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Glynn L, Mc Cann M, Mc Cabe C. Smartphone applications supporting self-management programme for adults with Chronic Obstructive Pulmonary Disease: A Scoping Review. PLOS DIGITAL HEALTH 2024; 3:e0000532. [PMID: 38870123 PMCID: PMC11175531 DOI: 10.1371/journal.pdig.0000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) significantly impacts on both the quality and quantity of life for patients due to frequent exacerbations requiring hospital admissions resulting in increased morbidity and mortality. A self-management programme purpose is to increase one's knowledge, confidence, and skills to self-manage their chronic illness such as COPD. OBJECTIVE The objective of this review will therefore answer the following research question: What is the current literature pertaining to the use of a smartphone app in supporting a comprehensive self-management programme among COPD patients? A preliminary search was conducted in, Medline, Embase and CINAHL databases to ascertain index terms and keywords. Following this a rigorous search was carried out on Medline, Embase, CINAHL, Web of Science and ASSIA. The findings from this search are presented in tabular form using the PRSIMA flow diagram. RESULTS In this review, fifteen studies met the inclusion criteria. Across all studies participants engaged with the app and developed self-management skills and knowledge to manage their chronic illness. However, engagement with the app without third party involvement declined over time. Technical issues did not cause harm to participants but in some cases contributed to reduced engagement. Smartphone self-management apps empowered a cohort of COPD participants to engage in managing their chronic illness which proved useful in detecting exacerbations earlier resulting in reducing the need for hospitalisations over a three-to-six-month period. By reducing hospitalisations incurred a cost savings for health care and an improved quality and quantity of life for these participants. CONCLUSION It is evident from the literature that smartphone self-management apps may positively influence participants self-management decisions in terms of knowledge, increase physical activity, self-efficacy that may result in reduced hospitalisation and improved quality of life. It is clear that technical issues and sustained engagement over longer periods of time remains a challenge.
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Affiliation(s)
- Lisa Glynn
- School of Nursing and Midwifery, University of Galway, Ireland
| | - Margaret Mc Cann
- School of Nursing and Midwifery, Trinity College, Dublin 2, Ireland
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Vögeli B, Arenja N, Schütz N, Nef T, Buluschek P, Saner H. 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. JMIR Res Protoc 2024; 13:e55953. [PMID: 38820577 PMCID: PMC11179017 DOI: 10.2196/55953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 06/02/2024] Open
Abstract
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.
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Affiliation(s)
- Benjamin Vögeli
- Department of Cardiology, Solothurner Spitäler AG, Kantonsspital Olten, Olten, Switzerland
| | - Nisha Arenja
- Department of Cardiology, Solothurner Spitäler AG, Kantonsspital Olten, Olten, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Narayan Schütz
- Stanford School of Medicine, Stanford University, Stanford, CA, United States
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | | | - Hugo Saner
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Leenen JPL, Scherrenberg M, Bruins W, Boyne J, Vranken J, Brunner la Rocca HP, Dendale P, van der Velde AE. Usability of a digital health platform to support home hospitalization in heart failure patients: a multicentre feasibility study among healthcare professionals. Eur J Cardiovasc Nurs 2024; 23:188-196. [PMID: 37294588 DOI: 10.1093/eurjcn/zvad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
AIMS Heart failure (HF) is a common cause of mortality and (re)hospitalizations. The NWE-Chance project explored the feasibility of providing hospitalizations at home (HH) supported by a newly developed digital health platform. The aim of this study was to explore the perceived usability by healthcare professionals (HCPs) of a digital platform in addition to HH for HF patients. METHODS AND RESULTS A prospective, international, multicentre, single-arm interventional study was conducted. Sixty-three patients and 22 HCPs participated. The HH consisted of daily home visits by the nurse and use of the platform, consisting of a portable blood pressure device, weight scale, pulse oximeter, a wearable chest patch to measure vital signs (heart rate, respiratory rate, activity level, and posture), and an eCoach for the patient. Primary outcome was usability of the platform measured by the System Usability Scale halfway and at the end of the study. Overall usability was rated as sufficient (mean score 72.1 ± 8.9) and did not differ between the measurements moments (P = 0.690). The HCPs reported positive experiences (n = 7), negative experiences (n = 13), and recommendations (n = 6) for the future. Actual use of the platform was 79% of the HH days. CONCLUSION A digital health platform to support HH was considered usable by HCPs, although actual use of the platform was limited. Therefore, several improvements in the integration of the digital platform into clinical workflows and in defining the precise role of the digital platform and its use are needed to add value before full implementation. REGISTRATION clinicaltrials.gov NCT04084964.
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Affiliation(s)
- Jobbe P L Leenen
- Connected Care Centre, Isala Hospital, Dr. van Heesweg 2, Zwolle, AB 8025, The Netherlands
- Isala Academy, Isala Hospital, Dr. van Heesweg 2, Zwolle, AB 8025, The Netherlands
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Salvatorstraat 20, Hasselt 3500, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Martelarenlaan 42, Hasselt 3500, Belgium
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt 3500, Belgium
| | - Wendy Bruins
- Isala Heart Centre, Isala Hospital, Dr. van Heesweg 2, Zwolle, AB 8025, The Netherlands
| | - Josiane Boyne
- Cardiology Department, Maastricht University Medical Centre, Minderbroedersberg 4-6, Maastricht, 6211 LK, The Netherlands
| | - Julie Vranken
- Faculty of Medicine and Life Sciences, UHasselt, Martelarenlaan 42, Hasselt 3500, Belgium
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt 3500, Belgium
| | - Hans-Peter Brunner la Rocca
- Cardiology Department, Maastricht University Medical Centre, Minderbroedersberg 4-6, Maastricht, 6211 LK, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Salvatorstraat 20, Hasselt 3500, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Martelarenlaan 42, Hasselt 3500, Belgium
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt 3500, Belgium
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Parikh RV, Axelrod AW, Ambrosy AP, Tan TC, Bhatt AS, Fitzpatrick JK, Lee KK, Adatya S, Vasadia JV, Dinh HH, Go AS. Association Between Participation in a Heart Failure Telemonitoring Program and Health Care Utilization and Death Within an Integrated Health Care Delivery System. J Card Fail 2023; 29:1642-1654. [PMID: 37220825 DOI: 10.1016/j.cardfail.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The clinical usefulness of remote telemonitoring to reduce postdischarge health care use and death in adults with heart failure (HF) remains controversial. METHODS AND RESULTS Within a large integrated health care delivery system, we matched patients enrolled in a postdischarge telemonitoring intervention from 2015 to 2019 to patients not receiving telemonitoring at up to a 1:4 ratio on age, sex, and calipers of a propensity score. Primary outcomes were readmissions for worsening HF and all-cause death within 30, 90, and 365 days of the index discharge; secondary outcomes were all-cause readmissions and any outpatient diuretic dose adjustments. We matched 726 patients receiving telemonitoring to 1985 controls not receiving telemonitoring, with a mean age of 75 ± 11 years and 45% female. Patients receiving telemonitoring did not have a significant reduction in worsening HF hospitalizations (adjusted rate ratio [aRR] 0.95, 95% confidence interval [CI] 0.68-1.33), all-cause death (adjusted hazard ratio 0.60, 95% CI 0.33-1.08), or all-cause hospitalization (aRR 0.82, 95% CI 0.65-1.05) at 30 days, but did have an increase in outpatient diuretic dose adjustments (aRR 1.84, 95% CI 1.44-2.36). All associations were similar at 90 and 365 days postdischarge. CONCLUSIONS A postdischarge HF telemonitoring intervention was associated with more diuretic dose adjustments but was not significantly associated with HF-related morbidity and mortality.
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Affiliation(s)
- Rishi V Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California
| | - Amir W Axelrod
- Department of Cardiology, Kaiser Permanente Vallejo Medical Center, Vallejo, California
| | - Andrew P Ambrosy
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Ankeet S Bhatt
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Jesse K Fitzpatrick
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Keane K Lee
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Sirtaz Adatya
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Jitesh V Vasadia
- Department of Cardiology, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, California
| | - Howard H Dinh
- Department of Cardiology, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, California; Department of Medicine (Nephrology), Stanford University School of Medicine, Palo Alto, California.
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Stremmel C, Breitschwerdt R. Digital Transformation in the Diagnostics and Therapy of Cardiovascular Diseases: Comprehensive Literature Review. JMIR Cardio 2023; 7:e44983. [PMID: 37647103 PMCID: PMC10500361 DOI: 10.2196/44983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The digital transformation of our health care system has experienced a clear shift in the last few years due to political, medical, and technical innovations and reorganization. In particular, the cardiovascular field has undergone a significant change, with new broad perspectives in terms of optimized treatment strategies for patients nowadays. OBJECTIVE After a short historical introduction, this comprehensive literature review aimed to provide a detailed overview of the scientific evidence regarding digitalization in the diagnostics and therapy of cardiovascular diseases (CVDs). METHODS We performed an extensive literature search of the PubMed database and included all related articles that were published as of March 2022. Of the 3021 studies identified, 1639 (54.25%) studies were selected for a structured analysis and presentation (original articles: n=1273, 77.67%; reviews or comments: n=366, 22.33%). In addition to studies on CVDs in general, 829 studies could be assigned to a specific CVD with a diagnostic and therapeutic approach. For data presentation, all 829 publications were grouped into 6 categories of CVDs. RESULTS Evidence-based innovations in the cardiovascular field cover a wide medical spectrum, starting from the diagnosis of congenital heart diseases or arrhythmias and overoptimized workflows in the emergency care setting of acute myocardial infarction to telemedical care for patients having chronic diseases such as heart failure, coronary artery disease, or hypertension. The use of smartphones and wearables as well as the integration of artificial intelligence provides important tools for location-independent medical care and the prevention of adverse events. CONCLUSIONS Digital transformation has opened up multiple new perspectives in the cardiovascular field, with rapidly expanding scientific evidence. Beyond important improvements in terms of patient care, these innovations are also capable of reducing costs for our health care system. In the next few years, digital transformation will continue to revolutionize the field of cardiovascular medicine and broaden our medical and scientific horizons.
