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Laubham M, Dodeja AK, Kumthekar R, Shay V, D'Emilio N, Conroy S, Mah ML, Alvarado C, Kamp A. Patient Driven EKG Device Performance in Adults with Fontan Palliation. Pediatr Cardiol 2024:10.1007/s00246-024-03614-6. [PMID: 39152263 DOI: 10.1007/s00246-024-03614-6] [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] [Received: 04/11/2024] [Accepted: 08/02/2024] [Indexed: 08/19/2024]
Abstract
The aim of this study was to evaluate the accuracy of the KardiaMobile (KM) device in adults with a Fontan palliation, and to assess the KM function as a screening tool for atrial arrhythmias. While patient driven electrocardiogram (EKG) devices are becoming a validated way to evaluate cardiac arrhythmias, their role for patients with congenital heart disease is less clear. Patients with single ventricle Fontan palliation have a high prevalence of atrial arrhythmias and represent a unique cohort that could benefit from early detection of atrial arrhythmias. This single center prospective study enrolled adult patients with Fontan palliation to use the KM heart rhythm monitoring device for both symptomatic episodes and asymptomatic weekly screening over a 1-year period. Accuracy was assessed by comparing the automatic KM interpretation (KM-auto) to an electrophysiologist overread (KM-EP) and traditional EKG. Fifty patients were enrolled and 510 follow-up transmissions were received. The sensitivity and specificity of enrollment KM-auto compared to EKG was 65% and 100%, respectively. The sensitivity and specificity of enrollment KM-auto compared to the KM-EP was 75% and 96%, respectively. In the adult Fontan palliation, the accuracy of the KM device to detect a normal rhythm was reliable and best with a physician overread. Abnormal or uninterpretable KM-auto device interpretations, symptomatic transmissions, and any transmissions with a high heart rate compared to a patient's normal baseline should warrant further review.
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Affiliation(s)
- Matthew Laubham
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- The Ohio State University Medical Center, Columbus, OH, 43210, USA.
| | - Anudeep K Dodeja
- University of Connecticut School of Medicine and Connecticut Children's Hospital Hartford, Hartford, CT, 06106, USA
| | - Rohan Kumthekar
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- The Ohio State University Medical Center, Columbus, OH, 43210, USA
| | - Victoria Shay
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Center for Biostatistics, The Ohio State University, Wexner Medical Center, Columbus, OH, 43210, USA
| | - Nathan D'Emilio
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Sara Conroy
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Center for Biostatistics, The Ohio State University, Wexner Medical Center, Columbus, OH, 43210, USA
- Biostatistics Resource, Nationwide Children's Hospital, Abigail Wexner Research Institute, Columbus, OH, 43205, USA
| | - May Ling Mah
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- The Ohio State University Medical Center, Columbus, OH, 43210, USA
| | - Chance Alvarado
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Center for Biostatistics, The Ohio State University, Wexner Medical Center, Columbus, OH, 43210, USA
- Biostatistics Resource, Nationwide Children's Hospital, Abigail Wexner Research Institute, Columbus, OH, 43205, USA
| | - Anna Kamp
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- The Ohio State University Medical Center, Columbus, OH, 43210, USA
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2
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Baron R, Haick H. Mobile Diagnostic Clinics. ACS Sens 2024; 9:2777-2792. [PMID: 38775426 PMCID: PMC11217950 DOI: 10.1021/acssensors.4c00636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 06/29/2024]
Abstract
This article reviews the revolutionary impact of emerging technologies and artificial intelligence (AI) in reshaping modern healthcare systems, with a particular focus on the implementation of mobile diagnostic clinics. It presents an insightful analysis of the current healthcare challenges, including the shortage of healthcare workers, financial constraints, and the limitations of traditional clinics in continual patient monitoring. The concept of "Mobile Diagnostic Clinics" is introduced as a transformative approach where healthcare delivery is made accessible through the incorporation of advanced technologies. This approach is a response to the impending shortfall of medical professionals and the financial and operational burdens conventional clinics face. The proposed mobile diagnostic clinics utilize digital health tools and AI to provide a wide range of services, from everyday screenings to diagnosis and continual monitoring, facilitating remote and personalized care. The article delves into the potential of nanotechnology in diagnostics, AI's role in enhancing predictive analytics, diagnostic accuracy, and the customization of care. Furthermore, the article discusses the importance of continual, noninvasive monitoring technologies for early disease detection and the role of clinical decision support systems (CDSSs) in personalizing treatment guidance. It also addresses the challenges and ethical concerns of implementing these advanced technologies, including data privacy, integration with existing healthcare infrastructure, and the need for transparent and bias-free AI systems.
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Affiliation(s)
- Roni Baron
- Department
of Biomedical Engineering, Technion—Israel
Institute of Technology, Haifa 3200003, Israel
| | - Hossam Haick
- Department
of Chemical Engineering and the Russell Berrie Nanotechnology Institute, Technion—Israel Institute of Technology, Haifa 3200003, Israel
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3
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Shiue M, Nyman A, Karvell R, Partington SL, Preminger TJ, Reda C, Ruckdeschel E, Sullivan K, Tobin L, Vaikunth SS, Saef J, Tedla BA, Kim YY. Experiences and Attitudes Toward Telemedicine in an Adult Congenital Heart Disease Clinic: Lessons Learned from the COVID-19 Pandemic. Pediatr Cardiol 2024:10.1007/s00246-024-03533-6. [PMID: 38836881 DOI: 10.1007/s00246-024-03533-6] [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] [Received: 03/09/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has driven a broader adoption of telemedicine (TM). We aim to describe adult congenital heart disease (ACHD) patient experiences with TM and explore factors associated with positive attitude toward future TM visits. This is a cross-sectional, single-center study in an outpatient ACHD clinic from February to June, 2022. Between-group comparisons were made using Wilcoxon-Rank Sum, Chi-Square, or Fisher-Exact tests. Univariate logistic regression was performed for variables that could correlate with a "positive" attitude toward future TM visits. Significance was determined using an alpha level of 0.05. Of 262 patients (median age 33 years, 55% female, 81% White), 115 (44%) had a prior TM visit and 110 (96%) reported a positive experience. There were 64 (24%) with a positive attitude toward future TM visits. Concerns include lack of cardiac testing and limited quality of visit. Patients with visits every 3-6 months (Odds Ratio [OR] 2.44; p < 0.01) and prior TM visit (OR 1.89; p = 0.03) had higher odds of a positive attitude toward future TM, whereas males had lower odds (OR 0.53; p = 0.04). Age, annual income, disease complexity, distance from clinic, and employment status were not associated. There is high rate of satisfaction with TM among ACHD patients but only one-quarter indicated interest in using TM in the future. Factors associated with interest in TM visits are identified, and together with patient feedback, can be used to understand potential role of TM for the ACHD population in the post-pandemic era.
