 15 studies on the uptake of DHIs for cardiovascular disease or diabetes were identified, of which 13 (87%) focused on people with an African-American background. The review found evidence supporting the use of DHIs in minority ethnic populations when specific factors are considered in implementation and design, including patients? beliefs, health needs, education and literacy levels, material circumstances, culture, social networks, and wider community and the supporting health care systems. Conclusions: Our context-mechanism-outcome configurations provide a useful guide for the future development of DHIs targeted at South Asian and Black minority ethnic populations, with specific recommendations for improving cultural competency and promoting accessibility and inclusivity of design. UR - https://www.jmir.org/2023/1/e40630 UR - http://dx.doi.org/10.2196/40630 UR - http://www.ncbi.nlm.nih.gov/pubmed/36607732 ID - info:doi/10.2196/40630 ER - TY - JOUR AU - Hughes, Zachary AU - Simkowski, Julia AU - Mendapara, Parry AU - Fink, Nicolas AU - Gupta, Sparsh AU - Youmans, Quentin AU - Khan, Sadiya AU - Wilcox, Jane AU - Mutharasan, Kannan R. PY - 2022/11/28 TI - Racial and Socioeconomic Differences in Heart Failure Hospitalizations and Telemedicine Follow-up During the COVID-19 Pandemic: Retrospective Cohort Study JO - JMIR Cardio SP - e39566 VL - 6 IS - 2 KW - heart failure KW - disparities KW - disparity KW - SARS-CoV-2 KW - Coronavirus KW - pandemic KW - COVID-19 KW - hospitalization KW - telemedicine KW - heart disease KW - heart KW - socioeconomic KW - cardiology KW - cardiac KW - hospital admission KW - intensive care unit KW - ICU admission KW - mortality KW - inequality KW - inequalities KW - minority KW - health disparity KW - racial KW - ethnic N2 - Background: Low rates of heart failure (HF) hospitalizations were observed during the 2020 peak of the COVID-19 pandemic. Additionally, posthospitalization follow-up transitioned to a predominantly telemedicine model. It is unknown whether the shift to telemedicine impacted disparities in posthospitalization follow-up or HF readmissions. Objective: The aim of this paper is to determine whether the shift to telemedicine impacted racial and ethnic as well as socioeconomic disparities in acute decompensated heart failure (ADHF) follow-up and HF readmissions. We additionally sought to investigate the impact of the COVID-19 pandemic on the severity of ADHF hospitalizations. Methods: This was a retrospective cohort study of HF admissions across 8 participating hospitals during the initial peak of the COVID-19 pandemic (March 15 to June 1, 2020), compared to the same time frame in 2019. Patients were stratified by race, ethnicity, and median neighborhood income. Hospital and intensive care unit (ICU) admission rates, inpatient mortality, 7-day follow-up, and 30-day readmissions were assessed. Results: From March 15, 2019, to June 1, 2020, there were 1162 hospitalizations for ADHF included in the study. There were significantly fewer admissions for ADHF in 2020, compared with 2019 (442 vs 720; P<.001). Patients in 2020 had higher rates of ICU admission, compared with 2019 (15.8% vs 11.1%; P=.02). This trend was seen across all subgroups and was significant for patients from the highest income quartile (17.89% vs 10.99%; P=.02). While there was a trend toward higher inpatient mortality in 2020 versus 2019 (4.3% vs 2.8%; P=.17), no difference was seen among different racial and socioeconomic groups. Telemedicine comprised 81.6% of 7-day follow-up in 2020, with improvement in 7-day follow-up rates (40.5% vs 29.6%; P<.001). Inequities in 7-day follow-up for patients from non-Hispanic Black racial backgrounds compared to those from non-Hispanic White backgrounds decreased during the pandemic. Additionally, those with telemedicine follow-up were less likely to be readmitted in 30 days when compared to no follow-up (13.8% vs 22.4%; P=.03). Conclusions: There were no major differences in HF ICU admissions or inpatient mortality for different racial and socioeconomic groups during the COVID-19 pandemic. Inequalities in 7-day follow-up were reduced with the advent of telemedicine and decreased 30-day readmission rates for those who had telemedicine follow-up. UR - https://cardio.jmir.org/2022/2/e39566 UR - http://dx.doi.org/10.2196/39566 UR - http://www.ncbi.nlm.nih.gov/pubmed/36409959 ID - info:doi/10.2196/39566 ER - TY - JOUR AU - Anugu, Pramod AU - Ansari, Yusuf Md Abu AU - Min, Yuan-I AU - Benjamin, J. Emelia AU - Murabito, Joanne AU - Winters, Karen AU - Turner, Erica AU - Correa, Adolfo PY - 2022/11/21 TI - Digital Connectedness in the Jackson Heart Study: Cross-sectional Study JO - J Med Internet Res SP - e37501 VL - 24 IS - 11 KW - teleresearch KW - mobile technology KW - cardiovascular disease KW - Jackson Heart Study KW - mobile phone N2 - Background: Although new approaches for data collection, such as mobile technology and teleresearch, have demonstrated new opportunities for the conduct of more timely and less costly surveys in community-based studies, literature on the feasibility of conducing cardiovascular disease research using mobile health (mHealth) platforms among middle-aged and older African Americans has been limited. Objective: The purpose of this study was to contribute to the knowledge regarding the penetrance of internet and mobile technologies, such as cellphones or smartphones in existing large cohort studies of cardiovascular disease. Methods: A digital connectedness survey was conducted in the Jackson Heart Study (JHS), a Mississippi-based African American cohort study, as part of the annual follow-up calls with participants from July 2017 to February 2019. Results: Of the 4024 participants contacted, 2564 (63.7%) completed the survey. Among survey respondents, 2262 (88.2%) reported use of internet or cellphone, and 1593 (62.1%) had a smartphone. Compared to nonusers (n=302), internet or cellphone users (n=2262) were younger (mean age 80.1, SD 8.0 vs 68.2, SD 11.3 years), more likely to be affluent (n=778, 40.1% vs n=39, 15.4%), and had greater than high school education (n=1636, 72.5% vs n=85, 28.1%). Internet or cellphone users were less likely to have cardiovascular disease history compared to nonusers (136/2262, 6.6% vs 41/302, 15.8%). The prevalence of current smoking and average BMI were similar between internet or cellphone users and nonusers. Among internet or cellphone users, 1316 (58.3%) reported use of email, 504 (22.3%) reported use of apps to track or manage health, and 1269 (56.1%) expressed interest in using JHS-developed apps. Conclusions: Our findings suggest that it is feasible to use mHealth technologies to collect survey data among African Americans already enrolled in a longitudinal study. Our findings also highlight the need for more efforts to reduce the age and education divide in access and use of internet and smartphones for tracking health and research in African American communities. UR - https://www.jmir.org/2022/11/e37501 UR - http://dx.doi.org/10.2196/37501 UR - http://www.ncbi.nlm.nih.gov/pubmed/36409531 ID - info:doi/10.2196/37501 ER - TY - JOUR AU - Sivakumar, Bridve AU - Lemonde, Manon AU - Stein, Matthew AU - Goldstein, Sarah AU - Mak, Susanna AU - Arcand, JoAnne PY - 2022/10/26 TI - Evaluating Health Care Provider Perspectives on the Use of Mobile Apps to Support Patients With Heart Failure Management: Qualitative Descriptive Study JO - JMIR Cardio SP - e40546 VL - 6 IS - 2 KW - heart failure KW - mobile health KW - mHealth KW - eHealth KW - mobile apps KW - adherence KW - self-management KW - mobile phone N2 - Background: Nonadherence to diet and medical therapies in heart failure (HF) contributes to poor HF outcomes. Mobile apps may be a promising way to improve adherence because they increase knowledge and behavior change via education and monitoring. Well-designed apps with input from health care providers (HCPs) can lead to successful adoption of such apps in practice. However, little is known about HCPs? perspectives on the use of mobile apps to support HF management. Objective: The aim of this study is to determine HCPs? perspectives (needs, motivations, and challenges) on the use of mobile apps to support patients with HF management. Methods: A qualitative descriptive study using one-on-one semistructured interviews, informed by the diffusion of innovation theory, was conducted among HF HCPs, including cardiologists, nurses, and nurse practitioners. Transcripts were independently coded by 2 researchers and analyzed using content analysis. Results: The 21 HCPs (cardiologists: n=8, 38%; nurses: n=6, 29%; and nurse practitioners: n=7, 33%) identified challenges and opportunities for app adoption across 5 themes: participant-perceived factors that affect app adoption?these include patient age, technology savviness, technology access, and ease of use; improved delivery of care?apps can support remote care; collect, share, and assess health information; identify adverse events; prevent hospitalizations; and limit clinic visits; facilitating patient engagement in care?apps can provide feedback and reinforcement, facilitate connection and communication between patients and their HCPs, support monitoring, and track self-care; providing patient support through education?apps can provide HF-related information (ie, diet and medications); and participant views on app features for their patients?HCPs felt that useful apps would have reminders and alarms and participative elements (gamification, food scanner, and quizzes). Conclusions: HCPs had positive views on the use of mobile apps to support patients with HF management. These findings can inform effective development and implementation strategies of HF management apps in clinical practice. UR - https://cardio.jmir.org/2022/2/e40546 UR - http://dx.doi.org/10.2196/40546 UR - http://www.ncbi.nlm.nih.gov/pubmed/36287588 ID - info:doi/10.2196/40546 ER - TY - JOUR AU - Lewinski, A. Allison AU - Walsh, Conor AU - Rushton, Sharron AU - Soliman, Diana AU - Carlson, M. Scott AU - Luedke, W. Matthew AU - Halpern, J. David AU - Crowley, J. Matthew AU - Shaw, J. Ryan AU - Sharpe, A. Jason AU - Alexopoulos, Anastasia-Stefania AU - Tabriz, Alishahi Amir AU - Dietch, R. Jessica AU - Uthappa, M. Diya AU - Hwang, Soohyun AU - Ball Ricks, A. Katharine AU - Cantrell, Sarah AU - Kosinski, S. Andrzej AU - Ear, Belinda AU - Gordon, M. Adelaide AU - Gierisch, M. Jennifer AU - Williams Jr, W. John AU - Goldstein, M. Karen PY - 2022/8/26 TI - Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review JO - J Med Internet Res SP - e37100 VL - 24 IS - 8 KW - telemedicine KW - diabetes mellitus, type 2 KW - heart failure KW - pulmonary disease KW - chronic obstructive KW - veterans KW - delivery of health care KW - systematic review N2 - Background: Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of telehealth as an equivalent and equitable replacement for in-person care and to assess potential adverse effects. Objective: We conducted a systematic review to address the following question: among adults, what is the effect of synchronous telehealth (real-time response among individuals via phone or phone and video) compared with in-person care (or compared with phone, if synchronous video care) for chronic management of CHF, chronic obstructive pulmonary disease, and T2DM on key disease-specific clinical outcomes and health care use? Methods: We followed systematic review methodologies and searched two databases (MEDLINE and Embase). We included randomized or quasi-experimental studies that evaluated the effect of synchronously delivered telehealth for relevant chronic conditions that occurred over ?2 encounters and in which some or all in-person care was supplanted by care delivered via phone or video. We assessed the bias using the Cochrane Effective Practice and Organization of Care risk of bias (ROB) tool and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation. We described the findings narratively and did not conduct meta-analysis owing to the small number of studies and the conceptual heterogeneity of the identified interventions. Results: We identified 8662 studies, and 129 (1.49%) were reviewed at the full-text stage. In total, 3.9% (5/129) of the articles were retained for data extraction, all of which (5/5, 100%) were randomized controlled trials. The CHF study (1/5, 20%) was found to have high ROB and randomized patients (n=210) to receive quarterly automated asynchronous web-based review and follow-up of telemetry data versus synchronous personal follow-up (in-person vs phone-based) for 1 year. A 3-way comparison across study arms found no significant differences in clinical outcomes. Overall, 80% (4/5) of the studies (n=466) evaluated synchronous care for patients with T2DM (ROB was judged to be low for 2, 50% of studies and high for 2, 50% of studies). In total, 20% (1/5) of the studies were adequately powered to assess the difference in glycosylated hemoglobin level between groups; however, no significant difference was found. Intervention design varied greatly from remote monitoring of blood glucose combined with video versus in-person visits to an endocrinology clinic to a brief, 3-week remote intervention to stabilize uncontrolled diabetes. No articles were identified for chronic obstructive pulmonary disease. Conclusions: This review found few studies with a variety of designs and interventions that used telehealth as a replacement for in-person care. Future research should consider including observational studies and studies on additional highly prevalent chronic diseases. UR - https://www.jmir.org/2022/8/e37100 UR - http://dx.doi.org/10.2196/37100 UR - http://www.ncbi.nlm.nih.gov/pubmed/36018711 ID - info:doi/10.2196/37100 ER - TY - JOUR AU - Cakmak, S. Ayse AU - Perez Alday, A. Erick AU - Densen, Samuel AU - Najarro, Gabriel AU - Rout, Pratik AU - Rozell, J. Christopher AU - Inan, T. Omer AU - Shah, J. Amit AU - Clifford, D. Gari PY - 2022/8/24 TI - Passively Captured Interpersonal Social Interactions and Motion From Smartphones for Predicting Decompensation in Heart Failure: Observational Cohort Study JO - JMIR Form Res SP - e36972 VL - 6 IS - 8 KW - heart failure KW - mobile device KW - social interaction KW - heart disease KW - mobile health KW - hospitalization N2 - Background: Heart failure (HF) is a major cause of frequent hospitalization and death. Early detection of HF symptoms using smartphone-based monitoring may reduce adverse events in a low-cost, scalable way. Objective: We examined the relationship of HF decompensation events with smartphone-based features derived from passively and actively acquired data. Methods: This was a prospective cohort study in which we monitored HF participants? social and movement activities using a smartphone app and followed them for clinical events via phone and chart review and classified the encounters as compensated or decompensated by reviewing the provider notes in detail. We extracted motion, location, and social interaction passive features and self-reported quality of life weekly (active) with the short Kansas City Cardiomyopathy Questionnaire (KCCQ-12) survey. We developed and validated an algorithm for classifying decompensated versus compensated clinical encounters (hospitalizations or clinic visits). We evaluated models based on single modality as well as early and late fusion approaches combining patient-reported outcomes and passive smartphone data. We used Shapley additive explanation values to quantify the contribution and impact of each feature to the model. Results: We evaluated 28 participants with a mean age of 67 years (SD 8), among whom 11% (3/28) were female and 46% (13/28) were Black. We identified 62 compensated and 48 decompensated clinical events from 24 and 22 participants, respectively. The highest area under the precision-recall curve (AUCPr) for classifying decompensation was with a late fusion approach combining KCCQ-12, motion, and social contact features using leave-one-subject-out cross-validation for a 2-day prediction window. It had an AUCPr of 0.80, with an area under the receiver operator curve (AUC) of 0.83, a positive predictive value (PPV) of 0.73, a sensitivity of 0.77, and a specificity of 0.88 for a 2-day prediction window. Similarly, the 4-day window model had an AUC of 0.82, an AUCPr of 0.69, a PPV of 0.62, a sensitivity of 0.68, and a specificity of 0.87. Passive social data provided some of the most informative features, with fewer calls of longer duration associating with a higher probability of future HF decompensation. Conclusions: Smartphone-based data that includes both passive monitoring and actively collected surveys may provide important behavioral and functional health information on HF status in advance of clinical visits. This proof-of-concept study, although small, offers important insight into the social and behavioral determinants of health and the feasibility of using smartphone-based monitoring in this population. Our strong results are comparable to those of more active and expensive monitoring approaches, and underscore the need for larger studies to understand the clinical significance of this monitoring method. UR - https://formative.jmir.org/2022/8/e36972 UR - http://dx.doi.org/10.2196/36972 UR - http://www.ncbi.nlm.nih.gov/pubmed/36001367 ID - info:doi/10.2196/36972 ER - TY - JOUR AU - Chu, Cherry AU - Stamenova, Vess AU - Fang, Jiming AU - Shakeri, Ahmad AU - Tadrous, Mina AU - Bhatia, Sacha R. PY - 2022/8/4 TI - The Association Between Telemedicine Use and Changes in Health Care Usage and Outcomes in Patients With Congestive Heart Failure: Retrospective Cohort Study JO - JMIR Cardio SP - e36442 VL - 6 IS - 2 KW - telemedicine KW - telehealth KW - eHealth KW - digital health KW - population KW - outcomes KW - health service KW - health system KW - utilization KW - congestive heart failure KW - cardiology KW - health outcome KW - clinical outcome KW - patient outcome KW - heart KW - cardiac KW - ambulatory KW - COVID-19 N2 - Background: Telemedicine use has become widespread owing to the COVID-19 pandemic, but its impact on patient outcomes remains unclear. Objective: We sought to investigate the effect of telemedicine use on changes in health care usage and clinical outcomes in patients diagnosed with congestive heart failure (CHF). Methods: We conducted a population-based retrospective cohort study using administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14 and September 30, 2020, and a heart failure diagnosis any time prior to March 14, 2020. Telemedicine users were propensity score?matched with unexposed users based on several baseline characteristics. Monthly use of various health care services was compared between the 2 groups during 12 months before to 3 months after their index in-person or telemedicine ambulatory visit after March 14, 2020, using generalized estimating equations. Results: A total of 11,131 pairs of telemedicine and unexposed patients were identified after matching (49% male; mean age 78.9, SD 12.0 years). All patients showed significant reductions in health service usage from pre- to postindex visit. There was a greater decline across time in the unexposed group than in the telemedicine group for CHF admissions (ratio of slopes for high- vs low-frequency users 1.02, 95% CI 1.02-1.03), cardiovascular admissions (1.03, 95% CI 1.02-1.04), any-cause admissions (1.03, 95% CI 1.02-1.04), any-cause ED visits (1.03, 95% CI 1.03-1.04), visits with any cardiologist (1.01, 95% CI 1.01-1.02), laboratory tests (1.02, 95% CI 1.02-1.03), diagnostic tests (1.04, 95% CI 1.03-1.05), and new prescriptions (1.02, 95% CI 1.01-1.03). However, the decline in primary care visit rates was steeper among telemedicine patients than among unexposed patients (ratio of slopes 0.99, 95% CI 0.99-1.00). Conclusions: Overall health care usage over time appeared higher among telemedicine users than among low-frequency users or nonusers, suggesting that telemedicine was used by patients with the greatest need or that it allowed patients to have better access or continuity of care among those who received it. UR - https://cardio.jmir.org/2022/2/e36442 UR - http://dx.doi.org/10.2196/36442 UR - http://www.ncbi.nlm.nih.gov/pubmed/35881831 ID - info:doi/10.2196/36442 ER - TY - JOUR AU - Albuquerque de Almeida, Fernando AU - Corro Ramos, Isaac AU - Al, Maiwenn AU - Rutten-van Mölken, Maureen PY - 2022/8/4 TI - Home Telemonitoring and a Diagnostic Algorithm in the Management of Heart Failure in the Netherlands: Cost-effectiveness Analysis JO - JMIR Cardio SP - e31302 VL - 6 IS - 2 KW - discrete event simulation KW - cost-effectiveness KW - early warning systems KW - home telemonitoring KW - diagnostic algorithm KW - heart failure N2 - 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. UR - https://cardio.jmir.org/2022/2/e31302 UR - http://dx.doi.org/10.2196/31302 UR - http://www.ncbi.nlm.nih.gov/pubmed/35925670 ID - info:doi/10.2196/31302 ER - TY - JOUR AU - Buhr, Lorina AU - Kaufmann, Martiana Pauline Lucie AU - Jörß, Katharina PY - 2022/8/3 TI - Attitudes of Patients With Chronic Heart Failure Toward Digital Device Data for Self-documentation and Research in Germany: Cross-sectional Survey Study JO - JMIR Cardio SP - e34959 VL - 6 IS - 2 KW - mobile health KW - mHealth KW - digital devices KW - wearables KW - heart failure KW - data sharing KW - consent KW - mobile phone N2 - Background: In recent years, the use of digital mobile measurement devices (DMMDs) for self-documentation in cardiovascular care in Western industrialized health care systems has increased. For patients with chronic heart failure (cHF), digital self-documentation plays an increasingly important role in self-management. Data from DMMDs can also be integrated into telemonitoring programs or data-intensive medical research to collect and evaluate patient-reported outcome measures through data sharing. However, the implementation of data-intensive devices and data sharing poses several challenges for doctors and patients as well as for the ethical governance of data-driven medical research. Objective: This study aims to explore the potential and challenges of digital device data in cardiology research from patients? perspectives. Leading research questions of the study concerned the attitudes of patients with cHF toward health-related data collected in the use of digital devices for self-documentation as well as sharing these data and consenting to data sharing for research purposes. Methods: A cross-sectional survey of patients of a research in cardiology was conducted at a German university medical center (N=159) in 2020 (March to July). Eligible participants were German-speaking adult patients with cHF at that center. A pen-and-pencil questionnaire was sent by mail. Results: Most participants (77/105, 73.3%) approved digital documentation, as they expected the device data to help them observe their body and its functions more objectively. Digital device data were believed to provide cognitive support, both for patients? self-assessment and doctors? evaluation of their patients? current health condition. Interestingly, positive attitudes toward DMMD data providing cognitive support were, in particular, voiced by older patients aged >65 years. However, approximately half of the participants (56/105, 53.3%) also reported difficulty in dealing with self-documented data that lay outside the optimal medical target range. Furthermore, our findings revealed preferences for the self-management of DMMD data disclosed for data-intensive medical research among German patients with cHF, which are best implemented with a dynamic consent model. Conclusions: Our findings provide potentially valuable insights for introducing DMMD in cardiovascular research in the German context. They have several practical implications, such as a high divergence in attitudes among patients with cHF toward different data-receiving organizations as well as a large variance in preferences for the modes of receiving information included in the consenting procedure for data sharing for research. We suggest addressing patients? multiple views on consenting and data sharing in institutional normative governance frameworks for data-intensive medical research. UR - https://cardio.jmir.org/2022/2/e34959 UR - http://dx.doi.org/10.2196/34959 UR - http://www.ncbi.nlm.nih.gov/pubmed/35921134 ID - info:doi/10.2196/34959 ER - TY - JOUR AU - Bhatia, Ankit AU - Ewald, Gregory AU - Maddox, Thomas PY - 2022/6/30 TI - The Novel Data Collection and Analytics Tools for Remote Patient Monitoring in Heart Failure (Nov-RPM-HF) Trial: Protocol for a Single-Center Prospective Trial JO - JMIR Res Protoc SP - e32873 VL - 11 IS - 6 KW - heart failure KW - remote patient monitoring KW - clinical innovation KW - digital health KW - mHealth KW - mobile health KW - cardiology N2 - Background: Heart failure remains a leading cause of mortality and a major driver of health care utilization. Despite numerous medical advances in heart failure, associated hospitalizations continue to increase, owing largely to suboptimal outpatient management. Remote patient monitoring (RPM) aims to further address this current need in heart failure care by providing data to clinical teams to act pre-emptively to address clinical decompensation. However, to date, RPM approaches using noninvasive home-based patient sensors have failed to demonstrate clinical efficacy. Objective: The Novel Data Collection and Analytics Tools for Remote Patient Monitoring in Heart Failure (Nov-RPM-HF) Trial aims to address current noninvasive RPM limitations. Nov-RPM-HF will evaluate a clinician co-designed RPM platform using emerging data collection and presentation tools for heart failure management. These tools include a ballistocardiograph to monitor nocturnal patient biometrics, clinical alerts for abnormal biometrics, and longitudinal data presentation for clinician review. Methods: Nov-RPM-HF is a 100-patient single-center prospective trial, evaluating patients over 6 months. The outcomes will include patient adherence to data collection, patient/clinician-perceived utility of the RPM platform, medication changes including the titration of guideline-directed medical therapy to target doses, heart failure symptoms/performance status, and unplanned heart failure hospitalizations or emergency department visits. Results: This prospective trial began enrollment in March 2020 and anticipates enrollment completion by June 2022, with trial completion by December 2022. Conclusions: This trial protocol aims to provide a systematic framework for the evaluation of heart failure RPM strategies, which are currently heavily used but seldom robustly studied. The trial results will help to inform the role of noninvasive RPM as a viable clinical management strategy in heart failure care. International Registered Report Identifier (IRRID): DERR1-10.2196/32873 UR - https://www.researchprotocols.org/2022/6/e32873 UR - http://dx.doi.org/10.2196/32873 UR - http://www.ncbi.nlm.nih.gov/pubmed/35771609 ID - info:doi/10.2196/32873 ER - TY - JOUR AU - Kim, Byeol AU - Nguyen, Phong AU - Loke, Yue-Hin AU - Cleveland, Vincent AU - Liu, Xiaolong AU - Mass, Paige AU - Hibino, Narutoshi AU - Olivieri, Laura AU - Krieger, Axel PY - 2022/6/17 TI - Virtual Reality Cardiac Surgical Planning Software (CorFix) for Designing Patient-Specific Vascular Grafts: Development and Pilot Usability Study JO - JMIR Cardio SP - e35488 VL - 6 IS - 1 KW - virtual reality KW - congenital heart disease KW - surgical planning KW - usability study KW - heart KW - surgery N2 - Background: Patients with single ventricle heart defects receive 3 stages of operations culminating in the Fontan procedure. During the Fontan procedure, a vascular graft is sutured between the inferior vena cava and pulmonary artery to divert deoxygenated blood flow to the lungs via passive flow. Customizing the graft configuration can maximize the long-term benefits. However, planning patient-specific procedures has several challenges, including the ability for physicians to customize grafts and evaluate their hemodynamic performance. Objective: The aim of this study was to develop a virtual reality (VR) Fontan graft modeling and evaluation software for physicians. A user study was performed to achieve 2 additional goals: (1) to evaluate the software when used by medical doctors and engineers, and (2) to explore the impact of viewing hemodynamic simulation results in numerical and graphical formats. Methods: A total of 5 medical professionals including 4 physicians (1 fourth-year resident, 1 third-year cardiac fellow, 1 pediatric intensivist, and 1 pediatric cardiac surgeon) and 1 biomedical engineer voluntarily participated in the study. The study was pre-scripted to minimize the variability of the interactions between the experimenter and the participants. All participants were trained to use the VR gear and our software, CorFix. Each participant designed 1 bifurcated and 1 tube-shaped Fontan graft for a single patient. A hemodynamic performance evaluation was then completed, allowing the participants to further modify their tube-shaped design. The design time and hemodynamic performance for each graft design were recorded. At the end of the study, all participants were provided surveys to evaluate the usability and learnability of the software and rate the intensity of VR sickness. Results: The average times for creating 1 bifurcated and 1 tube-shaped graft after a single 10-minute training session were 13.40 and 5.49 minutes, respectively, with 3 out 5 bifurcated and 1 out of 5 tube-shaped graft designs being in the benchmark range of hepatic flow distribution. Reviewing hemodynamic performance results and modifying the tube-shaped design took an average time of 2.92 minutes. Participants who modified their tube-shaped graft designs were able to improve the nonphysiologic wall shear stress (WSS) percentage by 7.02%. All tube-shaped graft designs improved the WSS percentage compared to the native surgical case of the patient. None of the designs met the benchmark indexed power loss. Conclusions: VR graft design software can quickly be taught to physicians with no engineering background or VR experience. Improving the CorFix system could improve performance of the users in customizing and optimizing grafts for patients. With graphical visualization, physicians were able to improve WSS percentage of a tube-shaped graft, lowering the chance of thrombosis. Bifurcated graft designs showed potential strength in better flow split to the lungs, reducing the risk for pulmonary arteriovenous malformations. UR - https://cardio.jmir.org/2022/1/e35488 UR - http://dx.doi.org/10.2196/35488 UR - http://www.ncbi.nlm.nih.gov/pubmed/35713940 ID - info:doi/10.2196/35488 ER - TY - JOUR AU - Apantaku, Glory AU - Mitton, Craig AU - Wong, Hubert AU - Ho, Kendall PY - 2022/6/2 TI - Home Telemonitoring Technology for Patients With Heart Failure: Cost-Consequence Analysis of a Pilot Study JO - JMIR Form Res SP - e32147 VL - 6 IS - 6 KW - cost-consequence analysis KW - feasibility study KW - pilot study KW - heart failure KW - cardiology KW - cardiovascular disease KW - economic analysis KW - telehealth KW - health care cost KW - home monitoring KW - digital monitor KW - health monitor N2 - Background: Heart failure (HF) is a costly health condition and a major public health problem. It is estimated that 2%-3% of the population in developed countries has HF, and the prevalence increases to 8% among patients aged ?75 years. Home telemonitoring is a form of noninvasive, remote patient monitoring that aims to improve the care and management of patients with chronic HF. Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring (TEC4Home) is a project that implements and evaluates a comprehensive home monitoring protocol designed to support patients with HF as they transition from the emergency department to home. Objective: The aim of this study is to assess the cost of using the home monitoring platform (TEC4Home) relative to usual care for patients with HF. Methods: This study is a cost-consequence analysis of the TEC4Home pilot study. The analysis was conducted from a partial societal perspective, including direct and indirect health care costs. The aim is to assess the costs of the home monitoring platform relative to usual care and track costs related to health care utilization during the 90-day postdischarge period. Results: Economic analysis of the TEC4Home pilot study showed a positive trend in cost savings for patients using TEC4Home. From both the health system perspective (Pre TEC4Home cost per patient: CAD $2924 vs post TEC4Home cost per patient: CAD $1293; P=.01) and partial societal perspective (Pre TEC4Home cost per patient: CAD $2411 vs post TEC4Home cost per patient: CAD $1108; P=.01), we observed a statistically significant cost saving per patient. Conclusions: In line with the advantages of conducting an economic analysis alongside a feasibility study, the economic analysis of the TEC4Home pilot study facilitated the piloting of patient questionnaires and informed the methodology for a full clinical trial. UR - https://formative.jmir.org/2022/6/e32147 UR - http://dx.doi.org/10.2196/32147 UR - http://www.ncbi.nlm.nih.gov/pubmed/35653179 ID - info:doi/10.2196/32147 ER - TY - JOUR AU - Yeung, Kan Andy Wai AU - Kulnik, Tino Stefan AU - Parvanov, D. Emil AU - Fassl, Anna AU - Eibensteiner, Fabian AU - Völkl-Kernstock, Sabine AU - Kletecka-Pulker, Maria AU - Crutzen, Rik AU - Gutenberg, Johanna AU - Höppchen, Isabel AU - Niebauer, Josef AU - Smeddinck, David Jan AU - Willschke, Harald AU - Atanasov, G. Atanas PY - 2022/5/11 TI - Research on Digital Technology Use in Cardiology: Bibliometric Analysis JO - J Med Internet Res SP - e36086 VL - 24 IS - 5 KW - cardiovascular KW - heart KW - hypertension KW - atrial fibrillation KW - cardiopulmonary resuscitation KW - electrocardiography KW - photoplethysmography KW - wearable device, digital health, mHealth KW - cardiology KW - cardiac KW - health application N2 - Background: Digital technology uses in cardiology have become a popular research focus in recent years. However, there has been no published bibliometric report that analyzed the corresponding academic literature in order to derive key publishing trends and characteristics of this scientific area. Objective: We used a bibliometric approach to identify and analyze the academic literature on digital technology uses in cardiology, and to unveil popular research topics, key authors, institutions, countries, and journals. We further captured the cardiovascular conditions and diagnostic tools most commonly investigated within this field. Methods: The Web of Science electronic database was queried to identify relevant papers on digital technology uses in cardiology. Publication and citation data were acquired directly from the database. Complete bibliographic data were exported to VOSviewer, a dedicated bibliometric software package, and related to the semantic content of titles, abstracts, and keywords. A term map was constructed for findings visualization. Results: The analysis was based on data from 12,529 papers. Of the top 5 most productive institutions, 4 were based in the United States. The United States was the most productive country (4224/12,529, 33.7%), followed by United Kingdom (1136/12,529, 9.1%), Germany (1067/12,529, 8.5%), China (682/12,529, 5.4%), and Italy (622/12,529, 5.0%). Cardiovascular diseases that had been frequently investigated included hypertension (152/12,529, 1.2%), atrial fibrillation (122/12,529, 1.0%), atherosclerosis (116/12,529, 0.9%), heart failure (106/12,529, 0.8%), and arterial stiffness (80/12,529, 0.6%). Recurring modalities were electrocardiography (170/12,529, 1.4%), angiography (127/12,529, 1.0%), echocardiography (127/12,529, 1.0%), digital subtraction angiography (111/12,529, 0.9%), and photoplethysmography (80/12,529, 0.6%). For a literature subset on smartphone apps and wearable devices, the Journal of Medical Internet Research (20/632, 3.2%) and other JMIR portfolio journals (51/632, 8.0%) were the major publishing venues. Conclusions: Digital technology uses in cardiology target physicians, patients, and the general public. Their functions range from assisting diagnosis, recording cardiovascular parameters, and patient education, to teaching laypersons about cardiopulmonary resuscitation. This field already has had a great impact in health care, and we anticipate continued growth. UR - https://www.jmir.org/2022/5/e36086 UR - http://dx.doi.org/10.2196/36086 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544307 ID - info:doi/10.2196/36086 ER - TY - JOUR AU - Kwon, Soonil AU - Lee, So-Ryoung AU - Choi, Eue-Keun AU - Ahn, Hyo-Jeong AU - Song, Hee-Seok AU - Lee, Young-Shin AU - Oh, Seil AU - Lip, H. Gregory Y. PY - 2022/5/9 TI - Comparison Between the 24-hour Holter Test and 72-hour Single-Lead Electrocardiogram Monitoring With an Adhesive Patch-Type Device for Atrial Fibrillation Detection: Prospective Cohort Study JO - J Med Internet Res SP - e37970 VL - 24 IS - 5 KW - atrial fibrillation KW - diagnosis KW - electrocardiogram KW - wearable device KW - health monitoring KW - Holter KW - cardiac KW - arrhythmia KW - ECG KW - EKG KW - digital tool KW - cardiology KW - patient monitoring KW - outpatient clinic KW - cardiac health KW - diagnostic KW - patient KW - clinician KW - digital health N2 - Background: There is insufficient evidence for the use of single-lead electrocardiogram (ECG) monitoring with an adhesive patch-type device (APD) over an extended period compared to that of the 24-hour Holter test for atrial fibrillation (AF) detection. Objective: In this paper, we aimed to compare AF detection by the 24-hour Holter test and 72-hour single-lead ECG monitoring using an APD among patients with AF. Methods: This was a prospective, single-center cohort study. A total of 210 patients with AF with clinical indications for the Holter test at cardiology outpatient clinics were enrolled in the study. The study participants were equipped with both the Holter device and APD for the first 24 hours. Subsequently, only the APD continued ECG monitoring for an additional 48 hours. AF detection during the first 24 hours was compared between the two devices. The diagnostic benefits of extended monitoring using the APD were evaluated. Results: A total of 200 patients (mean age 60 years; n=141, 70.5% male; and n=59, 29.5% female) completed 72-hour ECG monitoring with the APD. During the first 24 hours, both monitoring methods detected AF in the same 40/200 (20%) patients (including 20 patients each