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Mattison G, Canfell OJ, Smith D, Forrester D, Reid D, Töyräs J, Dobbins C. "An excellent servant but a terrible master": Understanding the value of wearables for self-management in people with cystic fibrosis and their healthcare providers - A qualitative study. Int J Med Inform 2024; 189:105532. [PMID: 38925023 DOI: 10.1016/j.ijmedinf.2024.105532] [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: 01/02/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Wearables hold potential to improve chronic disease self-management in conditions like cystic fibrosis (CF) through remote monitoring, early detection of illness and motivation. Little is known about the acceptability and sustainability of integrating wearables into routine care from the perspectives of people with CF (pwCF) and their treating clinicians. METHODS A cross-sectional qualitative study involving semi-structured interviews with adult pwCF and focus groups comprising members of a CF multidisciplinary team (MDT) were conducted at a specialist CF centre in Australia. A phenomenological orientation underpinned the study. Inductive thematic analysis was performed using the Framework method. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS Nine pwCF and eight members of a CF MDT, representing six clinical disciplines, participated in the study. Eight themes were inductively generated from the data, of which four were identified from each group. PwCF valued wearables for providing real-time data to motivate healthy behaviours and support shared goal-setting with healthcare providers. Wearables did not influence adherence to CF-specific self-management practices and had some hardware limitations. Members of the CF MDT recognised potential benefits of remote monitoring and shared goal-setting, but advised caution regarding data accuracy, generating patient anxiety in certain personality traits, and lack of evidence supporting use in CF self-management. CONCLUSIONS Perspectives on integrating wearables into CF care were cautiously optimistic, with emerging risks related to patient anxiety and lack of evidence moderating acceptance.
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Affiliation(s)
- Graeme Mattison
- Queensland Digital Health Centre, The University of Queensland, Brisbane, Australia; The Prince Charles Hospital, Metro North Hospitals and Health Service, Brisbane, Australia; Digital Health Cooperative Research Centre, Sydney Knowledge Hub, The University of Sydney, Sydney, Australia.
| | - Oliver J Canfell
- Queensland Digital Health Centre, The University of Queensland, Brisbane, Australia; Digital Health Cooperative Research Centre, Sydney Knowledge Hub, The University of Sydney, Sydney, Australia; UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia; Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College, London SE1 9NH, UK
| | - Daniel Smith
- The Prince Charles Hospital, Metro North Hospitals and Health Service, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Doug Forrester
- The Prince Charles Hospital, Metro North Hospitals and Health Service, Brisbane, Australia; Faculty of Health Sciences, Curtin University, Perth, Australia
| | - David Reid
- The Prince Charles Hospital, Metro North Hospitals and Health Service, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia; QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Juha Töyräs
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia; Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Chelsea Dobbins
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
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Kamdar M, Jethwani K, Centi AJ, Agboola S, Fischer N, Traeger L, Rinaldi S, Strand J, Ritchie C, Temel JS, Greer JA, Kvedar J, El-Jawarhi A, Jackson V. A Digital Therapeutic Application (ePAL) to Manage Pain in Patients With Advanced Cancer: A Randomized Controlled Trial. J Pain Symptom Manage 2024; 68:261-271. [PMID: 38866116 DOI: 10.1016/j.jpainsymman.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Patients with advanced cancer often experience immense cancer pain that negatively impacts their quality of life. Interventions to address cancer-related pain are limited. METHODS We conducted a randomized trial of a digital therapeutic app (ePAL) for patients with advanced cancer receiving care in a specialty palliative care clinic at a tertiary care hospital. Patients were randomized to ePAL or usual care. ePAL included 1) active pain monitoring; 2) artificial intelligence algorithm to triage patient symptoms; and 3) patient education to address barriers to pain management. Participants were instructed to use ePAL over eight weeks. Patient-reported pain symptoms were assessed at baseline, Week-4, and Week-8 (primary endpoint) using the Brief Pain Inventory. Secondary outcomes include pain-related hospitalizations by Week-8. RESULTS We enrolled 112 patients who were randomly assigned to ePAL (N = 56) or usual care (N = 56). Patients utilized ePAL on average 2.1 times per week to report pain symptoms, and 47.6% reported their pain at least once per week over eight weeks. Patients randomized to ePAL reported lower pain scores at Week-4 (mean: 3.16 vs. 4.28, P = 0.010) and week-8 (mean:2.99 vs. 4.05, P = 0.017), compared to those receiving usual care. Participants randomized to ePAL were less likely to experience a pain-related hospitalization compared to those in the usual care group (7.1% vs. 23.2% P = 0.018) CONCLUSIONS: ePAL was associated with lower patient-reported pain and fewer pain-related hospitalizations compared to usual care in patients with advanced cancer. This study demonstrates the promise of digital therapeutics for improving patients' symptoms while reducing burdensome hospitalizations.