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Affiliation(s)
- Mia Shiue
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Annique Nyman
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Robert Karvell
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Sara L Partington
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Tamar J Preminger
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Christian Reda
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Emily Ruckdeschel
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Kathleen Sullivan
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Lynda Tobin
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Sumeet S Vaikunth
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Joshua Saef
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Bruke A Tedla
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Yuli Y Kim
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Division of Cardiology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 2Nd Floor E. Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Koole MA, de Jong S, Mulder BJ, Bouma BJ, Schuuring MJ. Value of Extended Arrhythmia Screening in Adult Congenital Heart Disease Patients. Arrhythm Electrophysiol Rev 2024; 13:e07. [PMID: 38807745 PMCID: PMC11131155 DOI: 10.15420/aer.2023.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/27/2023] [Indexed: 05/30/2024] Open
Abstract
The European Society of Cardiology guidelines for the management of adult congenital heart disease patients recommend screening for arrhythmias and bradycardias in symptomatic patients, often being done by means of an ambulatory 24-48-hour Holter or implantable loop recorder (ILR). However, nowadays non-invasive instruments, such as patches, smartwatches and smartphones based on single-lead ECGs that perform extended monitoring, are also available. The aim of this narrative review was to assess whether these instruments, when they detect arrhythmias and bradycardias in patients with adult congenital heart disease, will lead to meaningful changes in clinical care. Clinically meaningful changes include adjustment of medication, cardioversion, electrophysiology study, ablation or implantation of a cardiovascular implantable electronic device. The following monitoring instruments are discussed: cumulative Holter, 2-week continuous monitor, smartwatchand smartphone-based single-lead ECG, and ILR. The diagnostic yield of extended rhythm monitoring is high, and varies between 18% (smartphone-based single-lead ECG) and 41% with ILR. In conclusion, contemporary arrhythmia screening includes various new non-invasive technologies that are promising new tools as an alternative to Holter monitoring or ILR. However, the optimal mode of detection is still unclear due to the lack of head-to-head comparisons.
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Affiliation(s)
- Maarten Antonius Koole
- Department of Cardiology, Amsterdam UMC Amsterdam, the Netherlands
- Cardiology Centres of the Netherlands Amsterdam, the Netherlands
- Department of Cardiology, Rode Kruis Ziekenhuis Beverwijk, the Netherlands
| | - Sanne de Jong
- Department of Cardiology, Amsterdam UMC Amsterdam, the Netherlands
| | - Barbara J Mulder
- Department of Cardiology, Amsterdam UMC Amsterdam, the Netherlands
| | | | - Mark Johan Schuuring
- Department of Cardiology, Amsterdam UMC Amsterdam, the Netherlands
- Department of Cardiology, Medisch Spectrum Twente Enschede, the Netherlands
- Circulatory Health, UMC Utrecht Utrecht, the Netherlands
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5
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Padovani P, Singh Y, Pass RH, Vasile CM, Nield LE, Baruteau AE. E-Health: A Game Changer in Fetal and Neonatal Cardiology? J Clin Med 2023; 12:6865. [PMID: 37959330 PMCID: PMC10650296 DOI: 10.3390/jcm12216865] [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: 10/05/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Technological advancements have greatly impacted the healthcare industry, including the integration of e-health in pediatric cardiology. The use of telemedicine, mobile health applications, and electronic health records have demonstrated a significant potential to improve patient outcomes, reduce healthcare costs, and enhance the quality of care. Telemedicine provides a useful tool for remote clinics, follow-up visits, and monitoring for infants with congenital heart disease, while mobile health applications enhance patient and parents' education, medication compliance, and in some instances, remote monitoring of vital signs. Despite the benefits of e-health, there are potential limitations and challenges, such as issues related to availability, cost-effectiveness, data privacy and security, and the potential ethical, legal, and social implications of e-health interventions. In this review, we aim to highlight the current application and perspectives of e-health in the field of fetal and neonatal cardiology, including expert parents' opinions.