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Hoerold M, Heytens H, Debbeler CM, Ehrentreich S, Rauwolf T, Schmeißer A, Gottschalk M, Bitzer EM, Braun-Dullaeus RC, Apfelbacher CJ. An evidence map of systematic reviews on models of outpatient care for patients with chronic heart diseases. Syst Rev 2023; 12:80. [PMID: 37149625 PMCID: PMC10163805 DOI: 10.1186/s13643-023-02227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/30/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Chronic heart disease affects millions of people worldwide and the prevalence is increasing. By now, there is an extensive literature on outpatient care of people with chronic heart disease. We aimed to systematically identify and map models of outpatient care for people with chronic heart disease in terms of the interventions included and the outcomes measured and reported to determine areas in need of further research. METHODS We created an evidence map of published systematic reviews. PubMed, Cochrane Library (Wiley), Web of Science, and Scopus were searched to identify all relevant articles from January 2000 to June 2021 published in English or German language. From each included systematic review, we abstracted search dates, number and type of included studies, objectives, populations, interventions, and outcomes. Models of care were categorised into six approaches: cardiac rehabilitation, chronic disease management, home-based care, outpatient clinic, telemedicine, and transitional care. Intervention categories were developed inductively. Outcomes were mapped onto the taxonomy developed by the COMET initiative. RESULTS The systematic literature search identified 8043 potentially relevant publications on models of outpatient care for patients with chronic heart diseases. Finally, 47 systematic reviews met the inclusion criteria, covering 1206 primary studies (including double counting). We identified six different models of care and described which interventions were used and what outcomes were included to measure their effectiveness. Education-related and telemedicine interventions were described in more than 50% of the models of outpatient care. The most frequently used outcome domains were death and life impact. CONCLUSION Evidence on outpatient care for people with chronic heart diseases is broad. However, comparability is limited due to differences in interventions and outcome measures. Outpatient care for people with coronary heart disease and atrial fibrillation is a less well-studied area compared to heart failure. Our evidence mapping demonstrates the need for a core outcome set and further studies to examine the effects of models of outpatient care or different interventions with adjusted outcome parameters. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42020166330).
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Affiliation(s)
- Madlen Hoerold
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany.
| | - Heike Heytens
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Carla Maria Debbeler
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Saskia Ehrentreich
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Thomas Rauwolf
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Alexander Schmeißer
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Marc Gottschalk
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Eva Maria Bitzer
- Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, Freiburg, Baden-Würtemberg, 79117, Germany
| | - Ruediger C Braun-Dullaeus
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Christian J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
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Zwack CC, Haghani M, Hollings M, Zhang L, Gauci S, Gallagher R, Redfern J. The evolution of digital health technologies in cardiovascular disease research. NPJ Digit Med 2023; 6:1. [PMID: 36596833 PMCID: PMC9808768 DOI: 10.1038/s41746-022-00734-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/29/2022] [Indexed: 01/04/2023] Open
Abstract
When implemented in practice, digital technologies have shown improvements in morbidity and mortality outcomes in patients with cardiovascular disease (CVD). For scholars, research into digital technologies in cardiovascular care has been relatively recent, thus it is important to understand the history of digital health technology in cardiovascular research-its emergence, rate of growth, hot topics, and its temporal evolution. The aim of this study was to analyse more than 16,000 articles in this domain based on their scientometric indicators. Web of Science (WoS) Core Collection was accessed and searched at several levels, including titles, abstracts, keywords, authors, sources and individual articles. Analysis examined the temporal shifts in research and scholarly focus based on keywords, networks of collaboration, topical divisions in relation to digital technologies, and influential publications. Findings showed this research area is growing exponentially. Co-citation analysis revealed twenty prominent research streams and identified variation in the magnitude of activities in each stream. A recent emergence of research activities in digital technology in cardiovascular rehabilitation (CR), out-of-hospital cardiac arrest (OHCA), and arrythmia research was also demonstrated. Conversely, wearable technologies, activity tracking and electronic medical records research are now past their peak of reported research activity. With increasing amounts of novel technologies becoming available and more patients taking part in remote health care monitoring, further evaluation and research into digital technologies, including their long-term effectiveness, is needed. Furthermore, emerging technologies, which are evaluated and/or validated should be considered for implementation into clinical practice as treatment and prevention modalities for CVD.
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Affiliation(s)
- Clara C. Zwack
- grid.1013.30000 0004 1936 834XSchool of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Milad Haghani
- grid.1005.40000 0004 4902 0432School of Civil and Environmental Engineering, University of New South Wales, Sydney, Australia
| | - Matthew Hollings
- grid.1013.30000 0004 1936 834XSchool of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Ling Zhang
- grid.1013.30000 0004 1936 834XSydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Sarah Gauci
- grid.1021.20000 0001 0526 7079Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC Australia
| | - Robyn Gallagher
- grid.1013.30000 0004 1936 834XSydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Julie Redfern
- grid.1013.30000 0004 1936 834XSchool of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
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Chan A, Cohen R, Robinson KM, Bhardwaj D, Gregson G, Jutai JW, Millar J, Ríos Rincón A, Roshan Fekr A. Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review. JMIR Aging 2022; 5:e40079. [PMID: 36441572 DOI: 10.2196/40079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies. OBJECTIVE This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks. METHODS A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented. RESULTS The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied. CONCLUSIONS Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users.
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Affiliation(s)
- Andrew Chan
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Rachel Cohen
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Katherine-Marie Robinson
- School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada.,Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada
| | - Devvrat Bhardwaj
- Department of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Geoffrey Gregson
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Jeffrey W Jutai
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,LIFE Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jason Millar
- School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada.,Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada
| | - Adriana Ríos Rincón
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Atena Roshan Fekr
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Manavi T, Ijaz M, O’Grady H, Nagy M, Martina J, Finucane C, Sharif F, Zafar H. Design and Haemodynamic Analysis of a Novel Anchoring System for Central Venous Pressure Measurement. SENSORS (BASEL, SWITZERLAND) 2022; 22:8552. [PMID: 36366251 PMCID: PMC9659073 DOI: 10.3390/s22218552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND/OBJECTIVE In recent years, treatment of heart failure patients has proved to benefit from implantation of pressure sensors in the pulmonary artery (PA). While longitudinal measurement of PA pressure profoundly improves a clinician's ability to manage HF, the full potential of central venous pressure as a clinical tool has yet to be unlocked. Central venous pressure serves as a surrogate for the right atrial pressure, and thus could potentially predict a wider range of heart failure conditions. However, it is unclear if current sensor anchoring methods, designed for the PA, are suitable to hold pressure sensors safely in the inferior vena cava. The purpose of this study was to design an anchoring system for accurate apposition in inferior vena cava and evaluate whether it is a potential site for central venous pressure measurement. MATERIALS AND METHODS A location inferior to the renal veins was selected as an optimal site based on a CT scan analysis. Three anchor designs, a 10-strut anchor, and 5-struts with and without loops, were tested on a custom-made silicone bench model of Vena Cava targeting the infra-renal vena cava. The model was connected to a pulsatile pump system and a heated water bath that constituted an in-vitro simulation unit. Delivery of the inferior vena cava implant was accomplished using a preloaded introducer and a dilator as a push rod to deploy the device at the target area. The anchors were subjected to manual compression tests to evaluate their stability against dislodgement. Computational Fluid Dynamics (CFD) analysis was completed to characterize blood flow in the anchor's environment using pressure-based transient solver. Any potential recirculation zones or disturbances in the blood flow caused by the struts were identified. RESULTS We demonstrated successful anchorage and deployment of the 10-strut anchor in the Vena Cava bench model. The 10-strut anchor remained stable during several compression attempts as compared with the other two 5-strut anchor designs. The 10-strut design provided the maximum number of contact points with the vessel in a circular layout and was less susceptible to movement or dislodgement during compression tests. Furthermore, the CFD simulation provided haemodynamic analysis of the optimum 10-strut anchor design. CONCLUSIONS This study successfully demonstrated the design and deployment of an inferior vena cava anchoring system in a bench test model. The 10-strut anchor is an optimal design as compared with the two other 5-strut designs; however, substantial in-vivo experiments are required to validate the safety and accuracy of such implants. The CFD simulation enabled better understanding of the haemodynamic parameters and any disturbances in the blood flow due to the presence of the anchor. The ability to place a sensor technology in the vena cava could provide a simple and minimally invasive approach for heart failure patients.
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Affiliation(s)
- Tejaswini Manavi
- Cardiovascular Research & Innovation Centre, University of Galway, H91 TK33 Galway, Ireland
- Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Masooma Ijaz
- Cardiovascular Research & Innovation Centre, University of Galway, H91 TK33 Galway, Ireland
- Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Helen O’Grady
- Cardiovascular Research & Innovation Centre, University of Galway, H91 TK33 Galway, Ireland
- Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | | | | | - Ciaran Finucane
- Department of Medical Physics and Bioengineering, Mercer’s Institute for Successful Ageing, St James’s Hospital Dublin, D08 NHY1 Dublin, Ireland
| | - Faisal Sharif
- Cardiovascular Research & Innovation Centre, University of Galway, H91 TK33 Galway, Ireland
- Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Department of Cardiology, University Hospital Galway, H91 YR71 Galway, Ireland
- BioInnovate, H91 TK33 Galway, Ireland
| | - Haroon Zafar
- Cardiovascular Research & Innovation Centre, University of Galway, H91 TK33 Galway, Ireland
- Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- College of Science and Engineering, University of Galway, H91 TK33 Galway, Ireland
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Efficacy of ICD/CRT-D Remote Monitoring in Patients With HFrEF: a Bayesian Meta-analysis of Randomized Controlled Trials. Curr Heart Fail Rep 2022; 19:435-444. [PMID: 36205832 DOI: 10.1007/s11897-022-00579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE OF REVIEW To evaluate remote monitoring using implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) devices as an adjunctive tool to the traditional care of patients with heart failure (HF). RECENT FINDINGS We included 11 trials encompassing 5965 patients. Absolute risk difference (ARD) with 95% credible interval (CrI) was estimated. Pooled (posterior) risk difference was computed using Bayesian hierarchical methods. The ARD for mortality was centered at - 0.01 (95% CrI: - 0.03; 0.01, Tau: 0.02), with an 82% probability of ARD of ICD/CRT-D remote monitoring with respect to control being less than 0. The ARD for cardiovascular mortality was centered at - 0.03 (95% CrI: - 0.11; 0.05, Tau: 0.10), with an 84% probability of ARD of ICD/CRT-D remote monitoring with respect to control being less than 0. ICD/CRT-D remote monitoring in patients with HF is associated with a higher probability of reduced all-cause and cardiovascular mortality compared with standard care alone.