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Affiliation(s)
- Mihir Kamdar
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA.
| | | | | | | | | | - Lara Traeger
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Simone Rinaldi
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Jacob Strand
- Medicine, Mayo Clinic (J.S.), Rochester, Minnesota, USA
| | - Christine Ritchie
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Joseph A Greer
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Joseph Kvedar
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Areej El-Jawarhi
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Vicki Jackson
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
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Rosman L, Lampert R, Zhuo S, Li Q, Varma N, Burg M, Gaffey AE, Armbruster T, Gehi A. Wearable Devices, Health Care Use, and Psychological Well-Being in Patients With Atrial Fibrillation. J Am Heart Assoc 2024; 13:e033750. [PMID: 39011944 DOI: 10.1161/jaha.123.033750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/05/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Wearables are increasingly used by patients with atrial fibrillation (AF) for symptom monitoring and health management, but their impact on patient health care use and psychological well-being is not well understood. METHODS AND RESULTS In this retrospective, propensity-matched study of patients with AF, survey and electronic health record data were merged to compare AF-specific health care use (outpatient/inpatient visits, rhythm-related testing, and procedures) and informal health care use (telephone calls and patient portal messages) over a 9-month period between wearable users and nonusers. We also examined the effects of wearable cardiac monitoring features (eg, heart rate alerts, irregular rhythm notification, and ECG) on patient behavior and well-being. Of 172 patients with AF in this analysis (age, 72.6±9.0 years; 42% women), 83 used a wearable. Compared with nonusers, wearable users reported higher rates of symptom monitoring and preoccupation (P=0.03) and more AF treatment concerns (P=0.02). Moreover, 20% of wearable users experienced anxiety and always contacted their doctors in response to irregular rhythm notifications. After matching, AF-specific health care use was significantly greater among wearable users compared with nonusers (P=0.04), including significantly higher rates of ECGs, echocardiograms/transesophageal echocardiogram, and ablation. Wearable users were also significantly more likely to use informal health care resources compared with nonusers (P=0.05). CONCLUSIONS Wearables were associated with higher rates of symptom monitoring and preoccupation, AF treatment concerns, AF-specific health care use, and use of informal health care resources. Prospective, randomized studies are needed to understand the net effects of wearables and their alerts on patients, providers, and the health care system.
