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Koehler F, Koehler J, Bramlage P, Vettorazzi E, Wegscheider K, Lezius S, Spethmann S, Iakoubov R, Vijayan A, Winkler S, Melzer C, Schütt K, Dessapt-Baradez C, Paar WD, Koehler K, Müller-Wieland D. Impact of telemedical management on hospitalization and mortality in heart failure patients with diabetes: a post-hoc subgroup analysis of the TIM-HF2 trial. Cardiovasc Diabetol 2024; 23:198. [PMID: 38867198 PMCID: PMC11170842 DOI: 10.1186/s12933-024-02285-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The TIM-HF2 study demonstrated that remote patient management (RPM) in a well-defined heart failure (HF) population reduced the percentage of days lost due to unplanned cardiovascular hospital admissions or all-cause death during 1-year follow-up (hazard ratio 0.80) and all-cause mortality alone (HR 0.70). Higher rates of hospital admissions and mortality have been reported in HF patients with diabetes compared with HF patients without diabetes. Therefore, in a post-hoc analysis of the TIM-HF2 study, we investigated the efficacy of RPM in HF patients with diabetes. METHODS TIM-HF2 study was a randomized, controlled, unmasked (concealed randomization), multicentre trial, performed in Germany between August 2013 and May 2018. HF-Patients in NYHA class II/III who had a HF-related hospital admission within the previous 12 months, irrespective of left ventricular ejection fraction, and were randomized to usual care with or without added RPM and followed for 1 year. The primary endpoint was days lost due to unplanned cardiovascular hospitalization or due to death of any cause. This post-hoc analysis included 707 HF patients with diabetes. RESULTS In HF patients with diabetes, RPM reduced the percentage of days lost due to cardiovascular hospitalization or death compared with usual care (HR 0.66, 95% CI 0.48-0.90), and the rate of all-cause mortality alone (HR 0.52, 95% CI 0.32-0.85). RPM was also associated with an improvement in quality of life (mean difference in change in global score of Minnesota Living with Heart Failure Questionnaire score (MLHFQ): - 3.4, 95% CI - 6.2 to - 0.6). CONCLUSION These results support the use of RPM in HF patients with diabetes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01878630.
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Affiliation(s)
- Friedrich Koehler
- Centre for Cardiovascular Telemedicine, Deutsches Herzzentrum der Charité (DHZC), Charitéplatz 1, 10117, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany.
| | - Johanna Koehler
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sebastian Spethmann
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Roman Iakoubov
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Anjaly Vijayan
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Sebastian Winkler
- Clinic for Internal Medicine and Cardiology, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Christoph Melzer
- Centre for Cardiovascular Telemedicine, Deutsches Herzzentrum der Charité (DHZC), Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katharina Schütt
- Department of Internal Medicine I, RWTH Aachen University Hospital, Aachen, Germany
| | | | | | - Kerstin Koehler
- Centre for Cardiovascular Telemedicine, Deutsches Herzzentrum der Charité (DHZC), Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dirk Müller-Wieland
- Department of Internal Medicine I, RWTH Aachen University Hospital, Aachen, Germany
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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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Martini E, Boldo M, Aldegheri S, Valè N, Filippetti M, Smania N, Bertucco M, Picelli A, Bombieri N. Enabling Gait Analysis in the Telemedicine Practice through Portable and Accurate 3D Human Pose Estimation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107016. [PMID: 35907374 DOI: 10.1016/j.cmpb.2022.107016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/24/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
Human pose estimation (HPE) through deep learning-based software applications is a trend topic for markerless motion analysis. Thanks to the accuracy of the state-of-the-art technology, HPE could enable gait analysis in the telemedicine practice. On the other hand, delivering such a service at a distance requires the system to satisfy multiple and different constraints like accuracy, portability, real-time, and privacy compliance at the same time. Existing solutions either guarantee accuracy and real-time (e.g., the widespread OpenPose software on well-equipped computing platforms) or portability and data privacy (e.g., light convolutional neural networks on mobile phones). We propose a portable and low-cost platform that implements real-time and accurate 3D HPE through an embedded software on a low-power off-the-shelf computing device that guarantees privacy by default and by design. We present an extended evaluation of both accuracy and performance of the proposed solution conducted with a marker-based motion capture system (i.e., Vicon) as ground truth. The results show that the platform achieves real-time performance and high-accuracy with a deviation below the error tolerance when compared to the marker-based motion capture system (e.g., less than an error of 5∘ on the estimated knee flexion difference on the entire gait cycle and correlation 0.91<ρ<0.99). We provide a proof-of-concept study, showing that such portable technology, considering the limited discrepancies with respect to the marker-based motion capture system and its working tolerance, could be used for gait analysis at a distance without leading to different clinical interpretation.
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Affiliation(s)
- Enrico Martini
- Department of Computer Science, University of Verona, Italy.
| | - Michele Boldo
- Department of Computer Science, University of Verona, Italy.
| | | | - Nicola Valè
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC) - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
| | - Mirko Filippetti
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC) - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC) - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
| | - Matteo Bertucco
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC) - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
| | - Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC) - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
| | - Nicola Bombieri
- Department of Computer Science, University of Verona, Italy.
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Smart Home Technology Solutions for Cardiovascular Diseases: A Systematic Review. APPLIED SYSTEM INNOVATION 2022. [DOI: 10.3390/asi5030051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiovascular diseases (CVD) are the leading cause of mortality globally. Despite improvement in therapies, people with CVD lack support for monitoring and managing their condition at home and out of hospital settings. Smart Home Technologies have potential to monitor health status and support people with CVD in their homes. We explored the Smart Home Technologies available for CVD monitoring and management in people with CVD and acceptance of the available technologies to end-users. We systematically searched four databases, namely Medline, Web of Science, Embase, and IEEE, from 1990 to 2020 (search date 18 March 2020). “Smart-Home” was defined as a system using integrated sensor technologies. We included studies using sensors, such as wearable and non-wearable devices, to capture vital signs relevant to CVD at home settings and to transfer the data using communication systems, including the gateway. We categorised the articles for parameters monitored, communication systems and data sharing, end-user applications, regulations, and user acceptance. The initial search yielded 2462 articles, and the elimination of duplicates resulted in 1760 articles. Of the 36 articles eligible for full-text screening, we selected five Smart Home Technology studies for CVD management with sensor devices connected to a gateway and having a web-based user interface. We observed that the participants of all the studies were people with heart failure. A total of three main categories—Smart Home Technology for CVD management, user acceptance, and the role of regulatory agencies—were developed and discussed. There is an imperative need to monitor CVD patients’ vital parameters regularly. However, limited Smart Home Technology is available to address CVD patients’ needs and monitor health risks. Our review suggests the need to develop and test Smart Home Technology for people with CVD. Our findings provide insights and guidelines into critical issues, including Smart Home Technology for CVD management, user acceptance, and regulatory agency’s role to be followed when designing, developing, and deploying Smart Home Technology for CVD.
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