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11
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Ben Ismail E, Jaana M, Sherrard H, MacPhee E. IVR System Use by Patients with Heart Failure: Compliance and Services Utilization Patterns. J Med Syst 2022; 46:69. [PMID: 36104511 PMCID: PMC9474272 DOI: 10.1007/s10916-022-01847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 10/25/2022]
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12
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Peiris RG, Ross H, Chan CT, Poon S, Auguste BL, Rac VE, Farkouh M, McDonald M, Kaczorowski J, Code J, Duero Posada J, Ong S, Kobulnik J, Tomlinson G, Huszti E, Arcand J, Thomas SG, Akbari A, Maunder R, Grover S, Seto E, Simard A, Pope B, Bains M, McIntyre C, Torbay C, Syed F, Nolan RP. Automated digital counselling with social network support as a novel intervention for patients with heart failure: protocol for randomised controlled trial. BMJ Open 2022; 12:e059635. [PMID: 36691152 PMCID: PMC9445232 DOI: 10.1136/bmjopen-2021-059635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/25/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Heart failure (HF) symptoms improve through self-care, for which adherence remains low among patients despite the provision of education for these behaviours by clinical teams. Open Access Digital Community Promoting Self-Care, Peer Support and Health Literacy (ODYSSEE-vCHAT) combines automated digital counselling with social network support to improve mortality and morbidity, engagement with self-care materials, and health-related quality of life. METHODS AND ANALYSIS Use of ODYSSEE-vCHAT via Internet-connected personal computer by 162 HF patients will be compared with a control condition over 22 months. The primary outcome is a composite index score of all-cause mortality, all-cause emergency department visits, and HF-related hospitalisation at trial completion. Secondary outcomes include individual components of the composite index, engagement with self-care materials, and patient-reported measures of physical and psychosocial well-being, disease management, health literacy, and substance use. Patients are recruited from tertiary care hospitals in Toronto, Canada and randomised on a 1:1 ratio to both arms of the trial. Online assessments occur at baseline (t=0), months 4, 8 and 12, and trial completion. Ordinal logistic regression analyses and generalised linear models will evaluate primary and secondary outcomes. ETHICS AND DISSEMINATION The trial has been approved by the research ethics boards at the University Health Network (20-5960), Sunnybrook Hospital (5117), and Mount Sinai Hospital (21-022-E). Informed consent of eligible patients occurs in person or online. Findings will be shared with key stakeholders and the public. Results will allow for the preparation of a Canada-wide phase III trial to evaluate the efficacy of ODYSSEE-vCHAT in improving clinical outcomes and raising the standard of outpatient care. TRIAL REGISTRATION NUMBER NCT04966104.
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Affiliation(s)
- Rachel Grace Peiris
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Heather Ross
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
- Division of Nephrology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Stephanie Poon
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bourne Lewis Auguste
- Division of Nephrology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Valeria E Rac
- Institute of Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Michael Farkouh
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Peter Munk Centre of Excellence in Multinational Clinical Trials, University Health Network, Toronto, Ontario, Canada
| | - Michael McDonald
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montreal Faculty of Medicine, Montreal, Quebec, Canada
| | - Jillianne Code
- Department of Curriculum and Pedagogy, University of British Columbia, Vancouver, British Columbia, Canada
- HeartLife Foundation, Vancouver, British Columbia, Canada
| | - Juan Duero Posada
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Stephanie Ong
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Kobulnik
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, Sinai Health System, Toronto, Ontario, Canada
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
- Division of Biostatistics, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Ella Huszti
- Institute of Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Scott G Thomas
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Ayub Akbari
- Division of Nephrology, Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Maunder
- Department of Psychiatry, Sinai Health System, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Steven Grover
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Emily Seto
- Institute of Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
| | - Anne Simard
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Brad Pope
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Marc Bains
- HeartLife Foundation, Vancouver, British Columbia, Canada
| | - Carmen McIntyre
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Chris Torbay
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Fatima Syed
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Robert P Nolan
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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13
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İnal Ö, Tunçer B. Telephone-based joint protection education in lateral epicondylitis: A randomized controlled trial. Work 2022; 72:1421-1428. [DOI: 10.3233/wor-211002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Lateral epicondylitis (LE) can occur for many different reasons such as compelling repetitive movements in daily readings, incorrect posture use and work-related factors. Although several treatments are available for LE, the optimal evidence-based treatment remains uncertain. Joint protection techniques have been developed as a self-management intervention to reduce pain and disability and improve functionality by applying ergonomic approaches. OBJECTIVES: This study aimed to investigate the effects of telephone-based follow up on top of a home-based joint protection education programme on pain and functionality in individuals with LE. METHODS: Individuals were randomly assigned into 2 groups; 1) telephone-based group, receiving telephone-based follow-up on top of a home-based joint protection education programme, and 2) home-based group, receiving home-based joint protection education alone. Both groups were given training that increased awareness in LE and home-based exercise programme. In addition, telephone-based group was followed up by telephone three days a week for four weeks. RESULTS: Improvements from baseline to 4th week in Turkish version of the Patient-Rated Tennis Elbow Evaluation-pain (p = 0.001; effect size = 1.11) and function (p < 0.001; effect size = 1.77), Upper Extremity Functional Index (p = 0.001; effect size = 0.85) and The Turkish version of the Joint Protection Behavior Assessment-Short Form (p < 0.001; effect size = 1.54) in the telephone-based group were significantly higher than the improvements in the home-based group. CONCLUSIONS: Telephone-based follow-up in individuals with LE contributed to the awareness of pain, functionality and joint protection methods. Telephone-based joint protection education programmes can offer a health service within the scope of preventive and protective intervention programmes for LE.
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Affiliation(s)
- Özgü İnal
- Department of Occupational Therapy, Faculty of Gülhane Health Science, Health Science University, Ankara, Turkey
| | - Berna Tunçer
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Trakya University, Edirne, Turkey
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14
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op ‘t Hoog SAJJ, Eskes AM, van Oers JAH, Boerrigter JL, Prins-Smulders MWJC, Oomen M, van der Hoeven JG, Vermeulen H, Vloet LCM. A Quality Improvement Project to Support Post-Intensive Care Unit Patients with COVID-19: Structured Telephone Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9689. [PMID: 35955045 PMCID: PMC9368104 DOI: 10.3390/ijerph19159689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND More than 50% of intensive care unit (ICU) survivors suffer from long-lasting physical, psychosocial, and cognitive health impairments, also called "post-intensive care syndrome" (PICS). Intensive care admission during the COVID-19 pandemic was especially uncertain and stressful, both for patients and for their family. An additional risk of developing symptoms of PICS was feared in the absence of structural aftercare for the patient and family shortly after discharge from the hospital. The purpose of this quality improvement study was to identify PICS symptoms and to support post-intensive care patients and families in the transition from the hospital to the home. Therefore, we offered post-ICU patients and families structured telephone support (STS). METHODS This was a quality improvement study during the 2019 COVID-19 pandemic. A project team developed and implemented a tool to structure telephone calls to identify and order symptoms according to the PICS framework and to give individual support based on this information. We supported post-ICU patients diagnosed with COVID-19 pneumonia and their family caregivers within four weeks after hospital discharge. The reported findings were both quantitative and qualitative. RESULTS Forty-six post-ICU patients received structured telephone support and reported symptoms in at least one of the three domains of the PICS framework. More than half of the patients experienced a loss of strength or condition and fatigue. Cognitive and psychological impairments were reported less frequently. Family caregivers reported fewer impairments concerning fatigue and sleeping problems and expressed a need for a continuity of care. Based on the obtained information, the ICU nurse practitioners were able to check if individual care plans were optimal and clear and, if indicated, initiated disciplines to optimize further follow-up. CONCLUSIONS The implementation of the STS tool gave insight in the impairments of post-ICU patients. Surprisingly, family caregivers expressed fewer impairments. Giving support early after hospital discharge in a structured way may contribute to providing guidance in the individual care plans and treatment of the early symptoms of PICS (-F).
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Affiliation(s)
- Sabine A. J. J. op ‘t Hoog
- Department of Intensive Care, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands
- Research Department of Emergency and Critical Care, HAN University of Applied Science, 6525 EN Nijmegen, The Netherlands
| | - Anne M. Eskes
- Department of Surgery, Amerstam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4222, Australia
| | - Jos A. H. van Oers
- Department of Intensive Care, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands
| | - José L. Boerrigter
- Department of Surgery, Amerstam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Meike W. J. C. Prins-Smulders
- Department of Intensive Care, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands
- Research Department of Emergency and Critical Care, HAN University of Applied Science, 6525 EN Nijmegen, The Netherlands
| | - Margo Oomen
- Department of Intensive Care, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands
| | - Johannes G. van der Hoeven
- Department of Intensive Care Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, 6500 HB Nijmegen, The Netherlands
- Foundation Family and Patient Centered Intensive Care, 1801 GB Alkmaar, The Netherlands
| | - Lilian C. M. Vloet
- Research Department of Emergency and Critical Care, HAN University of Applied Science, 6525 EN Nijmegen, The Netherlands
- Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, 6500 HB Nijmegen, The Netherlands
- Foundation Family and Patient Centered Intensive Care, 1801 GB Alkmaar, The Netherlands
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15
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AlHabeeb W. Heart failure disease management program: A review. Medicine (Baltimore) 2022; 101:e29805. [PMID: 35945723 PMCID: PMC9351896 DOI: 10.1097/md.0000000000029805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Disease management programs (DMPs) have shown great potential for optimizing care of chronically ill patients, thereby improving health outcomes and patient satisfaction. This had led to an overall reduction in healthcare costs. Longer life expectancy has led to increased utilization of healthcare facilities, which may lead to a rise in costs. DMPs are an effective means of improving care and compliance and ultimately curbing inappropriate resource utilization. The present study reviews different definitions proposed for disease management, its components, the evidence behind it, and the conditions for success. It also examines heart failure management as an example of a DMP, exploring the complexity surrounding implementation of guideline-based approaches in patient care. A literature search on DMPs was conducted using PubMed, MEDLINE, and Google Scholar, including heart failure management programs from articles published from 2000 to 2020. This reviewed emphasized on the management of important biomarkers and cardiovascular indicators such as glycemic levels, urine output to improve efficacy of disease management programme during patient treatment. The review concluded that diseases like heart failure can be combat by improving the quality of care for patients and reducing the burden on the public healthcare system. Moreover, DMPs have proved to be an effective way of improving care and compliance with treatment.
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Affiliation(s)
- Waleed AlHabeeb
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia
- *Correspondence: Waleed AlHabeeb, P.O. Box 2925, Riyadh 11461, Saudi Arabia (e-mail: )
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Healthcare providers’ perspectives on using smart home systems to improve self-management and care in people with heart failure: A qualitative study. Int J Med Inform 2022; 167:104837. [DOI: 10.1016/j.ijmedinf.2022.104837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/24/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
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Mohan B, Singh B, Singh K, Naik N, Roy A, Goyal A, SIngh G, Aggarwal S, Saini A, Tandon R, Chhabra ST, Aslam N, Wander GS, Prabhakaran D. Impact of a nurse-led teleconsultation strategy for cardiovascular disease management during COVID-19 pandemic in India: a pyramid model feasibility study. BMJ Open 2022; 12:e056408. [PMID: 35798525 PMCID: PMC9263376 DOI: 10.1136/bmjopen-2021-056408] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic necessitated the use of telemedicine to maintain continuity of care for patients with cardiovascular diseases (CVDs). This study aimed to demonstrate the feasibility of implementing a nurse-led teleconsultation strategy for CVD management during the COVID-19 pandemic in India and evaluated the impact of nurse-led teleconsultations on patient treatment satisfaction. DESIGN, SETTING AND PARTICIPANTS We developed a two-stage teleconsultation strategy and tested the feasibility of implementing a nurse-led teleconsultation strategy to manage CVD in a northern state (Punjab) in India. A multidisciplinary team of experts developed the treatment protocol used for teleconsultations to manage CVD. Nurses were trained to provide teleconsultation, triaging of patients and referrals to the physicians. Patients with CVD who had an outpatient visit or hospitalisation between September 2019 and March 2020 at the Dayanand Medical College Hospital, Ludhiana, India, were contacted by phone and offered teleconsultations. Telemedicine strategy comprised: stage 1 nurse-led teleconsultations and stage 2 physician-led teleconsultations. Descriptive analysis was performed to report the proportion of patients triaged by the two-stage telemedicine strategy, and patient's clinical characteristics, and treatment satisfaction between the nurse-led versus physician-led teleconsultations. RESULTS Overall, nurse-led stage 1 teleconsultations were provided to 12 042 patients with CVD. The mean (SD) age of the participants was 58.9 years (12.8), and men were 65.4%. A relatively small proportion of patients (6.3%) were referred for the stage-2 physician-led teleconsultations and of these only 8.4% required hospitalisations. During stage 1 nurse-led teleconsultations, patients were referred to the physicians due to uncontrolled diabetes (24.9%), uncontrolled hypertension (18.7%) and congestive heart failure (16.2%). The patient's treatment satisfaction was similar between the nurse-led versus physician-led teleconsultations (p=0.07). CONCLUSION This study showed that a nurse-led telemedicine strategy is feasible to implement in a resource-constraint setting for triaging patients with CVD and reduces physician's burden.