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Affiliation(s)
- Lindsey Rosman
- Department of Medicine, Division of Cardiology University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Rachel Lampert
- Department of Internal Medicine (Section of Cardiovascular Medicine) Yale University School of Medicine New Haven CT USA
| | - Songcheng Zhuo
- Department of Biostatistics University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Quefeng Li
- Department of Biostatistics University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic Cleveland OH USA
| | - Matthew Burg
- Department of Internal Medicine (Section of Cardiovascular Medicine) Yale University School of Medicine New Haven CT USA
- VA Connecticut Healthcare System West Haven CT USA
| | - Allison E Gaffey
- Department of Internal Medicine (Section of Cardiovascular Medicine) Yale University School of Medicine New Haven CT USA
- VA Connecticut Healthcare System West Haven CT USA
| | - Tiffany Armbruster
- Department of Medicine, Division of Cardiology University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Anil Gehi
- Department of Medicine, Division of Cardiology University of North Carolina at Chapel Hill Chapel Hill NC USA
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Wiebe M, Mackay M, Krishnan R, Tian J, Larsson J, Modanloo S, Job McIntosh C, Sztym M, Elton-Smith G, Rose A, Ho C, Greenshaw A, Cao B, Chan A, Hayward J. Feasibility characteristics of wrist-worn fitness trackers in health status monitoring for post-COVID patients in remote and rural areas. PLOS DIGITAL HEALTH 2024; 3:e0000571. [PMID: 39172978 PMCID: PMC11340956 DOI: 10.1371/journal.pdig.0000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 07/04/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Common, consumer-grade biosensors mounted on fitness trackers and smartwatches can measure an array of biometrics that have potential utility in post-discharge medical monitoring, especially in remote/rural communities. The feasibility characteristics for wrist-worn biosensors are poorly described for post-COVID conditions and rural populations. METHODS We prospectively recruited patients in rural communities who were enrolled in an at-home rehabilitation program for post-COVID conditions. They were asked to wear a FitBit Charge 2 device and biosensor parameters were analyzed [e.g. heart rate, sleep, and activity]. Electronic patient reported outcome measures [E-PROMS] for mental [bi-weekly] and physical [daily] symptoms were collected using SMS text or email [per patient preference]. Exit surveys and interviews evaluated the patient experience. RESULTS Ten patients were observed for an average of 58 days and half [N = 5] were monitored for 8 weeks or more. Five patients [50%] had been hospitalized with COVID [mean stay = 41 days] and 4 [36%] had required mechanical ventilation. As baseline, patients had moderate to severe levels of anxiety, depression, and stress; fatigue and shortness of breath were the most prevalent physical symptoms. Four patients [40%] already owned a smartwatch. In total, 575 patient days of patient monitoring occurred across 10 patients. Biosensor data was usable for 91.3% of study hours and surveys were completed 82.1% and 78.7% of the time for physical and mental symptoms, respectively. Positive correlations were observed between stress and resting heart rate [r = 0.360, p<0.01], stress and daily steps [r = 0.335, p<0.01], and anxiety and daily steps [r = 0.289, p<0.01]. There was a trend toward negative correlation between sleep time and physical symptom burden [r = -0.211, p = 0.05]. Patients reported an overall positive experience and identified the potential for wearable devices to improve medical safety and access to care. Concerns around data privacy/security were infrequent. CONCLUSIONS We report excellent feasibility characteristics for wrist-worn biosensors and e-PROMS as a possible substrate for multi-modal disease tracking in post-COVID conditions. Adapting consumer-grade wearables for medical use and scalable remote patient monitoring holds great potential.
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Affiliation(s)
- Madeleine Wiebe
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Marnie Mackay
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Ragur Krishnan
- Department of Electrical and Computer Engineering, Faculty of Engineering University of Alberta, Edmonton, Canada
| | - Julie Tian
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Jakob Larsson
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Setayesh Modanloo
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Christiane Job McIntosh
- Neurosciences, Rehabilitation and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
| | - Melissa Sztym
- Covenant Health Rural Health Services, Edmonton, Canada
| | | | - Alyssa Rose
- Covenant Health Rural Health Services, Edmonton, Canada
| | - Chester Ho
- Glenrose Rehabilitation Hospital, Edmonton, Canada
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Andrew Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Bo Cao