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Affiliation(s)
- Paul Padovani
- CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, 44000 Nantes, France;
- CHU Nantes, INSERM, CIC FEA 1413, Nantes Université, 44000 Nantes, France
| | - Yogen Singh
- Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Robert H. Pass
- Department of Pediatric Cardiology, Mount Sinai Kravis Children’s Hospital, New York, NY 10029, USA;
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France;
| | - Lynne E. Nield
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON M5S 1A1, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Alban-Elouen Baruteau
- CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, 44000 Nantes, France;
- CHU Nantes, INSERM, CIC FEA 1413, Nantes Université, 44000 Nantes, France
- CHU Nantes, CNRS, INSERM, L’Institut du Thorax, Nantes Université, 44000 Nantes, France
- INRAE, UMR 1280, PhAN, Nantes Université, 44000 Nantes, France
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6
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Girvin ZP, Silver ES, Liberman L. Comparison of AliveCor KardiaMobile Six-Lead ECG with Standard ECG in Pediatric Patients. Pediatr Cardiol 2023; 44:689-694. [PMID: 36056945 DOI: 10.1007/s00246-022-02998-7] [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] [Received: 05/06/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
Abstract
The AliveCor KardiaMobile (ACKM) is a remote electrocardiogram (ECG) monitoring device. Little research has been conducted on its accuracy with pediatric patients. This prospective study aims to compare the ACKM six-lead device with a standard fifteen-lead ECG in measuring the QTc, QRS, and axis in pediatric patients. Pediatric patients ages 5 to 21 years were enrolled prospectively to have their ECG recorded using an ACKM six-lead device following a recording with the standard 15-lead ECG. A pediatric electrophysiologist measured the QTc, QRS interval, and QRS axis for both ECGs. Bland-Altman analysis was performed to assess agreement among measurements. The study included 141 patients. The mean age was 12.3 ± 4.4 years. Average heart rate was 79 ± 16 bpm. The mean difference in the QTc measurements for a paired standard ECG and ACKM was - 0.6 ms [95% confidence interval - 48 to 47 ms]. Of the ACKM QTc measurements, 117 (83%) were within 30 ms of the standard ECG. The mean difference in paired QRS measurements was - 1.3 ms [95% confidence interval - 23 to 21 ms]. Of the ACKM QRS measurements, 134 (95%) were within 20 ms of the standard ECG. The measured axis was the same for 84% of ACKM and standard ECGs. Over 80% of the ACKM six-lead ECGs produced QTc, QRS, and axis deviation measurements within a clinically useful range of the standard ECG. However, it is not accurate enough to be used consistently in place of a standard ECG for QTc and QRS measurement for pediatric patients.
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Affiliation(s)
- Zachary P Girvin
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Eric S Silver
- Department of Pediatrics, Columbia University Irving Medical Center, 3959 Broadway Ave - 2 North, New York, NY, 10032, USA
| | - Leonardo Liberman
- Department of Pediatrics, Columbia University Irving Medical Center, 3959 Broadway Ave - 2 North, New York, NY, 10032, USA.
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Koole MA, Kauw D, Kooiman KM, de Groot JR, Robbers-Visser D, Tulevski II, Mulder BJ, Bouma BJ, Schuuring MJ. An implantable loop recorder or smartphone based single-lead electrocardiogram to detect arrhythmia in adults with congenital heart disease? Front Cardiovasc Med 2023; 9:1099014. [PMID: 36684593 PMCID: PMC9852830 DOI: 10.3389/fcvm.2022.1099014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 01/09/2023] Open
Abstract
Background The European Society of Cardiology (ESC) guidelines for the management of adult congenital heart disease (ACHD) recommend screening in patients at risk for arrhythmic events. However, the optimal mode of detection is unknown. Methods Baseline and follow-up data of symptomatic ACHD patients who received an implantable loop recorder (ILR) or who participated in a smartphone based single-lead electrocardiogram study were collected. The primary endpoint was time to first detected arrhythmia. Results In total 116 ACHD patients (mean age 42 years, 44% male) were studied. The ILR group (n = 23) differed from the smartphone based single-lead electrocardiogram group (n = 93) in having a greater part of males and had more severe CHD and (near) syncope as qualifying diagnosis. In the smartphone based single-lead electrocardiogram group history of arrhythmia and palpitations were more frequent (all p < 0.05). Monitoring was performed for 40 and 79 patient-years for the ILR- and smartphone based single-lead electrocardiogram group, respectively. Arrhythmias occurred in 33 patients with an equal median time for both groups to first arrhythmia of 3 months (HR of 0.7, p = 0.81). Furthermore, atrial fibrillation occurred most often (n = 16) and common therapy changes included medication changes (n = 7) and implantation of pacemaker or Implantable Cardioverter Defibrillator (ICD) (N = 4). Symptoms or mode of detection were not a determinant of the first event. Conclusion Non-invasive smartphone based single-lead electrocardiogram monitoring could be an acceptable alternative for ILR implantation in detecting arrhythmia in symptomatic ACHD patients in respect to diagnostic yield, safety and management decisions, especially in those without syncope.
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Affiliation(s)
- Maarten A. Koole
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Cardiology Centers of the Netherlands, Amsterdam, Netherlands
- Department of Cardiology, Rode Kruis Ziekenhuis Beverwijk, Beverwijk, Netherlands
| | - Dirkjan Kauw
- Department of Cardiology, Haga Teaching Hospital, The Hague, Netherlands
| | - Kirsten M. Kooiman
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Joris R. de Groot
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Barbara J. Mulder
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Berto J. Bouma
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mark J. Schuuring
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
- Department of Cardiology, UMC Utrecht, Utrecht, Netherlands
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8
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Croon PM, Selder JL, Allaart CP, Bleijendaal H, Chamuleau SAJ, Hofstra L, Išgum I, Ziesemer KA, Winter MM. Current state of artificial intelligence-based algorithms for hospital admission prediction in patients with heart failure: a scoping review . EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:415-425. [PMID: 36712159 PMCID: PMC9707890 DOI: 10.1093/ehjdh/ztac035] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 05/04/2023]
Abstract
AIMS Patients with congestive heart failure (HF) are prone to clinical deterioration leading to hospital admissions, burdening both patients and the healthcare system. Predicting hospital admission in this patient group could enable timely intervention, with subsequent reduction of these admissions. To date, hospital admission prediction remains challenging. Increasing amounts of acquired data and development of artificial intelligence (AI) technology allow for the creation of reliable hospital prediction algorithms for HF patients. This scoping review describes the current literature on strategies and performance of AI-based algorithms for prediction of hospital admission in patients with HF. METHODS AND RESULTS PubMed, EMBASE, and the Web of Science were used to search for articles using machine learning (ML) and deep learning methods to predict hospitalization in patients with HF. After eligibility screening, 23 articles were included. Sixteen articles predicted 30-day hospital (re-)admission resulting in an area under the curve (AUC) ranging from 0.61 to 0.79. Six studies predicted hospital admission over longer time periods ranging from 6 months to 3 years, with AUC's ranging from 0.65 to 0.78. One study prospectively evaluated performance of a disposable sensory patch at home after hospitalization which resulted in an AUC of 0.89 for unplanned hospital admission prediction. CONCLUSION AI has the potential to enable prediction of hospital admission in HF patients. Improvement of data management, adding new data sources such as telemonitoring data and ML models and prospective and external validation of current models must be performed before clinical applicability is possible.