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Affiliation(s)
- Bishav Mohan
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Bhupinder Singh
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Kavita Singh
- Centre for Chronic Conditions and Injuries, Public Health Foundation, Gurugram, India
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Goyal
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Gurbhej SIngh
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Shivaansh Aggarwal
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Aftabh Saini
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Rohit Tandon
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | | | - Naved Aslam
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation, Gurugram, India
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Apantaku G, Mitton C, Wong H, Ho K. Home Telemonitoring Technology for Patients With Heart Failure: Cost-Consequence Analysis of a Pilot Study. JMIR Form Res 2022; 6:e32147. [PMID: 35653179 PMCID: PMC9204565 DOI: 10.2196/32147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/14/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Glory Apantaku
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hubert Wong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kendall Ho
- Digital Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
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McBeath KCC, Angermann CE, Cowie MR. Digital Technologies to Support Better Outcome and Experience of Care in Patients with Heart Failure. Curr Heart Fail Rep 2022; 19:75-108. [PMID: 35486314 PMCID: PMC9051015 DOI: 10.1007/s11897-022-00548-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW In this article, we review a range of digital technologies for possible application in heart failure patients, with a focus on lessons learned. We also discuss a future model of heart failure management, as digital technologies continue to become part of standard care. RECENT FINDINGS Digital technologies are increasingly used by healthcare professionals and those living with heart failure to support more personalised and timely shared decision-making, earlier identification of problems, and an improved experience of care. The COVID-19 pandemic has accelerated the acceptability and implementation of a range of digital technologies, including remote monitoring and health tracking, mobile health (wearable technology and smartphone-based applications), and the use of machine learning to augment data interpretation and decision-making. Much has been learned over recent decades on the challenges and opportunities of technology development, including how best to evaluate the impact of digital health interventions on health and healthcare, the human factors involved in implementation and how best to integrate dataflows into the clinical pathway. Supporting patients with heart failure as well as healthcare professionals (both with a broad range of health and digital literacy skills) is crucial to success. Access to digital technologies and the internet remains a challenge for some patients. The aim should be to identify the right technology for the right patient at the right time, in a process of co-design and co-implementation with patients.
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Affiliation(s)
- K C C McBeath
- Royal Brompton Hospital (Guy's & St Thomas' NHS Foundation Trust), Sydney Street, London, SW3 6NP, UK
| | - C E Angermann
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Würzburg, Germany
| | - M R Cowie
- Royal Brompton Hospital (Guy's & St Thomas' NHS Foundation Trust), Sydney Street, London, SW3 6NP, UK.
- School of Cardiovascular Medicine, Faculty of Medicine & Lifesciences, King's College London, London, UK.
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20
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Li E, Tsopra R, Jimenez G, Serafini A, Gusso G, Lingner H, Fernandez MJ, Irving G, Petek D, Hoffman R, Lazic V, Memarian E, Koskela T, Collins C, Espitia SM, Clavería A, Nessler K, O’Neill BG, Hoedebecke K, Ungan M, Laranjo L, Ghafur S, Fontana G, Majeed A, Car J, Darzi A, Neves AL. General practitioners' perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study. PLOS DIGITAL HEALTH 2022; 1:e0000029. [PMID: 36812543 PMCID: PMC9931239 DOI: 10.1371/journal.pdig.0000029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs' perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June-September 2020. GPs' perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients' preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure.
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Affiliation(s)
- Edmond Li
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
- * E-mail: (EL); (ALN)
| | - Rosy Tsopra
- INSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine, F-75006 Paris, France
- Inria Paris, Paris, France
- Department of Medical Informatics, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Geronimo Jimenez
- Center for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Heidrun Lingner
- Hannover Medical School, Center for Public, Health and Healthcare, German Center for Lung Research (DZL) / BREATH Hannover, Germany
| | - Maria Jose Fernandez
- Leiro Health Center, Leiro, Spain
- Galicia South Health Research Institute, Vigo, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Spain
| | - Greg Irving
- Health Research Institute, Edge Hill University, Ormskirk, United Kingdom
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ensieh Memarian
- Department of Clinical Sciences in Malmö, Lund University, Internal Medicine- Epidemiology Research Group, Skane University Hospital, Malmö, Sweden
| | - Tuomas Koskela
- General Practice, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Finland
| | | | | | - Ana Clavería
- Galicia South Health Research Institute, Vigo, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Spain
- Primary Care Research Unit. Vigo Health Area, Vigo, Spain
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Braden Gregory O’Neill
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Kyle Hoedebecke
- Department of Utilization Management, Oscar Health, Dallas, United States of America
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Saira Ghafur
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gianluca Fontana
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Josip Car
- Center for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Leiro Health Center, Leiro, Spain
- Galicia South Health Research Institute, Vigo, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Spain
| | - Ara Darzi
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Ana Luisa Neves
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
- * E-mail: (EL); (ALN)
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21
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Kirakalaprathapan A, Oremus M. Efficacy of telehealth in integrated chronic disease management for older, multimorbid adults with heart failure: A systematic review. Int J Med Inform 2022; 162:104756. [PMID: 35381436 DOI: 10.1016/j.ijmedinf.2022.104756] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND We conducted a systematic review to assess the comparative efficacy of integrated telehealth versus other strategies of chronic disease management in older, multimorbid adults with heart failure (HF) in primary care and community settings. Specific efficacy outcomes included CVD-related hospitalizations, rehospitalizations, and mortality. MATERIALS AND METHODS We searched for randomized controlled trials (RCTs) in MEDLINE, Scopus, EMBASE, CINAHL, and CENTRAL from the date of each database's inception to January 2020. The literature search retrieved 9,181 articles, which were screened by two independent raters. Twenty-two of these articles were included in the systematic review. Data extraction, risk of bias assessment, and narrative synthesis followed article screening. RESULTS This systematic review found that integrated telehealth is efficacious in reducing CVD-related hospitalizations, rehospitalizations, and mortality in older, multimorbid adults within primary care and community settings. However, numerous discrepancies existed between the studies, due largely to differences in telehealth modalities and risk of bias. Overall, the combinations of modalities were so diverse that the reviewed literature did not suggest an optimal integrated telehealth strategy. At most, no more than three studies featured the same combination of telehealth modalities and outcomes. Furthermore, only 3 of the 22 included RCTs scored low on the Cochrane risk of bias tool. CONCLUSIONS Researchers should focus on the quality of future RCTs to better assess the efficacy of different telehealth modalities in multimorbid older adults with HF. Also, since all the included RCTs focused on HF, a knowledge gap exists with regard to the efficacy of using integrated telehealth to manage other cardiovascular diseases (CVD).
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Affiliation(s)
| | - Mark Oremus
- School of Public Health Sciences, University of Waterloo, Canada.
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22
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Choudhary N, Chakravarty K, Kharbanda PS, Lal V, Baishya J. Satisfaction and effectiveness of tele-medicine in follow-up of people with epilepsy in a resource-poor setting during COVID-19. Epilepsy Behav 2022; 128:108569. [PMID: 35104733 DOI: 10.1016/j.yebeh.2022.108569] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Effectiveness of different tele-medicine strategies varies in different medical conditions. Use of basic tele-medicine strategy like mobile health (m-health) can be an effective option in different medical conditions in a resource-poor setting. AIMS To study effectiveness and satisfaction of tele-medicine among persons with epilepsy (PWE) in a developing nation during COVID-19 pandemic. METHODS Persons with epilepsy aged 18 years or more who have attended epilepsy clinic at least once physically and were asked for regular follow-up were included. A cross-sectional telephonic survey was conducted to assess effectiveness of tele-medicine over past 1 year. Satisfaction was assessed by tele-medicine satisfaction questionnaire. RESULT 31.9% of PWE have used tele-medicine facility in last 1 year and 58.2% were unaware of the availability of such a facility. Among those who utilized tele-medicine, 95.3% were able to explain their concerns satisfactorily during tele-consultation and change in prescription was done in 42.8%. None experienced any new adverse event. Overall, more than 95% were satisfied with tele-consultation and more than 80% wanted to use it again. CONCLUSION Even basic tele-medicine strategies can be a very effective and satisfactory mode of follow-up for PWE in resource-poor settings. Steps should be undertaken to make people aware of the availability of such a facility.
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Affiliation(s)
- Neetu Choudhary
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamalesh Chakravarty
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parampreet S Kharbanda
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitupam Baishya
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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23
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Kotalczyk A, Imberti JF, Lip GYH, Wright DJ. Telemedical Monitoring Based on Implantable Devices-the Evolution Beyond the CardioMEMS™ Technology. Curr Heart Fail Rep 2022; 19:7-14. [PMID: 35174451 PMCID: PMC8853059 DOI: 10.1007/s11897-021-00537-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
Purpose of the Review We aimed to provide an overview of telemedical monitoring and its impact on outcomes among heart failure (HF) patients. Recent Findings Most HF readmissions may be prevented if clinical parameters are strictly controlled via telemedical monitoring. Predictive algorithms for patients with cardiovascular implantable electronic devices (e.g., Triage-HF Plus by Medtronic or HeartLogic by Boston Scientific) were developed to identify patients at significantly increased risk of HF events. However, randomized control trial-based data are heterogeneous regarding the advantages of telemedical monitoring in HF patients. The likelihood of adverse clinical outcomes increases when pulmonary artery pressure (PAP) rises, usually days to weeks before clinical manifestations of HF. A wireless monitoring system (CardioMEMS™) detecting changes in PAP was proposed for HF patients. CardioMEMS™ transmits data to the healthcare provider and allows to institute timely intensification of HF therapies. CardioMEMS™-guided pharmacotherapy reduced a risk of HF-related hospitalization (hazard ratio [HR]: 0.72; 95% confidence interval (CI) 0.60–0–0.85; p < 0.01). Summary Relevant developments and innovations of telemedical care may improve clinical outcomes among HF patients. The use of CardioMEMS™ was found to be safe and cost-effective by reducing the rates of HF hospitalizations.