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Andrew Chan
- Glenrose Rehabilitation Hospital, Edmonton, Canada
| | - Jake Hayward
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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5
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Uher I, Vašková H, Poráčová J, Cimbolákova I, Küchelová Z, Buková A, Bernasovská J. Innovative health tracker that provides advanced functionalities to support and guide users in modifying their lifestyle: a Straussian ground theory approach. Front Psychol 2024; 15:1389340. [PMID: 38947903 PMCID: PMC11211626 DOI: 10.3389/fpsyg.2024.1389340] [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: 02/21/2024] [Accepted: 04/25/2024] [Indexed: 07/02/2024] Open
Abstract
Objective Health can be described as the state of homeostasis and optimal functioning across various bio-psycho-social dimensions and processes, allowing an individual to adapt and respond effectively to extrinsic and intrinsic challenges. Our thoughts, choices, behaviors, experiences, and feelings shape our existence. By transitioning from unconscious reactions to conscious responses, we can establish novel habits and behaviors, actively embracing positive shifts in our lifestyle. Subjects and methods The presented examination focuses on the smartwatch (SW), analyzing the incorporation of potentially progressive attributes that could enrich our lifestyle pursuits. The objective is not the health disorders themselves but the employment of wearable devices to create a strong sense of coherence in the Straussian grounded theory approach. The study had no subjects. Results The potential of the SW has been partially explored in lifestyle intervention, modification, research, and practice. Conclusion Based on our examination, creating an innovative SW capable of aiding individuals in better comprehending their behaviors and motivating them toward comprehensive changes in their lifestyle is a challenging yet attainable endeavor. Our ambition is to bring into existence SW capable of comprehensively measuring and evaluating interoception, circadian rhythm (CR), selected lifestyle pillars, and their associated components, and seamlessly integrating them into current SW features. It focuses on boosting motivation, maintenance, and amelioration regarding one's lifestyle. The novel approach strives to boost both immediate and underlying factors that actively contribute to improving one's metacognition.
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Affiliation(s)
- Ivan Uher
- Institute of Physical Education and Sport, P. J. Šafárik University, KoŠice, Slovakia
| | - Hedviga Vašková
- Faculty of Humanities and Natural Sciences, University of Prešov, Prešov, Slovakia
| | - Janka Poráčová
- Faculty of Humanities and Natural Sciences, University of Prešov, Prešov, Slovakia
| | - Iveta Cimbolákova
- Institute of Physical Education and Sport, P. J. Šafárik University, KoŠice, Slovakia
| | - Zuzana Küchelová
- Institute of Physical Education and Sport, P. J. Šafárik University, KoŠice, Slovakia
| | - Alexandra Buková
- Institute of Physical Education and Sport, P. J. Šafárik University, KoŠice, Slovakia
| | - Jarmila Bernasovská
- Faculty of Humanities and Natural Sciences, University of Prešov, Prešov, Slovakia
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Post E, Hall DA, Bloem BR. Reply to "An Apple a Day Will Not Keep the (Parkinson's Disease) Doctor at Bay!". Ann Neurol 2024; 95:1013-1014. [PMID: 38558217 DOI: 10.1002/ana.26937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Erik Post
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, the Netherlands
| | - Deborah A Hall
- Department of Neurological Sciences, Rush University, Chicago, Illinois, USA
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, the Netherlands
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Ginsburg GS, Picard RW, Friend SH. Key Issues as Wearable Digital Health Technologies Enter Clinical Care. N Engl J Med 2024; 390:1118-1127. [PMID: 38507754 DOI: 10.1056/nejmra2307160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Geoffrey S Ginsburg
- From the All of Us Research Program, National Institutes of Health, Bethesda, MD (G.S.G.); the MIT Media Lab, Cambridge, and Empatica, Boston - both in Massachusetts (R.W.P.); the Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.H.F.), and 4YouandMe, Seattle (S.H.F.)
| | - Rosalind W Picard
- From the All of Us Research Program, National Institutes of Health, Bethesda, MD (G.S.G.); the MIT Media Lab, Cambridge, and Empatica, Boston - both in Massachusetts (R.W.P.); the Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.H.F.), and 4YouandMe, Seattle (S.H.F.)
| | - Stephen H Friend
- From the All of Us Research Program, National Institutes of Health, Bethesda, MD (G.S.G.); the MIT Media Lab, Cambridge, and Empatica, Boston - both in Massachusetts (R.W.P.); the Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.H.F.), and 4YouandMe, Seattle (S.H.F.)