with paroxysmal and persistent AF). Compared to the 24-hour Holter test, the APD increased the AF detection rate by 1.5-fold (58/200; 29%) and 1.6-fold (64/200; 32%) with 48- and 72-hour monitoring, respectively. With the APD, the number of newly discovered patients with paroxysmal AF was 20/44 (45.5%), 18/44 (40.9%), and 6/44 (13.6%) at 24-, 48-, and 72-hour monitoring, respectively. Compared with 24-hour Holter monitoring, 72-hour monitoring with the APD increased the detection rate of paroxysmal AF by 2.2-fold (44/20). Conclusions: Compared to the 24-hour Holter test, AF detection could be improved with 72-hour single-lead ECG monitoring with the APD. UR - https://www.jmir.org/2022/5/e37970 UR - http://dx.doi.org/10.2196/37970 UR - http://www.ncbi.nlm.nih.gov/pubmed/35532989 ID - info:doi/10.2196/37970 ER - TY - JOUR AU - Hammond, M. Michael AU - Zhang, Yuankai AU - Pathiravasan, H. Chathurangi AU - Lin, Honghuang AU - Sardana, Mayank AU - Trinquart, Ludovic AU - Benjamin, J. Emelia AU - Borrelli, Belinda AU - Manders, S. Emily AU - Fusco, Kelsey AU - Kornej, Jelena AU - Spartano, L. Nicole AU - Kheterpal, Vik AU - Nowak, Christopher AU - McManus, D. David AU - Liu, Chunyu AU - Murabito, M. Joanne PY - 2022/4/27 TI - Relations Between BMI Trajectories and Habitual Physical Activity Measured by a Smartwatch in the Electronic Cohort of the Framingham Heart Study: Cohort Study JO - JMIR Cardio SP - e32348 VL - 6 IS - 1 KW - mobile health KW - BMI KW - smartwatch KW - physical activity KW - cardiovascular diseases KW - cardiology KW - digital health KW - mHealth KW - mobile health apps N2 - 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. UR - https://cardio.jmir.org/2022/1/e32348 UR - http://dx.doi.org/10.2196/32348 UR - http://www.ncbi.nlm.nih.gov/pubmed/35476038 ID - info:doi/10.2196/32348 ER - TY - JOUR AU - Brocki, Cristina Barbara AU - Andreasen, Jesper Jan AU - Aaroe, Jens AU - Andreasen, Jane AU - Thorup, Brun Charlotte PY - 2022/4/26 TI - Exercise-Based Real-time Telerehabilitation for Older Adult Patients Recently Discharged After Transcatheter Aortic Valve Implantation: Mixed Methods Feasibility Study JO - JMIR Rehabil Assist Technol SP - e34819 VL - 9 IS - 2 KW - telerehabilitation KW - transcatheter aortic valve implantation KW - cardiac surgery KW - cardiac rehabilitation KW - exercise training KW - older adults KW - tablet N2 - Background: The use of telehealth technology to improve functional recovery following transcatheter aortic valve implantation (TAVI) has not been investigated. Objective: In this study, we aimed to examine the feasibility of exercise-based cardiac telerehabilitation after TAVI. Methods: This was a single-center, prospective, nonrandomized study using a mixed methods approach. Data collection included testing, researchers? observations, logbooks, and individual patient interviews, which were analyzed using a content analysis approach. The intervention lasted 3 weeks and consisted of home-based web-based exercise training, an activity tracker, a TAVI information website, and 1 web-based session with a nurse. Results: Of the initially included 13 patients, 5 (40%) completed the study and were interviewed; the median age was 82 (range 74-84) years, and the sample comprised 3 men and 2 women. Easy access to supervised exercise training at home with real-time feedback and use of the activity tracker to count daily steps were emphasized by the patients who completed the intervention. Reasons for patients not completing the program included poor data coverage, participants? limited information technology skills, and a lack of functionality in the systems used. No adverse events were reported. Conclusions: Exercise-based telerehabilitation for older people after TAVI, in the population as included in this study, and delivered as a web-based intervention, does not seem feasible, as 60% (8/13) of patients did not complete the study. Those completing the intervention highly appreciated the real-time feedback during the web-based training sessions. Future studies should address aspects that support retention rates and enhance patients? information technology skills. UR - https://rehab.jmir.org/2022/2/e34819 UR - http://dx.doi.org/10.2196/34819 UR - http://www.ncbi.nlm.nih.gov/pubmed/35471263 ID - info:doi/10.2196/34819 ER - TY - JOUR AU - Treskes, Willem Roderick AU - van den Akker-van Marle, Elske M. AU - van Winden, Louise AU - van Keulen, Nicole AU - van der Velde, Tjeerd Enno AU - Beeres, Saskia AU - Atsma, Douwe AU - Schalij, Jan Martin PY - 2022/4/25 TI - The Box?eHealth in the Outpatient Clinic Follow-up of Patients With Acute Myocardial Infarction: Cost-Utility Analysis JO - J Med Internet Res SP - e30236 VL - 24 IS - 4 KW - smart technology KW - myocardial infarction KW - cost-utility KW - outpatients KW - cost-effectiveness KW - eHealth KW - remote monitoring KW - cost of care KW - quality of life N2 - Background: Smartphone compatible wearables have been released on the consumers market, enabling remote monitoring. Remote monitoring is often named as a tool to reduce the cost of care. Objective: The primary purpose of this paper is to describe a cost-utility analysis of an eHealth intervention compared to regular follow-up in patients with acute myocardial infarction (AMI). Methods: In this trial, of which clinical results have been published previously, patients with an AMI were randomized in a 1:1 fashion between an eHealth intervention and regular follow-up. The remote monitoring intervention consisted of a blood pressure monitor, weight scale, electrocardiogram device, and step counter. Furthermore, two in-office outpatient clinic visits were replaced by e-visits. The control group received regular care. The differences in mean costs and quality of life per patient between both groups during one-year follow-up were calculated. Results: Mean costs per patient were ?2417±2043 (US $2657±2246) for the intervention and ?2888±2961 (US $3175±3255) for the control group. This yielded a cost reduction of ?471 (US $518) per patient. This difference was not statistically significant (95% CI ??275 to ?1217; P=.22, US $?302 to $1338). The average quality-adjusted life years in the first year of follow-up was 0.74 for the intervention group and 0.69 for the control (difference ?0.05, 95% CI ?0.09 to ?0.01; P=.01). Conclusions: eHealth in the outpatient clinic setting for patients who suffered from AMI is likely to be cost-effective compared to regular follow-up. Further research should be done to corroborate these findings in other patient populations and different care settings. Trial Registration: ClinicalTrials.gov NCT02976376; https://clinicaltrials.gov/ct2/show/NCT02976376 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8038 UR - https://www.jmir.org/2022/4/e30236 UR - http://dx.doi.org/10.2196/30236 UR - http://www.ncbi.nlm.nih.gov/pubmed/35468091 ID - info:doi/10.2196/30236 ER - TY - JOUR AU - Bezerra Giordan, Leticia AU - Ronto, Rimante AU - Chau, Josephine AU - Chow, Clara AU - Laranjo, Liliana PY - 2022/4/20 TI - Use of Mobile Apps in Heart Failure Self-management: Qualitative Study Exploring the Patient and Primary Care Clinician Perspective JO - JMIR Cardio SP - e33992 VL - 6 IS - 1 KW - mobile app KW - mHealth KW - heart failure KW - self-management KW - eHealth KW - telehealth N2 - Background: Mobile apps have the potential to support patients with heart failure and facilitate disease self-management, but this area of research is recent and rapidly evolving, with inconsistent results for efficacy. So far, most of the published studies evaluated the feasibility of a specific app or assessed the quality of apps available in app stores. Research is needed to explore patients? and clinicians? perspectives to guide app development, evaluation, and implementation into models of care. Objective: This study aims to explore the patient and primary care clinician perspective on the facilitators and barriers to using mobile apps, as well as desired features, to support heart failure self-management. Methods: This is a qualitative phenomenological study involving face-to-face semistructured interviews. Interviews were conducted in a general practice clinic in Sydney, Australia. Eligible participants were adult patients with heart failure and health care professionals who provided care to these patients at the clinic. Patients did not need to have previous experience using heart failure mobile apps to be eligible for this study. The interviews were audio-recorded, transcribed, and analyzed using inductive thematic data analysis in NVivo 12. Results: A total of 12 participants were interviewed: 6 patients (mean age 69 [SD 7.9] years) and 6 clinicians. The interviews lasted from 25 to 45 minutes. The main facilitators to the use of apps to support heart failure self-management were communication ability, personalized feedback and education, and automated self-monitoring. Patients mentioned that chat-like features and ability to share audio-visual information can be helpful for getting support outside of clinical appointments. Clinicians considered helpful to send motivational messages to patients and ask them about signs and symptoms of heart failure decompensation. Overall, participants highlighted the importance of personalization, particularly in terms of feedback and educational content. Automated self-monitoring with wireless devices was seen to alleviate the burden of tracking measures such as weight and blood pressure. Other desired features included tools to monitor patient-reported outcomes and support patients? mental health and well-being. The main barriers identified were the patients? unwillingness to engage in a new strategy to manage their condition using an app, particularly in the case of low digital literacy. However, clinicians mentioned this barrier could potentially be overcome by introducing the app soon after an exacerbation, when patients might be more willing to improve their self-management and avoid rehospitalization. Conclusions: The use of mobile apps to support heart failure self-management may be facilitated by features that increase the usefulness and utility of the app, such as communication ability in-between consultations and personalized feedback. Also important is facilitating ease of use by supporting automated self-monitoring through integration with wireless devices. Future research should consider these features in the co-design and testing of heart failure mobile apps with patients and clinicians. UR - https://cardio.jmir.org/2022/1/e33992 UR - http://dx.doi.org/10.2196/33992 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442205 ID - info:doi/10.2196/33992 ER - TY - JOUR AU - Bezerra Giordan, Leticia AU - Tong, Ly Huong AU - Atherton, J. John AU - Ronto, Rimante AU - Chau, Josephine AU - Kaye, David AU - Shaw, Tim AU - Chow, Clara AU - Laranjo, Liliana PY - 2022/3/31 TI - The Use of Mobile Apps for Heart Failure Self-management: Systematic Review of Experimental and Qualitative Studies JO - JMIR Cardio SP - e33839 VL - 6 IS - 1 KW - heart failure KW - self-management KW - mobile health KW - mobile app KW - secondary prevention KW - mobile phone N2 - Background: Heart failure self-management is essential to avoid decompensation and readmissions. Mobile apps seem promising in supporting heart failure self-management, and there has been a rapid growth in publications in this area. However, to date, systematic reviews have mostly focused on remote monitoring interventions using nonapp types of mobile technologies to transmit data to health care providers, rarely focusing on supporting patient self-management of heart failure. Objective: This study aims to systematically review the evidence on the effect of heart failure self-management apps on health outcomes, patient-reported outcomes, and patient experience. Methods: Four databases (PubMed, Embase, CINAHL, and PsycINFO) were searched for studies examining interventions that comprised a mobile app targeting heart failure self-management and reported any health-related outcomes or patient-reported outcomes or perspectives published from 2008 to December 2021. The studies were independently screened. The risk of bias was appraised using Cochrane tools. We performed a narrative synthesis of the results. The protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42020158041). Results: A total of 28 articles (randomized controlled trials [RCTs]: n=10, 36%), assessing 23 apps, and a total of 1397 participants were included. The most common app features were weight monitoring (19/23, 83%), symptom monitoring (18/23, 78%), and vital sign monitoring (15/23, 65%). Only 26% (6/23) of the apps provided all guideline-defined core components of heart failure self-management programs: education, symptom monitoring, medication support, and physical activity support. RCTs were small, involving altogether 717 participants, had ?6 months of follow-up, and outcomes were predominantly self-reported. Approximately 20% (2/10) of RCTs reported a significant improvement in their primary outcomes: heart failure knowledge (P=.002) and self-care (P=.004). One of the RCTs found a significant reduction in readmissions (P=.02), and 20% (2/10) of RCTs reported higher unplanned clinic visits. Other experimental studies also found significant improvements in knowledge, self-care, and readmissions, among others. Less than half of the studies involved patients and clinicians in the design of apps. Engagement with the intervention was poorly reported, with only 11% (3/28) of studies quantifying app engagement metrics such as frequency of use over the study duration. The most desirable app features were automated self-monitoring and feedback, personalization, communication with clinicians, and data sharing and integration. Conclusions: Mobile apps may improve heart failure self-management; however, more robust evaluation studies are needed to analyze key end points for heart failure. On the basis of the results of this review, we provide a road map for future studies in this area. UR - https://cardio.jmir.org/2022/1/e33839 UR - http://dx.doi.org/10.2196/33839 UR - http://www.ncbi.nlm.nih.gov/pubmed/35357311 ID - info:doi/10.2196/33839 ER - TY - JOUR AU - Shan, Rongzi AU - Chandra, V. Neha AU - Hsu, J. Jeffrey AU - Fraschilla, Stephanie AU - Moore, Melissa AU - Ardehali, Abbas AU - Nsair, Ali AU - Parikh, V. Rushi PY - 2022/3/30 TI - The Impact of Transitioning From In-Person to Virtual Heart Transplantation Selection Committee Meetings: Observational Study JO - JMIR Cardio SP - e35490 VL - 6 IS - 1 KW - telemedicine KW - transplantation KW - heart failure KW - physician KW - heart transplant KW - virtual meeting KW - interprofessional relations KW - health systems KW - selection committee N2 - Background: Heart transplant selection committee meetings have transitioned from in-person to remote video meetings during the COVID-19 pandemic, but how this impacts committee members and patient outcomes is unknown. Objective: The aim of this study is to determine the perceived impact of remote video transplant selection meetings on usability and patient care and to measure patient selection outcomes during the transition period from in-person to virtual meetings. Methods: A 35-item anonymous survey was developed and distributed electronically to the heart transplant selection committee. We reviewed medical records to compare the outcomes of patients presented at in-person meetings (January-March 2020) to those presented during video meetings (March-June 2020). Results: Among 83 committee members queried, 50 were regular attendees. Of the 50 regular attendees, 24 (48%) were physicians and 26 (52%) were nonphysicians, including nurses, social workers, and coordinators; 46 responses were received, 23 (50%) from physicians and 23 (50%) from nonphysicians, with 41 responses fully completed. Overall, respondents were satisfied with the videoconference format and felt that video meetings did not impact patient care and were an acceptable alternative to in-person meetings. However, 54% (22/41) preferred in-person meetings, with 71% (15/21) of nonphysicians preferring in-person meetings compared to only 35% (7/20) of physicians (P=.02). Of the 46 new patient evaluations presented, there was a statistically nonsignificant trend toward fewer patients initially declined at video meetings compared with in-person meetings (6/24, 25% compared to 10/22, 45%; P=.32). Conclusions: The transition from in-person to video heart transplant selection committee meetings was well-received and did not appear to affect committee members? perceived ability to deliver patient care. Patient selection outcomes were similar between meeting modalities. UR - https://cardio.jmir.org/2022/1/e35490 UR - http://dx.doi.org/10.2196/35490 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353041 ID - info:doi/10.2196/35490 ER - TY - JOUR AU - Ye, Siqin AU - Anstey, Edmund D. AU - Grauer, Anne AU - Metser, Gil AU - Moise, Nathalie AU - Schwartz, Joseph AU - Kronish, Ian AU - Abdalla, Marwah PY - 2022/3/23 TI - The Impact of Telemedicine Visits on the Controlling High Blood Pressure Quality Measure During the COVID-19 Pandemic: Retrospective Cohort Study JO - JMIR Form Res SP - e32403 VL - 6 IS - 3 KW - telemedicine KW - hypertension KW - blood pressure KW - quality of care KW - impact KW - COVID-19 KW - cohort KW - cardiology KW - telehealth KW - retrospective N2 - Background: Telemedicine visit use vastly expanded during the COVID-19 pandemic, and this has had an uncertain impact on cardiovascular care quality. Objective: We sought to examine the association between telemedicine visits and the failure to meet the Controlling High Blood Pressure (BP) quality measure from the Centers for Medicare & Medicaid Services. Methods: This was a retrospective cohort study of 32,727 adult patients with hypertension who were seen in primary care and cardiology clinics at an urban, academic medical center from February to December 2020. The primary outcome was a failure to meet the Controlling High Blood Pressure quality measure, which was defined as having no BP recorded or having a last recorded BP of ?140/90 mm Hg (ie, poor BP control). Multivariable logistic regression was used to assess the association between telemedicine visit use during the study period (none, 1 telemedicine visit, or ?2 telemedicine visits) and poor BP control; we adjusted for demographic and clinical characteristics. Results: During the study period, no BP was recorded for 2.3% (486/20,745) of patients with in-person visits only, 27.1% (1863/6878) of patients with 1 telemedicine visit, and 25% (1277/5104) of patients with ?2 telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (1 telemedicine visit: odds ratio [OR] 2.06, 95% CI 1.94-2.18; P<.001; ?2 telemedicine visits: OR 2.49, 95% CI 2.31-2.68; P<.001; reference: in-person visits only). This effect disappeared when the analysis was restricted to patients with at least 1 recorded BP (1 telemedicine visit: OR 0.89, 95% CI 0.83-0.95; P=.001; ?2 telemedicine visits: OR 0.91, 95% CI 0.83-0.99; P=.03). Conclusions: Increased telemedicine visit use is associated with poorer performance on the Controlling High Blood Pressure quality measure. However, telemedicine visit use may not negatively impact BP control when BP is recorded. UR - https://formative.jmir.org/2022/3/e32403 UR - http://dx.doi.org/10.2196/32403 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138254 ID - info:doi/10.2196/32403 ER - TY - JOUR AU - Johnson, E. Amber AU - Routh, Shuvodra AU - Taylor, N. Christy AU - Leopold, Meagan AU - Beatty, Kathryn AU - McNamara, M. Dennis AU - Davis, M. Esa PY - 2022/3/21 TI - Developing and Implementing an mHealth Heart Failure Self-care Program to Reduce Readmissions: Randomized Controlled Trial JO - JMIR Cardio SP - e33286 VL - 6 IS - 1 KW - mHealth KW - heart failure KW - self-care KW - remote monitoring KW - telehealth KW - cardiology KW - hospital readmission KW - self-management KW - mobile health KW - patient-centered N2 - Background: Patients admitted with decompensated heart failure (HF) are at risk for hospital readmission and poor quality of life during the discharge period. Lifestyle behavior modifications that promote the self-management of chronic cardiac diseases have been associated with an improved quality of life. However, whether a mobile health (mHealth) program can assist patients in the self-management of HF during the acute posthospital discharge period is unknown. Objective: We aimed to develop an mHealth program designed to enhance patients? self-management of HF by increasing knowledge, self-efficacy, and symptom detection. We hypothesized that patients hospitalized with HF would be willing to use a feasibly deployed mHealth program after their hospital discharge. Methods: We employed a patient-centered outcomes research methodology to design a stakeholder-informed mHealth program. Adult patients with HF admitted to a large academic hospital were enrolled and randomized to receive the mHealth intervention versus usual care. Our feasibility outcomes included ease of program deployment, use of the clinical escalation process, duration of participant recruitment, and participant attrition. Surveys assessing the demographics and clinical characteristics of HF were measured at baseline and at 30 and 90 days after discharge. Results: The study period was between July 1, 2019, and April 7, 2020. The mean cohort (N=31) age was 60.4 (range 22-85) years. Over half of the participants were men (n=18, 58%) and 77% (n=24) were White. There were no significant differences in baseline measures. We determined that an educational mHealth program tailored for patients with HF is feasibly deployed and acceptable by patients. Though not significant, we found notable trends including a higher mean quality of life at 30 days posthospitalization among program users and a longer duration before rehospitalization, which are suggestive of better HF prognosis. Conclusions: Our mHealth tool should be further assessed in a larger comparative effectiveness trial. Our pilot intervention offers promise as an innovative means to help HF patients lead healthy, independent lives. These preliminary data suggest that patient-centered mHealth tools can enable high-risk patients to play a role in the management of their HF after discharge. Trial Registration: ClinicalTrials.gov NCT03982017; https://clinicaltrials.gov/ct2/show/NCT03982017 UR - https://cardio.jmir.org/2022/1/e33286 UR - http://dx.doi.org/10.2196/33286 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311679 ID - info:doi/10.2196/33286 ER - TY - JOUR AU - Larsen, Hoejkjaer Lisbeth AU - Lauritzen, Hedegaard Maja AU - Sinkjaer, Mikkel AU - Kjaer, W. Troels PY - 2022/3/15 TI - The Effect of Wearable Tracking Devices on Cardiorespiratory Fitness Among Inactive Adults: Crossover Study JO - JMIR Cardio SP - e31501 VL - 6 IS - 1 KW - activity tracking KW - cardiorespiratory fitness KW - mHealth KW - mobile health KW - motivation KW - physical activity KW - self-monitoring KW - wearable KW - cardio KW - fitness KW - cardiorespiratory KW - behavior change N2 - 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. UR - https://cardio.jmir.org/2022/1/e31501 UR - http://dx.doi.org/10.2196/31501 UR - http://www.ncbi.nlm.nih.gov/pubmed/35289763 ID - info:doi/10.2196/31501 ER - TY - JOUR AU - Morken, Margreta Ingvild AU - Storm, Marianne AU - Søreide, Arne Jon AU - Urstad, Hjorthaug Kristin AU - Karlsen, Bjørg AU - Husebø, Lunde Anne Marie PY - 2022/2/15 TI - Posthospitalization Follow-Up of Patients With Heart Failure Using eHealth Solutions: Restricted Systematic Review JO - J Med Internet Res SP - e32946 VL - 24 IS - 2 KW - adherence KW - eHealth KW - heart failure KW - posthospitalization follow-up KW - patient outcome KW - review N2 - Background: Heart failure (HF) is a clinical syndrome with high incidence rates, a substantial symptom and treatment burden, and a significant risk of readmission within 30 days after hospitalization. The COVID-19 pandemic has revealed the significance of using eHealth interventions to follow up on the care needs of patients with HF to support self-care, increase quality of life (QoL), and reduce readmission rates during the transition between hospital and home. Objective: The aims of this review are to summarize research on the content and delivery modes of HF posthospitalization eHealth interventions, explore patient adherence to the interventions, and examine the effects on the patient outcomes of self-care, QoL, and readmissions. Methods: A restricted systematic review study design was used. Literature searches and reviews followed the (PRISMA-S) Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension checklist, and the CINAHL, MEDLINE, Embase, and Cochrane Library databases were searched for studies published between 2015 and 2020. The review process involved 3 groups of researchers working in pairs. The Mixed Methods Appraisal Tool was used to assess the included studies? methodological quality. A thematic analysis method was used to analyze data extracted from the studies. Results: A total of 18 studies were examined in this review. The studies were published between 2015 and 2019, with 56% (10/18) of them published in the United States. Of the 18 studies, 16 (89%) were randomized controlled trials, and 14 (78%) recruited patients upon hospital discharge to eHealth interventions lasting from 14 days to 12 months. The studies involved structured telephone calls, interactive voice response, and telemonitoring and included elements of patient education, counseling, social and emotional support, and self-monitoring of symptoms and vital signs. Of the 18 studies, 11 (61%) provided information on patient adherence, and the adherence levels were 72%-99%. When used for posthospitalization follow-up of patients with HF, eHealth interventions can positively affect QoL, whereas its impact is less evident for self-care and readmissions. Conclusions: This review suggests that patients with HF should receive prompt follow-up after hospitalization and eHealth interventions have the potential to improve these patients? QoL. Patient adherence in eHealth follow-up trials shows promise for successful future interventions and adherence research. Further studies are warranted to examine the effects of eHealth interventions on self-care and readmissions among patients with HF. UR - https://www.jmir.org/2022/2/e32946 UR - http://dx.doi.org/10.2196/32946 UR - http://www.ncbi.nlm.nih.gov/pubmed/35166680 ID - info:doi/10.2196/32946 ER - TY - JOUR AU - Aquino, Maria AU - Griffith, Janessa AU - Vattaparambil, Tessy AU - Munce, Sarah AU - Hladunewich, Michelle AU - Seto, Emily PY - 2022/2/7 TI - Patients? and Providers? Perspectives on and Needs of Telemonitoring to Support Clinical Management and Self-care of People at High Risk for Preeclampsia: Qualitative Study JO - JMIR Hum Factors SP - e32545 VL - 9 IS - 1 KW - high-risk pregnancy KW - blood pressure KW - preeclampsia KW - telemonitoring KW - home monitoring KW - mHealth N2 - Background: Preeclampsia is one of the leading causes of maternal mortality worldwide, with a global prevalence at 2%-8% of pregnancies. Patients at high risk for preeclampsia (PHRPE) have an increased risk of complications, such as fetal growth restriction, preterm delivery, abnormal clotting, and liver and kidney disease. Telemonitoring for PHRPE may allow for timelier diagnosis and enhanced management, which may improve maternal and perinatal outcomes. Objective: The objective of this study is to determine the perceptions and needs of PHRPE and their health care providers with respect to telemonitoring through semistructured interviews with both groups. This study explored (1) what the needs and challenges of monitoring PHRPE are during pregnancy and in the postpartum period and (2) what features are required in a telemonitoring program to support self-care and clinical management of PHRPE. Methods: This study used a qualitative descriptive approach, and thematic analysis was conducted. PHRPE and health care providers from a high-risk obstetrical clinic in a large academic hospital in Toronto, Canada, were asked to participate in individual semistructured interviews. Two researchers jointly developed a coding framework and separately coded each interview to ensure that the interviews were double-coded. The software program NVivo version 12 was used to help organize the codes. Results: In total, 7 PHRPE and 5 health care providers, which included a nurse practitioner and physicians, participated in the semistructured interviews. Using thematic analysis, perceptions on the benefits, barriers, and desired features were determined. Perceived benefits of telemonitoring for PHRPE included close monitoring of home blood pressure (BP) measurements and appropriate interventions for abnormal BP readings; the development of a tailored telemonitoring system for pregnant patients; and facilitation of self-management. Perceived barriers to telemonitoring for PHRPE included financial and personal barriers, as well as the potential for increased clinician workload. Desired features of a secure platform for PHRPE included the facilitation of self-management for patients and decision making for clinicians, as well as the inclusion of evidence-based action prompts. Conclusions: The perceptions of patients and providers on the use of telemonitoring for PHRPE support the need for a telemonitoring program for the management of PHRPE. Recommendations from this study include the specific features of a telemonitoring program for PHRPE, as well as the use of frameworks and design processes in the design and implementation of a telemonitoring program for PHRPE. UR - https://humanfactors.jmir.org/2022/1/e32545 UR - http://dx.doi.org/10.2196/32545 UR - http://www.ncbi.nlm.nih.gov/pubmed/35129445 ID - info:doi/10.2196/32545 ER - TY - JOUR AU - Wong, Cheong Kam AU - Nguyen, N. Tu AU - Marschner, Simone AU - Turnbull, Samual AU - Burns, Jenner Mason AU - Ne, Anna Jia Yi AU - Gopal, Vishal AU - Indrawansa, Balasuriya Anupama AU - Trankle, A. Steven AU - Usherwood, Tim AU - Kumar, Saurabh AU - Lindley, I. Richard AU - Chow, K. Clara PY - 2022/2/1 TI - Patient-Led Mass Screening for Atrial Fibrillation in the Older Population Using Handheld Electrocardiographic Devices Integrated With a Clinician-Coordinated Remote Central Monitoring System: Protocol for a Randomized Controlled Trial and Process Evaluation JO - JMIR Res Protoc SP - e34778 VL - 11 IS - 2 KW - atrial fibrillation KW - screening KW - handheld KW - electrocardiogram KW - ECG KW - acceptability KW - user perception KW - user experience KW - barrier KW - enabler KW - older adults KW - elderly KW - feasibility KW - effectiveness KW - implementation KW - monitoring KW - aging KW - cardiovascular KW - cardiology KW - heart disease KW - mobile phone N2 - Background: Atrial fibrillation (AF) is common in older people and increases the risk of stroke. The feasibility and effectiveness of the implementation of a patient-led AF screening program for older people are unknown. Objective: This study aims to examine the feasibility and effectiveness of an AF screening program comprising patient-led monitoring of single-lead electrocardiograms (ECGs) with clinician-coordinated central monitoring to diagnose AF among community-dwelling people aged ?75 years in Australia. Methods: This is a nationwide randomized controlled implementation trial conducted via the internet and remotely among 200 community-dwelling adults aged ?75 years with no known AF. Randomization will be performed in a 1:1 allocation ratio for the intervention versus control. Intervention group participants will be enrolled in the monitoring program at randomization. They will receive a handheld single-lead ECG device and training on the self-recording of ECGs on weekdays and submit their ECGs via their smartphones. The control group participants will receive usual care from their general practitioners for the initial 6 months and then commence the 6-month monitoring program. The ECGs will be reviewed centrally by trained personnel. Participants and their general practitioners will be notified of AF and other clinically significant ECG abnormalities. Results: This study will establish the feasibility and effectiveness of implementing the intervention in this patient population. The primary clinical outcome is the AF detection rate, and the primary feasibility outcome is the patient satisfaction score. Other outcomes include appropriate use of anticoagulant therapy, participant recruitment rate, program engagement (eg, frequency of ECG transmission), agreement in ECG interpretation between the device automatic algorithm and clinicians, the proportion of participants who complete the trial and number of dropouts, and the impact of frailty on feasibility and outcomes. We will conduct a qualitative evaluation to examine the barriers to and acceptability and enablers of implementation. Ethics approval was obtained from the human research ethics committee at the University of Sydney (project number 2020/680). The results will be disseminated via conventional scienti?c forums, including peer-reviewed publications and presentations at national and international conferences. Conclusions: By incorporating an integrated health care approach involving patient empowerment, centralized clinician-coordinated ECG monitoring, and facilitation of primary care and specialist services, it is possible to diagnose and treat AF early to reduce stroke risk. This study will provide new information on how to implement AF screening using digital health technology practicably and feasibly for older and frail populations residing in the community. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000184875; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380877 International Registered Report Identifier (IRRID): DERR1-10.2196/34778 UR - https://www.researchprotocols.org/2022/2/e34778 UR - http://dx.doi.org/10.2196/34778 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103614 ID - info:doi/10.2196/34778 ER - TY - JOUR AU - Ware, Patrick AU - Shah, Amika AU - Ross, Joan Heather AU - Logan, Gordon Alexander AU - Segal, Phillip AU - Cafazzo, Antony Joseph AU - Szacun-Shimizu, Katarzyna AU - Resnick, Myles AU - Vattaparambil, Tessy AU - Seto, Emily PY - 2022/1/26 TI - Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study JO - J Med Internet Res SP - e31754 VL - 24 IS - 1 KW - telemonitoring KW - telemedicine KW - heart failure KW - diabetes KW - hypertension KW - tertiary health care KW - multiple chronic conditions KW - mobile phone N2 - Background: Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on telemonitoring for this population. Objective: This randomized controlled trial and embedded qualitative study aims to evaluate the impact on and experiences of patients and health care providers (HCPs) using a telemonitoring system with decision support to manage patients with complex conditions, including those with multiple chronic conditions, compared with the standard of care. Methods: A pragmatic, unblinded, 6-month randomized controlled trial sought to recruit 146 patients with ?1 diagnosis of heart failure (HF), uncontrolled hypertension (HT), and insulin-requiring diabetes mellitus (DM) from outpatient specialty settings in Toronto, Ontario, Canada. Participants were randomized into the control and telemonitoring groups, with the latter being instructed to take readings relevant to their conditions. The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status (36-Item Short Form Health Survey questionnaire). Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported health service use. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group was interviewed about their experiences. Results: A total of 96 patients were recruited and randomized. Recruitment was terminated early because of implementation challenges and the onset of the COVID-19 pandemic. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of patients with HF found improvements in self-care maintenance (P=.04) and physical quality of life (P=.046). Opinions expressed by the 5 HCPs and 13 patients who were interviewed differed based on the monitored conditions. Although patients with HF reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care and the design of the decision support, whereby fluctuations in the status of HT and DM typically required less urgent interventions compared with patients with HF. Conclusions: We recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary but not sufficient components of such programs for patients with complex conditions and lower acuity. We conclude that telemonitoring for patients with complex conditions or within multidisciplinary care settings may be best operationalized through nurse-led models of care. Trial Registration: ClinicalTrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8367 UR - https://www.jmir.org/2022/1/e31754 UR - http://dx.doi.org/10.2196/31754 UR - http://www.ncbi.nlm.nih.gov/pubmed/35080502 ID - info:doi/10.2196/31754 ER - TY - JOUR AU - Leigh, W. Jonathan AU - Gerber, S. Ben AU - Gans, P. Christopher AU - Kansal, M. Mayank AU - Kitsiou, Spyros PY - 2022/1/14 TI - Smartphone Ownership and Interest in Mobile Health Technologies for Self-care Among Patients With Chronic Heart Failure: Cross-sectional Survey Study JO - JMIR Cardio SP - e31982 VL - 6 IS - 1 KW - mHealth KW - smartphone KW - mobile phone KW - heart failure KW - self-care KW - self-management N2 - Background: Heart failure (HF) is a highly prevalent chronic condition that places a substantial burden on patients, families, and health care systems worldwide. Recent advances in mobile health (mHealth) technologies offer great opportunities for supporting many aspects of HF self-care. There is a need to better understand patients? adoption of and interest in using mHealth for self-monitoring and management of HF symptoms. Objective: The purpose of this study is to assess smartphone ownership and patient attitudes toward using mHealth technologies for HF self-care in a predominantly minority population in an urban clinical setting. Methods: We conducted a cross-sectional survey of adult outpatients (aged ?18 years) at an academic outpatient HF clinic in the Midwest. The survey comprised 34 questions assessing patient demographics, ownership of smartphones and other mHealth devices, frequently used smartphone features, use of mHealth apps, and interest in using mHealth technologies for vital sign and HF symptom self-monitoring and management. Results: A total of 144 patients were approached, of which 100 (69.4%) participated in the study (63/100, 63% women). The participants had a mean age of 61.3 (SD 12.25) years and were predominantly Black or African American (61/100, 61%) and Hispanic or Latino (18/100, 18%). Almost all participants (93/100, 93%) owned a cell phone. The share of patients who owned a smartphone was 68% (68/100). Racial and ethnic minorities that identified as Black or African American or Hispanic or Latino reported higher smartphone ownership rates compared with White patients with HF (45/61, 74% Black or African American and 11/18, 61% Hispanic or Latino vs 9/17, 53% White). There was a moderate and statistically significant association between smartphone ownership and age (Cramér V [?C]=0.35; P<.001), education (?C=0.29; P=.001), and employment status (?C=0.3; P=.01). The most common smartphone features used by the participants were SMS text messaging (51/68, 75%), internet browsing (43/68, 63%), and mobile apps (41/68, 60%). The use of mHealth apps and wearable activity trackers (eg, Fitbits) for self-monitoring of HF-related parameters was low (15/68, 22% and 15/100, 15%, respectively). The most popular HF-related self-care measures participants would like to monitor using mHealth technologies were physical activity (46/68, 68%), blood pressure (44/68, 65%), and medication use (40/68, 59%). Conclusions: Most patients with HF have smartphones and are interested in using commercial mHealth apps and connected health devices to self-monitor their condition. Thus, there is a great opportunity to capitalize on the high smartphone ownership among racial and ethnic minority patients to increase reach and enhance HF self-management through mHealth interventions. UR - https://cardio.jmir.org/2022/1/e31982 UR - http://dx.doi.org/10.2196/31982 UR - http://www.ncbi.nlm.nih.gov/pubmed/35029533 ID - info:doi/10.2196/31982 ER - TY - JOUR AU - Chen, Ying-Hsien AU - Hung, Chi-Sheng AU - Huang, Ching-Chang AU - Lee, Jen-Kuang AU - Yu, Jiun-Yu AU - Ho, Yi-Lwun PY - 2022/1/10 TI - The Impact of Synchronous Telehealth Services With a Digital Platform on Day-by-Day Home Blood Pressure Variability in Patients with Cardiovascular Diseases: Retrospective Cohort Study JO - J Med Internet Res SP - e22957 VL - 24 IS - 1 KW - blood pressure KW - variability KW - telehealth KW - hypertension KW - cardiovascular disease KW - chronic disease KW - heart KW - digital platform KW - cohort KW - management KW - intervention N2 - Background: Hypertension is associated with a large global disease burden with variable control rates across different regions and races. Telehealth has recently emerged as a health care strategy for managing chronic diseases, but there are few reports regarding the effects of synchronous telehealth services on home blood pressure (BP) control and variability. Objective: The objective of this study is to investigate the effect of synchronous telehealth services with a digital platform on home BP. Methods: This retrospective study was conducted by the Taiwan ELEctroHEALTH study group at the Telehealth Center of the National Taiwan University Hospital. We analyzed home BP data taken from 2888 patients with cardiovascular disease (CVD) enrolled in our telehealth program between 2009 to 2017. Of the 2888 patients with CVD, 348 (12.05%) patients who received home BP surveillance for ?56 days were selected for BP analysis. Patients were stratified into three groups: (1) poorly controlled hypertension, (2) well-controlled hypertension, and (3) nonhypertension. The mean, SD, coefficient of variation (CV), and average real variability were calculated. Results: Telehealth interventions significantly and steadily reduced systolic blood pressure (SBP) in the poorly controlled hypertension group from 144.8.2±9.2 to 133.7±10.2 mmHg after 2 months (P<.001). BP variability reduced in all patients: SBP-SD decreased from 7.8±3.4 to 7.3±3.4 after 2 months (P=.004), and SBP-CV decreased from 6.3±2.5 to 5.9±2.6 after 2 months (P=.004). Event-free survival (admission) analysis stratified by SBP-SD showed longer time to first hospitalization for Q1 patients compared with Q4 patients (P=.02, odds ratio 2.15, 95% CI 1.18-3.89). Conclusions: Synchronous telehealth intervention may improve home BP control and decrease day-by-day home BP variability in patients with CVD. UR - https://www.jmir.org/2022/1/e22957 UR - http://dx.doi.org/10.2196/22957 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006089 ID - info:doi/10.2196/22957 ER - TY - JOUR AU - Ramachandran, Joann Hadassah AU - Jiang, Ying AU - Teo, Claire Jun Yi AU - Yeo, Joo Tee AU - Wang, Wenru PY - 2022/1/7 TI - Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review JO - J Med Internet Res SP - e34657 VL - 24 IS - 1 KW - technology acceptance KW - coronary heart disease KW - home-based KW - telerehabilitation KW - web-based KW - mobile application KW - acceptance KW - heart KW - rehabilitation KW - app KW - review KW - evaluation KW - cardiac KW - cardiology KW - perspective KW - usability KW - acceptability N2 - Background: An understanding of the technology acceptance of home-based cardiac telerehabilitation programs is paramount if they are to be designed and delivered to target the needs and preferences of patients with coronary heart disease; however, the current state of technology acceptance of home-based cardiac telerehabilitation has not been systematically evaluated in the literature. Objective: We aimed to provide a comprehensive summary of home-based cardiac telerehabilitation technology acceptance in terms of (1) the timing and approaches used and (2) patients? perspectives on its usability, utility, acceptability, acceptance, and external variables. Methods: We searched PubMed, CENTRAL, Embase, CINAHL, PsycINFO, and Scopus (inception to July 2021) for English-language papers that reported empirical evidence on the technology acceptance of early-phase home-based cardiac telerehabilitation in patients with coronary heart disease. Content analysis was undertaken. Results: The search identified 1798 studies, of which 18 studies, with 14 unique home-based cardiac telerehabilitation programs, met eligibility criteria. Technology acceptance (of the home-based cardiac telerehabilitation programs) was mostly evaluated at intra- and posttrial stages using questionnaires (n=10) and usage data (n=11). The least used approach was evaluation through qualitative interviews (n=3). Usability, utility, acceptability, and acceptance were generally favored. External variables that influenced home-based cardiac telerehabilitation usage included component quality, system quality, facilitating conditions, and intrinsic factors. Conclusions: Home-based cardiac telerehabilitation usability, utility, acceptability, and acceptance were high; yet, a number of external variables influenced acceptance. Findings and recommendations from this review can provide guidance for developing and evaluating patient-centered home-based cardiac telerehabilitation programs to stakeholders and clinicians. UR - https://www.jmir.org/2022/1/e34657 UR - http://dx.doi.org/10.2196/34657 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994711 ID - info:doi/10.2196/34657 ER - TY - JOUR AU - Elzinga, O. Willem AU - Prins, Samantha AU - Borghans, M. Laura G. J. AU - Gal, Pim AU - Vargas, A. Gabriel AU - Groeneveld, J. Geert AU - Doll, J. Robert PY - 2021/12/30 TI - Detection of Clenbuterol-Induced Changes in Heart Rate Using At-Home Recorded Smartwatch Data: Randomized Controlled Trial JO - JMIR Form Res SP - e31890 VL - 5 IS - 12 KW - photoplethysmography KW - smartwatch KW - wearable KW - at-home KW - heart rate KW - RCT KW - wearable device KW - digital health KW - cardiovascular KW - cardiology KW - sensors KW - heart rate sensor KW - smart technology N2 - Background: Although electrocardiography is the gold standard for heart rate (HR) recording in clinical trials, the increasing availability of smartwatch-based HR monitors opens up possibilities for drug development studies. Smartwatches allow for inexpensive, unobtrusive, and continuous HR estimation for potential detection of treatment effects outside the clinic, during daily life. Objective: The aim of this study is to evaluate the repeatability and sensitivity of smartwatch-based HR estimates collected during a randomized clinical trial. Methods: The data were collected as part of a multiple-dose, investigator-blinded, randomized, placebo-controlled, parallel-group study of 12 patients with Parkinson disease. After a 6-day baseline period, 4 and 8 patients were treated for 7 days with an ascending dose of placebo and clenbuterol, respectively. Throughout the study, the smartwatch provided HR and sleep state estimates. The HR estimates were quantified as the 2.5th, 50th, and 97.5th percentiles within awake and asleep segments. Linear mixed models were used to calculate the following: (1) the intraclass correlation coefficient (ICC) of estimated sleep durations, (2) the ICC and minimum detectable effect (MDE) of the HR estimates, and (3) the effect sizes of the HR estimates. Results: Sleep duration was moderately repeatable (ICC=0.64) and was not significantly affected by study day (P=.83), clenbuterol (P=.43), and study day by clenbuterol (P=.73). Clenbuterol-induced changes were detected in the asleep HR as of the first night (+3.79 beats per minute [bpm], P=.04) and in the awake HR as of the third day (+8.79 bpm, P=.001). The median HR while asleep had the highest repeatability (ICC=0.70). The MDE (N=12) was found to be smaller when patients were asleep (6.8 bpm to 11.7 bpm) than while awake (10.7 bpm to 22.1 bpm). Overall, the effect sizes for clenbuterol-induced changes were higher while asleep (0.49 to 2.75) than while awake (0.08 to 1.94). Conclusions: We demonstrated the feasibility of using smartwatch-based HR estimates to detect clenbuterol-induced changes during clinical trials. The asleep HR estimates were most repeatable and sensitive to treatment effects. We conclude that smartwatch-based HR estimates obtained during daily living in a clinical trial can be used to detect and track treatment effects. Trial Registration: Netherlands Trials Register NL8002; https://www.trialregister.nl/trial/8002 UR - https://formative.jmir.org/2021/12/e31890 UR - http://dx.doi.org/10.2196/31890 UR - http://www.ncbi.nlm.nih.gov/pubmed/34967757 ID - info:doi/10.2196/31890 ER - TY - JOUR AU - Biersteker, Tom AU - Hilt, Alexander AU - van der Velde, Enno AU - Schalij, Jan Martin AU - Treskes, Willem Roderick PY - 2021/12/16 TI - Real-World Experience of mHealth Implementation in Clinical Practice (the Box): Design and Usability Study JO - JMIR Cardio SP - e26072 VL - 5 IS - 2 KW - eHealth KW - mHealth KW - remote patient monitoring KW - cardiology KW - patient satisfaction KW - patient empowerment KW - mobile phone N2 - Background: Mobile health (mHealth) is an emerging field of scientific interest worldwide. Potential benefits include increased patient engagement, improved clinical outcomes, and reduced health care costs. However, mHealth is often studied in projects or trials, and structural implantation in clinical practice is less common. Objective: The purpose of this paper is to outline the design of the Box and its implementation and use in an outpatient clinic setting. The impact on logistical outcomes and patient and provider satisfaction is discussed. Methods: In 2016, an mHealth care track including smartphone-compatible devices, named the Box, was implemented in the cardiology department of a tertiary medical center in the Netherlands. Patients with myocardial infarction, rhythm disorders, cardiac surgery, heart failure, and congenital heart disease received devices to measure daily weight, blood pressure, heart rate, temperature, and oxygen saturation. In addition, professional and patient user comments on the experience with the care track were obtained via structured interviews. Results: From 2016 to April 2020, a total of 1140 patients were connected to the mHealth care track. On average, a Box cost ?350 (US $375), not including extra staff costs. The median patient age was 60.8 (IQR 52.9-69.3) years, and 73.59% (839/1140) were male. A median of 260 (IQR 105-641) measurements was taken on a median of 189 (IQR 98-372) days. Patients praised the ease of use of the devices and felt more involved with their illness and care. Professionals reported more productive outpatient consultations as well as improved insight into health parameters such as blood pressure and weight. A feedback loop from the hospital to patient to focus on measurements was commented as an important improvement by both patients and professionals. Conclusions: In this study, the design and implementation of an mHealth care track for outpatient follow-up of patients with various cardiovascular diseases is described. Data from these 4 years indicate that mHealth is feasible to incorporate in outpatient management and is generally well-accepted by patients and providers. Limitations include the need for manual measurement data checks and the risk of data overload. Moreover, the tertiary care setting in which the Box was introduced may limit the external validity of logistical and financial end points to other medical centers. More evidence is needed to show the effects of mHealth on clinical outcomes and on cost-effectiveness. UR - https://cardio.jmir.org/2021/2/e26072 UR - http://dx.doi.org/10.2196/26072 UR - http://www.ncbi.nlm.nih.gov/pubmed/34642159 ID - info:doi/10.2196/26072 ER - TY - JOUR AU - Ali, Lilas AU - Wallström, Sara AU - Fors, Andreas AU - Barenfeld, Emmelie AU - Fredholm, Eva AU - Fu, Michael AU - Goudarzi, Mahboubeh AU - Gyllensten, Hanna AU - Lindström Kjellberg, Irma AU - Swedberg, Karl AU - Vanfleteren, W. Lowie E. G. AU - Ekman, Inger PY - 2021/12/13 TI - Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial JO - J Med Internet Res SP - e26794 VL - 23 IS - 12 KW - chronic heart failure KW - chronic obstructive pulmonary disease KW - digital platform KW - eHealth KW - patient-centered care KW - person-centered care KW - randomized controlled trial KW - telehealth N2 - Background: Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce. Objective: The aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF. Methods: A multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5%) or PCC combined with usual care (110/222, 49.5%). The intervention?s main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention. Results: No significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (P=.047), although it was not maintained until the end of the 6-month follow-up (P=.24). This effect was driven by a change in general self-efficacy from baseline. Conclusions: PCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF. Trial Registration: ClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817 UR - https://www.jmir.org/2021/12/e26794 UR - http://dx.doi.org/10.2196/26794 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898447 ID - info:doi/10.2196/26794 ER - TY - JOUR AU - Ghorbani, Banafsheh AU - Jackson, C. Alun AU - Noorchenarboo, Mohammad AU - Mandegar, H. Mohammad AU - Sharifi, Farshad AU - Mirmoghtadaie, Zohrehsadat AU - Bahramnezhad, Fatemeh PY - 2021/12/10 TI - Comparing the Effects of Gamification and Teach-Back Training Methods on Adherence to a Therapeutic Regimen in Patients After Coronary Artery Bypass Graft Surgery: Randomized Clinical Trial JO - J Med Internet Res SP - e22557 VL - 23 IS - 12 KW - teach back KW - gamification KW - treatment regimen KW - coronary artery bypass graft KW - patient training N2 - Background: Patients undergoing coronary artery bypass graft surgery (CABGS) may fail to adhere to their treatment regimen for many reasons. Among these, one of the most important reasons for nonadherence is the inadequate training of such patients or training using inappropriate methods. Objective: This study aimed to compare the effect of gamification and teach-back training methods on adherence to a therapeutic regimen in patients after CABGS. Methods: This randomized clinical trial was conducted on 123 patients undergoing CABGS in Tehran, Iran, in 2019. Training was provided to the teach-back group individually. In the gamification group, an app developed for the purpose was installed on each patient?s smartphone, with training given via this device. The control group received usual care, or routine training. Adherence to the therapeutic regimen was assessed using a questionnaire on adherence to a therapeutic regimen (physical activity and dietary regimen) and an adherence scale as a pretest and a 1-month posttest. Results: One-way analysis of variance (ANOVA) for comparing the mean scores of teach-back and gamification training methods showed that the mean normalized scores for the dietary regimen (P<.001, F=71.80), movement regimen (P<.001, F=124.53), and medication regimen (P<.001, F=9.66) before and after intervention were significantly different between the teach-back, gamification, and control groups. In addition, the results of the Dunnett test showed that the teach-back and gamification groups were significantly different from the control group in all three treatment regimen methods. There was no statistically significant difference in adherence to the therapeutic regimen between the teach-back and control groups. Conclusions: Based on the results of this study, the use of teach-back and gamification training approaches may be suggested for patients after CABGS to facilitate adherence to the therapeutic regimen. Trial Registration: Iranian Registry of Clinical Trials IRCT20111203008286N8; https://en.irct.ir/trial/41507 UR - https://www.jmir.org/2021/12/e22557 UR - http://dx.doi.org/10.2196/22557 UR - http://www.ncbi.nlm.nih.gov/pubmed/34890346 ID - info:doi/10.2196/22557 ER - TY - JOUR AU - Dorsch, P. Michael AU - Farris, B. Karen AU - Rowell, E. Brigid AU - Hummel, L. Scott AU - Koelling, M. Todd PY - 2021/12/7 TI - The Effects of the ManageHF4Life Mobile App on Patients With Chronic Heart Failure: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e26185 VL - 9 IS - 12 KW - mHealth KW - remote monitoring KW - self-management KW - self-care KW - heart failure KW - medical therapy KW - mobile app N2 - Background: The successful management of heart failure (HF) involves guideline-based medical therapy as well as self-management behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. Objective: The aim of this paper was to evaluate the efficacy of enhanced self-management via a mobile app intervention on health-related quality of life, self-management, and HF readmissions. Methods: A single-center randomized controlled trial was performed. Participants older than 45 years and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group (?app group?) used a mobile app, and the intervention prompted daily self-monitoring and promoted self-management. The control group (?no-app group?) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire score and recurrent HF admissions. Results: A total of 83 participants were enrolled and completed all baseline assessments. Baseline characteristics were similar between the groups except for the prevalence of ischemic HF. The app group had a reduced MLHFQ at 6 weeks (mean 37.5, SD 3.5 vs mean 48.2, SD 3.7; P=.04) but not at 12 weeks (mean 44.2, SD 4 vs mean 45.9, SD 4; P=.78), compared to the no-app group. There was no effect of the app on the SCHFI at 6 or 12 weeks. The time to first HF readmission was not statistically different between the app group and the no-app group (app group 11/42, 26% vs no-app group 12/41, 29%; hazard ratio 0.89, 95% CI 0.39-2.02; P=.78) over 12 weeks. Conclusions: The adaptive mobile app intervention, which focused on promoting self-monitoring and self-management, improved the MLHFQ at 6 weeks but did not sustain its effects at 12 weeks. No effect was seen on HF self-management measured by self-report. Further research is needed to enhance engagement in the app for a longer period and to determine if the app can reduce HF readmissions in a larger study. Trial Registration: ClinicalTrials.gov NCT03149510; https://clinicaltrials.gov/ct2/show/NCT03149510 UR - https://mhealth.jmir.org/2021/12/e26185 UR - http://dx.doi.org/10.2196/26185 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878990 ID - info:doi/10.2196/26185 ER - TY - JOUR AU - Artanian, Veronica AU - Ware, Patrick AU - Rac, E. Valeria AU - Ross, J. Heather AU - Seto, Emily PY - 2021/11/25 TI - Experiences and Perceptions of Patients and Providers Participating in Remote Titration of Heart Failure Medication Facilitated by Telemonitoring: Qualitative Study JO - JMIR Cardio SP - e28259 VL - 5 IS - 2 KW - telemonitoring KW - remote KW - titration KW - monitoring KW - mHealth KW - heart failure KW - qualitative KW - mobile phone N2 - Background: Guideline-directed medical therapy (GDMT), optimized to target doses, improves health outcomes in patients with heart failure. However, GDMT remains underused, with <25% of patients receiving target doses in clinical practice. A randomized controlled trial was conducted at the Peter Munk Cardiac Centre in Toronto to compare a remote GDMT titration intervention with standard in-office titration. This randomized controlled trial found that remote titration increased the proportion of patients who achieved optimal GDMT doses, decreased the time to dose optimization, and reduced the number of essential clinic visits. This paper presents findings from the qualitative component of the mixed methods study, which evaluated the implementation of the remote titration intervention. Objective: The objective of the qualitative component is to assess the perceptions and experiences of clinicians and patients with heart failure who participated in the remote titration intervention to identify factors that affected the implementation of the intervention. Methods: We conducted semistructured interviews with clinicians (n=5) and patients (n=11) who participated in the remote titration intervention. Questions probed the experiences of the participants to identify factors that can serve as barriers and facilitators to its implementation. Conventional content analysis was first used to analyze the interviews and gain direct information based on the participants? unique perspectives. Subsequently, the generated themes were delineated and mapped following a multilevel framework. Results: Patients and clinicians indicated that the intervention was easy to use, integrated well into their routines, and removed practical barriers to titration. Key implementation facilitators from the patients? perspective included the reduction in clinic visits and daily monitoring of their condition, whereas clinicians emphasized the benefits of rapid drug titration and efficient patient management. Key implementation barriers included the resources necessary to support the intervention and lack of physician remuneration. Conclusions: This study presents results from a real-world implementation assessment of remote titration facilitated by telemonitoring. It is among the first to provide insight into the perception of the remote titration process by clinicians and patients. Our findings indicate that the relative advantages that remote titration presents over standard care strongly appeal to both clinicians and patients. However, to ensure uptake and adherence, it is important to ensure that suitable patients are enrolled and the impact on the physicians? workload is minimized. The implementation of remote titration is now more critical than ever, as it can help provide access to care for patients during times when physical distancing is required. Trial Registration: ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID): RR2-10.2196/19705 UR - https://cardio.jmir.org/2021/2/e28259 UR - http://dx.doi.org/10.2196/28259 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842546 ID - info:doi/10.2196/28259 ER - TY - JOUR AU - Seiler, Amber AU - Biundo, Eliana AU - Di Bacco, Marco AU - Rosemas, Sarah AU - Nicolle, Emmanuelle AU - Lanctin, David AU - Hennion, Juliette AU - de Melis, Mirko AU - Van Heel, Laura PY - 2021/10/15 TI - Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation JO - JMIR Cardio SP - e27720 VL - 5 IS - 2 KW - cardiac implantable electronic devices KW - remote monitoring KW - patient management KW - clinic efficiency KW - digital health KW - mobile phone N2 - Background: The number of patients with cardiac implantable electronic device (CIED) is increasing, creating a substantial workload for device clinics. Objective: This study aims to characterize the workflow and quantify clinic staff time requirements for managing patients with CIEDs. Methods: A time and motion workflow evaluation was performed in 11 US and European CIEDs clinics. Workflow tasks were repeatedly timed during 1 business week of observation at each clinic; these observations included all device models and manufacturers. The mean cumulative staff time required to review a remote device transmission and an in-person clinic visit were calculated, including all necessary clinical and administrative tasks. The annual staff time to manage a patient with a CIED was modeled using CIED transmission volumes, clinical guidelines, and the published literature. Results: A total of 276 in-person clinic visits and 2173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4 to 13.5 minutes for therapeutic devices (pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy) and from 11.3 to 12.9 minutes for diagnostic devices such as insertable cardiac monitors (ICMs). Mean staff time per in-person visit ranged from 37.8 to 51.0 and from 39.9 to 45.8 minutes for therapeutic devices and ICMs, respectively. Including all remote and in-person follow-ups, the estimated annual time to manage a patient with a CIED ranged from 1.6 to 2.4 hours for therapeutic devices and from 7.7 to 9.3 hours for ICMs. Conclusions: The CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs the implementation of efficiency improvements, including remote solutions. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow. UR - https://cardio.jmir.org/2021/2/e27720 UR - http://dx.doi.org/10.2196/27720 UR - http://www.ncbi.nlm.nih.gov/pubmed/34156344 ID - info:doi/10.2196/27720 ER - TY - JOUR AU - Stollfuss, Barbara AU - Richter, Manuel AU - Drömann, Daniel AU - Klose, Hans AU - Schwaiblmair, Martin AU - Gruenig, Ekkehard AU - Ewert, Ralf AU - Kirchner, C. Martin AU - Kleinjung, Frank AU - Irrgang, Valeska AU - Mueller, Christian PY - 2021/10/8 TI - Digital Tracking of Physical Activity, Heart Rate, and Inhalation Behavior in Patients With Pulmonary Arterial Hypertension Treated With Inhaled Iloprost: Observational Study (VENTASTEP) JO - J Med Internet Res SP - e25163 VL - 23 IS - 10 KW - 6-minute walk distance KW - 6MWD KW - Breelib KW - daily physical activity KW - digital monitoring KW - health-related quality of life KW - iloprost KW - Ventavis KW - inhalation behavior KW - mobile phone KW - pulmonary arterial hypertension KW - PAH KW - sleeping behavior KW - behavior KW - sleep KW - monitoring KW - physical activity KW - heart KW - cardiology N2 - Background: Pulmonary arterial hypertension restricts the ability of patients to perform routine physical activities. As part of pulmonary arterial hypertension treatment, inhaled iloprost can be administered via a nebulizer that tracks inhalation behavior. Pulmonary arterial hypertension treatment is guided by intermittent clinical measurements, such as 6-minute walk distance, assessed during regular physician visits. Continuous digital monitoring of physical activity may facilitate more complete assessment of the impact of pulmonary arterial hypertension on daily life. Physical activity tracking with a wearable has not yet been assessed with simultaneous tracking of pulmonary arterial hypertension medication intake. Objective: We aimed to digitally track the physical parameters of patients with pulmonary arterial hypertension who were starting treatment with iloprost using a Breelib nebulizer. The primary objective was to investigate correlations between changes in digital physical activity measures and changes in traditional clinical measures and health-related quality of life over 3 months. Secondary objectives were to evaluate inhalation behavior, adverse events, and changes in heart rate and sleep quality. Methods: We conducted a prospective, multicenter observational study of adults with pulmonary arterial hypertension in World Health Organization functional class III who were adding inhaled iloprost to existing pulmonary arterial hypertension therapy. Daily distance walked, step count, number of standing-up events, heart rate, and 6-minute walk distance were digitally captured using smartwatch (Apple Watch Series 2) and smartphone (iPhone 6S) apps during a 3-month observation period (which began when iloprost treatment began). Before and at the end of the observation period (within 2 weeks), we also evaluated 6-minute walk distance, Borg dyspnea, functional class, B-type natriuretic peptide (or N-terminal pro?B-type natriuretic peptide) levels, health-related quality of life (EQ-5D questionnaire), and sleep quality (Pittsburgh Sleep Quality Index). Results: Of 31 patients, 18 were included in the full analysis (observation period: median 91.5 days, IQR 88.0 to 92.0). Changes from baseline in traditional and digital 6-minute walk distance were moderately correlated (r=0.57). Physical activity (daily distance walked: median 0.4 km, IQR ?0.2 to 1.9; daily step count: median 591, IQR ?509 to 2413) and clinical measures (traditional 6-minute walk distance: median 26 m, IQR 0 to 40) changed concordantly from baseline to the end of the observation period. Health-related quality of life showed little change. Total sleep score and resting heart rate slightly decreased. Distance walked and step count showed short-term increases after each iloprost inhalation. No new safety signals were identified (safety analysis set: n=30). Conclusions: Our results suggest that despite challenges, parallel monitoring of physical activity, heart rate, and iloprost inhalation is feasible in patients with pulmonary arterial hypertension and may complement traditional measures in guiding treatment; however, the sample size of this study limits generalizability. Trial Registration: ClinicalTrials.gov NCT03293407; https://clinicaltrials.gov/ct2/show/NCT03293407 International Registered Report Identifier (IRRID): RR2-10.2196/12144 UR - https://www.jmir.org/2021/10/e25163 UR - http://dx.doi.org/10.2196/25163 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623313 ID - info:doi/10.2196/25163 ER - TY - JOUR AU - Ranjan, Yatharth AU - Althobiani, Malik AU - Jacob, Joseph AU - Orini, Michele AU - Dobson, JB Richard AU - Porter, Joanna AU - Hurst, John AU - Folarin, A. Amos PY - 2021/10/7 TI - Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study JO - JMIR Res Protoc SP - e28873 VL - 10 IS - 10 KW - mHealth KW - COVID-19 KW - mobile health KW - remote monitoring KW - wearables KW - internet of things KW - lung diseases KW - respiratory health KW - mental health KW - cardiopulmonary diseases N2 - Background: Chronic lung disorders like chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are characterized by exacerbations. They are unpleasant for patients and sometimes severe enough to cause hospital admission and death. Moreover, due to the COVID-19 pandemic, vulnerable populations with these disorders are at high risk, and their routine care cannot be done properly. Remote monitoring offers a low cost and safe solution for gaining visibility into the health of people in their daily lives, making it useful for vulnerable populations. Objective: The primary objective is to assess the feasibility and acceptability of remote monitoring using wearables and mobile phones in patients with pulmonary diseases. The secondary objective is to provide power calculations for future studies centered around understanding the number of exacerbations according to sample size and duration. Methods: Twenty participants will be recruited in each of three cohorts (COPD, IPF, and posthospitalization COVID). Data collection will be done remotely using the RADAR-Base (Remote Assessment of Disease And Relapse) mobile health (mHealth) platform for different devices, including Garmin wearable devices and smart spirometers, mobile app questionnaires, surveys, and finger pulse oximeters. Passive data include wearable-derived continuous heart rate, oxygen saturation, respiration rate, activity, and sleep. Active data include disease-specific patient-reported outcome measures, mental health questionnaires, and symptom tracking to track disease trajectory. Analyses will assess the feasibility of lung disorder remote monitoring (including data quality, data completeness, system usability, and system acceptability). We will attempt to explore disease trajectory, patient stratification, and identification of acute clinical events such as exacerbations. A key aspect is understanding the potential of real-time data collection. We will simulate an intervention to acquire responses at the time of the event to assess model performance for exacerbation identification. Results: The Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH) study provides a unique opportunity to assess the use of remote monitoring in the evaluation of lung disorders. The study started in the middle of June 2021. The data collection apparatus, questionnaires, and wearable integrations were setup and tested by the clinical teams prior to the start of recruitment. While recruitment is ongoing, real-time exacerbation identification models are currently being constructed. The models will be pretrained daily on data of previous days, but the inference will be run in real time. Conclusions: The RALPMH study will provide a reference infrastructure for remote monitoring of lung diseases. It specifically involves information regarding the feasibility and acceptability of remote monitoring and the potential of real-time data collection and analysis in the context of chronic lung disorders. It will help plan and inform decisions in future studies in the area of respiratory health. Trial Registration: ISRCTN Registry ISRCTN16275601; https://www.isrctn.com/ISRCTN16275601 International Registered Report Identifier (IRRID): PRR1-10.2196/28873 UR - https://www.researchprotocols.org/2021/10/e28873 UR - http://dx.doi.org/10.2196/28873 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319235 ID - info:doi/10.2196/28873 ER - TY - JOUR AU - Schukraft, Sara AU - Boukhayma, Assim AU - Cook, Stéphane AU - Caizzone, Antonino PY - 2021/10/7 TI - Remote Blood Pressure Monitoring With a Wearable Photoplethysmographic Device (Senbiosys): Protocol for a Single-Center Prospective Clinical Trial JO - JMIR Res Protoc SP - e30051 VL - 10 IS - 10 KW - continuous blood pressure monitoring KW - photoplethysmography KW - arterial line KW - Senbiosys KW - wearable devices KW - blood pressure KW - remote monitoring KW - continuous monitoring KW - mHealth KW - mobile health N2 - Background: Wearable devices can provide user-friendly, accurate, and continuous blood pressure (BP) monitoring to assess patients? vital signs and achieve remote patient management. Remote BP monitoring can substantially improve BP control. The newest cuffless BP monitoring devices have emerged in patient care using photoplethysmography. Objective: The Senbiosys trial aims to compare BP measurements of a new device capturing a photoplethysmography signal on the finger versus invasive measurements performed in patients with an arterial catheter in the intensive care unit (ICU) or referred for a coronarography at the Hospital of Fribourg. Methods: The Senbiosys study is a single-center, single-arm, prospective trial. The study population consists of adult patients undergoing coronarography or patients in the ICU with an arterial catheter in place. This study will enroll 35 adult patients, including 25 patients addressed for a coronarography and 10 patients in the ICU. The primary outcome is the assessment of mean bias (95% CI) for systolic BP, diastolic BP, and mean BP between noninvasive and invasive BP measurements. Secondary outcomes include a reliability index (Qualification Index) for BP epochs and count of qualified epochs. Results: Patient recruitment started in June 2021. Results are expected to be published by December 2021. Conclusions: The findings of the Senbiosys trial are expected to improve remote BP monitoring. The diagnosis and treatment of hypertension should benefit from these advancements. Trial Registration: ClinicalTrials.gov NCT04379986; https://clinicaltrials.gov/ct2/show/NCT04379986 International Registered Report Identifier (IRRID): PRR1-10.2196/30051 UR - https://www.researchprotocols.org/2021/10/e30051 UR - http://dx.doi.org/10.2196/30051 UR - http://www.ncbi.nlm.nih.gov/pubmed/34617912 ID - info:doi/10.2196/30051 ER - TY - JOUR AU - Itoh, Hidetaka AU - Amiya, Eisuke AU - Narita, Koichi AU - Shimbo, Mai AU - Taya, Masanobu AU - Komuro, Issei AU - Hasegawa, Takashi AU - Makita, Shigeru AU - Kimura, Yutaka PY - 2021/10/4 TI - Efficacy and Safety of Remote Cardiac Rehabilitation in the Recovery Phase of Cardiovascular Diseases: Protocol for a Multicenter, Nonrandomized, Single-Arm, Interventional Trial JO - JMIR Res Protoc SP - e30725 VL - 10 IS - 10 KW - cardiac rehabilitation KW - remote system KW - e-learning KW - exercise capacity KW - rehabilitation KW - cardiovascular disease KW - monitoring system KW - disease prevention KW - cardiology N2 - Background: Conventional group-based outpatient cardiac rehabilitation through monitoring and center-based approaches for patients in the recovery phase has shown strong evidence for the prevention of cardiovascular diseases. However, there are some cases in which maintaining attendance of center-based cardiac rehabilitation is difficult. Objective: This study aims to ascertain the safety and efficacy of remote cardiac rehabilitation (RCR) in the recovery phase in patients with cardiovascular disease. Methods: Patients satisfying the study criteria will be recruited from multiple institutions (approximately 30) across Japan. In total, 75 patients (approximately 2 or 3 patients from each institution) are proposed to be recruited. Patients enrolled in the RCR group will be lent devices necessary for RCR (including calibrated ergometers and tablets). Patients will perform anaerobic exercise at home using ergometer for 30-40 minutes at least 3 times weekly. During exercise, an instructor