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Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Jacopo F Imberti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - David Justin Wright
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK. .,Liverpool Heart & Chest Hospital, Liverpool, UK.
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24
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Mura M, Rivoire E, Dehina-Khenniche L, Weiss-Gayet M, Chazaud B, Faes C, Connes P, Long A, Rytz CL, Mury P, Delrieu L, Gouraud E, Bordet M, Schiava ND, Lermusiaux P, Arsicot M, Millon A, Pialoux V. Effectiveness of an individualized home-based physical activity program in surgery-free non-endarterectomized asymptomatic stroke patients: a study protocol for the PACAPh interventional randomized trial. Trials 2022; 23:145. [PMID: 35164816 PMCID: PMC8842739 DOI: 10.1186/s13063-022-06061-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/27/2022] [Indexed: 02/06/2023] Open
Abstract
Background Carotid atherosclerotic plaques remain silent until their rupture, which may lead to detrimental ischemic events such as strokes. This is due, in part, to intraplaque hemorrhages (IPH) and the resulting inflammatory processes, which may promote carotid plaque vulnerability. Currently, the benefits of carotid endarterectomy remain unclear for asymptomatic patients. Interestingly, the completion of physical activity (PA) may have beneficial effects; however, the paucity of current data warrants robust longitudinal interventions. We therefore aim to study the effects of a 6-month longitudinal personalized home-based PA program on IPH, biological, and inflammatory markers in asymptomatic stroke patients. Methods Eighty patients (≥ 18 years old) will be recruited for the Physical Activity and Carotid Atherosclerotic Plaque Hemorrhage (PACAPh) clinical trial from the Hospices Civils de Lyon. Patients will be eligible if they present with carotid stenosis ≥ 50% and are asymptomatic from any ischemic events for at least 6 months. Recruited patients will be randomized into either a PA or a control group, and assessed at baseline and after 6 months. At both time points, all patients will be assessed using magnetic resonance imaging to assess IPH, blood sampling to measure inflammatory markers and monocytic phenotyping, PA and sedentary behavior questionnaires, 6-min walking test, and maximal isometric quadricep contraction test. The randomized PA intervention will consist of reaching a daily walking step goal individually tailored to each patient. Steps will be collected using a wirelessly connected wristband. The number of steps completed by individuals in the PA group will be re-evaluated bimonthly to encourage walking habits. Discussion The PACAPh study is the first of its kind representing a feasible, easily accessible therapeutic strategy for asymptomatic stroke patients. We hypothesize that the personalized home-based PA program will reduce IPH and modulate inflammatory and biological parameters in patients presenting with carotid plaques. If the results of the PACAPh study prove to be beneficial on such health parameters, the implementation of such kind of intervention in the daily treatment of these patients would be an advantageous and cost-effective practice to adopt globally. Trial registration This study has been approved by the National Ethics Committee (IDRCB:2019-A01543-54/SI:19.06.21.40640). ClinicalTrials.gov NCT04053166
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25
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Ware P, Shah A, Ross HJ, Logan AG, Segal P, Cafazzo JA, Szacun-Shimizu K, Resnick M, Vattaparambil T, Seto E. Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study. J Med Internet Res 2022; 24:e31754. [PMID: 35080502 PMCID: PMC8829695 DOI: 10.2196/31754] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/22/2021] [Accepted: 12/03/2021] [Indexed: 01/22/2023] Open
Abstract
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
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Affiliation(s)
- Patrick Ware
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Amika Shah
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Heather Joan Ross
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Alexander Gordon Logan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Nephrology, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Nephrology, University Health Network, Toronto, ON, Canada
| | - Phillip Segal
- Division of Endocrinology, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph Antony Cafazzo
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | - Myles Resnick
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Tessy Vattaparambil
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Emily Seto
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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26
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Cruz IO, Costa S, Teixeira R, Franco F, Gonçalves L. Telemonitoramento da Insuficiência Cardíaca – A Experiência de um Centro. Arq Bras Cardiol 2021; 118:599-604. [PMID: 35137786 PMCID: PMC8959025 DOI: 10.36660/abc.20201264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
Fundamento A evolução natural da insuficiência cardíaca é uma pior progressiva e internações hospitalares recorrentes. São necessárias estratégias para se detectar descompensações em tempo hábil. O uso do telemonitoramento da insuficiência cardíaca é inconsistente. Objetivos Este estudo tem o objetivo de avaliar o impacto desse programa de telemonitoramento (PTM) em internações hospitalares e admissões em serviços de emergência. Métodos Este é um estudo retrospectivo observacional que analisou dados de todos os pacientes que se cadastraram no PTM de janeiro a 2018 a dezembro de 2019. Foram coletados dados demográficos, clínicos e relacionados ao PTM. O número de internações hospitalares e admissões em serviços de emergência do ano anterior e posterior ao cadastro foram comparados, utilizando-se o teste de Wilcoxon. Um p-valor bilateral de <0,05 foi considerado significativo. Resultados Um total de 39 pacientes foram cadastrados, com uma média de idade de 62,1 ± 14 anos e predominância de pacientes do sexo masculino (90%). As causas mais comuns de insuficiência cardíaca foram cardiomiopatia isquêmica e dilatada. A fração de ejeção média foi de 30% e o tempo mediano da duração da doença foi de 84 meses (FIQ 33-144). Pacientes que foram cadastrados por menos de um mês foram excluídos, com um total de 34 pacientes analisados. Os pacientes foram acompanhados no PTM por um período mediano de 320 dias. O número de admissões em serviços de emergência foi reduzido em 66% (p<0,001) e o número de internações hospitalares por insuficiência cardíaca foi reduzido em 68% (p<0,001). O PTM não teve impacto no número de internações hospitalares por outras causas. Conclusões Este estudo sugere que o PTM poderia reduzir a utilização de serviços de saúde em pacientes com insuficiência cardíaca.
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Abstract
Many telemedicine interventions fail to be implemented in medical care with non-use and discontinued use by patients being among the major reasons. The aim of this scoping review was to provide an overview of barriers associated with non-use and discontinued use of telemedicine. An electronic search was conducted in Pubmed in October 2019 and updated in November 2020, followed by a hand search in the beginning of 2021. All potential articles were screened by two independent reviewers based on predefined inclusion and exclusion criteria. A qualitative content analysis according to Mayring was carried out. The topics 'intervention', 'context of use' and 'user' were chosen as overarching themes. Out of 1377 potentially relevant articles, 73 were included. User-related barriers were mentioned in most of the analysed studies, followed by barriers related to the intervention. The analysis provides the basis for overcoming non-use issues in telemedicine.
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Affiliation(s)
| | - Peter Eh Schwarz
- Technische Universität Dresden, Germany; German Center for Diabetes Research (DZD), Germany
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28
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Albuquerque de Almeida F, Corro Ramos I, Al M, Rutten-van Mölken M. Home telemonitoring and a diagnostic algorithm in the management of heart failure in the Netherlands: a cost-effectiveness analysis (Preprint). JMIR Cardio 2021; 6:e31302. [PMID: 35925670 PMCID: PMC9389378 DOI: 10.2196/31302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/16/2021] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
| | - Isaac Corro Ramos
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Maiwenn Al
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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29
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Granados Santiago M, Valenza MC, Prados Román E, López López L, Muñoz Vigueras N, Cabrera Martos I, Cebrià I Iranzo MÀ. Impacts of tailored, rehabilitation nursing care on functional ability and quality of life in hospitalized elderly patients after rib fractures. Clin Rehabil 2021; 35:1544-1554. [PMID: 34092117 DOI: 10.1177/02692155211022734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We aimed to analyze the effects of a tailored rehabilitation nursing care program on functional ability and quality of life in patients with conservative treatment for rib fractures. DESIGN Randomized controlled trial. SETTING Inpatient rehabilitation hospital. SUBJECTS Rib fracture patients treated conservatively were randomized into two groups (experimental and control group). INTERVENTIONS Patients in control group received Treatment as Usual (TAU) and patients included in experimental group received TAU and an added tailored rehabilitation nursing care program (RNT). MAIN MEASURES At baseline, and end of hospitalization treatment, the functional ability was assessed with the Barthel Index, and the quality of life was evaluated with the EuroQol-5D. Additionally, the outcomes were assessed at six-month follow-up. RESULTS A total of 80 patients were included in the study, whose mean age was 77.19 SD 7.71 in the RNT group and 75.55 SD 9.46 in the TAU group. Our data showed a significant difference in the post-treatment gains in overall quality of life (74.25 SD 20.62 vs 60.28 SD 20.54), and functional ability (71.79 SD 23.85 vs 69.41 SD 24.30) between the RNT group and the TAU group (P < 0.05). Compared to the TAU group, the RNT group also showed a significant improvement in functional ability and quality of life at six-month follow-up. CONCLUSIONS A tailored rehabilitation nursing care program added to the conservative treatment during hospitalization can improve the functional ability and quality of life of patients after rib fractures at discharge and at six-month follow-up. TRIAL REGISTRATION ClinicalTrial.gov Identifier: NCT04168996.
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Affiliation(s)
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Esther Prados Román
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura López López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Natalia Muñoz Vigueras
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera Martos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Sukhanov MS, Karakulova YV, Prokhorov KV, Spasenkov GN, Koryagina NA. Experience of remote monitoring of patients with cardiovascular diseases in the Perm Krai. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The first review on the effectiveness of remote monitoring in cardiovascular patients was published in 2007, which is still relevant, reaching the peak during the Coronavirus disease 2019 (COVID-19) pandemic. Reduced availability of elective outpatient care, and sometimes reluctance of patients to visit the office due to the pandemic, required changes in ambulatory follow-up. In order to increase the availability of healthcare and reduce the mortality of Perm Krai population from cardiovascular diseases during the COVID-19 pandemic, a project for remote monitoring of high-cardiovascular-risk patients was developed and implemented.The developed remote monitoring project represents regular phone contacts with a patient included in the remote monitoring program, according to which the need for further face-to-face consultation, additional diagnostic tests and treatment strategy is determined. The working group of the project identified indications for including patients in remote monitoring, algorithms for phone contacts and management options depending on the responses received from patients.The project was launched in July 2020. Initially, it included five medical institutions, which selected 3901 patients.The results will be published as the project moves forward.