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Varma N, Han JK, Passman R, Rosman LA, Ghanbari H, Noseworthy P, Avari Silva JN, Deshmukh A, Sanders P, Hindricks G, Lip G, Sridhar AR. Promises and Perils of Consumer Mobile Technologies in Cardiovascular Care: JACC Scientific Statement. J Am Coll Cardiol 2024; 83:611-631. [PMID: 38296406 DOI: 10.1016/j.jacc.2023.11.024] [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: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 02/08/2024]
Abstract
Direct-to-consumer (D2C) wearables are becoming increasingly popular in cardiovascular health management because of their affordability and capability to capture diverse health data. Wearables may enable continuous health care provider-patient partnerships and reduce the volume of episodic clinic-based care (thereby reducing health care costs). However, challenges arise from the unregulated use of these devices, including questionable data reliability, potential misinterpretation of information, unintended psychological impacts, and an influx of clinically nonactionable data that may overburden the health care system. Further, these technologies could exacerbate, rather than mitigate, health disparities. Experience with wearables in atrial fibrillation underscores these challenges. The prevalent use of D2C wearables necessitates a collaborative approach among stakeholders to ensure effective integration into cardiovascular care. Wearables are heralding innovative disease screening, diagnosis, and management paradigms, expanding therapeutic avenues, and anchoring personalized medicine.
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Affiliation(s)
- Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Janet K Han
- Department of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Department of Cardiology, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA
| | - Rod Passman
- Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lindsey Anne Rosman
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Hamid Ghanbari
- Department of Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashanthan Sanders
- Department of Cardiology, University of Adelaide, South Australia, Australia
| | | | - Gregory Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
| | - Arun R Sridhar
- Department of Cardiology, Pulse Heart Institute, Seattle, Washington, USA; Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
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Ward MP, Malloy JS, Kannmacher C, Steinhubl SR. Educating the healthcare workforce of the future: lessons learned from the development and implementation of a 'Wearables in Healthcare' course. NPJ Digit Med 2023; 6:214. [PMID: 37990139 PMCID: PMC10663572 DOI: 10.1038/s41746-023-00964-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/05/2023] [Indexed: 11/23/2023] Open
Abstract
Digital health technologies will play an ever-increasing role in the future of healthcare. It is crucial that the people who will help make that transformation possible have the evidence-based and hands-on training necessary to address the many challenges ahead. To better prepare the future health workforce with the knowledge necessary to support the re-engineering of healthcare in an equitable, person-centric manner, we developed an experiential learning course-Wearables in Healthcare-for advanced undergraduate and graduate university students. Here we describe the components of that course and the lessons learned to help guide others interested in developing similar courses.
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Affiliation(s)
- Matthew P Ward
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
- Div. of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - J Scott Malloy
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Chris Kannmacher
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Steven R Steinhubl
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
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Dobson R, Stowell M, Warren J, Tane T, Ni L, Gu Y, McCool J, Whittaker R. Use of Consumer Wearables in Health Research: Issues and Considerations. J Med Internet Res 2023; 25:e52444. [PMID: 37988147 DOI: 10.2196/52444] [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: 09/04/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023] Open
Abstract
As wearable devices, which allow individuals to track and self-manage their health, become more ubiquitous, the opportunities are growing for researchers to use these sensors within interventions and for data collection. They offer access to data that are captured continuously, passively, and pragmatically with minimal user burden, providing huge advantages for health research. However, the growth in their use must be coupled with consideration of their potential limitations, in particular, digital inclusion, data availability, privacy, ethics of third-party involvement, data quality, and potential for adverse consequences. In this paper, we discuss these issues and strategies used to prevent or mitigate them and recommendations for researchers using wearables as part of interventions or for data collection.