will monitor the patient in real time (using interactive video tools and monitoring tools for various vital data). Moreover, educational instructions will be given 3 times weekly using e-learning methods. Results: The primary endpoint is the peak oxygen uptake 2-3 months from the start of exercise or 6-min walk test. The extracted data will be compared between RCR patients and controls without RCR. Conclusions: The establishment of the system of RCR proposed in this study will lead to the development of more extensive applications, which have been insufficient through conventional interventions. Trial Registration: University Hospital Medical Information Network?Clinical Trials Registry UMIN?CTR UMIN000042942; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048983 International Registered Report Identifier (IRRID): DERR1-10.2196/30725 UR - https://www.researchprotocols.org/2021/10/e30725 UR - http://dx.doi.org/10.2196/30725 UR - http://www.ncbi.nlm.nih.gov/pubmed/34407925 ID - info:doi/10.2196/30725 ER - TY - JOUR AU - Auener, L. Stefan AU - Remers, P. Toine E. AU - van Dulmen, A. Simone AU - Westert, P. Gert AU - Kool, B. Rudolf AU - Jeurissen, T. Patrick P. PY - 2021/9/29 TI - The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review JO - J Med Internet Res SP - e26744 VL - 23 IS - 9 KW - heart failure KW - telemonitoring KW - remote monitoring KW - health care utilization KW - eHealth N2 - Background: Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear. Objective: This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs. Methods: We searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used P<.05 and CIs not including 1.00 to determine whether the effect was statistically significant. Results: We included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38% (9/24) of studies, whereas emergency department visits were reduced in 13% (1/8) of studies. An increase in nonemergency department visits (6/9, 67% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization. Conclusions: Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs. UR - https://www.jmir.org/2021/9/e26744 UR - http://dx.doi.org/10.2196/26744 UR - http://www.ncbi.nlm.nih.gov/pubmed/34586072 ID - info:doi/10.2196/26744 ER - TY - JOUR AU - Han, Changho AU - Song, Youngjae AU - Lim, Hong-Seok AU - Tae, Yunwon AU - Jang, Jong-Hwan AU - Lee, Tak Byeong AU - Lee, Yeha AU - Bae, Woong AU - Yoon, Dukyong PY - 2021/9/10 TI - Automated Detection of Acute Myocardial Infarction Using Asynchronous Electrocardiogram Signals?Preview of Implementing Artificial Intelligence With Multichannel Electrocardiographs Obtained From Smartwatches: Retrospective Study JO - J Med Internet Res SP - e31129 VL - 23 IS - 9 KW - wearables KW - smartwatches KW - asynchronous electrocardiogram KW - artificial intelligence KW - deep learning KW - automatic diagnosis KW - myocardial infarction KW - timely diagnosis KW - machine learning KW - digital health KW - cardiac health KW - cardiology N2 - Background: When using a smartwatch to obtain electrocardiogram (ECG) signals from multiple leads, the device has to be placed on different parts of the body sequentially. The ECG signals measured from different leads are asynchronous. Artificial intelligence (AI) models for asynchronous ECG signals have barely been explored. Objective: We aimed to develop an AI model for detecting acute myocardial infarction using asynchronous ECGs and compare its performance with that of the automatic ECG interpretations provided by a commercial ECG analysis software. We sought to evaluate the feasibility of implementing multiple lead?based AI-enabled ECG algorithms on smartwatches. Moreover, we aimed to determine the optimal number of leads for sufficient diagnostic power. Methods: We extracted ECGs recorded within 24 hours from each visit to the emergency room of Ajou University Medical Center between June 1994 and January 2018 from patients aged 20 years or older. The ECGs were labeled on the basis of whether a diagnostic code corresponding to acute myocardial infarction was entered. We derived asynchronous ECG lead sets from standard 12-lead ECG reports and simulated a situation similar to the sequential recording of ECG leads via smartwatches. We constructed an AI model based on residual networks and self-attention mechanisms by randomly masking each lead channel during the training phase and then testing the model using various targeting lead sets with the remaining lead channels masked. Results: The performance of lead sets with 3 or more leads compared favorably with that of the automatic ECG interpretations provided by a commercial ECG analysis software, with 8.1%-13.9% gain in sensitivity when the specificity was matched. Our results indicate that multiple lead-based AI-enabled ECG algorithms can be implemented on smartwatches. Model performance generally increased as the number of leads increased (12-lead sets: area under the receiver operating characteristic curve [AUROC] 0.880; 4-lead sets: AUROC 0.858, SD 0.008; 3-lead sets: AUROC 0.845, SD 0.011; 2-lead sets: AUROC 0.813, SD 0.018; single-lead sets: AUROC 0.768, SD 0.001). Considering the short amount of time needed to measure additional leads, measuring at least 3 leads?ideally more than 4 leads?is necessary for minimizing the risk of failing to detect acute myocardial infarction occurring in a certain spatial location or direction. Conclusions: By developing an AI model for detecting acute myocardial infarction with asynchronous ECG lead sets, we demonstrated the feasibility of multiple lead-based AI-enabled ECG algorithms on smartwatches for automated diagnosis of cardiac disorders. We also demonstrated the necessity of measuring at least 3 leads for accurate detection. Our results can be used as reference for the development of other AI models using sequentially measured asynchronous ECG leads via smartwatches for detecting various cardiac disorders. UR - https://www.jmir.org/2021/9/e31129 UR - http://dx.doi.org/10.2196/31129 UR - http://www.ncbi.nlm.nih.gov/pubmed/34505839 ID - info:doi/10.2196/31129 ER - TY - JOUR AU - Kalwani, M. Neil AU - Johnson, N. Austin AU - Parameswaran, Vijaya AU - Dash, Rajesh AU - Rodriguez, Fatima PY - 2021/9/9 TI - Initial Outcomes of CardioClick, a Telehealth Program for Preventive Cardiac Care: Observational Study JO - JMIR Cardio SP - e28246 VL - 5 IS - 2 KW - telehealth KW - telemedicine KW - digital health KW - eHealth KW - preventive medicine KW - prevention KW - outpatient care KW - cardiovascular disease KW - cardiology KW - South Asian N2 - Background: Telehealth use has increased in specialty clinics, but there is limited evidence on the outcomes of telehealth in primary cardiovascular disease (CVD) prevention. Objective: The objective of this study was to evaluate the initial outcomes of CardioClick, a telehealth primary CVD prevention program. Methods: In 2017, the Stanford South Asian Translational Heart Initiative (a preventive cardiology clinic focused on high-risk South Asian patients) introduced CardioClick, which is a clinical pathway replacing in-person follow-up visits with video visits. We assessed patient engagement and changes in CVD risk factors in CardioClick patients and in a historical in-person cohort from the same clinic. Results: In this study, 118 CardioClick patients and 441 patients who received in-person care were included. CardioClick patients were more likely to complete the clinic?s CVD prevention program (76/118, 64.4% vs 173/441, 39.2%, respectively; P<.001) and they did so in lesser time (mean, 250 days vs 307 days, respectively; P<.001) than the patients in the historical in-person cohort. Patients who completed the CardioClick program achieved reductions in CVD risk factors, including blood pressure, lipid concentrations, and BMI, which matched or exceeded those observed in the historical in-person cohort. Conclusions: Telehealth can be used to deliver care effectively in a preventive cardiology clinic setting and may result in increased patient engagement. Further studies on telehealth outcomes are needed to determine the optimal role of virtual care models across diverse preventive medicine clinics. UR - https://cardio.jmir.org/2021/2/e28246 UR - http://dx.doi.org/10.2196/28246 UR - http://www.ncbi.nlm.nih.gov/pubmed/34499037 ID - info:doi/10.2196/28246 ER - TY - JOUR AU - Park, Sulki AU - Kum, Hye-Chung AU - Morrisey, A. Michael AU - Zheng, Qi AU - Lawley, A. Mark PY - 2021/9/6 TI - Adherence to Telemonitoring Therapy for Medicaid Patients With Hypertension: Case Study JO - J Med Internet Res SP - e29018 VL - 23 IS - 9 KW - telemedicine KW - hypertension KW - Medicaid KW - blood pressure KW - pulse KW - telemonitoring KW - mobile phone N2 - Background: Almost 50% of the adults in the United States have hypertension. Although clinical trials indicate that home blood pressure monitoring can be effective in managing hypertension, the reported results might not materialize in practice because of patient adherence problems. Objective: The aims of this study are to characterize the adherence of Medicaid patients with hypertension to daily telemonitoring, identify the impacts of adherence reminder calls, and investigate associations with blood pressure control. Methods: This study targeted Medicaid patients with hypertension from the state of Texas. A total of 180 days of blood pressure and pulse data in 2016-2018 from a telemonitoring company were analyzed for mean transmission rate and mean blood pressure change. The first 30 days of data were excluded because of startup effects. The protocols required the patients to transmit readings by a specified time daily. Patients not transmitting their readings received an adherence reminder call to troubleshoot problems and encourage transmission. The patients were classified into adherent and nonadherent cohorts; adherent patients were those who transmitted data on at least 80% of the days. Results: The mean patient age was 73.2 (SD 11.7) years. Of the 823 patients, 536 (65.1%) were women, and 660 (80.2%) were urban residents. The adherent cohort (475/823, 57.7%) had mean transmission rates of 74.9% before the adherence reminder call and 91.3% after the call, whereas the nonadherent cohort (348/823, 42.3%) had mean transmission rates of 39% and 58% before and after the call, respectively. From month 1 to month 5, the transmission rates dropped by 1.9% and 10.2% for the adherent and nonadherent cohorts, respectively. The systolic and diastolic blood pressure values improved by an average of 2.2 and 0.7 mm Hg (P<.001 and P=.004), respectively, for the adherent cohort during the study period, whereas only the systolic blood pressure value improved by an average of 1.6 mm Hg (P=.02) for the nonadherent cohort. Conclusions: Although we found that patients can achieve high levels of adherence, many experience adherence problems. Although adherence reminder calls help, they may not be sufficient. Telemonitoring lowered blood pressure, as has been observed in clinical trials. Furthermore, blood pressure control was positively associated with adherence. UR - https://www.jmir.org/2021/9/e29018 UR - http://dx.doi.org/10.2196/29018 UR - http://www.ncbi.nlm.nih.gov/pubmed/34486977 ID - info:doi/10.2196/29018 ER - TY - JOUR AU - Yatabe, Junichi AU - Yatabe, Sasaki Midori AU - Okada, Rika AU - Ichihara, Atsuhiro PY - 2021/8/31 TI - Efficacy of Telemedicine in Hypertension Care Through Home Blood Pressure Monitoring and Videoconferencing: Randomized Controlled Trial JO - JMIR Cardio SP - e27347 VL - 5 IS - 2 KW - blood pressure management KW - digital health KW - web-based medicine KW - prospective study KW - telemonitoring KW - blood pressure KW - monitoring KW - telemedicine KW - telehealth KW - efficacy KW - hypertension KW - video conference KW - safety KW - Japan N2 - Background: The burden of time is often the primary reason why patients discontinue their treatment. Telemedicine may help patients adhere to treatment by offering convenience. Objective: This study examined the efficacy and safety of telemedicine for the management of hypertension in Japan. Methods: Patients with uncomplicated hypertension were recruited through web advertising between November 2015 and February 2017. They were then screened, stratified by office systolic blood pressure (SBP), and randomized into two groups: usual care (UC) and telemedicine. The telemedicine group used a 3G network?attached home blood pressure (BP) monitoring device, consulted hypertension specialists from an academic hospital through web-based video visits, and received prescription medication by mail for 1 year. The UC group used the same BP monitoring device but was managed using self-recorded BP readings, which included their diary entries and office BP taken in a community practice setting. Results: Initial screening was completed by 99 patients, 54% of whom had untreated hypertension. Baseline BP was similar between the groups, but the weekly average SBP at the end of the 1-year study period was significantly lower in the telemedicine group (125, SD 9 mmHg vs 131, SD 12 mmHg, respectively; P=.02). SBP in the telemedicine group was 3.4 mmHg lower in the morning and 5.8 mmHg lower in the evening. The rate of SBP control (135 mmHg) was better in the telemedicine group (85.3% vs 70.0%; P=.01), and significant adverse events were not observed. Conclusions: We present evidence suggesting that antihypertensive therapy via home BP telemonitoring and web-based video visits achieve better BP control than conventional care and is a safe treatment alternative that warrants further investigation. Trial Registration: UMIN-CTR UMIN000025372; https://tinyurl.com/47ejkn4b UR - https://cardio.jmir.org/2021/2/e27347 UR - http://dx.doi.org/10.2196/27347 UR - http://www.ncbi.nlm.nih.gov/pubmed/34321194 ID - info:doi/10.2196/27347 ER - TY - JOUR AU - Skov Schacksen, Cathrine AU - Dyrvig, Anne-Kirstine AU - Henneberg, Celina Nanna AU - Dam Gade, Josefine AU - Spindler, Helle AU - Refsgaard, Jens AU - Hollingdal, Malene AU - Dittman, Lars AU - Dremstrup, Kim AU - Dinesen, Birthe PY - 2021/7/2 TI - Patient-Reported Outcomes From Patients With Heart Failure Participating in the Future Patient Telerehabilitation Program: Data From the Intervention Arm of a Randomized Controlled Trial JO - JMIR Cardio SP - e26544 VL - 5 IS - 2 KW - adherence KW - cardiology KW - cardiomyopathy KW - compliance KW - heart failure KW - heart KW - Kansas City Cardiomyopathy Questionnaire KW - monitoring KW - patient-reported outcome KW - patients KW - quality of life KW - rehabilitation KW - self-reporting KW - telehealth KW - telemonitoring N2 - Background: More than 37 million people worldwide have been diagnosed with heart failure, which is a growing burden on the health sector. Cardiac rehabilitation aims to improve patients? recovery, functional capacity, psychosocial well-being, and health-related quality of life. However, cardiac rehabilitation programs have poor compliance and adherence. Telerehabilitation may be a solution to overcome some of these challenges to cardiac rehabilitation by making it more individualized. As part of the Future Patient Telerehabilitation program, a digital toolbox aimed at enabling patients with heart failure to monitor and evaluate their own current status has been developed and tested using data from a patient-reported outcome questionnaire that the patient filled in every alternate week for 1 year. Objective: The aim of this study is to evaluate the changes in quality of life and well-being among patients with heart failure, who are participants in the Future Patient Telerehabilitation program over the course of 1 year. Methods: In total, 140 patients were enrolled in the Future Patient Telerehabilitation program and randomized into either the telerehabilitation group (n=70) or the control group (n=70). Of the 70 patients in the telerehabilitation group, 56 (80.0%) answered the patient-reported outcome questionnaire and completed the program, and these 56 patients comprised the study population. The patient-reported outcomes consisted of three components: (1) questions regarding the patients? sleep patterns assessed using the Spiegel Sleep Questionnaire; (2) measurements of physical limitations, symptoms, self-efficacy, social interaction, and quality of life assessed using the Kansas City Cardiomyopathy Questionnaire in 10 dimensions; and (3) 5 additional questions regarding psychological well-being that were developed by the research group. Results: The changes in scores during 1 year of the study were examined using 1-sample Wilcoxon signed-rank tests. There were significant differences in the scores for most of the slopes of the scores from the dimensions of the Kansas City Cardiomyopathy Questionnaire (P<.05). Conclusions: There was a significant increase in clinical and social well-being and quality of life during the 1-year period of participating in a telerehabilitation program. These results suggest that patient-reported outcome questionnaires may be used as a tool for patients in a telerehabilitation program that can both monitor and guide patients in mastering their own symptoms. Trial Registration: ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918 UR - https://cardio.jmir.org/2021/2/e26544 UR - http://dx.doi.org/10.2196/26544 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255642 ID - info:doi/10.2196/26544 ER - TY - JOUR AU - Lv, Meina AU - Wu, Tingting AU - Jiang, Shaojun AU - Chen, Wenjun AU - Zhang, Jinhua PY - 2021/6/11 TI - Effects of Telemedicine and mHealth on Systolic Blood Pressure Management in Stroke Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials JO - JMIR Mhealth Uhealth SP - e24116 VL - 9 IS - 6 KW - stroke KW - systolic blood pressure KW - mHealth KW - telemedicine KW - meta-analysis KW - self-management N2 - Background: Stroke is a common, harmful disease with high recurrence and mortality rates. Uncontrolled blood pressure is an important and changeable risk factor for stroke recurrence. Telemedicine and mobile health (mHealth) interventions may have the potential to facilitate the control of blood pressure among stroke survivors, but their effect has not been established. Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of telemedicine and mHealth interventions on the control of systolic blood pressure among stroke survivors. Methods: The research literature published up to June 28, 2020, and consisting of RCTs related to telemedicine and mHealth interventions was searched in PubMed, EMBASE, Web of Science, and the Cochrane Library. The Cochrane risk of bias tool (RoB 2.0) was used to evaluate the quality of the studies. The Cochran Q test and I2 statistic were used to assess heterogeneity. Data were meta-analyzed using a random-effects model. Mean difference (MD) with 95% CI and 95% prediction interval (PI) were calculated. Results: In total, 9 RCTs with a total sample size of 1583 stroke survivors met the inclusion criteria. Compared with the usual care, telemedicine and mHealth had a significantly greater impact on the control of systolic blood pressure (MD ?5.49; 95% CI ?7.87 to ?3.10; P<.001; 95% PI ?10.46 to ?0.51). A subgroup analysis showed that the intervention mode of telephone plus SMS text messaging (MD ?9.09; 95% CI ?12.71 to ?5.46; P<.001) or only telephone (MD ?4.34; 95% CI ?6.55 to ?2.13; P<.001; 95% PI ?7.24 to ?1.45) had a greater impact on the control of systolic blood pressure than usual care. Among the stroke survivors with an intervention interval ?1 week (MD ?6.51; 95% CI ?9.36 to ?3.66; P<.001; 95% PI ?12.91 to ?0.10) or a baseline systolic blood pressure ?140 mm Hg (MD ?6.15; 95% CI ?9.44 to ?2.86; P<.001; 95% PI ?13.55 to 1.26), the control of systolic blood pressure using telemedicine and mHealth was better than that of usual care. Conclusions: In general, telemedicine and mHealth reduced the systolic blood pressure of stroke survivors by an average of 5.49 mm Hg compared with usual care. Telemedicine and mHealth are a relatively new intervention mode with potential applications for the control of systolic blood pressure among stroke survivors, especially those with hypertensive stroke. UR - https://mhealth.jmir.org/2021/6/e24116 UR - http://dx.doi.org/10.2196/24116 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114961 ID - info:doi/10.2196/24116 ER - TY - JOUR AU - Bilger, Marcel AU - Koong, Leng Agnes Ying AU - Phoon, Yun Ian Kwong AU - Tan, Chuan Ngiap AU - Bahadin, Juliana AU - Bairavi, Joann AU - Batcagan-Abueg, M. Ada Portia AU - Finkelstein, A. Eric PY - 2021/6/9 TI - Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e27496 VL - 10 IS - 6 KW - telemedicine KW - home blood pressure monitoring KW - behavior change KW - hypertension KW - financial incentive KW - medication adherence KW - remote titration N2 - Background: Hypertension is prevalent in Singapore and is a major risk factor for cardiovascular morbidity and mortality and increased health care costs. Strategies to lower blood pressure include lifestyle modifications and home blood pressure monitoring. Nonetheless, adherence to home blood pressure monitoring remains low. This protocol details an algorithm for remote management of primary care patients with hypertension. Objective: The objective of this study was to determine whether wireless home blood pressure monitoring with or without financial incentives is more effective at reducing systolic blood pressure than nonwireless home blood pressure monitoring (usual care). Methods: This study was designed as a randomized controlled open-label superiority study. A sample size of 224 was required to detect differences of 10 mmHg in average systolic blood pressure. Participants were to be randomized, in the ratio of 2:3:3, into 1 of 3 parallel study arms :(1) usual care, (2) wireless home blood pressure monitoring, and (3) wireless home blood pressure monitoring with financial incentives. The primary outcome was the mean change in systolic blood pressure at month 6. The secondary outcomes were the mean reduction in diastolic blood pressure, cost of financial incentives, time taken for the intervention, adherence to home blood pressure monitoring, effectiveness of the framing of financial incentives in decreasing nonadherence to blood pressure self-monitoring and the adherence to antihypertensive medication at month 6. Results: This study was approved by SingHealth Centralised Institutional Review Board and registered. Between January 24, 2018 and July 10, 2018, 42 participants (18.75% of the required sample size) were enrolled, and 33 participants completed the month 6 assessment by January 31, 2019. Conclusions: Due to unforeseen events, the study was stopped prematurely; therefore, no results are available. Depending on the blood pressure information received from the patients, the algorithm can trigger immediate blood pressure advice (eg, Accident and Emergency department visit advice for extremely high blood pressure), weekly feedback on blood pressure monitoring, medication titration, or skipping of routine follow-ups. The inclusion of financial incentives framed as health capital provides a novel idea on how to promote adherence to remote monitoring, and ultimately, improve chronic disease management. Trial Registration: ClinicalTrials.gov NCT 03368417; https://clinicaltrials.gov/ct2/show/NCT03368417 International Registered Report Identifier (IRRID): DERR1-10.2196/27496 UR - https://www.researchprotocols.org/2021/6/e27496 UR - http://dx.doi.org/10.2196/27496 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106085 ID - info:doi/10.2196/27496 ER - TY - JOUR AU - Huang, Ching-Chang AU - Chen, Ying-Hsien AU - Hung, Chi-Sheng AU - Lee, Jen-Kuang AU - Hsu, Tse-Pin AU - Wu, Hui-Wen AU - Chuang, Pao-Yu AU - Chen, Ming-Fong AU - Ho, Yi-Lwun PY - 2021/6/8 TI - 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 JO - JMIR Public Health Surveill SP - e26605 VL - 7 IS - 6 KW - ambient air pollution KW - blood pressure KW - cardiovascular disease KW - chronic disease KW - climate KW - home blood pressure KW - particulate matter KW - pollution KW - remote monitoring KW - telehealth care KW - telemonitoring KW - weather N2 - 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. UR - https://publichealth.jmir.org/2021/6/e26605 UR - http://dx.doi.org/10.2196/26605 UR - http://www.ncbi.nlm.nih.gov/pubmed/34100764 ID - info:doi/10.2196/26605 ER - TY - JOUR AU - Ho, Kendall AU - Novak Lauscher, Helen AU - Cordeiro, Jennifer AU - Hawkins, Nathaniel AU - Scheuermeyer, Frank AU - Mitton, Craig AU - Wong, Hubert AU - McGavin, Colleen AU - Ross, Dianne AU - Apantaku, Glory AU - Karim, Ehsan Mohammad AU - Bhullar, Amrit AU - Abu-Laban, Riyad AU - Nixon, Suzanne AU - Smith, Tyler PY - 2021/6/3 TI - Testing the Feasibility of Sensor-Based Home Health Monitoring (TEC4Home) to Support the Convalescence of Patients With Heart Failure: Pre?Post Study JO - JMIR Form Res SP - e24509 VL - 5 IS - 6 KW - telemonitoring KW - heart failure KW - home health monitoring KW - technology KW - telehealth KW - emergency care KW - community care KW - emergency department KW - quality of life KW - self-efficacy N2 - Background: Patients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life. Objective: Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial. Methods: Patients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient?s condition. In our evaluation, the primary outcome was the combination of unscheduled emergency department revisits of discharged participants or death within 90 days. Secondary outcomes included 90-day hospital readmissions, patient quality of life (as measured by Veterans Rand 12-Item Health Survey and Kansas City Cardiomyopathy Scale), self-efficacy (as measured by European Heart Failure Self-Care Behaviour Scale 9), end-user experience, and health system cost-effectiveness including cost reduction and hospital bed capacity. In this feasibility study, we also tested the recruitment strategy, clinical protocols, evaluation framework, and data collection methods. Results: Seventy participants were enrolled into this trial. Participant engagement to monitoring was measured at 94% (N=70; ie, data submitted 56/60 days on average). Our evaluation framework allowed us to collect sound data, which also showed encouraging trends: a 79% reduction of emergency department revisits post monitoring, an 87% reduction in hospital readmissions, and a 60% reduction in the median hospital length of stay (n=36). Cost of hospitalization for participants decreased by 71%, and emergency department visit costs decreased by 58% (n=30). Overall health system costs for our participants showed a 56% reduction post monitoring (n=30). HF-specific quality of life (Kansas City Cardiomyopathy Scale) scores showed a significant increase of 101% (n=35) post monitoring (P<.001). General quality of life (Veterans Rand 12-Item Health Survey) improved by 19% (n=35) on the mental component score (P<.001) and 19% (n=35) on the physical component score (P=.02). Self-efficacy improved by 6% (n=35). Interviews with participants revealed that they were satisfied overall with the monitoring program and its usability, and participants reported being more engaged, educated, and involved in their self-management. Conclusions: Results from this small-sample feasibility study suggested that our HHM intervention can be beneficial in supporting patients post discharge. Additionally, key insights from the trial allowed us to refine our methods and procedures, such as shifting our recruitment methods to in-patient wards and increasing our scope of data collection. Although these findings are promising, a more rigorous trial design is required to test the true efficacy of the intervention. The results from this feasibility trial will inform our next step as we proceed with a randomized controlled trial across British Columbia. Trial Registration: ClinicalTrials.gov NCT03439384; https://clinicaltrials.gov/ct2/show/NCT03439384 UR - https://formative.jmir.org/2021/6/e24509 UR - http://dx.doi.org/10.2196/24509 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081015 ID - info:doi/10.2196/24509 ER - TY - JOUR AU - Friedman, M. Daniel AU - Goldberg, M. Jana AU - Molinsky, L. Rebecca AU - Hanson, A. Mark AU - Castaño, Adam AU - Raza, Syed-Samar AU - Janas, Nodar AU - Celano, Peter AU - Kapoor, Karen AU - Telaraja, Jina AU - Torres, L. Maria AU - Jain, Nayan AU - Wessler, D. Jeffrey PY - 2021/6/1 TI - A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population: Retrospective Analysis JO - JMIR Cardio SP - e29101 VL - 5 IS - 1 KW - heart failure KW - readmissions KW - skilled nursing facilities KW - posthospitalization KW - cardiovascular KW - cardiology KW - outcome KW - cost KW - virtual care KW - telehealth KW - telemedicine KW - mobile health KW - mHealth KW - digital health N2 - Background: Patients with heart failure (HF) in skilled nursing facilities (SNFs) have 30-day hospital readmission rates as high as 43%. A virtual cardiovascular care program, consisting of patient selection, initial televisit, postconsultation care planning, and follow-up televisits, was developed and delivered by Heartbeat Health, Inc., a cardiovascular digital health company, to 11 SNFs (3510 beds) in New York. The impact of this program on the expected SNF 30-day HF readmission rate is unknown, particularly in the COVID-19 era. Objective: The aim of the study was to assess whether a virtual cardiovascular care program could reduce the 30-day hospital readmission rate for patients with HF discharged to SNF relative to the expected rate for this population. Methods: We performed a retrospective case review of SNF patients who received a virtual cardiology consultation between August 2020 and February 2021. Virtual cardiologists conducted 1 or more telemedicine visit via smartphone, tablet, or laptop for cardiac patients identified by a SNF care team. Postconsult care plans were communicated to SNF clinical staff. Patients included in this analysis had a preceding index admission for HF. Results: We observed lower hospital readmission among patients who received 1 or more virtual consultations compared with the expected readmission rate for both cardiac (3% vs 10%, respectively) and all-cause etiologies (18% vs 27%, respectively) in a population of 3510 patients admitted to SNF. A total of 185/3510 patients (5.27%) received virtual cardiovascular care via the Heartbeat Health program, and 40 patients met study inclusion criteria and were analyzed, with 26 (65%) requiring 1 televisit and 14 (35%) requiring more than 1. Cost savings associated with this reduction in readmissions are estimated to be as high as US $860 per patient. Conclusions: The investigation provides initial evidence for the potential effectiveness and efficiency of virtual and digitally enabled virtual cardiovascular care on 30-day hospital readmissions. Further research is warranted to optimize the use of novel virtual care programs to transform delivery of cardiovascular care to high-risk populations. UR - https://cardio.jmir.org/2021/1/e29101 UR - http://dx.doi.org/10.2196/29101 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061037 ID - info:doi/10.2196/29101 ER - TY - JOUR AU - Gwon, Danbi AU - Cho, Hakyung AU - Shin, Hangsik PY - 2021/5/11 TI - Feasibility of a Waistband-Type Wireless Wearable Electrocardiogram Monitoring System Based on a Textile Electrode: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e26469 VL - 9 IS - 5 KW - electrocardiogram KW - telehealth KW - telemetry KW - telemonitoring KW - textile electrode KW - wearable system KW - smartphone KW - mobile phone N2 - Background: Electrocardiogram (ECG) monitoring in daily life is essential for effective management of cardiovascular disease, a leading cause of death. Wearable ECG measurement systems in the form of clothing have been proposed to replace Holter monitors used for clinical ECG monitoring; however, they have limitations in daily use because they compress the upper body and, in doing so, cause discomfort during wear. Objective: The purpose of this study was to develop a wireless wearable ECG monitoring system that includes a textile ECG electrode that can be applied to the lining of pants and can be used in the same way that existing lower clothing is worn, without compression to the upper body. Methods: A textile electrode with stretchable characteristics was fabricated by knitting a conductive yarn together with polyester-polyurethane fiber, which was then coated with silver compound; an ECG electrode was developed by placing it on an elastic band in a modified limb lead configuration. In addition, a system with analog-to-digital conversion, wireless communication, and a smartphone app was developed, allowing users to be able to check and store their own ECGs in real time. A signal processing algorithm was also developed to remove noise from the obtained signal and to calculate the heart rate. To evaluate the ECG and heart rate measurement performance of the developed module, a comparative evaluation with a commercial device was performed. ECGs were measured for 5 minutes each in standing, sitting, and lying positions; the mean absolute percentage errors of heart rates measured with both systems were then compared. Results: The system was developed in the form of a belt buckle with a size of 53 × 45 × 12 mm (width × height × depth) and a weight of 23 g. In a qualitative evaluation, it was confirmed that the P-QRS-T waveform was clearly observed in ECGs obtained with the wearable system. From the results of the heart rate estimation, the developed system could track changes in heart rate as calculated by a commercial ECG measuring device; in addition, the mean absolute percentage errors of heart rates were 1.80%, 2.84%, and 2.48% in the standing, sitting, and lying positions, respectively. Conclusions: The developed system was able to effectively measure ECG and calculate heart rate simply through being worn as existing clothing without upper body pressure. It is anticipated that general usability can be secured through further evaluation under more diverse conditions. UR - https://mhealth.jmir.org/2021/5/e26469 UR - http://dx.doi.org/10.2196/26469 UR - http://www.ncbi.nlm.nih.gov/pubmed/33973860 ID - info:doi/10.2196/26469 ER - TY - JOUR AU - Shah, Amika AU - Guessi, Milena AU - Wali, Sahr AU - Ware, Patrick AU - McDonald, Michael AU - O'Sullivan, Mary AU - Posada, Duero Juan AU - Ross, Heather AU - Seto, Emily PY - 2021/5/5 TI - The Resilience of Cardiac Care Through Virtualized Services During the COVID-19 Pandemic: Case Study of a Heart Function Clinic JO - JMIR Cardio SP - e25277 VL - 5 IS - 1 KW - telemedicine KW - telehealth KW - digital health KW - digital medicine KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - public health KW - surveillance KW - outbreak KW - pandemic KW - infectious disease KW - cardiology KW - patient KW - organizational innovation KW - organizational objectives KW - global health KW - resilience N2 - Background: Virtual care has historically faced barriers to widespread adoption. However, the COVID-19 pandemic has necessitated the rapid adoption and expansion of virtual care technologies. Although the intense and prolonged nature of the COVID-19 pandemic has renewed people?s interest in health systems resilience, which includes how services adapt or transform in response to shocks, evidence regarding the role of virtual care technologies in health systems resilience is scarce. Objective: At Toronto General Hospital in Ontario, Canada, the rapid virtualization of cardiac care began on March 9, 2020, as a response to the pandemic. The objective of this study was to understand people?s experiences with and the barriers and facilitators of the rapid virtualization and expansion of cardiac care resulting from the pandemic. Methods: A single-case study was conducted with 3 embedded units of analysis. Patients, clinicians, and staff were recruited purposively from an existing mobile, phone-based telemonitoring program at a heart function clinic in Toronto, Canada. Individual, semistructured phone interviews were conducted by two researchers and transcribed verbatim. An inductive thematic analysis at the semantic level was used to analyze transcripts and develop themes. Results: A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and staff (n=4). The following five themes were identified: (1) patient safety as a catalyst for virtual care adoption; (2) piecemeal virtual care solutions; (3) confronting new roles and workloads; (4) missing pieces in virtual care; and (5) the inequity paradox. The motivation to protect patient safety and a piecemeal approach to virtual care adoption facilitated the absorptive and adaptive resilience of cardiac care during the COVID-19 pandemic. However, ad hoc changes to clinic roles and workflows, challenges in building relationships through remote methods, and widened inequities were barriers that threatened virtual care sustainment. Conclusions: We contend that sustaining virtual care hinges upon transformative actions (rather than adaptive actions) that strengthen health systems so that they can face the dynamic and emergent challenges associated with COVID-19 and other shocks. Based on the barriers and facilitators we identified, we present the lessons we learned and recommend transformations for sustaining virtual care during and beyond the COVID-19 pandemic. UR - https://cardio.jmir.org/2021/1/e25277 UR - http://dx.doi.org/10.2196/25277 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878021 ID - info:doi/10.2196/25277 ER - TY - JOUR AU - Iqbal, Mujtaba Fahad AU - Joshi, Meera AU - Khan, Sadia AU - Ashrafian, Hutan AU - Darzi, Ara PY - 2021/5/4 TI - Implementation of Wearable Sensors and Digital Alerting Systems in Secondary Care: Protocol for a Real-World Prospective Study Evaluating Clinical Outcomes JO - JMIR Res Protoc SP - e26240 VL - 10 IS - 5 KW - remote sensing technology KW - clinical trial KW - patient deterioration KW - monitoring KW - ambulatory KW - wearable N2 - Background: Advancements in wearable sensors have caused a resurgence in their use, particularly because their miniaturization offers ambulatory advantages while performing continuous vital sign monitoring. Digital alerts can be generated following early recognition of clinical deterioration through breaches of set parameter thresholds, permitting earlier intervention. However, a systematic real-world evaluation of these alerting systems has yet to be conducted, and their efficacy remains unknown. Objective: The aim of this study is to implement wearable sensors and digital alerting systems in acute