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Affiliation(s)
- P M Croon
- Corresponding author. Tel: +31646123217,
| | - J L Selder
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C P Allaart
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H Bleijendaal
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - S A J Chamuleau
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - L Hofstra
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - I Išgum
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers-location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - K A Ziesemer
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - M M Winter
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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9
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Coats L, Chaudhry B. Ambulatory Care in Adult Congenital Heart Disease-Time for Change? J Clin Med 2022; 11:jcm11072058. [PMID: 35407666 PMCID: PMC9000074 DOI: 10.3390/jcm11072058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/29/2022] [Accepted: 04/03/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The adult congenital heart disease (ACHD) population is growing in size and complexity. This study evaluates whether present ambulatory care adequately detects problems and considers costs. METHODS A UK single-centre study of clinic attendances amongst 100 ACHD patients (40.4 years, median ACHD AP class 2B) between 2014 and 2019 and the COVID-19 restrictions period (March 2020-July 2021). RESULTS Between 2014 and 2019, there were 575 appointments. Nonattendance was 10%; 15 patients recurrently nonattended. Eighty percent of appointments resulted in no decision other than continued review. Electrocardiograms and echocardiograms were frequent, but new findings were rare (5.1%, 4.0%). Decision-making was more common with the higher ACHD AP class and symptoms. Emergency admissions (n = 40) exceeded elective (n = 25), with over half following unremarkable clinic appointments. Distance travelled to the ACHD clinic was 14.9 km (1.6-265), resulting in 433-564 workdays lost. During COVID 19, there were 127 appointments (56% in-person, 41% telephone and 5% video). Decisions were made at 37% in-person and 19% virtual consultations. Nonattendance was 3.9%; there were eight emergency admissions. CONCLUSION The main purpose of the ACHD clinic is surveillance. Presently, the clinic does not sufficiently predict or prevent emergency hospital admissions and is costly to patient and provider. COVID-19 has enforced different methods for delivering care that require further evaluation.
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Affiliation(s)
- Louise Coats
- Adult Congenital Heart Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Correspondence:
| | - Bill Chaudhry
- Bioscience Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
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10
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Zartner PA, Mini N, Momcilovic D, Schneider MB, Dittrich S. Telemonitoring with Electronic Devices in Patients with a Single Ventricle Anatomy. Thorac Cardiovasc Surg 2021; 69:e53-e60. [PMID: 34891178 PMCID: PMC8672881 DOI: 10.1055/s-0041-1735479] [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] [Indexed: 11/17/2022]
Abstract
Background A growing number of patients with a single ventricle anatomy, who had a
Fontan palliation as a child, are now reaching adulthood. Many need an epimyocardial
pacemaker system with an optional telemonitoring (TM) unit, which evaluates the collected
data and sends it via Internet to the patient's physician. There are no data on the
reliability and clinical relevance of these systems in this patient group. Methods We analyzed data in 48 consecutive patients (mean age 18 years, standard
deviation 9 years) with a Fontan or Fontan-like palliation who received a cardiac
implantable electronic device with a TM unit from Biotronik (Home Monitoring) or Medtronic
(CareLink) between 2005 and 2020 with regard to the reliability and clinical relevance of
the downloaded data. Results The observation period was from 4 months to 14 years (mean 7 years,
standard deviation 3.9 years). A total of 2.9 event messages (EMs)/patient/month and 1.3
intracardiac electrogram recordings/patient/month were received. Two patients died during
follow-up. The combination of regularly arriving statistical data and 313 clinically
relevant EMs led to the modification of antiarrhythmic or diuretic medication,
hospitalization with cardioversion or ablation, and cortisone therapy to avoid exit block
in 21 (44%) patients. Conclusion TM is an instrument to receive functional and physiologic parameters of
our Fontan patients. It provides the ability to respond early for signs of system failure,
or arrhythmia, even if the patient is not experiencing any problems. It is a useful tool
to manage this difficult patient population without frequent hospital visits.
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Affiliation(s)
- Peter A Zartner
- Department of Cardiology, German Paediatric Heart Centre, University of Bonn, Bonn, Germany
| | - Nathalie Mini
- Department of Cardiology, German Paediatric Heart Centre, University of Bonn, Bonn, Germany
| | - Diana Momcilovic
- Department of Cardiology and Pulmonology, University of Bonn, Bonn, Germany
| | - Martin B Schneider
- Department of Cardiology, German Paediatric Heart Centre, University of Bonn, Bonn, Germany
| | - Sven Dittrich
- Department of Paediatric Cardiology, University of Erlangen-Nuremberg, Erlangen, Germany
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11
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Rauwerdink A, Kasteleyn MJ, Chavannes NH, Schijven MP. Successes of and Lessons From the First Joint eHealth Program of the Dutch University Hospitals: Evaluation Study. J Med Internet Res 2021. [PMID: 34842536 DOI: 10.1016/j.ceh.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A total of 8 Dutch university hospitals are at the forefront of contributing meaningfully to a future-proof health care system. To stimulate nationwide collaboration and knowledge-sharing on the topic of evidence-based eHealth, the Dutch university hospitals joined forces from 2016 to 2019 with the first Citrien Fund (CF) program eHealth; 29 eHealth projects with various subjects and themes were selected, supported, and evaluated. To determine the accomplishment of the 10 deliverables for the CF program eHealth and to contribute to the theory and practice of formative evaluation of eHealth in general, a comprehensive evaluation was deemed essential. OBJECTIVE The first aim of this study is to evaluate whether the 10 deliverables of the CF program eHealth were accomplished. The second aim is to evaluate the progress of the 29 eHealth projects to determine the barriers to and facilitators of the development of the CF program eHealth projects. METHODS To achieve the first aim of this study, an evaluation study was carried out using an adapted version of the Commonwealth Scientific and Industrial Research Organization framework. A mixed methods study, consisting of a 2-part questionnaire and semistructured interviews, was conducted to analyze the second aim of the study. RESULTS The 10 deliverables of the CF program eHealth were successfully achieved. The program yielded 22 tangible eHealth solutions, and significant knowledge on the development and use of eHealth solutions. We have learned that the patient is enthusiastic about accessing and downloading their own medical data but the physicians are more cautious. It was not always possible to implement the Dutch set of standards for interoperability, owing to a lack of information technology (IT) capacities. In addition, more attention needed to be paid to patients with low eHealth skills, and education in such cases is important. The eHealth projects' progress aspects such as planning, IT services, and legal played an important role in the success of the 29 projects. The in-depth interviews illustrated that a novel eHealth solution should fulfill a need, that partners already having the knowledge and means to accelerate development should be involved, that clear communication with IT developers and other stakeholders is crucial, and that having a dedicated project leader with sufficient time is of utmost importance for the success of a project. CONCLUSIONS The 8 Dutch university hospitals were able to collaborate successfully and stimulate through a bottom-up approach, nationwide eHealth development and knowledge-sharing. In total, 22 tangible eHealth solutions were developed, and significant eHealth knowledge about their development and use was shared. The eHealth projects' progress aspects such as planning, IT services, and legal played an important role in the successful progress of the projects and should therefore be closely monitored when developing novel eHealth solutions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.ceh.2020.12.002.