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Affiliation(s)
- Rosie Dobson
- School of Population Health, University of Auckland, Auckland, New Zealand
- Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Melanie Stowell
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Taria Tane
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Lin Ni
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yulong Gu
- School of Health Sciences, Stockton University, Galloway, NJ, United States
| | - Judith McCool
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- School of Population Health, University of Auckland, Auckland, New Zealand
- Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
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Tian YJ(A, Jotterand F, Wangmo T. Remote Technologies and Filial Obligations at a Distance: New Opportunities and Ethical Challenges. Asian Bioeth Rev 2023; 15:479-504. [PMID: 37808448 PMCID: PMC10555987 DOI: 10.1007/s41649-023-00256-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 10/10/2023] Open
Abstract
The coupled growth of population aging and international migration warrants attention on the methods and solutions available to adult children living overseas to provide distance caregiving for their aging parents. Despite living apart from their parents, the transnational informal care literature has indicated that first-generation immigrants remain committed to carry out their filial caregiving obligations in extensive and creative ways. With functions to remotely access health information enabled by emergency, wearable, motion, and video sensors, remote monitoring technologies (RMTs) may thus also allow these international migrants to be alerted in sudden changes and remain informed of their parent's state of health. As technological solutions for caregiving, RMTs could allow independent living for older persons while any unusual deviations from normal health patterns are detected and appropriately supported. With a vignette of a distance care arrangement, we engage with concepts such as filial piety, in-absentia caregiving distress, and the social exchange theory, as well as the upholding of shifting cultural ideals to illustrate the complex dynamic of the satisfaction and quality of the informal caregiving relationship. This paper extends the traditional ethical issues in technology-aided caregiving, such as autonomy, privacy, and justice, to be considered within the context of distance care. We also posit newer ethical considerations such as consent in power imbalances, harm to caregivers, and stigma. These known and new ethical issues aim to encourage further ethically conscious design and use of RMTs to support distance care for older persons.
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Affiliation(s)
| | - Fabrice Jotterand
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, USA
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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12
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Kaplan DM, Greenleaf M, Lam WA. Wear With Care: A Call for Empirical Investigations of Adverse Outcomes of Consumer Health Wearables. MAYO CLINIC PROCEEDINGS. DIGITAL HEALTH 2023; 1:413-418. [PMID: 38143554 PMCID: PMC10745206 DOI: 10.1016/j.mcpdig.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Affiliation(s)
- Deanna M Kaplan
- Center for the Advancement of Diagnostics for a Just Society (ADJUST Center) (D.M.K., M.G., W.A.L.), and Department of Spiritual Health, Woodruff Health Sciences Center (D.M.K.), Emory University, Atlanta, GA; Department of Family and Preventive Medicine (D.M.K), and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Department of Pediatrics (W.A.L.), Emory University School of Medicine, Atlanta, GA; Emory University School of Medicine, Atlanta, GA (M.G.); and Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA (W.A.L.)
| | - Morgan Greenleaf
- Center for the Advancement of Diagnostics for a Just Society (ADJUST Center) (D.M.K., M.G., W.A.L.), and Department of Spiritual Health, Woodruff Health Sciences Center (D.M.K.), Emory University, Atlanta, GA; Department of Family and Preventive Medicine (D.M.K), and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Department of Pediatrics (W.A.L.), Emory University School of Medicine, Atlanta, GA; Emory University School of Medicine, Atlanta, GA (M.G.); and Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA (W.A.L.)
| | - Wilbur A Lam
- Center for the Advancement of Diagnostics for a Just Society (ADJUST Center) (D.M.K., M.G., W.A.L.), and Department of Spiritual Health, Woodruff Health Sciences Center (D.M.K.), Emory University, Atlanta, GA; Department of Family and Preventive Medicine (D.M.K), and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Department of Pediatrics (W.A.L.), Emory University School of Medicine, Atlanta, GA; Emory University School of Medicine, Atlanta, GA (M.G.); and Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA (W.A.L.)