general wards to evaluate the resultant clinical outcomes. Methods: Participants on acute general wards will be screened and recruited into a trial with a pre-post implementation design. In the preimplementation phase, the SensiumVitals monitoring system, which continuously measures temperature, heart, and respiratory rates, will be used for monitoring alongside usual care. In the postimplementation phase, alerts will be generated from the SensiumVitals system when pre-established thresholds for vital parameters have been crossed, requiring acknowledgement from health care staff; subsequent clinical outcomes will be analyzed. Results: Enrolment is currently underway, having started in September 2017, and is anticipated to end shortly. Data analysis is expected to be completed in 2021. Conclusions: This study will offer insight into the implementation of digital health technologies within a health care trust and aims to describe the effectiveness of wearable sensors for ambulatory continuous monitoring and digital alerts on clinical outcomes in acute general ward settings. Trial Registration: ClinicalTrials.gov NCT04638738; https://clinicaltrials.gov/ct2/show/NCT04638738. International Registered Report Identifier (IRRID): DERR1-10.2196/26240 UR - https://www.researchprotocols.org/2021/5/e26240 UR - http://dx.doi.org/10.2196/26240 UR - http://www.ncbi.nlm.nih.gov/pubmed/33944790 ID - info:doi/10.2196/26240 ER - TY - JOUR AU - Huygens, J. Martine W. AU - Voogdt-Pruis, R. Helene AU - Wouters, Myrah AU - Meurs, M. Maaike AU - van Lettow, Britt AU - Kleijweg, Conchita AU - Friele, D. Roland PY - 2021/5/3 TI - The Uptake and Use of Telemonitoring in Chronic Care Between 2014 and 2019: Nationwide Survey Among Patients and Health Care Professionals in the Netherlands JO - J Med Internet Res SP - e24908 VL - 23 IS - 5 KW - eHealth KW - telemonitoring KW - self-management KW - telemedicine KW - telehealth N2 - Background: Telemonitoring could offer solutions to the mounting challenges for health care and could improve patient self-management. Studies have addressed the benefits and challenges of telemonitoring for certain patient groups. Objective: This paper will examine the nationwide uptake of telemonitoring in chronic care in the Netherlands from 2014 to 2019 by means of an annual representative survey among patients and health care professionals. Methods: Between 2014 and 2019, approximately 2900 patients with chronic diseases, 700 nurses, and 500 general practitioners (GPs) and medical specialists received a questionnaire. About 30 questions addressed topics about the use of eHealth and experiences with it, including data about telemonitoring. Results: Between 2014 and 2019, the use of telemonitoring remained stable for all groups except medical specialists. In medical specialist departments, the use of telemonitoring increased from 11.2% (18/161) in 2014 to 19.6% (36/184) in 2019 (?24=12.3; P=.02). In 2019, telemonitoring was used by 5.8% (28/485) of people with chronic disease. This was 18.2% (41/225) in GP organizations and 40.4% (44/109), 38.0% (78/205), and 8.9% (29/325) in the organizations of nurses working in primary, secondary, and elderly care, respectively. Up to 10% of the targeted patient group such as diabetics were regarded by health care professionals as suitable for using telemonitoring. The main benefits mentioned by the patients were ?comfort? (421/1043, 40.4%) and ?living at home for longer/more comfortably? (334/1047, 31.9%). Health care professionals added ?improvement of self-management? (63/176, 35.8% to 57/71, 80.3%), ?better understanding of the patient?s condition? (47/176, 26.7% to 42/71, 59.2%), ?reduction of workload? (53/134, 39.6% of nurses in elderly care), ?better tailoring of care plan to the patient?s situation? (95/225, 42.2% of GPs), and ?saves time for patients/caregivers? (61/176, 34.7% of medical specialists). Disadvantages mentioned by professionals were that ?it takes time to monitor data? (13/130, 10% to 108/225, 48.0%), ?it takes time to follow up alerts? (15/130, 11.5% to 117/225, 52.0%), and ?it is difficult to estimate which patients can work with telemonitoring? (22/113, 19.5% to 94/225, 41.8%). Conclusions: The uptake of telemonitoring in Dutch chronic care remained stable during 2014-2019 but increased among medical specialists. According to both patients and professionals, telemonitoring improves the quality of life and quality of care. Skills for suitably including eligible patients and for allocating the tasks of data monitoring and follow-up care within the team would help to further increase the use of telemonitoring. UR - https://www.jmir.org/2021/5/e24908 UR - http://dx.doi.org/10.2196/24908 UR - http://www.ncbi.nlm.nih.gov/pubmed/33938808 ID - info:doi/10.2196/24908 ER - TY - JOUR AU - Jiang, Xinchan AU - Yao, Jiaqi AU - You, Hoi-Sze Joyce PY - 2021/3/3 TI - Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis JO - J Med Internet Res SP - e26516 VL - 23 IS - 3 KW - telemonitoring KW - mobile health KW - smartphone KW - heart failure KW - COVID-19 KW - health care avoidance KW - cost-effectiveness N2 - Background: The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). Objective: We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. Methods: A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. Results: In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. Conclusions: Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong. UR - https://www.jmir.org/2021/3/e26516 UR - http://dx.doi.org/10.2196/26516 UR - http://www.ncbi.nlm.nih.gov/pubmed/33656440 ID - info:doi/10.2196/26516 ER - TY - JOUR AU - Akinosun, Samuel Adewale AU - Polson, Rob AU - Diaz - Skeete, Yohanca AU - De Kock, Hendrikus Johannes AU - Carragher, Lucia AU - Leslie, Stephen AU - Grindle, Mark AU - Gorely, Trish PY - 2021/3/3 TI - Digital Technology Interventions for Risk Factor Modification in Patients With Cardiovascular Disease: Systematic Review and Meta-analysis JO - JMIR Mhealth Uhealth SP - e21061 VL - 9 IS - 3 KW - digital technologies KW - mHealth KW - eHealth KW - risk factors KW - cardiovascular diseases KW - telehealth KW - cardiac rehabilitation KW - behavior KW - systematic review KW - meta-analysis KW - mobile phone N2 - 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). UR - https://mhealth.jmir.org/2021/3/e21061 UR - http://dx.doi.org/10.2196/21061 UR - http://www.ncbi.nlm.nih.gov/pubmed/33656444 ID - info:doi/10.2196/21061 ER - TY - JOUR AU - Schenck-Gustafsson, Karin AU - Carnlöf, Carina AU - Jensen-Urstad, Mats AU - Insulander, Per PY - 2021/2/18 TI - Improving Efficiency of Clinical Studies Using a Total Digital Approach: Prospective Observational Study JO - JMIR Form Res SP - e18385 VL - 5 IS - 2 KW - ECG recordings KW - women KW - palpitations KW - full digitalization KW - eAuthentication KW - BankID KW - clinical trial KW - mHealth KW - electrocardiogram N2 - Background: In general, most clinical studies have long recruitment periods. Signing the informed consent is particularly time-consuming when the participant must meet physically with the researchers. Therefore, introducing fully web-based techniques with the use of eAuthentication (BankID) and new digital electrocardiogram (ECG) monitoring could speed up inclusion time, increase adherence, and also reach out to more remote regions. Objective: The objectives of this study were to explore whether inclusion of a large number of participants could be realized quickly by using a total digital approach both for information and signing of informed consent, along with ECG monitoring and instant feedback on a mobile device. We also explored whether this approach can increase adherence in registration of ECG recordings and answering questionnaires, and if it would result in a more geographically uniform distribution of participants covering a wide age span. Methods: Women with palpitations were intensively studied over 2 months by means of a handheld ECG monitoring device (Coala Heart Monitor). The device connects to a smartphone or tablet, which allows the participants to obtain the results immediately. Recruitment, study information, and signing the informed consent form with the help of BankID were performed in a completely digital manner. Results: Between March and May 2018, 2424 women indicated their interest in participating in the study. On June 19, 2018, presumptive participants were invited to log in and register. After 25 days, 1082 women were included in the study; among these, 1020 women fulfilled the inclusion criteria, 913 of whom completed all phases of the study: recording ECG using the handheld device, completion of the prestudy questionnaires, and completion of the poststudy questionnaires 2 months after the ECG recordings. The dropout rate was 9%. In total, 101,804 ECG recordings were made. The mean age was 56 (SD 11) years (range 21-88 years) and 35 participants were 75 years or older. The participants were evenly distributed between living in the countryside and in cities. Conclusions: Total digital inclusion recruitment of 1082 participants was achieved in only 25 days, and resulted in a good geographical distribution, excellent adherence, and ability to reach a vast age span, including elderly women. Studies using a total digital design would be particularly appealing during a pandemic since physical contact should be avoided as much as possible. Trial Registration: ISRCTN Registry ISRCTN22495299; http://www.isrctn.com/ISRCTN22495299 UR - http://formative.jmir.org/2021/2/e18385/ UR - http://dx.doi.org/10.2196/18385 UR - http://www.ncbi.nlm.nih.gov/pubmed/33599617 ID - info:doi/10.2196/18385 ER - TY - JOUR AU - Wali, Sahr AU - Guessi Margarido, Milena AU - Shah, Amika AU - Ware, Patrick AU - McDonald, Michael AU - O'Sullivan, Mary AU - Duero Posada, Juan AU - Ross, Heather AU - Seto, Emily PY - 2021/1/22 TI - Expanding Telemonitoring in a Virtual World: A Case Study of the Expansion of a Heart Failure Telemonitoring Program During the COVID-19 Pandemic JO - J Med Internet Res SP - e26165 VL - 23 IS - 1 KW - telemedicine KW - telehealth KW - digital health KW - digital medicine KW - virtual care KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - public health KW - surveillance KW - outbreak KW - pandemic KW - infectious disease KW - cardiology KW - patient N2 - Background: To minimize the spread and risk of a COVID-19 outbreak, societal norms have been challenged with respect to how essential services are delivered. With pressures to reduce the number of in-person ambulatory visits, innovative models of telemonitoring have been used during the pandemic as a necessary alternative to support access to care for patients with chronic conditions. The pandemic has led health care organizations to consider the adoption of telemonitoring interventions for the first time, while others have seen existing programs rapidly expand. Objective: At the Toronto General Hospital in Ontario, Canada, the rapid expansion of a telemonitoring program began on March 9, 2020, in response to COVID-19. The objective of this study was to understand the experiences related to the expanded role of a telemonitoring program under the changing conditions of the pandemic. Methods: A single-case qualitative study was conducted with 3 embedded units of analysis. Semistructured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program at a heart function clinic in Toronto, Canada. Data were analyzed using inductive thematic analysis as well as Eakin and Gladstone?s value-adding approach to enhance the analytic interpretation of the study findings. Results: A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and operational staff (n=4). Four themes were identified: (1) providing care continuity through telemonitoring; (2) adapting telemonitoring operations for a more virtual health care system; (3) confronting virtual workflow challenges; and (4) fostering a meaningful patient-provider relationship. Beyond supporting virtual visits, the program?s ability to provide a more comprehensive picture of the patient?s health was valued. However, issues relating to the lack of system integration and alert-driven interactions jeopardized the perceived sustainability of the program. Conclusions: With the reduction of in-person visits during the pandemic, virtual services such as telemonitoring have demonstrated significant value. Based on our study findings, we offer recommendations to proactively adapt and scale telemonitoring programs under the changing conditions of an increasingly virtual health care system. These include revisiting the scope and expectations of telemedicine interventions, streamlining virtual patient onboarding processes, and personalizing the collection of patient information to build a stronger virtual relationship and a more holistic assessment of patient well-being. UR - http://www.jmir.org/2021/1/e26165/ UR - http://dx.doi.org/10.2196/26165 UR - http://www.ncbi.nlm.nih.gov/pubmed/33444153 ID - info:doi/10.2196/26165 ER - TY - JOUR AU - Singh, Aniruddha AU - Mountjoy, Natalie AU - McElroy, Doug AU - Mittal, Shilpi AU - Al Hemyari, Bashar AU - Coffey, Nicholas AU - Miller, Kristen AU - Gaines, Kenneth PY - 2021/1/22 TI - Patient Perspectives With Telehealth Visits in Cardiology During COVID-19: Online Patient Survey Study JO - JMIR Cardio SP - e25074 VL - 5 IS - 1 KW - COVID-19 KW - telehealth KW - cardiology KW - internet KW - broadband KW - patient satisfaction KW - restriction KW - survey N2 - Background: The rise of COVID-19 and the issue of a mandatory stay-at-home order in March 2020 led to the use of a direct-to-consumer model for cardiology telehealth in Kentucky. Kentucky has poor health outcomes and limited broadband connectivity. Given these and other practice-specific constraints, the region serves as a unique context to explore the efficacy of telehealth in cardiology. Objective: This study aims to determine the limitations of telehealth accessibility, patient satisfaction with telehealth relative to in-person visits, and the perceived advantages and disadvantages to telehealth. Our intent was two-fold. First, we wanted to conduct a rapid postassessment of the mandated overhaul of the health care delivery system, focusing on a representative specialty field, and how it was affecting patients. Second, we intend to use our findings to make suggestions about the future application of a telehealth model in specialty fields such as cardiology. Methods: We constructed an online survey in Qualtrics following the Patient Assessment of Communication During Telemedicine, a patient self-report questionnaire that has been previously developed and validated. We invited all patients who had a visit scheduled during the COVID-19 telehealth-only time frame to participate. Questions included factors for declining telehealth, patient satisfaction ratings of telehealth and in-person visits, and perceived advantages and disadvantages associated with telehealth. We also used electronic medical records to collect no-show data for in-person versus telehealth visits to check for nonresponse bias. Results: A total of 224 respondents began our survey (11% of our sample of 2019 patients). Our recruitment rate was 86% (n=193) and our completion rate was 62% (n=120). The no-show rate for telehealth visits (345/2019, 17%) was nearly identical to the typical no-show rate for in-person appointments. Among the 32 respondents who declined a telehealth visit, 20 (63%) cited not being aware of their appointment as a primary factor, and 15 (47%) respondents cited their opinion that a telehealth appointment was not medically necessary as at least somewhat of a factor in their decision. Both in-person and telehealth were viewed favorably, but in-person was rated higher across all domains of patient satisfaction. The only significantly lower mean score for telehealth (3.7 vs 4.2, P=.007) was in the clinical competence domain. Reduced travel time, lower visit wait time, and cost savings were seen as big advantages. Poor internet connectivity was rated as at least somewhat of a factor by 33.0% (35/106) of respondents. Conclusions: This study takes advantage of the natural experiment provided by the COVID-19 pandemic to assess the efficacy of telehealth in cardiology. Patterns of satisfaction are consistent across modalities and show that telehealth appears to be a viable alternative to in-person appointments. However, we found evidence that scheduling of telehealth visits may be problematic and needs additional attention. Additionally, we include a note of caution that patient satisfaction with telehealth may be artificially inflated during COVID-19 due to external health concerns connected with in-person visits. UR - http://cardio.jmir.org/2021/1/e25074/ UR - http://dx.doi.org/10.2196/25074 UR - http://www.ncbi.nlm.nih.gov/pubmed/33385234 ID - info:doi/10.2196/25074 ER - TY - JOUR AU - Herkert, Cyrille AU - Kraal, Johannes Jos AU - Spee, Ferdinand Rudolph AU - Serier, Anouk AU - Graat-Verboom, Lidwien AU - Kemps, Clemens Hareld Marijn PY - 2020/11/19 TI - Quality Assessment of an Integrated Care Pathway Using Telemonitoring in Patients with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease: Protocol for a Quasi-Experimental Study JO - JMIR Res Protoc SP - e20571 VL - 9 IS - 11 KW - chronic heart failure KW - chronic obstructive pulmonary disease KW - integrated care pathway KW - telemonitoring N2 - Background: Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often coexist and are associated with a high morbidity and reduced quality of life (QoL). Although these diseases share similarities in symptoms and clinical course, and exacerbations of both diseases often overlap, care pathways for both conditions are usually not integrated. This results in frequent outpatient consultations and suboptimal treatment during exacerbations, leading to frequent hospital admissions. Therefore, we propose an integrated care pathway for both diseases, using telemonitoring to detect deterioration at an early stage and a single case manager for both diseases. Objective: This study aims to investigate whether an integrated care pathway using telemonitoring in patients with combined CHF and COPD results in a higher general health-related QoL (HRQoL) as compared with the traditional care pathways. Secondary end points include disease-specific HRQoL, level of self-management, patient satisfaction, compliance to the program, and cost-effectiveness. Methods: This is a monocenter, prospective study using a quasi-experimental interrupted time series design. Thirty patients with combined CHF and COPD are included. The study period of 2.5 years per patient is divided into a preintervention phase (6 months) and a postintervention phase (2 years) in which end points are assessed. The intervention consists of an on-demand treatment strategy based on monitoring symptoms related to CHF/COPD and vital parameters (weight, blood pressure, heart rate, oxygen saturation, temperature), which are uploaded on a digital platform. The monitoring frequency and the limit values of the measurements to detect abnormalities are determined individually. Monitoring is performed by a case manager, who has the opportunity for a daily multidisciplinary meeting with both the cardiologist and the pulmonologist. Routine appointments at the outpatient clinic are cancelled and replaced by telemonitoring-guided treatment. Results: Following ethical approval of the study protocol, the first patient was included in May 2018. Inclusion is expected to be complete in May 2021. Conclusions: This study is the first to evaluate the effects of a novel integrated care pathway using telemonitoring for patients with combined CHF and COPD. Unique to this study is the concept of remote on-demand disease management by a single case manager for both diseases, combined with multidisciplinary meetings. Moreover, modern telemonitoring technology is used instead of, rather than as an addition to, regular care. Trial Registration: Netherlands Trial Register NL6741; https://www.trialregister.nl/trial/6741 International Registered Report Identifier (IRRID): DERR1-10.2196/20571 UR - https://www.researchprotocols.org/2020/11/e20571 UR - http://dx.doi.org/10.2196/20571 UR - http://www.ncbi.nlm.nih.gov/pubmed/33211017 ID - info:doi/10.2196/20571 ER - TY - JOUR AU - Ding, Hang AU - Chen, Huey Sheau AU - Edwards, Iain AU - Jayasena, Rajiv AU - Doecke, James AU - Layland, Jamie AU - Yang, A. Ian AU - Maiorana, Andrew PY - 2020/11/13 TI - Effects of Different Telemonitoring Strategies on Chronic Heart Failure Care: Systematic Review and Subgroup Meta-Analysis JO - J Med Internet Res SP - e20032 VL - 22 IS - 11 KW - telehealth KW - telemonitoring KW - mobile health KW - chronic heart failure KW - systematic review KW - meta-analysis N2 - Background: Telemonitoring studies in chronic heart failure are characterized by mixed mortality and hospitalization outcomes, which have deterred the uptake of telemonitoring in clinical practice. These mixed outcomes may reflect the diverse range of patient management strategies incorporated in telemonitoring. To address this, we compared the effects of different telemonitoring strategies on clinical outcomes. Objective: The aim of this systematic review and subgroup meta-analysis was to identify noninvasive telemonitoring strategies attributing to improvements in all-cause mortality or hospitalization outcomes for patients with chronic heart failure. Methods: We reviewed and analyzed telemonitoring strategies from randomized controlled trials (RCTs) comparing telemonitoring intervention with usual care. For each strategy, we examined whether RCTs that applied the strategy in the telemonitoring intervention (subgroup 1) resulted in a significantly lower risk ratio (RR) of all-cause mortality or incidence rate ratio (IRR) of all-cause hospitalization compared with RCTs that did not apply this strategy (subgroup 2). Results: We included 26 RCTs (N=11,450) incorporating 18 different telemonitoring strategies. RCTs that provided medication support were found to be associated with a significantly lower IRR value than RCTs that did not provide this type of support (P=.01; subgroup 1 IRR=0.83, 95% CI 0.72-0.95 vs subgroup 2 IRR=1.02, 95% CI 0.93-1.12). RCTs that applied mobile health were associated with a significantly lower IRR (P=.03; IRR=0.79, 95% CI 0.64-0.96 vs IRR=1.00, 95% CI 0.94-1.06) and RR (P=.01; RR=0.67, 95% CI 0.53-0.85 vs RR=0.95, 95% CI 0.84-1.07). Conclusions: Telemonitoring strategies involving medication support and mobile health were associated with improvements in all-cause mortality or hospitalization outcomes. These strategies should be prioritized in telemonitoring interventions for the management of patients with chronic heart failure. UR - http://www.jmir.org/2020/11/e20032/ UR - http://dx.doi.org/10.2196/20032 UR - http://www.ncbi.nlm.nih.gov/pubmed/33185554 ID - info:doi/10.2196/20032 ER - TY - JOUR AU - Tadas, Shreya AU - Coyle, David PY - 2020/11/11 TI - Barriers to and Facilitators of Technology in Cardiac Rehabilitation and Self-Management: Systematic Qualitative Grounded Theory Review JO - J Med Internet Res SP - e18025 VL - 22 IS - 11 KW - telemedicine KW - cardiovascular diseases KW - self-management KW - self-care KW - systematic review KW - grounded theory KW - mobile phone N2 - Background: Dealing with cardiovascular disease is challenging, and people often struggle to follow rehabilitation and self-management programs. Several systematic reviews have explored quantitative evidence on the potential of digital interventions to support cardiac rehabilitation (CR) and self-management. However, although promising, evidence regarding the effectiveness and uptake of existing interventions is mixed. This paper takes a different but complementary approach, focusing on qualitative data related to people?s experiences of technology in this space. Objective: Through a qualitative approach, this review aims to engage more directly with people?s experiences of technology that supports CR and self-management. The primary objective of this paper is to provide answers to the following research question: What are the primary barriers to and facilitators and trends of digital interventions to support CR and self-management? This question is addressed by synthesizing evidence from both medical and computer science literature. Given the strong evidence from the field of human-computer interaction that user-centered and iterative design methods increase the success of digital health interventions, we also assess the degree to which user-centered and iterative methods have been applied in previous work. Methods: A grounded theory literature review of articles from the following major electronic databases was conducted: ACM Digital Library, PsycINFO, Scopus, and PubMed. Papers published in the last 10 years, 2009 to 2019, were considered, and a systematic search with predefined keywords was conducted. Papers were screened against predefined inclusion and exclusion criteria. Comparative and in-depth analysis of the extracted qualitative data was carried out through 3 levels of iterative coding and concept development. Results: A total of 4282 articles were identified in the initial search. After screening, 61 articles remained, which were both qualitative and quantitative studies and met our inclusion criteria for technology use and health condition. Of the 61 articles, 16 qualitative articles were included in the final analysis. Key factors that acted as barriers and facilitators were background knowledge and in-the-moment understanding, personal responsibility and social connectedness, and the need to support engagement while avoiding overburdening people. Although some studies applied user-centered methods, only 6 involved users throughout the design process. There was limited evidence of studies applying iterative approaches. Conclusions: The use of technology is acceptable to many people undergoing CR and self-management. Although background knowledge is an important facilitator, technology should also support greater ongoing and in-the-moment understanding. Connectedness is valuable, but to avoid becoming a barrier, technology must also respect and enable individual responsibility. Personalization and gamification can also act as facilitators of engagement, but care must be taken to avoid overburdening people. Further application of user-centered and iterative methods represents a significant opportunity in this space. UR - http://www.jmir.org/2020/11/e18025/ UR - http://dx.doi.org/10.2196/18025 UR - http://www.ncbi.nlm.nih.gov/pubmed/33174847 ID - info:doi/10.2196/18025 ER - TY - JOUR AU - Artanian, Veronica AU - Ross, J. Heather AU - Rac, E. Valeria AU - O'Sullivan, Mary AU - Brahmbhatt, H. Darshan AU - Seto, Emily PY - 2020/11/3 TI - Impact of Remote Titration Combined With Telemonitoring on the Optimization of Guideline-Directed Medical Therapy for Patients With Heart Failure: Internal Pilot of a Randomized Controlled Trial JO - JMIR Cardio SP - e21962 VL - 4 IS - 1 KW - telemonitoring KW - remote KW - titration KW - monitoring KW - mHealth KW - heart failure N2 - Background: To improve health outcomes in patients with heart failure, guideline-directed medical therapy (GDMT) should be optimized to target doses. However, GDMT remains underutilized, with less than?25% of patients receiving target doses in clinical practice. Telemonitoring could provide reliable and real-time physiological data for clinical decision support to facilitate remote GDMT titration. Objective: This paper aims to present findings from an internal pilot study regarding the effectiveness of remote titration facilitated by telemonitoring. Methods: A 2-arm randomized controlled pilot trial comparing remote titration versus standard care in a heart function clinic was conducted. Patients were randomized to undergo remote medication titration facilitated by data from a smartphone-based telemonitoring system or standard titration performed during clinic visits. Results: A total of 42 patients with new-onset (10/42, 24%) and existing (32/42, 76%) heart failure and a mean age of 55.29 (SD 11.28) years were randomized between January and June 2019. Within 6 months of enrollment, 86% (18/21) of patients in the intervention group achieved optimal doses versus 48% (10/21) of patients in the control group. The median time to dose optimization was 11.0 weeks for the intervention group versus 18.8 weeks for the control group. The number of in-person visits in the intervention group was 54.5% lower than in the control group. Conclusions: The results of this pilot study suggest that remote titration facilitated by telemonitoring has the potential to increase the proportion of patients who achieve optimal GDMT doses, decrease time to dose optimization, and reduce the number of clinic visits. Remote titration may facilitate optimal and efficient titration of patients with heart failure while reducing the burden for patients to attend in-person clinic visits. Trial Registration: ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID): RR2-10.2196/preprints.19705 UR - http://cardio.jmir.org/2020/1/e21962/ UR - http://dx.doi.org/10.2196/21962 UR - http://www.ncbi.nlm.nih.gov/pubmed/33141094 ID - info:doi/10.2196/21962 ER - TY - JOUR AU - Cui, Fangfang AU - Ma, Qianqian AU - He, Xianying AU - Zhai, Yunkai AU - Zhao, Jie AU - Chen, Baozhan AU - Sun, Dongxu AU - Shi, Jinming AU - Cao, Mingbo AU - Wang, Zhenbo PY - 2020/10/23 TI - Implementation and Application of Telemedicine in China: Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e18426 VL - 8 IS - 10 KW - telemedicine KW - Chinese hospital KW - implementation KW - application KW - influencing factors N2 - Background: Telemedicine has been used widely in China and has benefited a large number of patients, but little is known about the overall development of telemedicine. Objective: The aim of this study was to perform a national survey to identify the overall implementation and application of telemedicine in Chinese tertiary hospitals and provide a scientific basis for the successful expansion of telemedicine in the future. Methods: The method of probability proportionate to size sampling was adopted to collect data from 161 tertiary hospitals in 29 provinces, autonomous regions, and municipalities. Charts and statistical tests were applied to compare the development of telemedicine, including management, network, data storage, software and hardware equipment, and application of telemedicine. Ordinal logistic regression was used to analyze the relationship between these factors and telemedicine service effect. Results: Approximately 93.8% (151/161) of the tertiary hospitals carried out telemedicine services in business-to-business mode. The most widely used type of telemedicine network was the virtual private network with a usage rate of 55.3% (89/161). Only a few tertiary hospitals did not establish data security and cybersecurity measures. Of the 161 hospitals that took part in the survey, 100 (62.1%) conducted remote videoconferencing supported by hardware instead of software. The top 5 telemedicine services implemented in the hospitals were teleconsultation, remote education, telediagnosis of medical images, tele-electrocardiography, and telepathology, with coverage rates of 86.3% (139/161), 57.1% (92/161), 49.7% (80/161), 37.9% (61/161), and 33.5% (54/161), respectively. The average annual service volume of teleconsultation reached 714 cases per hospital. Teleconsultation and telediagnosis were the core charging services. Multivariate analysis indicated that the adoption of direct-to-consumer mode (P=.003), support from scientific research funds (P=.01), charging for services (P<.001), number of medical professionals (P=.04), network type (P=.02), sharing data with other hospitals (P=.04), and expertise level (P=.03) were related to the effect of teleconsultation. Direct-to-consumer mode (P=.01), research funding (P=.01), charging for services (P=.01), establishment of professional management departments (P=.04), and 15 or more instances of remote education every month (P=.01) were found to significantly influence the effect of remote education. Conclusions: A variety of telemedicine services have been implemented in tertiary hospitals in China with a promising prospect, but the sustainability and further standardization of telemedicine in China are still far from accomplished. UR - http://mhealth.jmir.org/2020/10/e18426/ UR - http://dx.doi.org/10.2196/18426 UR - http://www.ncbi.nlm.nih.gov/pubmed/33095175 ID - info:doi/10.2196/18426 ER - TY - JOUR AU - Artanian, Veronica AU - Rac, E. Valeria AU - Ross, J. Heather AU - Seto, Emily PY - 2020/10/13 TI - Impact of Remote Titration Combined With Telemonitoring on the Optimization of Guideline-Directed Medical Therapy for Patients With Heart Failure: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e19705 VL - 9 IS - 10 KW - telemonitoring KW - telemedicine KW - remote titration KW - mHealth KW - heart failure N2 - Background: Guideline-directed medical therapy (GDMT), optimized to maximum tolerated doses, has been shown to improve clinical outcomes in patients with heart failure (HF). Timely use and optimization of GDMT can improve HF symptoms, reduce the burden of hospitalization, and increase survival rates, whereas GDMT deferral may worsen the progression of HF, decrease survival rates, and predispose patients to poor outcomes. However, studies indicate that GDMT remains underused, with less than?25% of patients receiving target doses in clinical practice. Telemonitoring is a potential component in the management of HF that can provide reliable and real-time physiological data for clinical decision support and facilitate remote titration of medication. Objective: The primary objective of this study is to evaluate the impact of remote titration facilitated by telemonitoring on health care outcomes, with a primary outcome measure being the proportion of patients achieving target doses. The secondary objective is to identify the barriers and facilitators that can affect the implementation and effectiveness of the intervention. Methods: A mixed methods study of a smartphone-based telemonitoring system is being conducted at the Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto. The study is based on an effectiveness-implementation hybrid design and incorporates process evaluations alongside the assessment of clinical outcomes. The effectiveness research component is assessed by a two-arm randomized controlled trial (RCT) aiming to enroll 108 patients. The RCT compares a remote titration strategy that uses data from a smartphone-based telemonitoring system with a standard titration program consisting of in-office visits. The implementation research component consists of a qualitative study based on semistructured interviews with a purposive sample of clinicians and patients. Results: Patient recruitment began in January 2019 at PMCC, with a total of 76 participants recruited by February 24, 2020 (39 in the intervention group and 37 in the control group). The final analysis is expected to be completed by the winter of 2021. Conclusions: This study will be among the first to provide evidence on the implementation of remote titration facilitated by telemonitoring and its impact on patient health outcomes. The successful use of telemonitoring for this purpose has the potential to alter the existing approach to titration of HF medication and support the development of a care delivery model that combines clinic visits with virtual follow-ups. Trial Registration: ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID): DERR1-10.2196/19705 UR - https://www.researchprotocols.org/2020/10/e19705 UR - http://dx.doi.org/10.2196/19705 UR - http://www.ncbi.nlm.nih.gov/pubmed/33048057 ID - info:doi/10.2196/19705 ER - TY - JOUR AU - Boodoo, Chris AU - Zhang, Qi AU - Ross, J. Heather AU - Alba, Carolina Ana AU - Laporte, Audrey AU - Seto, Emily PY - 2020/10/6 TI - Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis JO - J Med Internet Res SP - e18917 VL - 22 IS - 10 KW - cost utility analysis KW - cost effectiveness KW - telemedicine KW - heart failure KW - microsimulation KW - mobile phone N2 - Background: Heart failure (HF) is a major public health issue in Canada that is associated with high prevalence, morbidity, and mortality rates and high financial and social burdens. Telemonitoring (TM) has been shown to improve all-cause mortality and hospitalization rates in patients with HF. The Medly program is a TM intervention integrated as standard of care at a large Canadian academic hospital for ambulatory patients with HF that has been found to improve patient outcomes. However, the cost-effectiveness of the Medly program is yet to be determined. Objective: This study aims to conduct a cost-utility analysis of the Medly program compared with the standard of care for HF in Ontario, Canada, from the perspective of the public health care payer. Methods: Using a microsimulation model, individual patient data were simulated over a 25-year time horizon to compare the costs and quality-adjusted life years (QALYs) between the Medly program and standard care for patients with HF treated in the ambulatory care setting. Data were sourced from a Medly Program Evaluation study and literature to inform model parameters, such as Medly?s effectiveness in reducing mortality and hospitalizations, health care and intervention costs, and model transition probabilities. Scenario analyses were conducted in relation to HF severity and TM deployment models. One-way deterministic effectiveness analysis and probabilistic sensitivity analysis were performed to explore the impact on the results of uncertainty in model parameters. Results: The Medly program was associated with an average total cost of Can $102,508 (US $77,626) per patient and total QALYs of 5.51 per patient compared with the average cost of Can $97,497 (US $73,831) and QALYs of 4.95 per patient in the Standard Care Group. This led to an incremental cost of Can $5011 (US $3794) and incremental QALY of 0.566, resulting in an incremental cost-effectiveness ratio of Can $8850 (US $6701)/QALY. Cost-effectiveness improved in relation to patients with advanced HF and with deployment models in which patients used their own equipment. Baseline and alternative scenarios consistently showed probabilities of cost-effectiveness greater than 85% at a willingness-to-pay threshold of Can $50,000 (US $37,718). Although the results showed some sensitivity to assumptions about effectiveness parameters, the intervention was found to remain cost-effective. Conclusions: The Medly program for patients with HF is cost-effective compared with standard care using commonly reported willingness-to-pay thresholds. This study provides evidence for decision makers on the use of TM for HF, supports the use of a nurse-led model of TM that embeds clinically validated algorithms, and informs the use of economic modeling for future evaluations of early-stage health informatics technology. UR - https://www.jmir.org/2020/10/e18917 UR - http://dx.doi.org/10.2196/18917 UR - http://www.ncbi.nlm.nih.gov/pubmed/33021485 ID - info:doi/10.2196/18917 ER - TY - JOUR AU - Waqas, Ahmed AU - Teoh, Huat Soo AU - Lapão, Velez Luís AU - Messina, Ary Luiz AU - Correia, César Jorge PY - 2020/10/2 TI - Harnessing Telemedicine for the Provision of Health Care: Bibliometric and Scientometric Analysis JO - J Med Internet Res SP - e18835 VL - 22 IS - 10 KW - telemedicine KW - scientometric analysis KW - evidence synthesis KW - health information technology KW - research KW - theme N2 - Background: In recent decades, advances in information technology have given new momentum to telemedicine research. These advances in telemedicine range from individual to population levels, allowing the exchange of patient information for diagnosis and management of health problems, primary care prevention, and education of physicians via distance learning. Objective: This scientometric investigation aims to examine collaborative research networks, dominant research themes and disciplines, and seminal research studies that have contributed most to the field of telemedicine. This information is vital for scientists, institutions, and policy stakeholders to evaluate research areas where more infrastructural or scholarly contributions are required. Methods: For analyses, we used CiteSpace (version 4.0 R5; Drexel University), which is a Java-based software that allows scientometric analysis, especially visualization of collaborative networks and research themes in a specific field. Results: We found that scholarly activity has experienced a significant increase in the last decade. Most important works were conducted by institutions located in high-income countries. A discipline-specific shift from radiology to telestroke, teledermatology, telepsychiatry, and primary care was observed. The most important innovations that yielded a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational health, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and geriatrics. Conclusions: Despite a continuous rise in scholarly activity in telemedicine, we noticed several gaps in the literature. For instance, all the primary and secondary research central to telemedicine was conducted in the context of high-income countries, including the evidence synthesis approaches that pertained to implementation aspects of telemedicine. Furthermore, the research landscape and implementation of telemedicine infrastructure are expected to see exponential progress during and after the COVID-19 era. UR - https://www.jmir.org/2020/10/e18835 UR - http://dx.doi.org/10.2196/18835 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006571 ID - info:doi/10.2196/18835 ER - TY - JOUR AU - Liljeroos, Maria AU - Thylén, Ingela AU - Strömberg, Anna PY - 2020/9/28 TI - Patients' and Nurses? Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study JO - J Med Internet Res SP - e19550 VL - 22 IS - 9 KW - heart failure KW - remote patient monitoring KW - implantable cardioverter-defibrillator N2 - Background: The new generation of implantable cardioverter-defibrillators (ICDs) supports wireless technology, which enables remote patient monitoring (RPM) of the device. In Sweden, it is mainly registered nurses with advanced education and training in ICD devices who handle the arrhythmias and technical issues of the remote transmissions. Previous studies have largely focused on the perceptions of physicians, and it has not been explored how the patients? and nurses? experiences of RPM correspond to each other. Objective: Our objective is to describe, explore, and compare the experiences and perceptions, concerning RPM of ICD, of patients with heart failure (HF) and nurses performing ICD follow-up. Methods: This study has a cross-sectional, descriptive, mixed methods design. All patients with HF and an ICD with RPM from one region in Sweden, who had transitioned from office-based visits to implementing RPM, and ICD nurses from all ICD clinics in Sweden were invited to complete a purpose-designed, 8-item questionnaire to assess experiences of RPM. The questionnaire started with a neutral question: ?What are your experiences of RPM in general?? This was followed by one positive subscale with three questions (score range 3-12), with higher scores reflecting more positive experiences, and one negative subscale with three questions (score range 3-12), with lower scores reflecting more negative experiences. One open-ended question was analyzed with qualitative content analysis. Results: The sample consisted of 175 patients (response rate 98.9%) and 30 ICD nurses (response rate 60%). The majority of patients (154/175, 88.0%) and nurses (23/30, 77%) experienced RPM as very good; however, the nurses noted more downsides than did the patients. The mean scores of the negative experiences subscale were 11.5 (SD 1.1) for the patients and 10.7 (SD 0.9) for the nurses (P=.08). The mean scores of the positive experiences subscale were 11.1 (SD 1.6) for the patients and 8.5 (SD 1.9) for the nurses (P=.04). A total of 11 out of 175 patients (6.3%) were worried or anxious about what the RPM entailed, while 15 out of 30 nurses (50%) felt distressed by the responsibility that accompanied their work with RPM (P=.04). Patients found that RPM increased their own (173/175, 98.9%) and their relatives? (169/175, 96.6%) security, and all nurses (30/30, 100%) answered that they found RPM to be necessary from a safety perspective. Most patients found it to be an advantage with fewer office-based visits. Nurses found it difficult to handle different systems with different platforms, especially for smaller clinics with few patients. Another difficulty was to set the correct number of alarms for the individual patient. This caused a high number of transmissions and a risk to miss important information. Conclusions: Both patients and nurses found that RPM increased assurance, reliance, and safety. Few patients were anxious about what the RPM entailed, while about half of the nurses felt distressed by the responsibility that accompanied their work with RPM. To increase nurses? sense of security, it seems important to adjust organizational routines and reimbursement systems and to balance the workload. UR - http://www.jmir.org/2020/9/e19550/ UR - http://dx.doi.org/10.2196/19550 UR - http://www.ncbi.nlm.nih.gov/pubmed/32985997 ID - info:doi/10.2196/19550 ER - TY - JOUR AU - Mazoteras-Pardo, Victoria AU - Becerro-De-Bengoa-Vallejo, Ricardo AU - Losa-Iglesias, Elena Marta AU - Martínez-Jiménez, María Eva AU - Calvo-Lobo, César AU - Romero-Morales, Carlos AU - López-López, Daniel AU - Palomo-López, Patricia PY - 2020/7/24 TI - QardioArm Blood Pressure Monitoring in a Population With Type 2 Diabetes: Validation Study JO - J Med Internet Res SP - e19781 VL - 22 IS - 7 KW - blood pressure KW - hypertension KW - type 2 diabetes KW - mobile applications KW - software validation N2 - Background: Home blood pressure monitoring has many benefits, even more so, in populations prone to high blood pressure, such as persons with diabetes. Objective: The purpose of this research was to validate the QardioArm mobile device in a sample of individuals with noninsulin-dependent type 2 diabetes in accordance with the guidelines of the second International Protocol of the European Society of Hypertension. Methods: The sample consisted of 33 patients with type 2 diabetes. To evaluate the validity of QardioArm by comparing its data with that obtained with a digital sphygmomanometer (Omron M3 Intellisense), two nurses collected diastolic blood pressure, systolic blood pressure, and heart rate with both devices. Results: The analysis indicated that the test device QardioArm met all the validation requirements using a sample population with type 2 diabetes. Conclusions: This paper reports the first validation of QardioArm in a population of individuals with noninsulin-dependent type 2 diabetes. QardioArm for home monitoring of blood pressure and heart rate met the requirements of the second International Protocol of the European Society of Hypertension. UR - http://www.jmir.org/2020/7/e19781/ UR - http://dx.doi.org/10.2196/19781 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706672 ID - info:doi/10.2196/19781 ER - TY - JOUR AU - Jiang, Xinchan AU - Yao, Jiaqi AU - You, HS Joyce PY - 2020/7/6 TI - Telemonitoring Versus Usual Care for Elderly Patients With Heart Failure Discharged From the Hospital in the United States: Cost-Effectiveness Analysis JO - JMIR Mhealth Uhealth SP - e17846 VL - 8 IS - 7 KW - telemedicine KW - heart failure KW - hospitalization KW - cost KW - quality-adjusted life year KW - cost-effectiveness analysis N2 - Background: Telemonitoring-guided interventional management reduces the need for hospitalization and mortality of patients with chronic heart failure (CHF). Objective: This study aimed to analyze the cost-effectiveness of usual care with and without telemonitoring-guided management in patients with CHF discharged from the hospital, from the perspective of US health care providers. Methods: A lifelong Markov model was designed to estimate outcomes of (1) usual care alone for all postdischarge patients with CHF (New York Heart Association [NYHA] class I-IV), (2) usual care and telemonitoring for all postdischarge patients with CHF, (3) usual care for all postdischarge patients with CHF and telemonitoring for patients with NYHA class III to IV, and (4) usual care for all postdischarge patients with CHF plus telemonitoring for patients with NYHA class II to IV. Model inputs were derived from the literature and public data. Sensitivity analyses were conducted to assess the robustness of model. The primary outcomes were total direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Results: In the base case analysis, universal telemonitoring group gained the highest QALYs (6.2967 QALYs), followed by the telemonitoring for NYHA class II to IV group (6.2960 QALYs), the telemonitoring for NYHA class III to IV group (6.2450 QALYs), and the universal usual care group (6.1530 QALYs). ICERs of the telemonitoring for NYHA class III to IV group (US $35,393 per QALY) and the telemonitoring for NYHA class II to IV group (US $38,261 per QALY) were lower than the ICER of the universal telemonitoring group (US $100,458 per QALY). One-way sensitivity analysis identified five critical parameters: odds ratio of hospitalization for telemonitoring versus usual care, hazard ratio of all-cause mortality for telemonitoring versus usual care, CHF hospitalization cost and monthly outpatient costs for NYHA class I, and CHF hospitalization cost for NYHA class II. In probabilistic sensitivity analysis, probabilities of the universal telemonitoring, telemonitoring for NYHA class II to IV, telemonitoring for NYHA class III to IV, and universal usual care groups to be accepted as cost-effective at US $50,000 per QALY were 2.76%, 76.31%, 18.6%, and 2.33%, respectively. Conclusions: Usual care for all discharged patients with CHF plus telemonitoring-guided management for NYHA class II to IV patients appears to be the preferred cost-effective strategy. UR - https://mhealth.jmir.org/2020/7/e17846 UR - http://dx.doi.org/10.2196/17846 UR - http://www.ncbi.nlm.nih.gov/pubmed/32407288 ID - info:doi/10.2196/17846 ER - TY - JOUR AU - Indraratna, Praveen AU - Tardo, Daniel AU - Yu, Jennifer AU - Delbaere, Kim AU - Brodie, Matthew AU - Lovell, Nigel AU - Ooi, Sze-Yuan PY - 2020/7/6 TI - Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e16695 VL - 8 IS - 7 KW - mobile phone KW - text messaging KW - telemedicine KW - myocardial ischemia KW - heart failure KW - hypertension N2 - 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. UR - https://mhealth.jmir.org/2020/7/e16695 UR - http://dx.doi.org/10.2196/16695 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628615 ID - info:doi/10.2196/16695 ER - TY - JOUR AU - Vandekerckhove, Pieter AU - Vandekerckhove, Yves AU - Tavernier, Rene AU - De Jaegher, Kelly AU - de Mul, Marleen PY - 2020/6/25 TI - Leveraging User Experience to Improve Video Consultations in a Cardiology Practice During the COVID-19 Pandemic: Initial Insights JO - J Med Internet Res SP - e19771 VL - 22 IS - 6 KW - telemedicine KW - design thinking KW - cardiology KW - patient KW - COVID-19 KW - user experience UR - http://www.jmir.org/2020/6/e19771/ UR - http://dx.doi.org/10.2196/19771 UR - http://www.ncbi.nlm.nih.gov/pubmed/32519964 ID - info:doi/10.2196/19771 ER - TY - JOUR AU - Ferguson, Caleb AU - Inglis, C. Sally AU - Breen, P. Paul AU - Gargiulo, D. Gaetano AU - Byiers, Victoria AU - Macdonald, S. Peter AU - Hickman, D. Louise PY - 2020/6/18 TI - Clinician Perspectives on the Design and Application of Wearable Cardiac Technologies for Older Adults: Qualitative Study JO - JMIR Aging SP - e17299 VL - 3 IS - 1 KW - technology KW - arrhythmia KW - monitoring KW - older people KW - cardiology KW - qualitative KW - wearable N2 - Background: New wearable devices (for example, AliveCor or Zio patch) offer promise in detecting arrhythmia and monitoring cardiac health status, among other clinically useful parameters in older adults. However, the clinical utility and usability from the perspectives of clinicians is largely unexplored. Objective: This study aimed to explore clinician perspectives on the use of wearable cardiac monitoring technology for older adults. Methods: A descriptive qualitative study was conducted using semistructured focus group interviews. Clinicians were recruited through purposive sampling of physicians, nurses, and allied health staff working in 3 tertiary-level hospitals. Verbatim transcripts were analyzed using thematic content analysis to identify themes. Results: Clinicians representing physicians, nurses, and allied health staff working in 3 tertiary-level hospitals completed 4 focus group interviews between May 2019 and July 2019. There were 50 participants (28 men and 22 women), including cardiologists, geriatricians, nurses, and allied health staff. The focus groups generated the following 3 overarching, interrelated themes: (1) the current state of play, understanding the perceived challenges of patient cardiac monitoring in hospitals, (2) priorities in cardiac monitoring, what parameters new technologies should measure, and (3) cardiac monitoring of the future, ?the ideal device.? Conclusions: There remain pitfalls related to the design of wearable cardiac technology for older adults that present clinical challenges. These pitfalls and challenges likely negatively impact the uptake of wearable cardiac monitoring in routine clinical care. Partnering with clinicians and patients in the co-design of new wearable cardiac monitoring technologies is critical to optimize the use of these devices and their uptake in clinical care. UR - http://aging.jmir.org/2020/1/e17299/ UR - http://dx.doi.org/10.2196/17299 UR - http://www.ncbi.nlm.nih.gov/pubmed/32554377 ID - info:doi/10.2196/17299 ER - TY - JOUR AU - Cruz-Martínez, Rafael Roberto AU - Wentzel, Jobke AU - Asbjørnsen, Aune Rikke AU - Noort, Daniel Peter AU - van Niekerk, Magnus Johan AU - Sanderman, Robbert AU - van Gemert-Pijnen, EWC Julia PY - 2020/5/21 TI - Supporting Self-Management of Cardiovascular Diseases Through Remote Monitoring Technologies: Metaethnography Review of Frameworks, Models, and Theories Used in Research and Development JO - J Med Internet Res SP - e16157 VL - 22 IS - 5 KW - eHealth KW - telemedicine KW - development KW - implementation KW - evaluation KW - multidisciplinary KW - qualitative evidence synthesis KW - meta-ethnography KW - systematic review KW - remote monitoring KW - self-management KW - cardiovascular diseases KW - framework KW - model KW - theory N2 - Background: Electronic health (eHealth) is a rapidly evolving field informed by multiple scientific disciplines. Because of this, the use of different terms and concepts to explain the same phenomena and lack of standardization in reporting interventions often leaves a gap that hinders knowledge accumulation. Interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies are a cross-disciplinary area potentially affected by this gap. A review of the underlying frameworks, models, and theories that have informed projects at this crossroad could advance future research and development efforts. Objective: This research aimed to identify and compare underlying approaches that have informed interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies. The objective was to achieve an understanding of the distinct approaches by highlighting common or conflicting principles, guidelines, and methods. Methods: The metaethnography approach was used to review and synthesize researchers? reports on how they applied frameworks, models, and theories in their projects. Literature was systematically searched in 7 databases: Scopus, Web of Science, EMBASE, CINAHL, PsycINFO, Association for Computing Machinery Digital Library, and Cochrane Library. Included studies were thoroughly read and coded to extract data for the synthesis. Studies were mainly related by the key ingredients of the underlying approaches they applied. The key ingredients were finally translated across studies and synthesized into thematic clusters. Results: Of 1224 initial results, 17 articles were included. The articles described research and development of 10 different projects. Frameworks, models, and theories (n=43) applied by the projects were identified. Key ingredients (n=293) of the included articles were mapped to the following themes of eHealth development: (1) it is a participatory process; (2) it creates new infrastructures for improving health care, health, and well-being; (3) it is intertwined with implementation; (4) it integrates theory, evidence, and participatory approaches for persuasive design; (5) it requires continuous evaluation cycles; (6) it targets behavior change; (7) it targets technology adoption; and (8) it targets health-related outcomes. Conclusions: The findings of this review support and exemplify the numerous possibilities in the use of frameworks, models, and theories to guide research and development of eHealth. Participatory, user-centered design, and integration with empirical evidence and theoretical modeling were widely identified principles in the literature. On the contrary, less attention has been given to the integration of implementation in the development process and supporting novel eHealth-based health care infrastructures. To better integrate theory and evidence, holistic approaches can combine patient-centered studies with consolidated knowledge from expert-based approaches. Trial Registration: PROSPERO CRD42018104397; https://tinyurl.com/y8ajyajt International Registered Report Identifier (IRRID): RR2-10.2196/13334 UR - http://www.jmir.org/2020/5/e16157/ UR - http://dx.doi.org/10.2196/16157 UR - http://www.ncbi.nlm.nih.gov/pubmed/32436852 ID - info:doi/10.2196/16157 ER - TY - JOUR AU - Winchester, E. David AU - Cagino, Leigh PY - 2020/5/1 TI - A Redesigned Order Entry System for Reducing Low-Value Preprocedural Cardiology Consultations: Quality-Improvement Cohort Study JO - JMIR Perioper Med SP - e17669 VL - 3 IS - 1 KW - quality improvement KW - preoperative care KW - medical order entry systems N2 - Background: Preprocedural cardiac evaluation is a common reason for outpatient cardiology visits. Many patients who are referred to cardiology clinics for preprocedural evaluation are at low risk of perioperative events and do not require any further management. Our facility treats patients over a large geographic area; avoiding low-value consultations reduces time and travel burdens for patients. Objective: Our study objective was to assess the impact of a novel algorithm in the electronic order entry system aimed to guide clinicians toward patients who may benefit from cardiovascular referral. Methods: We retrospectively reviewed in-person consultations and electronic consultations (e-consults) to our cardiology service before and after implementation of the novel algorithm to assess changes in patterns of care. Data were stored in a custom electronic database on internal servers. Results: We reviewed 603 consultations to our cardiology clinic and found that 89 (14.7%) were sent for preprocedural evaluation. Of these, 39 (43.8% of preprocedural consultations) were e-consults. After implementation, we reviewed 360 consultations. The proportion of consultations for preprocedural evaluation did not decrease (n=47, 13.0%; P=.39). We observed an absolute increase of 13.6% in the proportion of consultations ordered as e-consults (27/47, 57.4%). During the postintervention period, we received no remarks, concerns, or criticisms from ordering clinicians about the process change and no reports of adverse events. Conclusions: Implementation of an ordering algorithm to reduce low-value preprocedural cardiology evaluations did not lead to a reduction in the number of overall preprocedural cardiology consultations. The number of patients seen electronically increased, potentially improving clinic access and reducing travel burden for patients. UR - https://periop.jmir.org/2020/1/e17669 UR - http://dx.doi.org/10.2196/17669 UR - http://www.ncbi.nlm.nih.gov/pubmed/33393916 ID - info:doi/10.2196/17669 ER - TY - JOUR AU - McGillion, Michael AU - Ouellette, Carley AU - Good, Amber AU - Bird, Marissa AU - Henry, Shaunattonie AU - Clyne, Wendy AU - Turner, Andrew AU - Ritvo, Paul AU - Ritvo, Sarah AU - Dvirnik, Nazari AU - Lamy, Andre AU - Whitlock, Richard AU - Lawton, Christopher AU - Walsh, Jake AU - Paterson, Ken AU - Duquette, Janine AU - Sanchez Medeiros, Karla AU - Elias, Fadi AU - Scott, Ted AU - Mills, Joseph AU - Harrington, Deborah AU - Field, Mark AU - Harsha, Prathiba AU - Yang, Stephen AU - Peter, Elizabeth AU - Bhavnani, Sanjeev AU - Devereaux, PJ PY - 2020/3/18 TI - Postoperative Remote Automated Monitoring and Virtual Hospital-to-Home Care System Following Cardiac and Major Vascular Surgery: User Testing Study JO - J Med Internet Res SP - e15548 VL - 22 IS - 3 KW - monitoring, physiologic KW - postoperative care KW - user testing N2 - Background: Cardiac and major vascular surgeries are common surgical procedures associated with high rates of postsurgical complications and related hospital readmission. In-hospital remote automated monitoring (RAM) and virtual hospital-to-home patient care systems have major potential to improve patient outcomes following cardiac and major vascular surgery. However, the science of deploying and evaluating these systems is complex and subject to risk of implementation failure. Objective: As a precursor to a randomized controlled trial (RCT), this user testing study aimed to examine user performance and acceptance of a RAM and virtual hospital-to-home care intervention, using Philip?s Guardian and Electronic Transition to Ambulatory Care (eTrAC) technologies, respectively. Methods: Nurses and patients participated in systems training and individual case-based user testing at two participating sites in Canada and the United Kingdom. Participants were video recorded and asked to think aloud while completing required user tasks and while being rated on user performance. Feedback was also solicited about the user experience, including user satisfaction and acceptance, through use of the Net Promoter Scale (NPS) survey and debrief interviews. Results: A total of 37 participants (26 nurses and 11 patients) completed user testing. The majority of nurse and patient participants were able to complete most required tasks independently, demonstrating comprehension and retention of required Guardian and eTrAC system workflows. Tasks which required additional prompting by the facilitator, for some, were related to the use of system features that enable continuous transmission of patient vital signs (eg, pairing wireless sensors to the patient) and assigning remote patient monitoring protocols. NPS scores by user group (nurses using Guardian: mean 8.8, SD 0.89; nurses using eTrAC: mean 7.7, SD 1.4; patients using eTrAC: mean 9.2, SD 0.75), overall NPS scores, and participant debrief interviews indicated nurse and patient satisfaction and acceptance of the Guardian and eTrAC systems. Both user groups stressed the need for additional opportunities to practice in order to become comfortable and proficient in the use of these systems. Conclusions: User testing indicated a high degree of user acceptance of Philips? Guardian and eTrAC systems among nurses and patients. Key insights were provided that informed refinement of clinical workflow training and systems implementation. These results were used to optimize workflows before the launch of an international RCT of in-hospital RAM and virtual hospital-to-home care for patients undergoing cardiac and major vascular surgery. UR - https://www.jmir.org/2020/3/e15548 UR - http://dx.doi.org/10.2196/15548 UR - http://www.ncbi.nlm.nih.gov/pubmed/32186521 ID - info:doi/10.2196/15548 ER - TY - JOUR AU - Aamodt, Thon Ina AU - Lycholip, Edita AU - Celutkiene, Jelena AU - von Lueder, Thomas AU - Atar, Dan AU - Falk, Sørum Ragnhild AU - Hellesø, Ragnhild AU - Jaarsma, Tiny AU - Strömberg, Anna AU - Lie, Irene PY - 2020/1/7 TI - Self-Care Monitoring of Heart Failure Symptoms and Lung Impedance at Home Following Hospital Discharge: Longitudinal Study JO - J Med Internet Res SP - e15445 VL - 22 IS - 1 KW - heart failure KW - telemedicine KW - lung impedance KW - diary KW - self-care KW - prospective study N2 - Background: Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. Objective: This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. Methods: This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals?one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the CardioSet Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. Results: The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. Conclusions: Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions. UR - https://www.jmir.org/2020/1/e15445 UR - http://dx.doi.org/10.2196/15445 UR - http://www.ncbi.nlm.nih.gov/pubmed/31909717 ID - info:doi/10.2196/15445 ER - TY - JOUR AU - Herkert, Cyrille AU - Kraal, Johannes Jos AU - van Loon, Agnes Eline Maria AU - van Hooff, Martijn AU - Kemps, Clemens Hareld Marijn PY - 2019/12/19 TI - Usefulness of Modern Activity Trackers for Monitoring Exercise Behavior in Chronic Cardiac Patients: Validation Study JO - JMIR Mhealth Uhealth SP - e15045 VL - 7 IS - 12 KW - cardiac diseases KW - activity trackers KW - energy metabolism KW - physical activity KW - validation studies N2 - Background: Improving physical activity (PA) is a core component of secondary prevention and cardiac (tele)rehabilitation. Commercially available activity trackers are frequently used to monitor and promote PA in cardiac patients. However, studies on the validity of these devices in cardiac patients are scarce. As cardiac patients are being advised and treated based on PA parameters measured by these devices, it is highly important to evaluate the accuracy of these parameters in this specific population. Objective: The aim of this study was to determine the accuracy and responsiveness of 2 wrist-worn activity trackers, Fitbit Charge 2 (FC2) and Mio Slice (MS), for the assessment of energy expenditure (EE) in cardiac patients. Methods: EE assessed by the activity trackers was compared with indirect calorimetry (Oxycon Mobile [OM]) during a laboratory activity protocol. Two groups were assessed: patients with stable coronary artery disease (CAD) with preserved left ventricular ejection fraction (LVEF) and patients with heart failure with reduced ejection fraction (HFrEF). Results: A total of 38 patients were included: 19 with CAD and 19 with HFrEF (LVEF 31.8%, SD 7.6%). The CAD group showed no significant difference in total EE between FC2 and OM (47.5 kcal, SD 112 kcal; P=.09), in contrast to a significant difference between MS and OM (88 kcal, SD 108 kcal; P=.003). The HFrEF group showed significant differences in EE between FC2 and OM (38 kcal, SD 57 kcal; P=.01), as well as between MS and OM (106 kcal, SD 167 kcal; P=.02). Agreement of the activity trackers was low in both groups (CAD: intraclass correlation coefficient [ICC] FC2=0.10, ICC MS=0.12; HFrEF: ICC FC2=0.42, ICC MS=0.11). The responsiveness of FC2 was poor, whereas MS was able to detect changes in cycling loads only. Conclusions: Both activity trackers demonstrated low accuracy in estimating EE in cardiac patients and poor performance to detect within-patient changes in the low-to-moderate exercise intensity domain. Although the use of activity trackers in cardiac patients is promising and could enhance daily exercise behavior, these findings highlight the need for population-specific devices and algorithms. UR - http://mhealth.jmir.org/2019/12/e15045/ UR - http://dx.doi.org/10.2196/15045 UR - http://www.ncbi.nlm.nih.gov/pubmed/31855191 ID - info:doi/10.2196/15045 ER - TY - JOUR AU - Giannola, Gabriele AU - Torcivia, Riccardo AU - Airò Farulla, Riccardo AU - Cipolla, Tommaso PY - 2019/12/18 TI - Outsourcing the Remote Management of Cardiac Implantable Electronic Devices: Medical Care Quality Improvement Project JO - JMIR Cardio SP - e9815 VL - 3 IS - 2 KW - remote monitoring KW - telemonitoring KW - cardiac implantable electronic devices KW - implantable defibrillators KW - pacemaker KW - implantable cardioverter defibrillator KW - triage outsourcing KW - follow-up N2 - Background: Remote management is partially replacing routine follow-up in patients implanted with cardiac implantable electronic devices (CIEDs). Although it reduces clinical staff time compared with standard in-office follow-up, a new definition of roles and responsibilities may be needed to review remote transmissions in an effective, efficient, and timely manner. Whether remote triage may be outsourced to an external remote monitoring center (ERMC) is still unclear. Objective: The aim of this health care quality improvement project was to evaluate the feasibility of outsourcing remote triage to an ERMC to improve patient care and health care resource utilization. Methods: Patients (N=153) with implanted CIEDs were followed up for 8 months. An ERMC composed of nurses and physicians reviewed remote transmissions daily following a specific remote monitoring (RM) protocol. A 6-month benchmarking phase where patients? transmissions were managed directly by hospital staff was evaluated as a term of comparison. Results: A total of 654 transmissions were recorded in the RM system and managed by the ERMC team within 2 working days, showing a significant time reduction compared with standard RM management (100% vs 11%, respectively, within 2 days; P<.001). A total of 84.3% (551/654) of the transmissions did not include a prioritized event and did not require escalation to the hospital clinician. High priority was assigned to 2.3% (15/654) of transmissions, which were communicated to the hospital team by email within 1 working day. Nonurgent device status events occurred in 88 cases and were communicated to the hospital within 2 working days. Of these, 11% (10/88) were followed by a hospitalization. Conclusions: The outsourcing of RM management to an ERMC safely provides efficacy and efficiency gains in patients? care compared with a standard in-hospital management. Moreover, the externalization of RM management could be a key tool for saving dedicated staff and facility time with possible positive economic impact. Trial Registration: ClinicalTrials.gov NCT01007474; http://clinicaltrials.gov/ct2/show/NCT01007474 UR - https://cardio.jmir.org/2019/2/e9815 UR - http://dx.doi.org/10.2196/cardio.9815 UR - http://www.ncbi.nlm.nih.gov/pubmed/31845898 ID - info:doi/10.2196/cardio.9815 ER - TY - JOUR AU - Guo, Xiaorong AU - Gu, Xiang AU - Jiang, Jiang AU - Li, Hongxiao AU - Duan, Ruoyu AU - Zhang, Yi AU - Sun, Lei AU - Bao, Zhengyu AU - Shen, Jianhua AU - Chen, Fukun PY - 2019/12/13 TI - A Hospital-Community-Family?Based Telehealth Program for Patients With Chronic Heart Failure: Single-Arm, Prospective Feasibility Study JO - JMIR Mhealth Uhealth SP - e13229 VL - 7 IS - 12 KW - telehealth KW - chronic heart failure KW - feasibility studies KW - precise follow-up KW - self-management N2 - Background: An increasing number of patients with chronic heart failure (CHF) are demanding more convenient and efficient modern health care systems, especially in remote areas away from central cities. Telehealth is receiving increasing attention, which may be useful to patients with CHF. Objective: This study aimed to evaluate the feasibility of a hospital-community-family (HCF)?based telehealth program, which was designed to implement remote hierarchical management in patients with CHF. Methods: This was a single-arm prospective study in which 70 patients with CHF participated in the HCF-based telehealth program for remote intervention for at least 4 months. The participants were recruited from the clinic and educated on the use of smart health tracking devices and mobile apps to collect and manually upload comprehensive data elements related to the risk of CHF self-care management. They were also instructed on how to use the remote platform and mobile app to send text messages, check notifications, and open video channels. The general practitioners viewed the index of each participant on the mobile app and provided primary care periodically, and cardiologists in the regional central hospital offered remote guidance, if necessary. The assessed outcomes included accomplishments of the program, usability and satisfaction, engagement with the intervention, and changes of heart failure?related health behaviors. Results: As of February 2018, a total of 66 individuals, aged 40-79 years, completed the 4-month study. Throughout the study period, 294 electronic medical records were formed on the remote monitoring service platform. In addition, a total of 89 remote consultations and 196 remote ward rounds were conducted. Participants indicated that they were generally satisfied with the intervention for its ease of use and usefulness. More than 91% (21/23) of physicians believed the program was effective, and 87% (20/23) of physicians stated that their professional knowledge could always be refreshed and enhanced through a library hosted on the platform and remote consultation. More than 60% (40/66) of participants showed good adherence to the care plan in the study period, and 79% (52/66) of patients maintained a consistent pattern of reporting and viewing their data over the course of the 4-month follow-up period. The program showed a positive effect on self-management for patients (healthy diet: P=.046, more fruit and vegetable intake: P=.02, weight monitoring: P=.002, blood pressure: P<.001, correct time: P=.049, and daily dosages of medicine taken: P=.006). Conclusions: The HCF-based telehealth program is feasible and provided researchers with evidence of remote hierarchical management for patients with CHF, which can enhance participants? and their families? access and motivation to engage in self-management. Further prospective studies with a larger sample size are necessary to confirm the program?s effectiveness. UR - https://mhealth.jmir.org/2019/12/e13229 UR - http://dx.doi.org/10.2196/13229 UR - http://www.ncbi.nlm.nih.gov/pubmed/31833835 ID - info:doi/10.2196/13229 ER - TY - JOUR AU - Harsha, Prathiba AU - Paul, E. James AU - Chong, A. Matthew AU - Buckley, Norm AU - Tidy, Antonella AU - Clarke, Anne AU - Buckley, Diane AU - Sirko, Zenon AU - Vanniyasingam, Thuva AU - Walsh, Jake AU - McGillion, Michael AU - Thabane, Lehana PY - 2019/10/28 TI - Challenges With Continuous Pulse Oximetry Monitoring and Wireless Clinician Notification Systems After Surgery: Reactive Analysis of a Randomized Controlled Trial JO - JMIR Med Inform SP - e14603 VL - 7 IS - 4 KW - continuous pulse oximetry KW - wireless notification KW - issues KW - evaluation of issues KW - clinical adoption framework KW - remote monitoring KW - postoperative monitoring KW - false alarm N2 - Background: Research has shown that introducing electronic Health (eHealth) patient monitoring interventions can improve healthcare efficiency and clinical outcomes. The VIGILANCE (VItal siGns monItoring with continuous puLse oximetry And wireless cliNiCian notification aftEr surgery) study was a randomized controlled trial (n=2049) designed to assess the impact of continuous vital sign monitoring with alerts sent to nursing staff when respiratory resuscitations with naloxone, code blues, and intensive care unit transfers occurred in a cohort of postsurgical patients in a ward setting. This report identifies and evaluates key issues and challenges associated with introducing wireless monitoring systems into complex hospital infrastructure during the VIGILANCE eHealth intervention implementation. Potential solutions and suggestions for future implementation research are presented. Objective: The goals of this study were to: (1) identify issues related to the deployment of the eHealth intervention system of the VIGILANCE study; and (2) evaluate the influence of these issues on intervention adoption. Methods: During the VIGILANCE study, issues affecting the implementation of the eHealth intervention were documented on case report forms, alarm event forms, and a nursing user feedback questionnaire. These data were collated by the research and nursing personnel and submitted to the research coordinator. In this evaluation report, the clinical adoption framework was used as a guide to organize the identified issues and evaluate their impact. Results: Using the clinical adoption framework, we identified issues within the framework dimensions of people, organization, and implementation at the meso level, as well as standards and funding issues at the macro level. Key issues included: nursing workflow changes with blank alarm forms (24/1030, 2.33%) and missing alarm forms (236/1030, 22.91%), patient withdrawal (110/1030, 10.68%), wireless network connectivity, false alarms (318/1030, 30.87%), monitor malfunction (36/1030, 3.49%), probe issues (16/1030, 1.55%), and wireless network standards. At the micro level, these issues affected the quality of