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Silva-Cardoso J, Juanatey JRG, Comin-Colet J, Sousa JM, Cavalheiro A, Moreira E. The Future of Telemedicine in the Management of Heart Failure Patients. Card Fail Rev 2021; 7:e11. [PMID: 34136277 PMCID: PMC8201465 DOI: 10.15420/cfr.2020.32] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/22/2021] [Indexed: 12/20/2022] Open
Abstract
Telemedicine (TM) is potentially a way of escalating heart failure (HF) multidisciplinary integrated care. Despite the initial efforts to implement TM in HF management, we are still at an early stage of its implementation. The coronavirus disease 2019 pandemic led to an increased utilisation of TM. This tendency will probably remain after the resolution of this threat. Face-to-face medical interventions are gradually transitioning to the virtual setting by using TM. TM can improve healthcare accessibility and overcome geographic inequalities. It promotes healthcare system efficiency gains, and improves patient self-management and empowerment. In cooperation with human intervention, artificial intelligence can enhance TM by helping to deal with the complexities of multicomorbidity management in HF, and will play a relevant role towards a personalised HF patient approach. Artificial intelligence-powered/telemedical/heart team/multidisciplinary integrated care may be the next step of HF management. In this review, the authors analyse TM trends in the management of HF patients and foresee its future challenges within the scope of HF multidisciplinary integrated care.
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Affiliation(s)
- José Silva-Cardoso
- Faculty of Medicine, University of PortoPorto, Portugal
- São João University Hospital CentrePorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
| | | | - Josep Comin-Colet
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de LlobregatBarcelona, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L’Hospitalet de LlobregatBarcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - José Maria Sousa
- São João University Hospital CentrePorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
| | - Ana Cavalheiro
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
- Department of Physical Rehabilitation, Centro Hospitalar do PortoPorto, Portugal
| | - Emília Moreira
- Faculty of Medicine, University of PortoPorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
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Wesley Milks M, Sahay S, Benza RL, Farber HW. Risk assessment in patients with pulmonary arterial hypertension in the era of COVID 19 pandemic and the telehealth revolution: State of the art review. J Heart Lung Transplant 2021; 40:172-182. [PMID: 33414063 PMCID: PMC7749286 DOI: 10.1016/j.healun.2020.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022] Open
Abstract
Patients affected by pulmonary arterial hypertension (PAH) benefit from intensive, continuous clinical monitoring to guide escalation of treatments that carry the potential to improve survival and quality of life. During the coronavirus disease 2019 pandemic, the need for physical distancing has fueled the expeditious expansion of various telehealth modalities, which may apply in a unique manner to individuals with PAH. Performance of objective risk assessments in patients with PAH remotely via telemedical visits and other telehealth mechanisms is unprecedented and not yet rigorously validated. The uniquely high risk for rapid deterioration in patients with PAH demands a high degree of sensitivity to detect changes in functional assessments. In this review, several telehealth modalities for potential utilization in risk assessment and treatment titration in patients with PAH are explored, yet additional study is needed for their validation with the pre-pandemic care paradigm.
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Affiliation(s)
- Michael Wesley Milks
- Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Sandeep Sahay
- Houston Methodist Lung Center, Division of Pulmonary, Critical care & Sleep Medicine, Houston Methodist Hospital, Houston, Texas; Weill Cornell Medicine College, Institute of Academic Medicine, Houston Methodist Hospital, Houston, Texas.
| | - Raymond L Benza
- Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Harrison W Farber
- Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts
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Feijen M, Egorova AD, Beeres SLMA, Treskes RW. Early Detection of Fluid Retention in Patients with Advanced Heart Failure: A Review of a Novel Multisensory Algorithm, HeartLogic TM. SENSORS 2021; 21:s21041361. [PMID: 33671930 PMCID: PMC7919012 DOI: 10.3390/s21041361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) hospitalisations due to decompensation are associated with shorter life expectancy and lower quality of life. These hospitalisations pose a significant burden on the patients, doctors and healthcare resources. Early detection of an upcoming episode of decompensation may facilitate timely optimisation of the ambulatory medical treatment and thereby prevent heart-failure-related hospitalisations. The HeartLogicTM algorithm combines data from five sensors of cardiac implantable electronic devices into a cumulative index value. It has been developed for early detection of fluid retention in heart failure patients. This review aims to provide an overview of the current literature and experience with the HeartLogicTM algorithm, illustrate how the index can be implemented in daily clinical practice and discuss ongoing studies and potential future developments of interest.
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Telemedicine for Pre-Employment Medical Examinations and Follow-Up Visits on Board Ships: A Narrative Review on the Feasibility. Healthcare (Basel) 2021; 9:healthcare9010069. [PMID: 33451120 PMCID: PMC7828583 DOI: 10.3390/healthcare9010069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/29/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Telemedicine has already been applied to various medical specialties for diagnosis, treatment, and follow-up visits for the general population. Telemedicine has also proven effective by providing advice, diagnosis, and treatment to seafarers during emergency medical events onboard ships. However, it has not yet been applied for pre-employment medical examinations and follow-up visits on board ships. OBJECTIVE This review aimed to assess the possibility of using telemedicine during periodic visits between one pre-employment medical examination and others on board ships, and to recommend necessary medical examination tests with screening intervals for seafarers. METHODS Various databases including PubMed, EMBASE, Scopus, CINAHL, and Cochrane Library were explored using different keywords, titles, and abstracts. Studies published between 1999 and 2019, in English, in peer-reviewed journal articles, and that are conference proceedings were considered. Finally, the studies included in this review were chosen on the basis of the eligibility criteria. RESULTS Out of a total of 168 studies, 85 studies were kept for further analysis after removing the duplicates. A further independent screening based on the inclusion and exclusion criteria resulted in the withdrawal of 51 studies that were not further considered for our analysis. Finally, 32 studies were left, which were critically reviewed. Out of 32 accepted studies, 10 studies demonstrated the effectiveness of the electrocardiogram (ECG) in monitoring and managing remote patients with heart failure, early diagnosis, and postoperative screening. In 15 studies, telespirometry was found to be effective in diagnosing and ruling out diseases, detecting lung abnormalities, and managing patients with chronic obstructive pulmonary disease (COPD) and asthma. Seven studies reported that telenephrology was effective, precise, accurate, and usable by non-medical personnel and that it reduced sample analysis times and procedures in laboratories. CONCLUSION using new technologies such as high-speed internet, video conferencing, and digital examination, personnel are able to make the necessary tests and perform virtual medical examination on board ships with necessary training.
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Dolan J, Mandras S, Mehta JP, Navas V, Tarver J, Chakinala M, Rahaghi F. Reducing rates of readmission and development of an outpatient management plan in pulmonary hypertension: lessons from congestive heart failure management. Pulm Circ 2020; 10:2045894020968471. [PMID: 33343880 PMCID: PMC7727062 DOI: 10.1177/2045894020968471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/03/2020] [Indexed: 11/16/2022] Open
Abstract
Pulmonary hypertension currently has minimal guidelines for outpatient disease management. Congestive heart failure studies, however, have shown effectiveness of disease management plans in reducing all-cause mortality and all-cause and congestive heart failure-related hospital readmissions. Heart failure exacerbation is a common reason for readmission in both pulmonary hypertension and congestive heart failure. Our aim was to review individual studies and comprehensive meta-analyses to identify effective congestive heart failure interventions that can be used to develop similar disease management plans for pulmonary hypertension. A comprehensive literature review from 1993 to 2019 included original articles, systematic reviews, and meta-analyses. We reviewed topics of outpatient congestive heart failure interventions to decrease congestive heart failure mortality and readmission and patient management strategies in congestive heart failure. The most studied interventions included case management, multidisciplinary intervention, structured telephone strategy, and tele-monitoring. Case management showed decreased all-cause mortality at 12 months, all-cause readmission at 12 months, and congestive heart failure readmission at 6 and 12 months. Multidisciplinary intervention resulted in decreased all-cause readmission and congestive heart failure readmission. There was some discrepancy on effectiveness of tele-monitoring programs in individual studies; however, meta-analyses suggest tele-monitoring provided reduced all-cause mortality and risk of congestive heart failure hospitalization. Structured telephone strategy had similar results to tele-monitoring including decreased risk of congestive heart failure hospitalization, without effect on mortality. Extrapolating from congestive heart failure data, it seems strategies to improve the health of pulmonary hypertension patients and development of comprehensive care programs should include structured telephone strategy and/or tele-monitoring, case management strategies, and multidisciplinary interventions.
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Affiliation(s)
- Justin Dolan
- Department of Pulmonology, Cleveland Clinic Florida, Weston, FL, USA
| | - Stacy Mandras
- Department of Cardiology, Ochsner Medical Center, Jefferson, LA, USA
| | - Jinesh P Mehta
- Department of Pulmonology, Cleveland Clinic Florida, Weston, FL, USA
| | - Viviana Navas
- Department of Cardiology, Cleveland Clinic Florida, Weston, FL, USA
| | - James Tarver
- Department of Cardiology, Center for Pulmonary Hypertension and Cardiovascular Disease, Orlando, FL, USA
| | - Murali Chakinala
- Department of Pulmonology, Washington University, St. Louis, MO, USA
| | - Franck Rahaghi
- Department of Pulmonology, Cleveland Clinic Florida, Weston, FL, USA
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Alhadramy OM. The Structure and the Outcome of Telephone-Based Cardiac Consultations During Lockdown: A Lesson From COVID-19. Cureus 2020; 12:e11585. [PMID: 33364109 PMCID: PMC7749865 DOI: 10.7759/cureus.11585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background In response to COVID-19, Saudi Arabia as many countries, implemented “lockdown” to contain the epidemic. This resulted in suspension of all outpatient services. The reliability of the alternative telecommunication cardiac services during that time is not well studied. Accordingly, the objective of this study is to describe the structure of the telephone-based cardiac consultation (TBCC) and to explore its outcome. Methods This is a cross-sectional study that has a prospective follow up on patients who underwent medical intervention. During the period of lockdown, Alre’aiah health care society in Almadinah Almunawwarah, Saudi Arabia, provided a community health service. This was achieved by announcing telephone numbers for consultations in most specialties. This study includes all TBCC of a single cardiologist. Detailed demographic data, medical, social and drug histories of the patients were collected in charts. Individuals were requested to measure blood pressure (BP) and heart rate (HR) at the time of TBCC. Accordingly, cardiovascular assessment and appropriate intervention were executed. Patients who needed medical intervention were followed up in one week. The data were analyzed using appropriate statistical methods. Results From 01 April till 15 June 2020, a total of 168 individuals sought TBCC. Their median age was 51.5 ± 12.7 years, and (57.1%) were females. Healthy individuals constituted (33.9%), and (59.9%) were non-smokers. The most common reported medical illnesses were hypertension (27.3%), diabetes (23.8%), heart failure (16.1%), and coronary artery disease (14.9%). Palpitations were encountered by 58 patients. None of them had high-risk features or cardiac disease. Stress, excessive smoking, and caffeine intake were thought to be responsible for palpitations in 52 individuals who were reassured and educated, and newly diagnosed hypertension was established prospectively in eight patients and they were started on medications. Chest pain was reported by 51 individuals. The diagnosis of typical angina was made in nine patients and they were instructed to seek emergency care. Atypical angina pain was established in 10 cases who were advised to seek formal consultation once lockdown ends. Reassurance was achieved in 32 individuals who had features of non-angina pain. Uncontrolled hypertension was reported by 32 patients. Blood pressure control was achieved prospectively in 70% of these patients who followed up by adjusting their antihypertensive drugs. Twenty-seven patients with heart failure complained of worsening shortness of breath. New York Heart Association (NYHA) class 1-2 was reported by 21 patients, and they were managed by doubling diuretic dose, 19 of them followed back and reported significant improvement. NYHA class 3-4 was established in 6 patients and they were instructed to seek emergency care. Conclusions When standard face-to-face cardiac consultations are compromised, a structured TBCC is considered feasible, seems effective, and promising alternative method of delivering the utmost cardiac care to the community. When conducted properly, it is useful to triage patients.