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13
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Paul TJ, Tran KV, Mehawej J, Lessard D, Ding E, Filippaios A, Howard-Wilson S, Otabil EM, Noorishirazi K, Naeem S, Hamel A, Han D, Chon KH, Barton B, Saczynski J, McManus D. Anxiety, patient activation, and quality of life among stroke survivors prescribed smartwatches for atrial fibrillation monitoring. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2023; 4:118-125. [PMID: 37600446 PMCID: PMC10435956 DOI: 10.1016/j.cvdhj.2023.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Background The detection of atrial fibrillation (AF) in stroke survivors is critical to decreasing the risk of recurrent stroke. Smartwatches have emerged as a convenient and accurate means of AF diagnosis; however, the impact on critical patient-reported outcomes, including anxiety, engagement, and quality of life, remains ill defined. Objectives To examine the association between smartwatch prescription for AF detection and the patient-reported outcomes of anxiety, patient activation, and self-reported health. Methods We used data from the Pulsewatch trial, a 2-phase randomized controlled trial that included participants aged 50 years or older with a history of ischemic stroke. Participants were randomized to use either a proprietary smartphone-smartwatch app for 30 days of AF monitoring or no cardiac rhythm monitoring. Validated surveys were deployed before and after the 30-day study period to assess anxiety, patient activation, and self-rated physical and mental health. Logistic regression and generalized estimation equations were used to examine the association between smartwatch prescription for AF monitoring and changes in the patient-reported outcomes. Results A total of 110 participants (mean age 64 years, 41% female, 91% non-Hispanic White) were studied. Seventy percent of intervention participants were novice smartwatch users, as opposed to 84% of controls, and there was no significant difference in baseline rates of anxiety, activation, or self-rated health between the 2 groups. The incidence of new AF among smartwatch users was 6%. Participants who were prescribed smartwatches did not have a statistically significant change in anxiety, activation, or self-reported health as compared to those who were not prescribed smartwatches. The results held even after removing participants who received an AF alert on the watch. Conclusion The prescription of smartwatches to stroke survivors for AF monitoring does not adversely affect key patient-reported outcomes. Further research is needed to better inform the successful deployment of smartwatches in clinical practice.
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Affiliation(s)
- Tenes J. Paul
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Khanh-Van Tran
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Eric Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Andreas Filippaios
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sakeina Howard-Wilson
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Edith Mensah Otabil
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kamran Noorishirazi
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Syed Naeem
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Alex Hamel
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Dong Han
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| | - Ki H. Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jane Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - David McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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14
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Silva-Trujillo AG, González González MJ, Rocha Pérez LP, García Villalba LJ. Cybersecurity Analysis of Wearable Devices: Smartwatches Passive Attack. SENSORS (BASEL, SWITZERLAND) 2023; 23:5438. [PMID: 37420605 DOI: 10.3390/s23125438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/14/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
Wearable devices are starting to gain popularity, which means that a large portion of the population is starting to acquire these products. This kind of technology comes with a lot of advantages, as it simplifies different tasks people do daily. However, as they recollect sensitive data, they are starting to be targets for cybercriminals. The number of attacks on wearable devices forces manufacturers to improve the security of these devices to protect them. Many vulnerabilities have appeared in communication protocols, specifically Bluetooth. We focus on understanding the Bluetooth protocol and what countermeasures have been applied during their updated versions to solve the most common security problems. We have performed a passive attack on six different smartwatches to discover their vulnerabilities during the pairing process. Furthermore, we have developed a proposal of requirements needed for maximum security of wearable devices, as well as the minimum requirements needed to have a secure pairing process between two devices via Bluetooth.