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Affiliation(s)
- Anneloek Rauwerdink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, Netherlands
- Citrien Fund program eHealth, Amsterdam, Netherlands
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12
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Rauwerdink A, Kasteleyn MJ, Chavannes NH, Schijven MP. Successes of and Lessons From the First Joint eHealth Program of the Dutch University Hospitals: Evaluation Study. J Med Internet Res 2021; 23:e25170. [PMID: 34842536 PMCID: PMC8663485 DOI: 10.2196/25170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/23/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A total of 8 Dutch university hospitals are at the forefront of contributing meaningfully to a future-proof health care system. To stimulate nationwide collaboration and knowledge-sharing on the topic of evidence-based eHealth, the Dutch university hospitals joined forces from 2016 to 2019 with the first Citrien Fund (CF) program eHealth; 29 eHealth projects with various subjects and themes were selected, supported, and evaluated. To determine the accomplishment of the 10 deliverables for the CF program eHealth and to contribute to the theory and practice of formative evaluation of eHealth in general, a comprehensive evaluation was deemed essential. OBJECTIVE The first aim of this study is to evaluate whether the 10 deliverables of the CF program eHealth were accomplished. The second aim is to evaluate the progress of the 29 eHealth projects to determine the barriers to and facilitators of the development of the CF program eHealth projects. METHODS To achieve the first aim of this study, an evaluation study was carried out using an adapted version of the Commonwealth Scientific and Industrial Research Organization framework. A mixed methods study, consisting of a 2-part questionnaire and semistructured interviews, was conducted to analyze the second aim of the study. RESULTS The 10 deliverables of the CF program eHealth were successfully achieved. The program yielded 22 tangible eHealth solutions, and significant knowledge on the development and use of eHealth solutions. We have learned that the patient is enthusiastic about accessing and downloading their own medical data but the physicians are more cautious. It was not always possible to implement the Dutch set of standards for interoperability, owing to a lack of information technology (IT) capacities. In addition, more attention needed to be paid to patients with low eHealth skills, and education in such cases is important. The eHealth projects' progress aspects such as planning, IT services, and legal played an important role in the success of the 29 projects. The in-depth interviews illustrated that a novel eHealth solution should fulfill a need, that partners already having the knowledge and means to accelerate development should be involved, that clear communication with IT developers and other stakeholders is crucial, and that having a dedicated project leader with sufficient time is of utmost importance for the success of a project. CONCLUSIONS The 8 Dutch university hospitals were able to collaborate successfully and stimulate through a bottom-up approach, nationwide eHealth development and knowledge-sharing. In total, 22 tangible eHealth solutions were developed, and significant eHealth knowledge about their development and use was shared. The eHealth projects' progress aspects such as planning, IT services, and legal played an important role in the successful progress of the projects and should therefore be closely monitored when developing novel eHealth solutions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.ceh.2020.12.002.
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Affiliation(s)
- Anneloek Rauwerdink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, Netherlands
- Citrien Fund program eHealth, Amsterdam, Netherlands
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13
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Krzowski B, Skoczylas K, Osak G, Żurawska N, Peller M, Kołtowski Ł, Zych A, Główczyńska R, Lodziński P, Grabowski M, Opolski G, Balsam P. Kardia Mobile and ISTEL HR applicability in clinical practice: a comparison of Kardia Mobile, ISTEL HR, and standard 12-lead electrocardiogram records in 98 consecutive patients of a tertiary cardiovascular care centre. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:467-476. [PMID: 36713595 PMCID: PMC9707955 DOI: 10.1093/ehjdh/ztab040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/20/2021] [Accepted: 05/11/2021] [Indexed: 02/01/2023]
Abstract
Aims Mobile, portable ECG-recorders allow the assessment of heart rhythm in out-of-hospital conditions and may prove useful for monitoring patients with cardiovascular diseases. However, the effectiveness of these portable devices has not been tested in everyday practice. Methods and results A group of 98 consecutive cardiology patients [62 males (63%), mean age 69 ± 12.9 years] were included in an academic care centre. For each patient, a standard 12-lead electrocardiogram (SE), as well as a Kardia Mobile 6L (KM) and Istel (IS) HR-2000 ECG were performed. Two groups of experienced physicians analysed obtained recordings. After analysing ECG tracings from SE, KM, and IS, quality was marked as good in 82%, 80%, and 72% of patients, respectively (P < 0.001). There were no significant differences between devices in terms of detecting sinus rhythm [SE (60%, n = 59), KM (58%, n = 56), and IS (61%, n = 60); SE vs. KM P = 0.53; SE vs. IS P = 0.76) and atrial fibrillation [SE (22%, n = 22), KM (22%, n = 21), and IS (18%, n = 18); (SE vs. KM P = 0.65; SE vs. IS = 0.1)]. KM had a sensitivity of 88.1% and a specificity of 89.7% for diagnosing sinus rhythm. IS showed 91.5% and 84.6% sensitivity and specificity, respectively. The sensitivity of KM in detecting atrial fibrillation was higher than IS (86.4% vs. 77.3%), but their specificity was comparable (97.4% vs. 98.7%). Conclusion Novel, portable devices are useful in showing sinus rhythm and detecting atrial fibrillation in clinical practice. However, ECG measurements concerning conduction and repolarization should be clarified with a standard 12-lead electrocardiogram.