the service in terms of support provided, the quality of the information yielded by the monitors, and the functionality, reliability, and performance of the monitoring system. As a result, these issues impacted access through the decreased ability of nurses to make complete use of the monitors, impacted care quality of the trial intervention through decreased effectiveness, and impacted productivity through interference in the coordination of care, thus decreasing clinical adoption of the monitoring system. Conclusions: Patient monitoring with eHealth technology in surgical wards has the potential to improve patient outcomes. However, proper planning that includes engagement of front-line nurses, installation of appropriate wireless network infrastructure, and use of comfortable cableless devices is required to maximize the potential of eHealth monitoring. Trial Registration: ClinicalTrials.gov NCT02907255; https://clinicaltrials.gov/ct2/show/NCT02907255 UR - http://medinform.jmir.org/2019/4/e14603/ UR - http://dx.doi.org/10.2196/14603 UR - http://www.ncbi.nlm.nih.gov/pubmed/31661079 ID - info:doi/10.2196/14603 ER - TY - JOUR AU - Mazoteras-Pardo, Victoria AU - Becerro-De-Bengoa-Vallejo, Ricardo AU - Losa-Iglesias, Elena Marta AU - López-López, Daniel AU - Palomo-López, Patricia AU - Rodríguez-Sanz, David AU - Calvo-Lobo, César PY - 2019/03/19 TI - Validation in the General Population of the iHealth Track Blood Pressure Monitor for Self-Measurement According to the European Society of Hypertension International Protocol Revision 2010: Descriptive Investigation JO - JMIR Mhealth Uhealth SP - e13137 VL - 7 IS - 3 KW - blood pressure determination KW - heart rate determination KW - validation studies KW - telemedicine N2 - Background: High blood pressure is one of the most common reasons why patients seek assistance in daily clinical practice. Screening for hypertension is fundamental and, because hypertension is identified only when blood pressure is measured, accurate measurements are key to the diagnosis and management of this disease. The European Society of Hypertension International Protocol revision 2010 (ESH-IP2) was developed to assess the validity of automatic blood pressure measuring devices that are increasingly being used to replace mercury sphygmomanometers. Objective: We sought to determine whether the iHealth Track blood pressure monitor meets ESH-IP2 requirements for self-measurement of blood pressure and heart rate at the brachial level and is appropriate for use in the general population. Methods: This study was a descriptive investigation. ESH-IP2 requires a total number of 33 participants. For each measure, the difference between observer and device blood pressure and heart rate values is calculated. In all, 99 pairs of blood pressure differences are classified into 3 categories (?5, ?10, and ?15 mm Hg), and 99 pairs of heart rate differences are classified into 3 categories (?3, ?5, and ?8 beats/min). We followed these protocol procedures in a convenience sample of 33 participants. Results: iHealth Track fulfilled ESH-IP2 requirements and passed the validation process successfully. We observed an absolute difference within 5 mm Hg in 75 of 99 comparisons for systolic blood pressure, 78 of 99 comparisons for diastolic blood pressure, and 89 of 99 comparisons for heart rate. The mean differences between the test and standard readings were 4.19 (SD 4.48) mm Hg for systolic blood pressure, 3.74 (SD 4.55) mm Hg for diastolic blood pressure, and 1.95 (SD 3.27) beats/min for heart rate. With regard to part 2 of ESH-IP2, we observed a minimum of 2 of 3 measurements within a 5-mm Hg difference in 29 of 33 participants for systolic blood pressure and 26 of 33 for diastolic blood pressure, and a minimum of 2 of 3 measurements within a 3-beat/min difference in 30 of 33 participants for heart rate. Conclusions: iHealth Track readings differed from the standard by less than 5, 10, and 15 mm Hg, fulfilling ESH-IP2 requirements. Consequently, this device is suitable for use in the general population. UR - http://mhealth.jmir.org/2019/3/e13137/ UR - http://dx.doi.org/10.2196/13137 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888331 ID - info:doi/10.2196/13137 ER - TY - JOUR AU - Falter, Maarten AU - Budts, Werner AU - Goetschalckx, Kaatje AU - Cornelissen, Véronique AU - Buys, Roselien PY - 2019/03/19 TI - Accuracy of Apple Watch Measurements for Heart Rate and Energy Expenditure in Patients With Cardiovascular Disease: Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e11889 VL - 7 IS - 3 KW - mobile health KW - heart rate KW - energy expenditure KW - validation KW - Apple Watch KW - wrist-worn devices KW - cardiovascular rehabilitation N2 - Background: Wrist-worn tracking devices such as the Apple Watch are becoming more integrated in health care. However, validation studies of these consumer devices remain scarce. Objectives: This study aimed to assess if mobile health technology can be used for monitoring home-based exercise in future cardiac rehabilitation programs. The purpose was to determine the accuracy of the Apple Watch in measuring heart rate (HR) and estimating energy expenditure (EE) during a cardiopulmonary exercise test (CPET) in patients with cardiovascular disease. Methods: Forty patients (mean age 61.9 [SD 15.2] yrs, 80% male) with cardiovascular disease (70% ischemic, 22.5% valvular, 7.5% other) completed a graded maximal CPET on a cycle ergometer while wearing an Apple Watch. A 12-lead electrocardiogram (ECG) was used to measure HR; indirect calorimetry was used for EE. HR was analyzed at three levels of intensity (seated rest, HR1; moderate intensity, HR2; maximal performance, HR3) for 30 seconds. The EE of the entire test was used. Bias or mean difference (MD), standard deviation of difference (SDD), limits of agreement (LoA), mean absolute error (MAE), mean absolute percentage error (MAPE), and intraclass correlation coefficients (ICCs) were calculated. Bland-Altman plots and scatterplots were constructed. Results: SDD for HR1, HR2, and HR3 was 12.4, 16.2, and 12.0 bpm, respectively. Bias and LoA (lower, upper LoA) were 3.61 (?20.74, 27.96) for HR1, 0.91 (?30.82, 32.63) for HR2, and ?1.82 (?25.27, 21.63) for HR3. MAE was 6.34 for HR1, 7.55 for HR2, and 6.90 for HR3. MAPE was 10.69% for HR1, 9.20% for HR2, and 6.33% for HR3. ICC was 0.729 (P<.001) for HR1, 0.828 (P<.001) for HR2, and 0.958 (P<.001) for HR3. Bland-Altman plots and scatterplots showed good correlation without systematic error when comparing Apple Watch with ECG measurements. SDD for EE was 17.5 kcal. Bias and LoA were 30.47 (?3.80, 64.74). MAE was 30.77; MAPE was 114.72%. ICC for EE was 0.797 (P<.001). The Bland-Altman plot and a scatterplot directly comparing Apple Watch and indirect calorimetry showed systematic bias with an overestimation of EE by the Apple Watch. Conclusions: In patients with cardiovascular disease, the Apple Watch measures HR with clinically acceptable accuracy during exercise. If confirmed, it might be considered safe to incorporate the Apple Watch in HR-guided training programs in the setting of cardiac rehabilitation. At this moment, however, it is too early to recommend the Apple Watch for cardiac rehabilitation. Also, the Apple Watch systematically overestimates EE in this group of patients. Caution might therefore be warranted when using the Apple Watch for measuring EE. UR - http://mhealth.jmir.org/2019/3/e11889/ UR - http://dx.doi.org/10.2196/11889 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888332 ID - info:doi/10.2196/11889 ER - TY - JOUR AU - Huang, Ching-Chang AU - Chen, Ying-Hsien AU - Hung, Chi-Sheng AU - Lee, Jen-Kuang AU - Hsu, Tse-Pin AU - Wu, Hui-Wen AU - Chuang, Pao-Yu AU - Chen, Ming-Fong AU - Ho, Yi-Lwun PY - 2019/03/04 TI - Assessment of the Relationship Between Ambient Temperature and Home Blood Pressure in Patients From a Web-Based Synchronous Telehealth Care Program: Retrospective Study JO - J Med Internet Res SP - e12369 VL - 21 IS - 3 KW - ambient temperature KW - home blood pressure KW - antihypertensive agents KW - retrospective studies N2 - Background: Decreased ambient temperature significantly increases office blood pressure, but few studies have evaluated the effect of ambient temperature on home blood pressure. Objective: We aimed to investigate the relationship between short-term ambient temperature exposure and home blood pressure. Methods: We recruited patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital. Blood pressure was measured at home by patients or their caregivers. We obtained hourly meteorological data for Taipei (temperature, relative humidity, and wind speed) for the same time period from the Central Weather Bureau, Taiwan. Results: From 2009 to 2013, we enrolled a total of 253 patients. Mean patient age was 70.28 (SD 13.79) years, and 66.0% (167/253) of patients were male. We collected a total of 110,715 home blood pressure measurements. Ambient temperature had a negative linear effect on all 3 home blood pressure parameters after adjusting for demographic and clinical factors and antihypertensive agents. A 1°C decrease was associated with a 0.5492-mm Hg increase in mean blood pressure, a 0.6841-mm Hg increase in systolic blood pressure, and a 0.2709-mm Hg increase in diastolic blood pressure. This temperature effect on home blood pressure was less prominent in patients with diabetes or hypertension. Antihypertensive agents modified this negative effect of temperature on home blood pressure to some extent, and angiotensin receptor blockers had the most favorable results. Conclusions: Short-term exposure to low ambient temperature significantly increased home blood pressure in patients with chronic cardiovascular diseases. Antihypertensive agents may modify this effect. UR - http://www.jmir.org/2019/3/e12369/ UR - http://dx.doi.org/10.2196/12369 UR - http://www.ncbi.nlm.nih.gov/pubmed/30829574 ID - info:doi/10.2196/12369 ER - TY - JOUR AU - Ware, Patrick AU - Dorai, Mala AU - Ross, J. Heather AU - Cafazzo, A. Joseph AU - Laporte, Audrey AU - Boodoo, Chris AU - Seto, Emily PY - 2019/02/26 TI - Patient Adherence to a Mobile Phone?Based Heart Failure Telemonitoring Program: A Longitudinal Mixed-Methods Study JO - JMIR Mhealth Uhealth SP - e13259 VL - 7 IS - 2 KW - telemonitoring KW - mHealth KW - adherence KW - heart failure N2 - Background: Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients consistently adhere to taking prescribed home readings. Objective: The objectives of this study were to (1) quantify the degree to which patients adhered to taking prescribed home readings in the context of a mobile phone?based TM program and (2) explain longitudinal adherence rates based on the duration of program enrollment, patient characteristics, and patient perceptions of the TM program. Methods: A mixed-methods explanatory sequential design was used to meet the 2 research objectives, and all explanatory methods were guided by the unified theory of acceptance and use of technology 2 (UTAUT2). Overall adherence rates were calculated as the proportion of days patients took weight, blood pressure, heart rate, and symptom readings over the total number of days they were enrolled in the program up to 1 year. Monthly adherence rates were also calculated as the proportion of days patients took the same 4 readings over each 30-day period following program enrollment. Next, simple and multivariate regressions were performed to determine the influence of time, age, sex, and disease severity on adherence rates. Additional explanatory methods included questionnaires at 6 and 12 months probing patients on the perceived benefits and ease of use of the TM program, an analysis of reasons for patients leaving the program, and semistructured interviews conducted with a purposeful sampling of patients (n=24) with a range of adherence rates and demographics. Results: Overall average adherence was 73.6% (SD 25.0) with average adherence rates declining over time at a rate of 1.4% per month (P<.001). The multivariate regressions found no significant effect of sex and disease severity on adherence rates. When grouping patients? ages by decade, age was a significant predictor (P=.04) whereby older patients had higher adherence rates over time. Adherence rates were further explained by patients? perceptions with regard to the themes of (1) performance expectancy (improvements in HF management and peace of mind), (2) effort expectancy (ease of use and technical issues), (3) facilitating conditions (availability of technical support and automated adherence calls), (4) social influence (support from family, friends, and trusted clinicians), and (5) habit (degree to which taking readings became automatic). Conclusions: The decline in adherence rates over time is consistent with findings from other studies. However, this study also found adherence to be the highest and most consistent over time in older age groups and progressively lower over time for younger age groups. These findings can inform the design and implementation of TM interventions that maximize patient adherence, which will enable a more accurate evaluation of impact and optimization of resources. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9911 UR - http://mhealth.jmir.org/2019/2/e13259/ UR - http://dx.doi.org/10.2196/13259 UR - http://www.ncbi.nlm.nih.gov/pubmed/30806625 ID - info:doi/10.2196/13259 ER - TY - JOUR AU - Warner, E. Bronwen AU - Velardo, Carmelo AU - Salvi, Dario AU - Lafferty, Kathryn AU - Crosbie, Sarah AU - Herrington, G. William AU - Haynes, Richard PY - 2018/12/21 TI - Feasibility of Telemonitoring Blood Pressure in Patients With Kidney Disease (Oxford Heart and Renal Protection Study-1): Observational Study JO - JMIR Cardio SP - e11332 VL - 2 IS - 2 KW - chronic kidney disease KW - blood pressure KW - telemonitoring KW - mobile phone N2 - Background: Blood pressure (BP) is a key modifiable risk factor for patients with chronic kidney disease (CKD), with current guidelines recommending strict control to reduce the risk of progression of both CKD and cardiovascular disease. Trials involving BP lowering require multiple visits to achieve target BP, which increases the costs of such trials, and in routine care, BP measured in the clinic may not accurately reflect the usual BP. Objective: We sought to assess whether a telemonitoring system for BP (using a Bluetooth-enabled BP machine that could transmit BP measurements to a tablet device installed with a bespoke app to guide the measurement of BP and collect questionnaire data) was acceptable to patients with CKD and whether patients would provide sufficient BP readings to assess variability and guide treatment. Methods: A total of 25 participants with CKD were trained to use the telemonitoring equipment and asked to record BP daily for 30 days, attend a study visit, and then record BP on alternate days for the next 60 days. They were also offered a wrist-worn applanation tonometry device (BPro) which measures BP every 15 minutes over a 24-hour period. Participants were given questionnaires at the 1- and 3-month time points; the questionnaires were derived from the System Usability Scale and Technology Acceptance Model. All eligible participants completed the study. Results: Mean participant age was 58 (SD 11) years, and mean estimated glomerular filtration rate was 36 (SD 13) mL/min/1.73m2. 13/25 (52%) participants provided >90% of the expected data and 18/25 (72%) provided >80% of the expected data. The usability of the telemonitoring system was rated highly, with mean scores of 84.9/100 (SE 2.8) after 30 days and 84.2/100 (SE 4.1) after 90 days. The coefficient of variation for the variability of systolic BP telemonitoring was 9.4% (95% CI 7.8-10.9) compared with 7.9% (95% CI 6.4-9.5) for the BPro device, P=.05 (and was 9.0% over 1 year in a recently completed trial with identical eligibility criteria), indicating that most variation in BP was short term. Conclusions: Telemonitoring is acceptable for patients with CKD and provides sufficient data to inform titration of antihypertensive therapies in either a randomized trial setting (comparing BP among different targets) or routine clinical practice. Such methods could be employed in both scenarios and reduce costs currently associated with such activities. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN13725286; http://www.isrctn.com/ISRCTN13725286 (Archived by WebCite at http://www.webcitation.org/74PAX51Ji). UR - http://cardio.jmir.org/2018/2/e11332/ UR - http://dx.doi.org/10.2196/11332 UR - http://www.ncbi.nlm.nih.gov/pubmed/30596204 ID - info:doi/10.2196/11332 ER - TY - JOUR AU - Isaranuwatchai, Wanrudee AU - Redwood, Olwen AU - Schauer, Adrian AU - Van Meer, Tim AU - Vallée, Jonathan AU - Clifford, Patrick PY - 2018/12/20 TI - A Remote Patient Monitoring Intervention for Patients With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Pre-Post Economic Analysis of the Smart Program JO - JMIR Cardio SP - e10319 VL - 2 IS - 2 KW - chronic heart failure KW - chronic obstructive pulmonary disease KW - costs KW - economic analysis KW - emergency department visits KW - hospitalizations KW - health service utilization KW - remote patient monitoring N2 - Background: Exacerbation of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are associated with high health care costs owing to increased emergency room (ER) visits and hospitalizations. Remote patient monitoring (RPM) interventions aim to improve the monitoring of symptoms to detect early deterioration and provide self-management strategies. As a result, RPM aims to reduce health resource utilization. To date, studies have inconsistently reported the benefits of RPM in chronic illnesses. The Smart Program is an RPM intervention that aims to provide clinical benefit to patients and economic benefit to health care payers. Objective: This study aims to economically evaluate the potential benefits of the Smart Program in terms of hospitalizations and ER visits and, thus, associated health care costs from the perspective of the public health care system. Methods: Seventy-four patients diagnosed with COPD or CHF from one hospital site were included in this one-group, pre-post study. The study involved a secondary data analysis of deidentified data collected during the study period ? from 3 months before program initiation (baseline), during the program, to 3 months after program completion (follow-up). Descriptive analysis was conducted for the study population characteristics at baseline, the clinical frailty score at baseline and 3-month follow-up, client satisfaction at 3-month follow-up, and number and costs of ER visits and hospitalizations throughout the study period. Furthermore, the cost of the Smart Program over a 3-month period was calculated from the perspective of the potential implementer. Results: The baseline characteristics of the study population (N=74) showed that the majority of patients had COPD (50/74, 68%), were female (42/74, 57%), and had an average age of 72 (SD 12) years. Using the Wilcoxon signed-rank test, the number of ER visits and hospitalizations, including their associated costs, were significantly reduced between baseline and 3-month follow-up (P<.001). The intervention showed a potential 68% and 35% reduction in ER visits and hospitalizations, respectively, between the 3-month pre- and 3-month postintervention period. The average cost of ER visits reduced from Can $243 at baseline to Can $67 during the 3-month follow-up, and reduced from Can $3842 to Can $1399 for hospitalizations. Conclusions: In this study, the number and cost of ER visits and hospitalizations appeared to be markedly reduced for patients with COPD or CHF when comparing data before and after the Smart Program implementation. Recognizing the limitations of the one-group, pre-post study design, RPM requires an upfront investment, but it has the potential to reduce health care costs to the system over time. This study represents another piece of evidence to support the potential value of RPM among patients with COPD or CHF. UR - http://cardio.jmir.org/2018/2/e10319/ UR - http://dx.doi.org/10.2196/10319 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758770 ID - info:doi/10.2196/10319 ER - TY - JOUR AU - Ware, Patrick AU - Ross, J. Heather AU - Cafazzo, A. Joseph AU - Laporte, Audrey AU - Gordon, Kayleigh AU - Seto, Emily PY - 2018/12/06 TI - User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study JO - JMIR Cardio SP - e11466 VL - 2 IS - 2 KW - telemonitoring KW - mHealth KW - diffusion of innovation KW - heart failure N2 - Background: Telemonitoring interventions for the management of heart failure have seen limited adoption in Canadian health systems, but isolated examples of telemonitoring programs do exist. An example of such a program was launched in a specialty heart failure clinic in Toronto, Canada, and a recent implementation evaluation concluded that reducing the cost of delivering the program is necessary to ensure its sustainability and scalability. Objective: The objectives of this study were to (1) understand which components of the telemonitoring program could be modified to reduce costs and adapted to other contexts while maintaining program fidelity and (2) describe the changes made to the telemonitoring program to enable its sustainability within the initial implementation site and scalability to other health organizations. Methods: Semistructured interviews probed the experiences of patients (n=23) and clinicians (n=8) involved in the telemonitoring program to identify opportunities for cost reduction and resource optimization. Ideas for adapting the program were informed by the interview results and prioritized based on (1) potential impact for sustainability and scalability, (2) feasibility, and (3) perceived risks to negatively impacting the program?s ability to yield desired health outcomes. Results: A total of 5 themes representing opportunities for cost reduction were discussed, including (1) Bring Your Own Device (BYOD), (2) technical support, (3) clinician role, (4) duration of enrollment, and (5) intensity of monitoring. The hardware used for the telemonitoring system and the modalities of providing technical support were found to be highly adaptable, which supported the decision to implement a BYOD model, whereby patients used their own smartphone, weight scale, and blood pressure cuff. Changes also included the development of a website aimed at reducing the burden on a technical support telehealth analyst. In addition, the interviews suggested that although it is important to have a clinician who is part of a patient?s circle of care monitoring telemonitoring alerts, the skill level and experience were moderately adaptable. Thus, a registered nurse was determined to be more cost-effective and was hired to replace the existing nurse practitioners in the frontline management of telemonitoring alerts and take over the technical support role from a telehealth analyst. Conclusions: This study provides a user-centered example of how necessary cost-reduction actions can be taken to ensure the sustainability and scalability of telemonitoring programs. In addition, the findings offer insights into what components of a telemonitoring program can be safely adapted to ensure its integration in various clinical settings. UR - http://cardio.jmir.org/2018/2/e11466/ UR - http://dx.doi.org/10.2196/11466 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758774 ID - info:doi/10.2196/11466 ER - TY - JOUR AU - Lee, Ho Jang AU - Park, Rang Yu AU - Kweon, Solbi AU - Kim, Seulgi AU - Ji, Wonjun AU - Choi, Chang-Min PY - 2018/11/14 TI - A Cardiopulmonary Monitoring System for Patient Transport Within Hospitals Using Mobile Internet of Things Technology: Observational Validation Study JO - JMIR Mhealth Uhealth SP - e12048 VL - 6 IS - 11 KW - wearable device KW - patient safety KW - intrahospital transport KW - oxygen saturation KW - heart rate KW - mobile application KW - real-time monitoring N2 - Background: During intrahospital transport, adverse events are inevitable. Real-time monitoring can be helpful for preventing these events during intrahospital transport. Objective: We attempted to determine the viability of risk signal detection using wearable devices and mobile apps during intrahospital transport. An alarm was sent to clinicians in the event of oxygen saturation below 90%, heart rate above 140 or below 60 beats per minute (bpm), and network errors. We validated the reliability of the risk signal transmitted over the network. Methods: We used two wearable devices to monitor oxygen saturation and heart rate for 23 patients during intrahospital transport for diagnostic workup or rehabilitation. To determine the agreement between the devices, records collected every 4 seconds were matched and imputation was performed if no records were collected at the same time by both devices. We used intraclass correlation coefficients (ICC) to evaluate the relationships between the two devices. Results: Data for 21 patients were delivered to the cloud over LTE, and data for two patients were delivered over Wi-Fi. Monitoring devices were used for 20 patients during intrahospital transport for diagnostic work up and for three patients during rehabilitation. Three patients using supplemental oxygen before the study were included. In our study, the ICC for the heart rate between the two devices was 0.940 (95% CI 0.939-0.942) and that of oxygen saturation was 0.719 (95% CI 0.711-0.727). Systemic error analyzed with Bland-Altman analysis was 0.428 for heart rate and ?1.404 for oxygen saturation. During the study, 14 patients had 20 risk signals: nine signals for eight patients with less than 90% oxygen saturation, four for four patients with a heart rate of 60 bpm or less, and seven for five patients due to network error. Conclusions: We developed a system that notifies the health care provider of the risk level of a patient during transportation using a wearable device and a mobile app. Although there were some problems such as missing values and network errors, this paper is meaningful in that the previously mentioned risk detection system was validated with actual patients. UR - http://mhealth.jmir.org/2018/11/e12048/ UR - http://dx.doi.org/10.2196/12048 UR - http://www.ncbi.nlm.nih.gov/pubmed/30429115 ID - info:doi/10.2196/12048 ER - TY - JOUR AU - Walsh, MJ Deirdre AU - Moran, Kieran AU - Cornelissen, Véronique AU - Buys, Roselien AU - Cornelis, Nils AU - Woods, Catherine PY - 2018/05/08 TI - Electronic Health Physical Activity Behavior Change Intervention to Self-Manage Cardiovascular Disease: Qualitative Exploration of Patient and Health Professional Requirements JO - J Med Internet Res SP - e163 VL - 20 IS - 5 KW - telemedicine KW - exercise KW - cardiovascular diseases KW - rehabilitation N2 - Background: Cardiovascular diseases are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation. Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based cardiac rehabilitation programs is low, with community-based cardiac rehabilitation rates and individual long-term exercise maintenance even lower. Home-based cardiac rehabilitation programs have been shown to be equally effective in clinical and health-related quality of life outcomes and yet are not readily available. Objective: Given the potential that home-based cardiac rehabilitation programs have, it is important to explore how to appropriately design any such intervention in conjunction with key stakeholders. The aim of this study was to engage with individuals with cardiovascular disease and other professionals within the health ecosystem to (1) understand the personal, social, and physical factors that inhibit or promote their capacity to engage with physical activity and (2) explore their technology competencies, needs, and wants in relation to an eHealth intervention. Methods: Fifty-four semistructured interviews were conducted across two countries. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Barriers to the implementation of PATHway were also explored specifically in relation to physical capability and safety as well as technology readiness and further mapped onto the COM-B model for future intervention design. Results: Key recommendations included collection of patient data and use of measurements, harnessing hospital based social connections, and advice to utilize a patient-centered approach with personalization and tailoring to facilitate optimal engagement. Conclusions: In summary, a multifaceted, personalizable intervention with an inclusively designed interface was deemed desirable for use among cardiovascular disease patients both by end users and key stakeholders. In-depth understanding of core needs of the population can aid intervention development and acceptability. UR - http://www.jmir.org/2018/5/e163/ UR - http://dx.doi.org/10.2196/jmir.9181 UR - http://www.ncbi.nlm.nih.gov/pubmed/29739740 ID - info:doi/10.2196/jmir.9181 ER - TY - JOUR AU - Ammenwerth, Elske AU - Modre-Osprian, Robert AU - Fetz, Bettina AU - Gstrein, Susanne AU - Krestan, Susanne AU - Dörler, Jakob AU - Kastner, Peter AU - Welte, Stefan AU - Rissbacher, Clemens AU - Pölzl, Gerhard PY - 2018/04/30 TI - HerzMobil, an Integrated and Collaborative Telemonitoring-Based Disease Management Program for Patients With Heart Failure: A Feasibility Study Paving the Way to Routine Care JO - JMIR Cardio SP - e11 VL - 2 IS - 1 KW - heart failure KW - telemedicine KW - delivery of health care, integrated KW - program evaluation N2 - Background: Heart failure is a major health problem associated with frequent hospital admissions. HerzMobil Tirol is a multidisciplinary postdischarge disease management program for heart failure patients to improve quality of life, prevent readmission, and reduce mortality and health care costs. It uses a telemonitoring system that is incorporated into a network of specialized heart failure nurses, physicians, and hospitals. Patients are equipped with a mobile phone, a weighing scale, and a blood pressure and heart rate monitor for daily acquisition and transmission of data on blood pressure, heart rate, weight, well-being, and drug intake. These data are transmitted daily and regularly reviewed by the network team. In addition, patients are scheduled for 3 visits with the network physician and 2 visits with the heart failure nurse within 3 months after hospitalization for acute heart failure. Objective: The objectives of this study were to evaluate the feasibility of HerzMobil Tirol by analyzing changes in health status as well as patients? self-care behavior and satisfaction and to derive recommendations for implementing a telemonitoring-based interdisciplinary disease management program for heart failure in everyday clinical practice. Methods: In this prospective, pilot, single-arm study including 35 elderly patients, the feasibility of HerzMobil Tirol was assessed by analyzing changes in health status (via Kansas City Cardiomyopathy Questionnaire, KCCQ), patients? self-care behavior (via European Heart Failure Self-Care Behavior Scale, revised into a 9-item scale, EHFScB-9), and user satisfaction (via Delone and McLean System Success Model). Results: A total of 43 patients joined the HerzMobil Tirol program, and of these, 35 patients completed it. The mean age of participants was 67 years (range: 43-86 years). Health status (KCCQ, range: 0-100) improved from 46.2 to 69.8 after 3 months. Self-care behavior (EHFScB-9, possible range: 9-22) after 3 months was 13.2. Patient satisfaction in all dimensions was 86% or higher. Lessons learned for the rollout of HerzMobil Tirol comprise a definite time schedule for interventions, solid network structures with clear process definition, a network coordinator, and specially trained heart failure nurses. Conclusions: On the basis of the positive evaluation results, HerzMobil Tirol has been officially introduced in the province of Tyrol in July 2017. It is, therefore, the first regular financed telehealth care program in Austria. UR - http://cardio.jmir.org/2018/1/e11/ UR - http://dx.doi.org/10.2196/cardio.9936 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758765 ID - info:doi/10.2196/cardio.9936 ER - TY - JOUR AU - Hermans, C. Mathilde AU - Van Mourik, S. Martijn AU - Hermens, J. Hermie AU - Baan Jr, Jan AU - Vis, M. Marije PY - 2018/03/16 TI - Remote Monitoring of Patients Undergoing Transcatheter Aortic Valve Replacement: A Framework for Postprocedural Telemonitoring JO - JMIR Cardio SP - e9 VL - 2 IS - 1 KW - transcatheter aortic valve replacement KW - postoperative care KW - electrocardiography KW - telemonitoring KW - telemedicine N2 - Background: The postprocedural trajectory of patients undergoing transcatheter aortic valve replacement (TAVR) involves in-hospital monitoring of potential cardiac rhythm or conduction disorders and other complications. Recent advances in telemonitoring technologies create opportunities to monitor electrocardiogram (ECG) and vital signs remotely, facilitating redesign of follow-up trajectories. Objective: This study aimed to outline a potential set-up of telemonitoring after TAVR. Methods: A multidisciplinary team systematically framed the envisioned telemonitoring scenario according to the intentions, People, Activities, Context, Technology (iPACT) and Functionality, Interaction, Content, Services (FICS) methods and identified corresponding technical requirements. Results: In this scenario, a wearable sensor system is used to continuously transmit ECG and contextual data to a central monitoring unit, allowing remote follow-up of ECG abnormalities and physical deteriorations. Telemonitoring is suggested as an alternative or supplement to current in-hospital monitoring after TAVR, enabling early hospital dismissal in eligible patients and accessible follow-up prolongation. Together, this approach aims to improve rehabilitation, enhance patient comfort, optimize hospital capacity usage, and reduce overall costs. Required technical components include continuous data acquisition, real-time data transfer, privacy-ensured storage, automatic event detection, and user-friendly interfaces. Conclusions: The suggested telemonitoring set-up involves a new approach to patient follow-up that could bring durable solutions for the growing scarcities in health care and for improving health care quality. To further explore the potential and feasibility of post-TAVR telemonitoring, we recommend evaluation of the overall impact on patient outcomes and of the safety, social, ethical, legal, organizational, and financial factors. UR - http://cardio.jmir.org/2018/1/e9/ UR - http://dx.doi.org/10.2196/cardio.9075 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758782 ID - info:doi/10.2196/cardio.9075 ER - TY - JOUR AU - Kropp, Caley AU - Ellis, Jordan AU - Nekkanti, Rajasekhar AU - Sears, Samuel PY - 2018/02/21 TI - Monitoring Patients With Implantable Cardioverter Defibrillators Using Mobile Phone Electrocardiogram: Case Study JO - JMIR Cardio SP - e5 VL - 2 IS - 1 KW - atrial fibrillation KW - ICD KW - ECG KW - mobile phone monitoring KW - mobile health KW - electrophysiology N2 - Background: Preventable poor health outcomes associated with atrial fibrillation continue to make early detection a priority. A one-lead mobile electrocardiogram (mECG) device given to patients with an implantable cardioverter defibrillator (ICD) allowed users to receive real-time ECG readings in 30 seconds. Objective: Three cases were selected from an institutional review board-approved clinical trial aimed at assessing mECG device usage and satisfaction, patient engagement, quality of life (QoL), and cardiac anxiety. These three specific cases were selected to examine a variety of possible patient presentations and user experiences. Methods: Three ICD patients with mobile phones who were being seen in an adult device clinic were asked to participate. The participants chosen represented individuals with varying degrees of reported education and patient engagement. Participants were instructed to use the mECG device at least once per day for 30 days. Positive ECGs for atrial fibrillation were evaluated in clinic. At follow-up, information was collected regarding their frequency of use of the mECG device and three psychological outcomes in the domains of patient engagement, QoL, and cardiac anxiety. Results: Each patient used the technology approximately daily or every other day as prescribed. At the 30-day follow-up, usage reports indicated an average of 32 readings per month per participant. At 90-day follow-up, usage reports indicated an average of 34 readings per month per participant. Two of the three participants self-reported a significant improvement in their physical QoL from baseline to completion, while simultaneously self-reporting a significant decrease in their mental QoL. All three participants reported high levels of device acceptance and technology satisfaction. Conclusions: This case study demonstrates that ICD patients with varying degrees of education and patient engagement were relatively active in their use of mECGs. All three participants using the mECG technology reported high technology satisfaction and device acceptance. High sensitivity, specificity, and accuracy of mECG technology may allow routine atrial fibrillation screening at lower costs, in addition to improving patient outcomes. UR - http://cardio.jmir.org/2018/1/e5/ UR - http://dx.doi.org/10.2196/cardio.8710 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758776 ID - info:doi/10.2196/cardio.8710 ER - TY - JOUR AU - Farnia, Troskah AU - Jaulent, Marie-Christine AU - Steichen, Olivier PY - 2018/01/16 TI - Evaluation Criteria of Noninvasive Telemonitoring for Patients With Heart Failure: Systematic Review JO - J Med Internet Res SP - e16 VL - 20 IS - 1 KW - telemedicine KW - outcome and process assessment (health care) KW - program evaluation KW - heart failure N2 - Background: Telemonitoring can improve heart failure (HF) management, but there is no standardized evaluation framework to comprehensively evaluate its impact. Objective: Our objectives were to list the criteria used in published evaluations of noninvasive HF telemonitoring projects, describe how they are used in the evaluation studies, and organize them into a consistent scheme. Methods: Articles published from January 1990 to August 2015 were obtained through MEDLINE, Web of Science, and EMBASE. Articles were eligible if they were original reports of a noninvasive HF telemonitoring evaluation study in the English language. Studies of implantable telemonitoring devices were excluded. Each selected