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Affiliation(s)
- Osama M Alhadramy
- Internal Medicine, College of Medicine, Taibah University, Medina, SAU
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Davidson R, Barrett DI, Rixon L, Newman S. How the Integration of Telehealth and Coordinated Care Approaches Impact Health Care Service Organization Structure and Ethos: Mixed Methods Study. JMIR Nurs 2020; 3:e20282. [PMID: 34345792 PMCID: PMC8279440 DOI: 10.2196/20282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 01/01/2023] Open
Abstract
Background Coordinated care and telehealth services have the potential to deliver quality care to chronically ill patients. They can both reduce the economic burden of chronic care and maximize the delivery of clinical services. Such services require new behaviors, routines, and ways of working to improve health outcomes, administrative efficiency, cost-effectiveness, and user (patient and health professional) experience. Objective The aim of this study was to assess how health care organization setup influences the perceptions and experience of service managers and frontline staff during the development and deployment of integrated care with and without telehealth. Methods As part of a multinational project exploring the use of coordinated care and telehealth, questionnaires were sent to service managers and frontline practitioners. These questionnaires gathered quantitative and qualitative data related to organizational issues in the implementation of coordinated care and telehealth. Three analytical stages were followed: (1) preliminary analysis for a direct comparison of the responses of service managers and frontline staff to a range of organizational issues, (2) secondary analysis to establish statistically significant relationships between baseline and follow-up questionnaires, and (3) thematic analysis of free-text responses of service managers and frontline staff. Results Both frontline practitioners and managers highlighted that training, tailored to the needs of different professional groups and staff grades, was a crucial element in the successful implementation of new services. Frontline staff were markedly less positive than managers in their views regarding the responsiveness of their organization and the pace of change. Conclusions The data provide evidence that the setup of health care services is positively associated with outcomes in several areas, particularly tailored staff training, rewards for good service, staff satisfaction, and patient involvement.
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Affiliation(s)
- Rosemary Davidson
- Institute for Health Research University of Bedfordshire Luton United Kingdom
| | - David Ian Barrett
- School of Health and Social Work University of Hull Hull United Kingdom
| | - Lorna Rixon
- Centre for Health Services Research City, University of London London United Kingdom
| | - Stanton Newman
- Centre for Health Services Research City, University of London London United Kingdom
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Gao L, Maddison R, Rawstorn J, Ball K, Oldenburg B, Chow C, McNaughton S, Lamb K, Amerena J, Nadurata V, Neil C, Cameron S, Moodie M. Economic evaluation protocol for a multicentre randomised controlled trial to compare Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) versus usual care cardiac rehabilitation among people with coronary heart disease. BMJ Open 2020; 10:e038178. [PMID: 32847918 PMCID: PMC7451486 DOI: 10.1136/bmjopen-2020-038178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION It is important to ascertain the cost-effectiveness of alternative services to traditional cardiac rehabilitation while the economic credentials of the Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) programme among people with coronary heart disease (CHD) are unknown. This economic protocol outlines the methods for undertaking a trial-based economic evaluation of SCRAM in the real-world setting in Australia. METHODS AND ANALYSIS The within-trial economic evaluation will be undertaken alongside a randomised controlled trial (RCT) designed to determine the effectiveness of SCRAM in comparison with the usual care cardiac rehabilitation (UC) alone in people with CHD. Pathway analysis will be performed to identify all the costs related to the delivery of SCRAM and UC. Both a healthcare system and a limited societal perspective will be adopted to gauge all costs associated with health resource utilisation and productivity loss. Healthcare resource use over the 6-month participation period will be extracted from administrative databases (ie, Pharmaceutical Benefits Scheme and Medical Benefits Schedule). Productivity loss will be measured by absenteeism from work (valued by human capital approach). The primary outcomes for the economic evaluation are maximal oxygen uptake (VO2max, mL/kg/min, primary RCT outcome) and quality-adjusted life years estimated from health-related quality of life as assessed by the Assessment of Quality of Life-8D instrument. The incremental cost-effectiveness ratio will be calculated using the differences in costs and benefits (ie, primary and secondary outcomes) between the two randomised groups from both perspectives with no discounting. All costs will be valued in Australian dollars for year 2020. ETHICS AND DISSEMINATION The study protocol has been approved under Australia's National Mutual Acceptance agreement by the Melbourne Health Human Research Ethics Committee (HREC/18/MH/119). It is anticipated that SCRAM is a cost-effective cardiac telerehabilitation programme for people with CHD from both a healthcare and a limited societal perspective in Australia. The evaluation will provide evidence to underpin national scale-up of the programme to a wider population. The results of the economic analysis will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12618001458224).
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Affiliation(s)
- Lan Gao
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Jonathan Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Brian Oldenburg
- Nossal Institute for Global Health, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Clara Chow
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah McNaughton
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Karen Lamb
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Amerena
- Cardiac Services, Barwon Health, Geelong, Victoria, Australia
- Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Voltaire Nadurata
- Department of Cardiology, Bendigo Health, Bendigo, Victoria, Australia
| | - Christopher Neil
- Western Clinical School, The University of Melbourne, Saint Albans, Victoria, Australia
| | - Stuart Cameron
- Applied Artificial Intelligence Institute, Deakin University, Burwood, Victoria, Australia
| | - Marj Moodie
- School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
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Consensus on Criteria for Good Practices in Video Consultation: A Delphi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155396. [PMID: 32727042 PMCID: PMC7432677 DOI: 10.3390/ijerph17155396] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022]
Abstract
The use of telemedicine has greatly increased, largely derived from the COVID-19 pandemic, which has created the need for a guide aimed towards the adequate management of a modality of health care: the video consultation. A Delphi study composed of three rounds was conducted with 16 experts in holding video consultations and managing non-technical skills from different specialties and nationalities to conceive a consensus on the criteria needed for properly managing video consultations by healthcare professionals. The consensus criteria were defined by three dimensions (preparation of video consultation, video consultation process, and post-video consultation) and their corresponding items. Excellent consensus data was obtained; therefore, use is recommended by any healthcare professional who is going to utilize a video consultation, in order to manage it effectively.
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Beerthuizen T, Rijssenbeek-Nouwens LH, van Koppen SM, Khusial RJ, Snoeck-Stroband JB, Sont JK. Internet-Based Self-Management Support After High-Altitude Climate Treatment for Severe Asthma: Randomized Controlled Trial. J Med Internet Res 2020; 22:e13145. [PMID: 32706692 PMCID: PMC7407281 DOI: 10.2196/13145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/29/2019] [Accepted: 03/29/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In patients with severe asthma, high-altitude climate treatment has been shown to improve asthma control. However, asthma symptoms and limitations may increase after finishing inpatient rehabilitation programs and returning to sea level. OBJECTIVE We assessed the effectiveness of a patient-tailored, internet-based, self-management strategy in addition to usual care after finishing high-altitude climate treatment. METHODS We performed a randomized controlled trial with a 1-year follow-up in patients from a high-altitude asthma center in Davos, Switzerland. At the end of a 12-week multidisciplinary rehabilitation program, 62 adults with asthma were randomized to receive either internet-based self-management support in addition to usual care (n=33) or usual care only after discharge (n=29). The endpoints were changes in asthma-related quality of life according to the Asthma Quality of Life Questionnaire (AQLQ) (a higher score is better) and asthma control according to the Asthma Control Questionnaire (ACQ) (a lower score is better), with a minimally important difference of 0.5 points for both. RESULTS Asthma-related quality of life and asthma control declined over time in the usual care strategy group, whereas there was a slower decline in the internet-based strategy group. For both endpoints, mixed-model analysis showed a significant positive effect in favor of internet-based self-management during follow-up (mean AQLQ score difference 0.39, 95% CI 0.092-0.69; P=.01 and ACQ score difference -0.50, 95% CI -0.86 to -0.15; P=.006), which was prominent among patients with uncontrolled asthma at discharge (AQLQ score difference 0.59, 95% CI 0.19-0.99; P=.003 and ACQ score difference -0.73, 95% CI -1.18 to -0.28; P=.002). CONCLUSIONS Internet-based self-management support was associated with a smaller decline in quality of life and asthma control as compared with usual care, especially in patients with lower asthma control, after completion of high-altitude climate treatment. Internet-based self-management support in adults with severe asthma seems feasible and effective to maintain quality of life and asthma control. TRIAL REGISTRATION The trial is registered in the Netherlands Trial Register (NTR1995).
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Affiliation(s)
- Thijs Beerthuizen
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
| | | | - Sophia M van Koppen
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
| | - Rishi J Khusial
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
| | - Jiska B Snoeck-Stroband
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
| | - Jacob K Sont
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
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Indraratna P, Tardo D, Yu J, Delbaere K, Brodie M, Lovell N, Ooi SY. Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e16695. [PMID: 32628615 PMCID: PMC7381017 DOI: 10.2196/16695] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/30/2020] [Accepted: 04/08/2020] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Praveen Indraratna
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia.,Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - Daniel Tardo
- Department of Medicine, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, The University of Notre Dame, Sydney, Australia
| | - Jennifer Yu
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia.,Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Matthew Brodie
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia.,Graduate School of Biomedical Engineering, The University of New South Wales, Sydney, Australia
| | - Nigel Lovell
- Graduate School of Biomedical Engineering, The University of New South Wales, Sydney, Australia
| | - Sze-Yuan Ooi
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia.,Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
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44
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Planinc I, Milicic D, Cikes M. Telemonitoring in Heart Failure Management. Card Fail Rev 2020; 6:e06. [PMID: 32377385 PMCID: PMC7199128 DOI: 10.15420/cfr.2019.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/11/2019] [Indexed: 12/24/2022] Open
Abstract
Telemonitoring (TM) aims to predict and prevent worsening heart failure (HF) episodes and improve self-care, patient education, treatment adherence and survival. There is a growing number of TM options for patients with HF, but there are numerous challenges in reaching positive outcomes. Conflicting evidence from clinical trials may be the result of the enormous heterogeneity of TM devices tested, differences in selected patient populations and variabilities between healthcare systems. This article covers some basic concepts of TM, looking at the recent advances in the most frequently used types of TM and the evidence to support its use in the care of people with HF.