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Affiliation(s)
- Bartosz Krzowski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland
| | - Kamila Skoczylas
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland
| | - Gabriela Osak
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland
| | - Natalia Żurawska
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland
| | - Michał Peller
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland
| | - Łukasz Kołtowski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland
| | - Aleksandra Zych
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland
| | - Renata Główczyńska
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland
| | - Piotr Lodziński
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland
| | - Paweł Balsam
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland
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Nederend M, Zandstra TE, Kiès P, Jongbloed MRM, Vliegen HW, Treskes RW, Schalij MJ, Atsma DE, Egorova AD. Potential of eHealth smart technology in optimization and monitoring of heart failure treatment in adults with systemic right ventricular failure. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:215-223. [PMID: 36712397 PMCID: PMC9707956 DOI: 10.1093/ehjdh/ztab028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 02/01/2023]
Abstract
Aims Patients with a systemic right ventricle (sRV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA are prone to heart failure and arrhythmias. This study evaluated feasibility, patient adherence, and satisfaction of a smart technology-based care pathway for heart failure treatment optimization in these patients. Methods and results Patients with symptomatic sRV failure eligible for initiation of sacubitril/valsartan were provided with four smartphone compatible devices (blood pressure monitor, weight scale, step counter, and rhythm monitor) and were managed according to a smart technology-based care pathway. Biweekly sacubitril/valsartan titration visits were replaced by electronical visits, patients were advised to continue measurements at least weekly after titration. Data of 24 consecutive sRV patients (median age 47 years, 50% female) who participated in the smart technology-based care pathway were analysed. Median home-hospital distance was 65 km (maximum 227 km). Most patients (20, 83.3%) submitted weekly measurements; 100% submitted prior to electronical visits. Titration conventionally occurs during a hospital visit. By implementing eHealth smart technology, 68 such trips to hospital were replaced by virtual visits facilitated by remote monitoring. An eHealth questionnaire was completed by 22 patients (92%), and 96% expressed satisfaction. After titration, 30 instances of remote adjustment of heart failure medication in addition to scheduled outpatient clinic visits occurred, one (4%) heart failure admission followed, despite ambulant adjustments. Five patients (21%) sent in rhythm registrations (n = 17), of these 77% showed sinus rhythm, whereas supraventricular tachycardia was detected in the remaining four registrations. Conclusion These data suggest that implementation of a smart technology-based care pathway for optimization of medical treatment sRV failure is feasible with high measurement adherence and patient satisfaction.
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Affiliation(s)
- Marieke Nederend
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Tjitske E Zandstra
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Anatomy & Embryology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Roderick W Treskes
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Martin J Schalij
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- National eHealth Living Lab, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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Achury Saldaña DM, Gonzalez RA, Garcia A, Mariño A, Aponte L, Bohorquez WR. Evaluation of a Mobile Application for Heart Failure Telemonitoring. Comput Inform Nurs 2021; 39:764-771. [PMID: 33993153 DOI: 10.1097/cin.0000000000000756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adequate adherence to treatment is indispensable in preventing adverse consequences in heart failure patients. Such adherence can be managed through heart failure clinics and various methods of follow-up. In recent years, the use of telemonitoring has shown promising benefits in supporting clinicians' follow-up, as well as contributing to patients' self-care. This article presents the development and evaluation of a telemonitoring application for heart failure, through a Web-based interface for clinicians and a mobile application for patients. The application was evaluated through a 6-month pilot observational descriptive study in 20 outpatients with reduced ejection fraction and two nurses, in the context of a heart failure clinic. A technological acceptance questionnaire was applied to all patients and nurses at the end of the study period. In use, the application generated 64 real-time alerts for early decision-making to prevent complications, and 91% of patients did not present hospital readmissions. Such results, along with high user acceptance, show potential utility of the application as an effective complementary strategy for follow-up of patients with heart failure.
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Affiliation(s)
- Diana Marcela Achury Saldaña
- Author Affiliations: Nursing Faculty (Ms Achury Saldaña) and Engineering Faculty (Dr Gonzalez), and Faculty of Medicine (Drs Garcia and Bohorquez), Pontificia Universidad Javeriana; and Heart Failure Clinic (Ms Aponte), Hospital Universitario San Ignacio (Dr Mariño), Bogotá, Colombia
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16
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Kolk MZH, Blok S, De Wildt MCC, Tjong FVY, Winter MM, Tulevski II, van den Born BJH, Somsen GA. Patient-reported outcomes in symptom-driven remote arrhythmia monitoring: evaluation of the Dutch HartWacht-telemonitoring programme. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:224-230. [PMID: 36712387 PMCID: PMC9707978 DOI: 10.1093/ehjdh/ztab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/19/2021] [Accepted: 03/05/2021] [Indexed: 02/01/2023]
Abstract
Aims There is limited quantitative evidence on the effect of symptom-driven telemonitoring for cardiac arrhythmias on patient-reported outcomes. We evaluated the effect of a symptom-driven remote arrhythmia monitoring programme on the patient-reported health-related quality of life (HRQoL), sense of safety, physical limitations, and self-management. Methods and results This was an observational retrospective longitudinal study of the symptom-driven HartWacht-telemonitoring programme using a remote single-lead electrocardiogram monitoring system. Real-world patient data from participants who were enrolled in the telemonitoring programme for (suspected) symptomatic atrial fibrillation (AF) between July 2017 and September 2019 were evaluated. Primary outcomes were the patient-reported generic HRQoL, disease-specific HRQoL, sense of safety, physical limitations, and self-management at date of enrolment, 3 months and 6 months of follow-up. Outcomes were compared to a historical control group consisting of AF patients receiving standard care. A total of 109 participants in the HartWacht programme [59 men (54%); mean age 61 ± 11 years; 72% diagnosed AF] were included in complete case analysis. There was no significant change in HRQoL and sense of safety during follow-up. A significant improvement in the perceived physical limitations was observed. The level of self-management declined significantly during follow-up. Comparisons to the historic control group (n = 83) showed no difference between the patient-reported disease-specific HRQoL, sense of safety and physical limitations at 6 months of follow-up. Conclusion Symptom-driven remote arrhythmia monitoring for AF does not seem to affect HRQoL and sense of safety, whereas the perceived physical limitations tend to improve. Patient-reported self-management declined during the first 6 months of participation.