article was screened to extract the description of the telemonitoring project and the evaluation process and criteria. A qualitative synthesis was performed. Results: We identified and reviewed 128 articles leading to 52 evaluation criteria classified into 6 dimensions: clinical, economic, user perspective, educational, organizational, and technical. The clinical and economic impacts were evaluated in more than 70% of studies, whereas the educational, organizational, and technical impacts were studied in fewer than 15%. User perspective was the most frequently covered dimension in the development phase of telemonitoring projects, whereas clinical and economic impacts were the focus of later phases. Conclusions: Telemonitoring evaluation frameworks should cover all 6 dimensions appropriately distributed along the telemonitoring project lifecycle. Our next goal is to build such a comprehensive evaluation framework for telemonitoring and test it on an ongoing noninvasive HF telemonitoring project. UR - http://www.jmir.org/2018/1/e16/ UR - http://dx.doi.org/10.2196/jmir.7873 UR - http://www.ncbi.nlm.nih.gov/pubmed/29339348 ID - info:doi/10.2196/jmir.7873 ER - TY - JOUR AU - Lee, Heesun AU - Park, Jun-Bean AU - Choi, Won Sae AU - Yoon, E. Yeonyee AU - Park, Eun Hyo AU - Lee, Eun Sang AU - Lee, Seung-Pyo AU - Kim, Hyung-Kwan AU - Cho, Hyun-Jai AU - Choi, Su-Yeon AU - Lee, Hae-Young AU - Choi, Jonghyuk AU - Lee, Young-Joon AU - Kim, Yong-Jin AU - Cho, Goo-Yeong AU - Choi, Jinwook AU - Sohn, Dae-Won PY - 2017/10/02 TI - Impact of a Telehealth Program With Voice Recognition Technology in Patients With Chronic Heart Failure: Feasibility Study JO - JMIR Mhealth Uhealth SP - e127 VL - 5 IS - 10 KW - heart failure KW - telemedicine KW - selfcare KW - compliance N2 - Background: Despite the advances in the diagnosis and treatment of heart failure (HF), the current hospital-oriented framework for HF management does not appear to be sufficient to maintain the stability of HF patients in the long term. The importance of self-care management is increasingly being emphasized as a promising long-term treatment strategy for patients with chronic HF. Objective: The objective of this study was to evaluate whether a new information communication technology (ICT)?based telehealth program with voice recognition technology could improve clinical or laboratory outcomes in HF patients. Methods: In this prospective single-arm pilot study, we recruited 31 consecutive patients with chronic HF who were referred to our institute. An ICT-based telehealth program with voice recognition technology was developed and used by patients with HF for 12 weeks. Patients were educated on the use of this program via mobile phone, landline, or the Internet for the purpose of improving communication and data collection. Using these systems, we collected comprehensive data elements related to the risk of HF self-care management such as weight, diet, exercise, medication adherence, overall symptom change, and home blood pressure. The study endpoints were the changes observed in urine sodium concentration (uNa), Minnesota Living with Heart Failure (MLHFQ) scores, 6-min walk test, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) as surrogate markers for appropriate HF management. Results: Among the 31 enrolled patients, 27 (87%) patients completed the study, and 10 (10/27, 37%) showed good adherence to ICT-based telehealth program with voice recognition technology, which was defined as the use of the program for 100 times or more during the study period. Nearly three-fourths of the patients had been hospitalized at least once because of HF before the enrollment (20/27, 74%); 14 patients had 1, 2 patients had 2, and 4 patients had 3 or more previous HF hospitalizations. In the total study population, there was no significant interval change in laboratory and functional outcome variables after 12 weeks of ICT-based telehealth program. In patients with good adherence to ICT-based telehealth program, there was a significant improvement in the mean uNa (103.1 to 78.1; P=.01) but not in those without (85.4 to 96.9; P=.49). Similarly, a marginal improvement in MLHFQ scores was only observed in patients with good adherence (27.5 to 21.4; P=.08) but not in their counterparts (19.0 to 19.7; P=.73). The mean 6-min walk distance and NT-proBNP were not significantly increased in patients regardless of their adherence. Conclusions: Short-term application of ICT-based telehealth program with voice recognition technology showed the potential to improve uNa values and MLHFQ scores in HF patients, suggesting that better control of sodium intake and greater quality of life can be achieved by this program. UR - https://mhealth.jmir.org/2017/10/e127/ UR - http://dx.doi.org/10.2196/mhealth.7058 UR - http://www.ncbi.nlm.nih.gov/pubmed/28970189 ID - info:doi/10.2196/mhealth.7058 ER - TY - JOUR AU - Chen, Ying-Hsien AU - Hung, Chi-Sheng AU - Huang, Ching-Chang AU - Hung, Yu-Chien AU - Hwang, Juey-Jen AU - Ho, Yi-Lwun PY - 2017/09/26 TI - Atrial Fibrillation Screening in Nonmetropolitan Areas Using a Telehealth Surveillance System With an Embedded Cloud-Computing Algorithm: Prospective Pilot Study JO - JMIR Mhealth Uhealth SP - e135 VL - 5 IS - 9 KW - atrial fibrillation KW - screen KW - cloud-computing algorithm KW - electrocardiography N2 - Background: Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. Objective: The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. Methods: We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Results: Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4%, 22/922) residents with AF were identified by the physician?s ECG interpretation, and only 0.2% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5% (95% CI 77.2%-99.9%) and specificity of 97.7% (95% CI 96.5%-98.5%). The overall satisfaction score for the process of AF screening was 92.1%. Conclusions: AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. UR - https://mhealth.jmir.org/2017/9/e135/ UR - http://dx.doi.org/10.2196/mhealth.8290 UR - http://www.ncbi.nlm.nih.gov/pubmed/28951384 ID - info:doi/10.2196/mhealth.8290 ER - TY - JOUR AU - Hargreaves, Sarah AU - Hawley, S. Mark AU - Haywood, Annette AU - Enderby, M. Pamela PY - 2017/06/28 TI - Informing the Design of ?Lifestyle Monitoring? Technology for the Detection of Health Deterioration in Long-Term Conditions: A Qualitative Study of People Living With Heart Failure JO - J Med Internet Res SP - e231 VL - 19 IS - 6 KW - independent living KW - human activities KW - heart failure KW - biomedical technology N2 - Background: Health technologies are being developed to help people living at home manage long-term conditions. One such technology is ?lifestyle monitoring? (LM), a telecare technology based on the idea that home activities may be monitored unobtrusively via sensors to give an indication of changes in health-state. However, questions remain about LM technology: how home activities change when participants experience differing health-states; and how sensors might capture clinically important changes to inform timely interventions. Objective: The objective of this paper was to report the findings of a study aimed at identifying changes in activity indicative of important changes in health in people with long-term conditions, particularly changes indicative of exacerbation, by exploring the relationship between home activities and health among people with heart failure (HF). We aimed to add to the knowledge base informing the development of home monitoring technologies designed to detect health deterioration in order to facilitate early intervention and avoid hospital admissions. Methods: This qualitative study utilized semistructured interviews to explore everyday activities undertaken during the three health-states of HF: normal days, bad days, and exacerbations. Potential recruits were identified by specialist nurses and attendees at an HF support group. The sample was purposively selected to include a range of experience of living with HF. Results: The sample comprised a total of 20 people with HF aged 50 years and above, and 11 spouses or partners of the individuals with HF. All resided in Northern England. Participant accounts revealed that home activities are in part shaped by the degree of intrusion from HF symptoms. During an exacerbation, participants undertook activities specifically to ease symptoms, and detailed activity changes were identified. Everyday activity was also influenced by a range of factors other than health. Conclusions: The study highlights the importance of careful development of LM technology to identify changes in activities that occur during clinically important changes in health. These detailed activity changes need to be considered by developers of LM sensors, platforms, and algorithms intended to detect early signs of deterioration. Results suggest that for LM to move forward, sensor set-up should be personalized to individual circumstances and targeted at individual health conditions. LM needs to take account of the uncertainties that arise from placing technology within the home, in order to inform sensor set-up and data interpretation. This targeted approach is likely to yield more clinically meaningful data and address some of the ethical issues of remote monitoring. UR - http://www.jmir.org/2017/6/e231/ UR - http://dx.doi.org/10.2196/jmir.6931 UR - http://www.ncbi.nlm.nih.gov/pubmed/28659253 ID - info:doi/10.2196/jmir.6931 ER - TY - JOUR AU - Hanlon, Peter AU - Daines, Luke AU - Campbell, Christine AU - McKinstry, Brian AU - Weller, David AU - Pinnock, Hilary PY - 2017/05/17 TI - Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer JO - J Med Internet Res SP - e172 VL - 19 IS - 5 KW - telehealth KW - telemonitoring KW - self-management KW - chronic disease KW - diabetes KW - heart failure KW - asthma KW - COPD KW - pulmonary disease, chronic obstructive KW - cancer N2 - Background: Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. Objective: The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. Methods: We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. Results: We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma. Conclusions: While telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established. UR - http://www.jmir.org/2017/5/e172/ UR - http://dx.doi.org/10.2196/jmir.6688 UR - http://www.ncbi.nlm.nih.gov/pubmed/28526671 ID - info:doi/10.2196/jmir.6688 ER - TY - JOUR AU - Bashi, Nazli AU - Karunanithi, Mohanraj AU - Fatehi, Farhad AU - Ding, Hang AU - Walters, Darren PY - 2017/01/20 TI - Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews JO - J Med Internet Res SP - e18 VL - 19 IS - 1 KW - systematic review KW - patient monitoring KW - mobile phone KW - telemedicine KW - heart failure N2 - Background: Many systematic reviews exist on the use of remote patient monitoring (RPM) interventions to improve clinical outcomes and psychological well-being of patients with heart failure. However, research is broadly distributed from simple telephone-based to complex technology-based interventions. The scope and focus of such evidence also vary widely, creating challenges for clinicians who seek information on the effect of RPM interventions. Objective: The aim of this study was to investigate the effects of RPM interventions on the health outcomes of patients with heart failure by synthesizing review-level evidence. Methods: We searched PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from 2005 to 2015. We screened reviews based on relevance to RPM interventions using criteria developed for this overview. Independent authors screened, selected, and extracted information from systematic reviews. AMSTAR (Assessment of Multiple Systematic Reviews) was used to assess the methodological quality of individual reviews. We used standardized language to summarize results across reviews and to provide final statements about intervention effectiveness. Results: A total of 19 systematic reviews met our inclusion criteria. Reviews consisted of RPM with diverse interventions such as telemonitoring, home telehealth, mobile phone?based monitoring, and videoconferencing. All-cause mortality and heart failure mortality were the most frequently reported outcomes, but others such as quality of life, rehospitalization, emergency department visits, and length of stay were also reported. Self-care and knowledge were less commonly identified. Conclusions: Telemonitoring and home telehealth appear generally effective in reducing heart failure rehospitalization and mortality. Other interventions, including the use of mobile phone?based monitoring and videoconferencing, require further investigation. UR - http://www.jmir.org/2017/1/e18/ UR - http://dx.doi.org/10.2196/jmir.6571 UR - http://www.ncbi.nlm.nih.gov/pubmed/28108430 ID - info:doi/10.2196/jmir.6571 ER - TY - JOUR AU - PY - 2016/12/18 TI - Supporting Heart Failure Patient Transitions From Acute to Community Care With Home Telemonitoring Technology: A Protocol for a Provincial Randomized Controlled Trial (TEC4Home) JO - JMIR Res Protoc SP - e198 VL - 5 IS - 4 KW - heart failure KW - telemedicine KW - remote sensing technology KW - emergency service, hospital KW - hospitalization KW - quality of life N2 - Background: Seniors with chronic diseases such as heart failure have complex care needs. They are vulnerable to their condition deteriorating and, without timely intervention, may require multiple emergency department visits and/or repeated hospitalizations. Upon discharge, the transition from the emergency department to home can be a vulnerable time for recovering patients with disruptions in the continuity of care. Remote monitoring of heart failure patients using home telemonitoring, coupled with clear communication protocols between health care professionals, can be effective in increasing the safety and quality of care for seniors with heart failure discharged from the emergency department. Objective: The aim of the Telehealth for Emergency-Community Continuity of Care Connectivity via Home Telemonitoring (TEC4Home) study is to generate evidence through a programmatic evaluation and a clinical trial to determine how home telemonitoring may improve care and increase patient safety during the transition of care and determine how it is best implemented to support patients with heart failure within this context. Methods: This 4-year project consists of 3 studies to comprehensively evaluate the outcomes and effectiveness of TEC4Home. Study 1 is a feasibility study with 90 patients recruited from 2 emergency department sites to test implementation and evaluation procedures. Findings from the feasibility study will be used to refine protocols for the larger trial. Study 2 is a cluster randomized controlled trial that will include 30 emergency department sites and 900 patients across British Columbia. The primary outcome of the randomized controlled trial will be emergency department revisits and hospital readmission rates. Secondary outcomes include health care resource utilization/costs, communication between members of the care team, and patient quality of life. Study 3 will run concurrently to study 2 and test the effectiveness of predictive analytic software to detect patient deterioration sooner. Results: It is hypothesized that TEC4Home will be a cost-effective strategy to decrease 90-day emergency department revisits and hospital admission rates and improve comfort and quality of life for seniors with heart failure. The results from this project will also help establish an innovation pathway for rapid and rigorous introduction of innovation into the health system. Conclusions: While there is some evidence about the effectiveness of home telemonitoring for some patients and conditions, the TEC4Home project will be one of the first protocols that implements and evaluates the technology for patients with heart failure as they transition from the emergency department to home care. The results from this research are expected to inform the full scale and spread of the home monitoring approach throughout British Columbia and Canada and to other chronic diseases. ClinicalTrial: ClinicalTrials.gov NCT02821065; https://clinicaltrials.gov/ct2/show/NCT02821065 (Archived by WebCite at http://www.webcitation.org/6ml2iwKax) UR - http://www.researchprotocols.org/2016/4/e198/ UR - http://dx.doi.org/10.2196/resprot.5856 UR - http://www.ncbi.nlm.nih.gov/pubmed/27977002 ID - info:doi/10.2196/resprot.5856 ER - TY - JOUR AU - Masterson Creber, M. Ruth AU - Maurer, S. Mathew AU - Reading, Meghan AU - Hiraldo, Grenny AU - Hickey, T. Kathleen AU - Iribarren, Sarah PY - 2016/06/14 TI - Review and Analysis of Existing Mobile Phone Apps to Support Heart Failure Symptom Monitoring and Self-Care Management Using the Mobile Application Rating Scale (MARS) JO - JMIR Mhealth Uhealth SP - e74 VL - 4 IS - 2 KW - mobile apps KW - mobile health KW - heart failure KW - self-care KW - self-management KW - review KW - symptom assessment KW - nursing informatics N2 - Background: Heart failure is the most common cause of hospital readmissions among Medicare beneficiaries and these hospitalizations are often driven by exacerbations in common heart failure symptoms. Patient collaboration with health care providers and decision making is a core component of increasing symptom monitoring and decreasing hospital use. Mobile phone apps offer a potentially cost-effective solution for symptom monitoring and self-care management at the point of need. Objective: The purpose of this review of commercially available apps was to identify and assess the functionalities of patient-facing mobile health apps targeted toward supporting heart failure symptom monitoring and self-care management. Methods: We searched 3 Web-based mobile app stores using multiple terms and combinations (eg, ?heart failure,? ?cardiology,? ?heart failure and self-management?). Apps meeting inclusion criteria were evaluated using the Mobile Application Rating Scale (MARS), IMS Institute for Healthcare Informatics functionality scores, and Heart Failure Society of America (HFSA) guidelines for nonpharmacologic management. Apps were downloaded and assessed independently by 2-4 reviewers, interclass correlations between reviewers were calculated, and consensus was met by discussion. Results: Of 3636 potentially relevant apps searched, 34 met inclusion criteria. Most apps were excluded because they were unrelated to heart failure, not in English or Spanish, or were games. Interrater reliability between reviewers was high. AskMD app had the highest average MARS total (4.9/5). More than half of the apps (23/34, 68%) had acceptable MARS scores (>3.0). Heart Failure Health Storylines (4.6) and AskMD (4.5) had the highest scores for behavior change. Factoring MARS, functionality, and HFSA guideline scores, the highest performing apps included Heart Failure Health Storylines, Symple, ContinuousCare Health App, WebMD, and AskMD. Peer-reviewed publications were identified for only 3 of the 34 apps. Conclusions: This review suggests that few apps meet prespecified criteria for quality, content, or functionality, highlighting the need for further refinement and mapping to evidence-based guidelines and room for overall quality improvement in heart failure symptom monitoring and self-care related apps. UR - http://mhealth.jmir.org/2016/2/e74/ UR - http://dx.doi.org/10.2196/mhealth.5882 UR - http://www.ncbi.nlm.nih.gov/pubmed/27302310 ID - info:doi/10.2196/mhealth.5882 ER - TY - JOUR AU - Agboola, Stephen AU - Jethwani, Kamal AU - Khateeb, Kholoud AU - Moore, Stephanie AU - Kvedar, Joseph PY - 2015/04/22 TI - Heart Failure Remote Monitoring: Evidence From the Retrospective Evaluation of a Real-World Remote Monitoring Program JO - J Med Internet Res SP - e101 VL - 17 IS - 4 KW - heart failure KW - telemonitoring KW - remote monitoring KW - self-management KW - hospitalizations KW - mortality N2 - Background: Given the magnitude of increasing heart failure mortality, multidisciplinary approaches, in the form of disease management programs and other integrative models of care, are recommended to optimize treatment outcomes. Remote monitoring, either as structured telephone support or telemonitoring or a combination of both, is fast becoming an integral part of many disease management programs. However, studies reporting on the evaluation of real-world heart failure remote monitoring programs are scarce. Objective: This study aims to evaluate the effect of a heart failure telemonitoring program, Connected Cardiac Care Program (CCCP), on hospitalization and mortality in a retrospective database review of medical records of patients with heart failure receiving care at the Massachusetts General Hospital. Methods: Patients enrolled in the CCCP heart failure monitoring program at the Massachusetts General Hospital were matched 1:1 with usual care patients. Control patients received care from similar clinical settings as CCCP patients and were identified from a large clinical data registry. The primary endpoint was all-cause mortality and hospitalizations assessed during the 4-month program duration. Secondary outcomes included hospitalization and mortality rates (obtained by following up on patients over an additional 8 months after program completion for a total duration of 1 year), risk for multiple hospitalizations and length of stay. The Cox proportional hazard model, stratified on the matched pairs, was used to assess primary outcomes. Results: A total of 348 patients were included in the time-to-event analyses. The baseline rates of hospitalizations prior to program enrollment did not differ significantly by group. Compared with controls, hospitalization rates decreased within the first 30 days of program enrollment: hazard ratio (HR)=0.52, 95% CI 0.31-0.86, P=.01). The differential effect on hospitalization rates remained consistent until the end of the 4-month program (HR=0.74, 95% CI 0.54-1.02, P=.06). The program was also associated with lower mortality rates at the end of the 4-month program: relative risk (RR)=0.33, 95% 0.11-0.97, P=.04). Additional 8-months follow-up following program completion did not show residual beneficial effects of the CCCP program on mortality (HR=0.64, 95% 0.34-1.21, P=.17) or hospitalizations (HR=1.12, 95% 0.90-1.41, P=.31). Conclusions: CCCP was associated with significantly lower hospitalization rates up to 90 days and significantly lower mortality rates over 120 days of the program. However, these effects did not persist beyond the 120-day program duration. UR - http://www.jmir.org/2015/4/e101/ UR - http://dx.doi.org/10.2196/jmir.4417 UR - http://www.ncbi.nlm.nih.gov/pubmed/25903278 ID - info:doi/10.2196/jmir.4417 ER - TY - JOUR AU - Zan, Shiyi AU - Agboola, Stephen AU - Moore, A. Stephanie AU - Parks, A. Kimberly AU - Kvedar, C. Joseph AU - Jethwani, Kamal PY - 2015/04/01 TI - Patient Engagement With a Mobile Web-Based Telemonitoring System for Heart Failure Self-Management: A Pilot Study JO - JMIR mHealth uHealth SP - e33 VL - 3 IS - 2 KW - heart failure KW - disease self-management KW - remote monitoring KW - telemonitoring KW - interactive voice response system KW - mobile health KW - Web portal KW - patient engagement KW - quality of life N2 - Background: Intensive remote monitoring programs for congestive heart failure have been successful in reducing costly readmissions, but may not be appropriate for all patients. There is an opportunity to leverage the increasing accessibility of mobile technologies and consumer-facing digital devices to empower patients in monitoring their own health outside of the hospital setting. The iGetBetter system, a secure Web- and telephone-based heart failure remote monitoring program, which leverages mobile technology and portable digital devices, offers a creative solution at lower cost. Objective: The objective of this pilot study was to evaluate the feasibility of using the iGetBetter system for disease self-management in patients with heart failure. Methods: This was a single-arm prospective study in which 21 ambulatory, adult heart failure patients used the intervention for heart failure self-management over a 90-day study period. Patients were instructed to take their weight, blood pressure, and heart rate measurements each morning using a WS-30 bluetooth weight scale, a self-inflating blood pressure cuff (Withings LLC, Issy les Moulineaux, France), and an iPad Mini tablet computer (Apple Inc, Cupertino, CA, USA) equipped with cellular Internet connectivity to view their measurements on the Internet. Outcomes assessed included usability and satisfaction, engagement with the intervention, hospital resource utilization, and heart failure-related quality of life. Descriptive statistics were used to summarize data, and matched controls identified from the electronic medical record were used as comparison for evaluating hospitalizations. Results: There were 20 participants (mean age 53 years) that completed the study. Almost all participants (19/20, 95%) reported feeling more connected to their health care team and more confident in performing care plan activities, and 18/20 (90%) felt better prepared to start discussions about their health with their doctor. Although heart failure-related quality of life improved from baseline, it was not statistically significant (P=.55). Over half of the participants had greater than 80% (72/90 days) weekly and overall engagement with the program, and 15% (3/20) used the interactive voice response telephone system exclusively for managing their care plan. Hospital utilization did not differ in the intervention group compared to the control group (planned hospitalizations P=.23, and unplanned hospitalizations P=.99). Intervention participants recorded shorter average length of hospital stay, but no significant differences were observed between intervention and control groups (P=.30). Conclusions: This pilot study demonstrated the feasibility of a low-intensive remote monitoring program leveraging commonly used mobile and portable consumer devices in augmenting care for a fairly young population of ambulatory patients with heart failure. Further prospective studies with a larger sample size and within more diverse patient populations is necessary to determine the effect of mobile-based remote monitoring programs such as the iGetBetter system on clinical outcomes in heart failure. UR - http://mhealth.jmir.org/2015/2/e33/ UR - http://dx.doi.org/10.2196/mhealth.3789 UR - http://www.ncbi.nlm.nih.gov/pubmed/25842282 ID - info:doi/10.2196/mhealth.3789 ER - TY - JOUR AU - Vuorinen, Anna-Leena AU - Leppänen, Juha AU - Kaijanranta, Hannu AU - Kulju, Minna AU - Heliö, Tiina AU - van Gils, Mark AU - Lähteenmäki, Jaakko PY - 2014/12/11 TI - Use of Home Telemonitoring to Support Multidisciplinary Care of Heart Failure Patients in Finland: Randomized Controlled Trial JO - J Med Internet Res SP - e282 VL - 16 IS - 12 KW - heart failure KW - telemonitoring KW - hospitalization KW - user experience KW - clinical outcomes KW - EHFSBS KW - health care resources N2 - Background: Heart failure (HF) patients suffer from frequent and repeated hospitalizations, causing a substantial economic burden on society. Hospitalizations can be reduced considerably by better compliance with self-care. Home telemonitoring has the potential to boost patients? compliance with self-care, although the results are still contradictory. Objective: A randomized controlled trial was conducted in order to study whether the multidisciplinary care of heart failure patients promoted with telemonitoring leads to decreased HF-related hospitalization. Methods: HF patients were eligible whose left ventricular ejection fraction was lower than 35%, NYHA functional class ?2, and who needed regular follow-up. Patients in the telemonitoring group (n=47) measured their body weight, blood pressure, and pulse and answered symptom-related questions on a weekly basis, reporting their values to the heart failure nurse using a mobile phone app. The heart failure nurse followed the status of patients weekly and if necessary contacted the patient. The primary outcome was the number of HF-related hospital days. Control patients (n=47) received multidisciplinary treatment according to standard practices. Patients? clinical status, use of health care resources, adherence, and user experience from the patients? and the health care professionals? perspective were studied. Results: Adherence, calculated as a proportion of weekly submitted self-measurements, was close to 90%. No difference was found in the number of HF-related hospital days (incidence rate ratio [IRR]=0.812, P=.351), which was the primary outcome. The intervention group used more health care resources: they paid an increased number of visits to the nurse (IRR=1.73, P<.001), spent more time at the nurse reception (mean difference of 48.7 minutes, P<.001), and there was a greater number of telephone contacts between the nurse and intervention patients (IRR=3.82, P<.001 for nurse-induced contacts and IRR=1.63, P=.049 for patient-induced contacts). There were no statistically significant differences in patients? clinical health status or in their self-care behavior. The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study. Conclusions: Home telemonitoring did not reduce the number of patients? HF-related hospital days and did not improve the patients? clinical condition. Patients in the telemonitoring group contacted the Cardiology Outpatient Clinic more frequently, and on this way increased the use of health care resources. Trial Registration: Clinicaltrials.gov NCT01759368; http://clinicaltrials.gov/show/NCT01759368 (Archived by WebCite at http://www.webcitation.org/6UFxiCk8Z). UR - http://www.jmir.org/2014/12/e282/ UR - http://dx.doi.org/10.2196/jmir.3651 UR - http://www.ncbi.nlm.nih.gov/pubmed/25498992 ID - info:doi/10.2196/jmir.3651 ER - TY - JOUR AU - Luzi, Mario AU - De Simone, Antonio AU - Leoni, Loira AU - Amellone, Claudia AU - Pisanò, Ennio AU - Favale, Stefano AU - Iacoviello, Massimo AU - Luise, Raffaele AU - Bongiorni, Grazia Maria AU - Stabile, Giuseppe AU - La Rocca, Vincenzo AU - Folino, Franco AU - Capucci, Alessandro AU - D'Onofrio, Antonio AU - Accardi, Francesco AU - Valsecchi, Sergio AU - Buia, Gianfranco PY - 2013/09/20 TI - Remote Monitoring for Implantable Defibrillators: A Nationwide Survey in Italy JO - Interact J Med Res SP - e27 VL - 2 IS - 2 KW - implantable defibrillator KW - remote monitoring KW - follow-up N2 - Background: Remote monitoring (RM) permits home interrogation of implantable cardioverter defibrillator (ICD) and provides an alternative option to frequent in-person visits. Objective: The Italia-RM survey aimed to investigate the current practice of ICD follow-up in Italy and to evaluate the adoption and routine use of RM. Methods: An ad hoc questionnaire on RM adoption and resource use during in-clinic and remote follow-up sessions was completed in 206 Italian implanting centers. Results: The frequency of routine in-clinic ICD visits was 2 per year in 158/206 (76.7%) centers, 3 per year in 37/206 (18.0%) centers, and 4 per year in 10/206 (4.9%) centers. Follow-up examinations were performed by a cardiologist in 203/206 (98.5%) centers, and by more than one health care worker in 184/206 (89.3%) centers. There were 137/206 (66.5%) responding centers that had already adopted an RM system, the proportion of ICD patients remotely monitored being 15% for single- and dual-chamber ICD and 20% for cardiac resynchronization therapy ICD. Remote ICD interrogations were scheduled every 3 months, and were performed by a cardiologist in 124/137 (90.5%) centers. After the adoption of RM, the mean time between in-clinic visits increased from 5 (SD 1) to 8 (SD 3) months (P<.001). Conclusions: In current clinical practice, in-clinic ICD follow-up visits consume a large amount of health care resources. The results of this survey show that RM has only partially been adopted in Italy and, although many centers have begun to implement RM in their clinical practice, the majority of their patients continue to be routinely followed-up by means of in-clinic visits. UR - http://www.i-jmr.org/2013/2/e27/ UR - http://dx.doi.org/10.2196/ijmr.2824 UR - http://www.ncbi.nlm.nih.gov/pubmed/24055720 ID - info:doi/10.2196/ijmr.2824 ER - TY - JOUR AU - Zanaboni, Paolo AU - Landolina, Maurizio AU - Marzegalli, Maurizio AU - Lunati, Maurizio AU - Perego, B. Giovanni AU - Guenzati, Giuseppe AU - Curnis, Antonio AU - Valsecchi, Sergio AU - Borghetti, Francesca AU - Borghi, Gabriella AU - Masella, Cristina PY - 2013/05/30 TI - Cost-Utility Analysis of the EVOLVO Study on Remote Monitoring for Heart Failure Patients With Implantable Defibrillators: Randomized Controlled Trial JO - J Med Internet Res SP - e106 VL - 15 IS - 5 KW - telemedicine KW - heart failure KW - implantable defibrillators KW - cost-effectiveness N2 - Background: Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. Objective: We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators. Methods: Two hundred patients implanted with a wireless transmission?enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained. Results: Overall, remote monitoring did not show significant annual cost savings for the health care system (?1962.78 versus ?2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (?291.36 versus ?381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of ?888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution. Conclusions: Remote management of heart failure patients with implantable defibrillators appears to be cost-effective compared to the conventional method of in-person evaluations. Trial Registration: ClinicalTrials.gov NCT00873899; http://clinicaltrials.gov/show/NCT00873899 (Archived by WebCite at http://www.webcitation.org/6H0BOA29f). UR - http://www.jmir.org/2013/5/e106/ UR - http://dx.doi.org/10.2196/jmir.2587 UR - http://www.ncbi.nlm.nih.gov/pubmed/23722666 ID - info:doi/10.2196/jmir.2587 ER - TY - JOUR AU - Seto, Emily AU - Leonard, J. Kevin AU - Cafazzo, A. Joseph AU - Barnsley, Jan AU - Masino, Caterina AU - Ross, J. Heather PY - 2012/02/16 TI - Mobile Phone-Based Telemonitoring for Heart Failure Management: A Randomized Controlled Trial JO - J Med Internet Res SP - e31 VL - 14 IS - 1 KW - heart failure KW - telemedicine KW - mobile phone KW - patient monitoring KW - randomized controlled trial N2 - Background: Previous trials of telemonitoring for heart failure management have reported inconsistent results, largely due to diverse intervention and study designs. Mobile phones are becoming ubiquitous and economical, but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined. Objective: The objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes. Methods: One hundred patients were recruited from a heart function clinic and randomized into telemonitoring and control groups. The telemonitoring group (N = 50) took daily weight and blood pressure readings and weekly single-lead ECGs, and answered daily symptom questions on a mobile phone over 6 months. Readings were automatically transmitted wirelessly to the mobile phone and then to data servers. Instructions were sent to the patients? mobile phones and alerts to a cardiologist?s mobile phone as required. Results: Baseline questionnaires were completed and returned by 94 patients, and 84 patients returned post-study questionnaires. About 70% of telemonitoring patients completed at least 80% of their possible daily readings. The change in quality of life from baseline to post-study, as measured with the Minnesota Living with Heart Failure Questionnaire, was significantly greater for the telemonitoring group compared to the control group (P = .05). A between-group analysis also found greater post-study self-care maintenance (measured with the Self-Care of Heart Failure Index) for the telemonitoring group (P = .03). Brain natriuretic peptide (BNP) levels, self-care management, and left ventricular ejection fraction (LVEF) improved significantly for both groups from baseline to post-study, but did not show a between-group difference. However, a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the telemonitoring group had significant improvements from baseline to post-study in BNP (decreased by 150 pg/mL, P = .02), LVEF (increased by 7.4%, P = .005) and self-care maintenance (increased by 7 points, P = .05) and management (increased by 14 points, P = .03), while the control group did not. No differences were found between the telemonitoring and control groups in terms of hospitalization, mortality, or emergency department visits, but the trial was underpowered to detect differences in these metrics. Conclusions: Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based telemonitoring system. The use of the mobile phone-based system had high adherence and was feasible for patients, including the elderly and those with no experience with mobile phones. Trial Registration: ClinicalTrials.gov NCT00778986 UR - http://www.jmir.org/2012/1/e31/ UR - http://dx.doi.org/10.2196/jmir.1909 UR - http://www.ncbi.nlm.nih.gov/pubmed/22356799 ID - info:doi/10.2196/jmir.1909 ER - TY - JOUR AU - Seto, Emily AU - Leonard, J. Kevin AU - Cafazzo, A. Joseph AU - Barnsley, Jan AU - Masino, Caterina AU - Ross, J. Heather PY - 2012/02/10 TI - Perceptions and Experiences of Heart Failure Patients and Clinicians on the Use of Mobile Phone-Based Telemonitoring JO - J Med Internet Res SP - e25 VL - 14 IS - 1 KW - heart failure KW - telemonitoring KW - mobile phone KW - patient monitoring KW - self-care KW - qualitative research N2 - Background: Previous trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs. Objectives: The objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring. Methods: Semi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based telemonitoring system for 6 months. The telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient?s mobile phone based on their physiological values. Alerts were also sent to a cardiologist?s mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach. Results: The telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients? heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from telemonitoring. Some clinical concerns included ongoing costs of the telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system. Conclusions: The success of a telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing telemonitoring solutions. Key Words: UR - http://www.jmir.org/2012/1/e25/ UR - http://dx.doi.org/10.2196/jmir.1912 UR - http://www.ncbi.nlm.nih.gov/pubmed/22328237 ID - info:doi/10.2196/jmir.1912 ER -