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Affiliation(s)
- Ivo Planinc
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb Zagreb, Croatia
| | - Davor Milicic
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb Zagreb, Croatia
| | - Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb Zagreb, Croatia
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Larina VN, Leonova MV, Bondarenkova AA, Larin VG. Patient compliance and physicians’ adherence to guidelines on heart failure with reduced ejection fraction. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- V. N. Larina
- N.I. Pirogov Russian National Research Medical University
| | | | | | - V. G. Larin
- N.I. Pirogov Russian National Research Medical University
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Sara JDS, Maor E, Borlaug B, Lewis BR, Orbelo D, Lerman LO, Lerman A. Non-invasive vocal biomarker is associated with pulmonary hypertension. PLoS One 2020; 15:e0231441. [PMID: 32298301 PMCID: PMC7162478 DOI: 10.1371/journal.pone.0231441] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/08/2020] [Indexed: 12/19/2022] Open
Abstract
Emerging data suggest that noninvasive voice biomarker analysis is associated with coronary artery disease. We recently showed that a vocal biomarker was associated with hospitalization and heart failure in patients with heart failure. We evaluate the association between a vocal biomarker and invasively measured indices of pulmonary hypertension (PH). Patients were referred for an invasive cardiac hemodynamic study between January 2017 and December 2018, and had their voices recorded on three separate occasions to their smartphone prior to each study. A pre-established vocal biomarker was determined based on each individual recording. The intra-class correlation co-efficient between the separate voice recording biomarker values for each individual participant was 0.829 (95% CI 0.740-0.889) implying very good agreement between values. Thus, the mean biomarker was calculated for each patient. Patients were divided into two groups: high pulmonary arterial pressure (PAP) defined as ≥ 35 mmHg (moderate or greater PH), versus lower PAP. Eighty three patients, mean age 61.6 ± 15.1 years, 37 (44.6%) male, were included. Patients with a high mean PAP (≥ 35 mmHg) had on average significantly higher values of the mean voice biomarker compared to those with a lower mean PAP (0.74 ± 0.85 vs. 0.40 ± 0.88 p = 0.046). Multivariate logistic regression showed that an increase in the mean voice biomarker by 1 unit was associated with a high PAP, odds ratio 2.31, 95% CI 1.05-5.07, p = 0.038. This study shows a relationship between a noninvasive vocal biomarker and an invasively derived hemodynamic index related to PH obtained during clinically indicated cardiac catheterization. These results may have important practical clinical implications for telemedicine and remote monitoring of patients with heart failure and PH.
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Affiliation(s)
- Jaskanwal Deep Singh Sara
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, United States of America
| | - Elad Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barry Borlaug
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, United States of America
| | - Bradley R. Lewis
- Division of Biomedical Statistics and Informatics, Mayo College of Medicine, Rochester, MN, United States of America
| | - Diana Orbelo
- Divison of Laryngology, Mayo College of Medicine, Rochester, MN, United States of America
| | - Lliach O. Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States of America
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, United States of America
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Rawstorn JC, Ball K, Oldenburg B, Chow CK, McNaughton SA, Lamb KE, Gao L, Moodie M, Amerena J, Nadurata V, Neil C, Cameron S, Maddison R. Smartphone Cardiac Rehabilitation, Assisted Self-Management Versus Usual Care: Protocol for a Multicenter Randomized Controlled Trial to Compare Effects and Costs Among People With Coronary Heart Disease. JMIR Res Protoc 2020; 9:e15022. [PMID: 32012103 PMCID: PMC7011127 DOI: 10.2196/15022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023] Open
Abstract
Background Alternative evidence-based cardiac rehabilitation (CR) delivery models that overcome significant barriers to access and delivery are needed to address persistent low utilization. Models utilizing contemporary digital technologies could significantly improve reach and fidelity as complementary alternatives to traditional center-based programs. Objective The aim of this study is to compare the effects and costs of the innovative Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) intervention with usual care CR. Methods In this investigator-, assessor-, and statistician-blinded parallel 2-arm randomized controlled trial, 220 adults (18+ years) with coronary heart disease are being recruited from 3 hospitals in metropolitan and regional Victoria, Australia. Participants are randomized (1:1) to receive advice to engage with usual care CR or the SCRAM intervention. SCRAM is a 24-week dual-phase intervention that includes 12 weeks of real-time remote exercise supervision and coaching from exercise physiologists, which is followed by 12 weeks of data-driven nonreal-time remote coaching via telephone. Both intervention phases include evidence- and theory-based multifactorial behavior change support delivered via smartphone push notifications. Outcomes assessed at baseline, 12 weeks, and 24 weeks include maximal aerobic exercise capacity (primary outcome at 24 weeks), modifiable cardiovascular risk factors, exercise adherence, secondary prevention self-management behaviors, health-related quality of life, and adverse events. Economic and process evaluations will determine cost-effectiveness and participant perceptions of the treatment arms, respectively. Results The trial was funded in November 2017 and received ethical approval in June 2018. Recruitment began in November 2018. As of September 2019, 54 participants have been randomized into the trial. Conclusions The innovative multiphase SCRAM intervention delivers real-time remote exercise supervision and evidence-based self-management behavioral support to participants, regardless of their geographic proximity to traditional center-based CR facilities. Our trial will provide unique and valuable information about effects of SCRAM on outcomes associated with cardiac and all-cause mortality, as well as acceptability and cost-effectiveness. These findings will be important to inform health care providers about the potential for innovative program delivery models, such as SCRAM, to be implemented at scale, as a complement to existing CR programs. The inclusion of a cohort comprising metropolitan-, regional-, and rural-dwelling participants will help to understand the role of this delivery model across health care contexts with diverse needs. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN): 12618001458224; anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374508. International Registered Report Identifier (IRRID) DERR1-10.2196/15022
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Affiliation(s)
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Karen Elaine Lamb
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Lan Gao
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Geelong, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Geelong, Australia
| | - John Amerena
- Geelong Cardiology Research Unit, Barwon Health, Geelong, Australia
| | | | - Christopher Neil
- Department of Medicine, Western Health and University of Melbourne, Sunshine, Australia
| | - Stuart Cameron
- Applied Artificial Intelligence Institute, Deakin University, Geelong, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Chambers D, Cantrell A, Booth A. Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BackgroundIn 2012, a series of systematic reviews summarised the evidence regarding interventions to reduce preventable hospital admissions. Although intervention effects were dependent on context, the reviews revealed a consistent picture of reduction across different interventions targeting cardiovascular and respiratory conditions. The research reported here sought to provide an in-depth understanding of how interventions that have been shown to reduce admissions for these conditions may work, with a view to supporting their effective implementation in practice.ObjectivesTo map the available evidence on interventions used in the UK NHS to reduce preventable admissions for cardiovascular and respiratory conditions and to conduct a realist synthesis of implementation evidence related to these interventions.MethodsFor the mapping review, six databases were searched for studies published between 2010 and October 2017. Studies were included if they were conducted in the UK, the USA, Canada, Australia or New Zealand; recruited adults with a cardiovascular or respiratory condition; and evaluated or described an intervention that could reduce preventable admissions or re-admissions. A descriptive summary of key characteristics of the included studies was produced. The studies included in the mapping review helped to inform the sampling frame for the subsequent realist synthesis. The wider evidence base was also engaged through supplementary searching. Data extraction forms were developed using appropriate frameworks (an implementation framework, an intervention template and a realist logic template). Following identification of initial programme theories (from the theoretical literature, empirical studies and insights from the patient and public involvement group), the review team extracted data into evidence tables. Programme theories were examined against the individual intervention types and collectively as a set. The resultant hypotheses functioned as synthesised statements around which an explanatory narrative referenced to the underpinning evidence base was developed. Additional searches for mid-range and overarching theories were carried out using Google Scholar (Google Inc., Mountain View, CA, USA).ResultsA total of 569 publications were included in the mapping review. The largest group originated from the USA. The included studies from the UK showed a similar distribution to that of the map as a whole, but there was evidence of some country-specific features, such as the prominence of studies of telehealth. In the realist synthesis, it was found that interventions with strong evidence of effectiveness overall had not necessarily demonstrated effectiveness in UK settings. This could be a barrier to using these interventions in the NHS. Facilitation of the implementation of interventions was often not reported or inadequately reported. Many of the interventions were diverse in the ways in which they were delivered. There was also considerable overlap in the content of interventions. The role of specialist nurses was highlighted in several studies. The five programme theories identified were supported to varying degrees by empirical literature, but all provided valuable insights.LimitationsThe research was conducted by a small team; time and resources limited the team’s ability to consult with a full range of stakeholders.ConclusionsOverall, implementation appears to be favoured by support for self-management by patients and their families/carers, support for services that signpost patients to consider alternatives to seeing their general practitioner when appropriate, recognition of possible reasons why patients seek admission, support for health-care professionals to diagnose and refer patients appropriately and support for workforce roles that promote continuity of care and co-ordination between services.Future workResearch should focus on understanding discrepancies between national and international evidence and the transferability of findings between different contexts; the design and evaluation of implementation strategies informed by theories about how the intervention being implemented might work; and qualitative research on decision-making around hospital referrals and admissions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Abstract
An effective discharge plan is associated with better outcomes in advanced heart failure (HF) patients. Furthermore, a patient-centred care planning can improve patients' satisfaction, quality of life, and enhance self-care. Telemedicine may allow optimized monitoring of advanced HF patients. Nevertheless, its implementation into clinical practice across European countries is still limited. This document reflects the key points discussed concerning effective management plans in advanced HF by a panel of experts during a Heart Failure Association meeting on physiological monitoring of the complex multimorbid HF patient.
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Affiliation(s)
- Loreena Hill
- Queen's University, Belfast, Northern Ireland, UK
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50
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Ponikowski P, Spoletini I, Coats AJS, Piepoli MF, Rosano GMC. Heart rate and blood pressure monitoring in heart failure. Eur Heart J Suppl 2019; 21:M13-M16. [PMID: 31908609 PMCID: PMC6937500 DOI: 10.1093/eurheartj/suz217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
It has been long known that incessant tachycardia and severe hypertension can cause heart failure (HF). In recent years, it has also been recognized that more modest elevations in either heart rate (HR) or blood pressure (BP), if sustained, can be a risk factor both for the development of HF and for mortality in patients with established HF. Heart rate and BP are thus both modifiable risk factors in the setting of HF. What is less clear is the question whether routine systematic monitoring of these simple physiological parameters to a target value can offer clinical benefits. Measuring these parameters clinically during patient review is recommended in HF management in most HF guidelines, both in the acute and chronic phases of the disease. More sophisticated systems now allow long-term automatic or remote monitoring of HR and BP and whether this more detailed patient information can improve clinical outcomes will require prospective RCTs to evaluate. In addition, analysis of patterns of both HR and BP variability can give insights into autonomic function, which is also frequently abnormal in HF. This window into autonomic dysfunction in our HF patients can also provide further independent prognostic information and may in itself be target for future interventional therapies. This article, developed during a consensus meeting of the Heart Failure Association of the ESC concerning the role of physiological monitoring in the complex multi-morbid HF patient, highlights the importance of repeated assessment of HR and BP in HF, and reviews gaps in our knowledge and potential future directions.
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Affiliation(s)
- Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Ilaria Spoletini
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | - Andrew J S Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | | | - Giuseppe M C Rosano
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
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