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Affiliation(s)
- Maarten Z H Kolk
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands,Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands,Corresponding author. Tel: 020 56 65550,
| | - Sebastiaan Blok
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands,Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Fleur V Y Tjong
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel M Winter
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands,Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Igor I Tulevski
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands,Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - G Aernout Somsen
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
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17
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Crawford R, Hughes C, McFadden S, Crawford J. A systematic review examining the clinical and health-care outcomes for congenital heart disease patients using home monitoring programmes. J Telemed Telecare 2021; 29:349-364. [PMID: 33470176 DOI: 10.1177/1357633x20984052] [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: 11/17/2022]
Abstract
OBJECTIVES This review aimed to present the clinical and health-care outcomes for patients with congenital heart disease (CHD) who use home monitoring technologies. METHODS Five databases were systematically searched from inception to November 2020 for quantitative studies in this area. Data were extracted using a pre-formatted data-collection table which included information on participants, interventions, outcome measures and results. Risk of bias was determined using the Cochrane Risk of Bias 2 tool for randomised controlled trials (RCTs), the Newcastle-Ottawa Quality Assessment Scale for cohort studies and the Institute of Health Economics quality appraisal checklist for case-series studies.Data synthesis: Twenty-two studies were included in this systematic review, which included four RCTs, 12 cohort studies and six case-series studies. Seventeen studies reported on mortality rates, with 59% reporting that home monitoring programmes were associated with either a significant reduction or trend for lower mortality and 12% reporting that mortality trended higher. Fourteen studies reported on unplanned readmissions/health-care resource use, with 29% of studies reporting that this outcome was significantly decreased or trended lower with home monitoring and 21% reported an increase. Impact on treatment was reported in 15 studies, with 67% of studies finding that either treatment was undertaken significantly earlier or significantly more interventions were undertaken in the home monitoring groups. CONCLUSION The use of home monitoring programmes may be beneficial in reducing mortality, enabling earlier and more timely detection and treatment of CHD complication. However, currently, this evidence is limited due to weakness in study designs.
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Tekkeşin Aİ, Hayıroğlu Mİ, Çinier G, Özdemir YS, İnan D, Yüksel G, Pay L, Parsova KE, Vatanoğlu EG, Şeker M, Durak F, Gürkan K. Lifestyle intervention using mobile technology and smart devices in patients with high cardiovascular risk: A pragmatic randomised clinical trial. Atherosclerosis 2021; 319:21-27. [PMID: 33465658 DOI: 10.1016/j.atherosclerosis.2020.12.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/19/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Mobile technology-based solutions present promising effects against cardiovascular diseases. Long-term follow-up in mobile phone-based interventions has not yet been elucidated as a primary prevention technique for cardiovascular diseases. The objective of the present trial is to evaluate the effectiveness of lifestyle intervention on the change in the atherosclerotic cardiovascular disease (ASCVD) risk score in a 1-year follow-up using smart phone technology in patients with high cardiovascular risk. METHODS This prospective, randomised, single-centre clinical investigation enrolled 242 and 241 patients to the intervention plus usual care and usual care arms, respectively. The primary outcome of this study was the 1-year ASCVD risk score adjusted to baseline ASCVD risk score. ASCVD risk scores were calculated for every study participant at the randomisation and final stages. RESULTS After a 1-year follow-up, the intervention plus usual care reduced the ASCVD score by 2.7% (adjusted treatment effect -2.7, 95% confidence interval (CI): -2.2,-3.3, p<0.0001). An improvement was observed in favour of the intervention plus usual care arm in the majority of the pre-specified secondary endpoints. The high sensitive troponin and high sensitive C-reactive protein levels at 1 year were similar between the two arms. The treatment effect was homogenous for diabetes mellitus, gender, systolic blood pressure, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides and body mass index; however, heterogeneity in the treatment effect was observed for age. CONCLUSIONS The lifestyle intervention using smart phone technology compared to usual care alone in patients with high cardiovascular risk reduced the ASCVD score at 1-year follow-up.
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Affiliation(s)
- Ahmet İlker Tekkeşin
- Department of Cardiology, Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Göksel Çinier
- Department of Cardiology, Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Yelda Soluk Özdemir
- Department of Physical Medication and Rehabilitation, Istanbul Physical Medication and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Duygu İnan
- Department of Cardiology, Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gizem Yüksel
- Department of Cardiology, Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Levent Pay
- Department of Cardiology, Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kemal Emrecan Parsova
- Department of Cardiology, Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Elif Gökçen Vatanoğlu
- Department of Cardiology, Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Şeker
- Department of Cardiology, Sultan II. Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Furkan Durak
- Department of Cardiology, Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kadir Gürkan
- Department of Cardiology, Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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20
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Tools to Support Self-Care Monitoring at Home: Perspectives of Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238916. [PMID: 33266245 PMCID: PMC7731418 DOI: 10.3390/ijerph17238916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/04/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
Self-care monitoring at home can be a challenge for patients with heart failure (HF). Tools that leverage information and communication technology (ICT), comprise medical devices, or have written material may support their efforts at home. The aim of this study was to describe HF patients’ experiences and their prioritization of tools that support, or could support, self-care monitoring at home. A descriptive qualitative design employing semi-structured interviews was used with HF patients living at home and attending an HF outpatient clinic in Norway. We used a deductive analysis approach, using the concept of self-care monitoring with ICT tools, paper-based tools, medical devices, and tools to consult with healthcare professionals (HCPs) as the categorization matrix. Nineteen HF patients with a mean age of 64 years participated. ICT tools are used by individual participants to identify changes in their HF symptoms, but are not available by healthcare services. Paper-based tools, medical devices, and face-to-face consultation with healthcare professionals are traditional tools that are available and used by individual participants. HF patients use traditional and ICT tools to support recognizing, identifying, and responding to HF symptoms at home, suggesting that they could be used if they are available and supplemented by in-person consultation with HCPs.
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21
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Abstract
Supplemental digital content is available in the text. Type D personality has been previously shown to increase the risk for mortality in patients with acquired heart disease.
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22
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Bouma BJ, Sieswerda GT, Post MC, Ebels T, van Kimmenade R, de Winter RJ, Mulder BJ. New developments in adult congenital heart disease. Neth Heart J 2020; 28:44-49. [PMID: 32780331 PMCID: PMC7419394 DOI: 10.1007/s12471-020-01455-5] [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: 11/24/2022] Open
Abstract
Congenital heart disease (CHD) affects 0.8% of live births and over the past decades technical improvements and large-scale repair has led to increased survival into adulthood of over 95% of the new-born. A new group of patients, those who survived their congenital heart defect, has emerged but late complications including heart failure, pulmonary hypertension (PH), arrhythmias, aneurysms and endocarditis appeared numerous, with a huge impact on mortality and morbidity. However, innovations over the past years have changed the landscape of adult CHD dramatically. In the diagnostic process important improvements have been made in the use of MRI, biomarkers, e‑health concepts and 3D visualisation of anatomy. Care is now concentrated in specialised centres, with a continuous emphasis on education and the introduction of weekly multidisciplinary consultations on diagnosis and intervention. Surgery and percutaneous intervention have been refined and new concepts applied, further reducing the burden of the congenital malformations. Research has matured from case series to global networks. Currently, adults with CHD are still facing high risks of early mortality and morbidity. By global collaboration and continuous education and development and innovation of our diagnostic and therapeutic arsenal, we will improve the perspectives of these young patients.
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Affiliation(s)
- B J Bouma
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - G T Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C Post
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - T Ebels
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R van Kimmenade
- Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - R J de Winter
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - B J Mulder
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Abstract
Cardiovascular diseases (CVDs) are responsible for more deaths than any other cause, with coronary heart disease and stroke accounting for two-thirds of those deaths. Morbidity and mortality due to CVD are largely preventable, through either primary prevention of disease or secondary prevention of cardiac events. Monitoring cardiac status in healthy and diseased cardiovascular systems has the potential to dramatically reduce cardiac illness and injury. Smart technology in concert with mobile health platforms is creating an environment where timely prevention of and response to cardiac events are becoming a reality.
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Affiliation(s)
- Jeffrey W. Christle
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California 94305, USA
- Stanford Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California 94305, USA
| | - Steven G. Hershman
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California 94305, USA
| | - Jessica Torres Soto
- Biomedical Informatics Program, Department of Biomedical Data Science, Stanford University, Stanford, California 94305, USA
| | - Euan A. Ashley
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California 94305, USA
- Stanford Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California 94305, USA
- Biomedical Informatics Program, Department of Biomedical Data Science, Stanford University, Stanford, California 94305, USA
- Stanford Center for Digital Health, Stanford University, Stanford, California 94305, USA
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Evolution of mHealth Eco-System: A Step Towards Personalized Medicine. ADVANCES IN INTELLIGENT SYSTEMS AND COMPUTING 2020. [DOI: 10.1007/978-981-15-1286-5_30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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25
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Verburg A, Selder JL, Schalij MJ, Schuuring MJ, Treskes RW. eHealth to improve patient outcome in rehabilitating myocardial infarction patients. Expert Rev Cardiovasc Ther 2019; 17:185-192. [PMID: 30732481 DOI: 10.1080/14779072.2019.1580570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cardiac rehabilitation is aimed at risk factor modification and improving quality of life. eHealth has a couple of potential benefits to improve this aim. The primary purpose of this review is to summarize available literature for eHealth strategies that have been investigated in randomized controlled trials in post-myocardial infarction (MI) patients. The second purpose of this review is to investigate the clinical effectiveness in post-MI patients. Areas covered: The literature was searched using PubMed. Randomized controlled trials (RCTs) describing interventions in patients that had experienced an ST-elevation myocardial infarction or non-ST acute coronary syndrome were eligible for inclusion. Fifteen full-texts were included and their results are described in this review. These RCTs described interventions that used remote coaching or remote monitoring in post-MI patients. Most interventions resulted in an improved cardiovascular risk profile. Remote coaching had a positive effect on activity and dietary intake. Expert opinion: eHealth might be clinically beneficial in post-MI patients, particularly for risk estimation. Moreover, eHealth as a tool for remote coaching on activity is a good addition to traditional cardiac rehabilitation programs. Further research needs to corroborate these findings.
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Affiliation(s)
- Ashley Verburg
- a Department of Cardiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Jasper L Selder
- b Department of Cardiology , Amsterdam UMC, location VU , Amsterdam , The Netherlands
| | - Martin J Schalij
- a Department of Cardiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Mark J Schuuring
- c Department of Cardiology , Amsterdam UMC , Amsterdam , The Netherlands
| | - Roderick W Treskes
- a Department of Cardiology , Leiden University Medical Center , Leiden , The Netherlands
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