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Affiliation(s)
- Alejandra Guadalupe Silva-Trujillo
- Facultad de Ingeniería, Universidad Autónoma de San Luis Potosí (UASLP), Zona Universitaria, San Luis Potosí 78290, Mexico
- Facultad de Informática, Group of Analysis, Security and Systems (GASS), Department of Software Engineering and Artificial Intelligence (DISIA), Faculty of Computer Science and Engineering, Office 431, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain
| | - Mauricio Jacobo González González
- Facultad de Ingeniería, Universidad Autónoma de San Luis Potosí (UASLP), Zona Universitaria, San Luis Potosí 78290, Mexico
- Instituto Tecnológico de Estudios Superiores de Monterrey, Escuela de Ingeniería y Ciencias, Departamento de Computación, Campus Puebla, Puebla 72453, Mexico
| | - Luis Pablo Rocha Pérez
- Facultad de Ingeniería, Universidad Autónoma de San Luis Potosí (UASLP), Zona Universitaria, San Luis Potosí 78290, Mexico
| | - Luis Javier García Villalba
- Facultad de Informática, Group of Analysis, Security and Systems (GASS), Department of Software Engineering and Artificial Intelligence (DISIA), Faculty of Computer Science and Engineering, Office 431, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain
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15
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Filippaios A, Tran KVT, Mehawej J, Ding E, Paul T, Lessard D, Barton B, Lin H, Naeem S, Otabil EM, Noorishirazi K, Dai Q, Sadiq H, Chon KH, Soni A, Saczynski J, McManus DD. Psychosocial measures in relation to smartwatch alerts for atrial fibrillation detection. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:198-200. [PMID: 36310684 PMCID: PMC9596300 DOI: 10.1016/j.cvdhj.2022.07.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andreas Filippaios
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Khanh-Van T Tran
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Eric Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Tenes Paul
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Honghuang Lin
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Syed Naeem
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Edith Mensah Otabil
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Kamran Noorishirazi
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Qiying Dai
- Division of Cardiovascular Medicine, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Hammad Sadiq
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Ki H Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| | - Apurv Soni
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jane Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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16
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de Angel V, Lewis S, White KM, Matcham F, Hotopf M. Clinical Targets and Attitudes Toward Implementing Digital Health Tools for Remote Measurement in Treatment for Depression: Focus Groups With Patients and Clinicians. JMIR Ment Health 2022; 9:e38934. [PMID: 35969448 PMCID: PMC9425163 DOI: 10.2196/38934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Remote measurement technologies, such as smartphones and wearable devices, can improve treatment outcomes for depression through enhanced illness characterization and monitoring. However, little is known about digital outcomes that are clinically meaningful to patients and clinicians. Moreover, if these technologies are to be successfully implemented within treatment, stakeholders' views on the barriers to and facilitators of their implementation in treatment must be considered. OBJECTIVE This study aims to identify clinically meaningful targets for digital health research in depression and explore attitudes toward their implementation in psychological services. METHODS A grounded theory approach was used on qualitative data from 3 focus groups of patients with a current diagnosis of depression and clinicians with >6 months of experience with delivering psychotherapy (N=22). RESULTS Emerging themes on clinical targets fell into the following two main categories: promoters and markers of change. The former are behaviors that participants engage in to promote mental health, and the latter signal a change in mood. These themes were further subdivided into external changes (changes in behavior) or internal changes (changes in thoughts or feelings) and mapped with potential digital sensors. The following six implementation acceptability themes emerged: technology-related factors, information and data management, emotional support, cognitive support, increased self-awareness, and clinical utility. CONCLUSIONS The promoters versus markers of change differentiation have implications for a causal model of digital phenotyping in depression, which this paper presents. Internal versus external subdivisions are helpful in determining which factors are more susceptible to being measured by using active versus passive methods. The implications for implementation within psychotherapy are discussed with regard to treatment effectiveness, service provision, and patient and clinician experience.
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Affiliation(s)
- Valeria de Angel
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Serena Lewis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychology, University of Bath, Bath, United Kingdom
| | - Katie M White
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Faith Matcham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,School of Psychology, University of Sussex, Falmer, East Sussex, United Kingdom
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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17
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Paroxysmal Atrial Fibrillation in Horses: Pathophysiology, Diagnostics and Clinical Aspects. Animals (Basel) 2022; 12:ani12060698. [PMID: 35327097 PMCID: PMC8944606 DOI: 10.3390/ani12060698] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in horses causing poor performance. As in humans, the condition can be intermittent in nature, known as paroxysmal atrial fibrillation (pAF). This review covers the literature relating to pAF in horses and includes references to the human literature to compare pathophysiology, clinical presentation, diagnostic tools and treatment. The arrhythmia is diagnosed by auscultation and electrocardiography (ECG), and clinical signs can vary from sudden loss of racing performance to reduced fitness or no signs at all. If left untreated, pAF may promote electrical, functional and structural remodeling of the myocardium, thus creating a substrate that is able to maintain the arrhythmia, which over time may progress into permanent AF. Long-term ECG monitoring is essential for diagnosing the condition and fully understanding the duration and frequency of pAF episodes. The potential to adapt human cardiac monitoring systems and computational ECG analysis is therefore of interest and may benefit future diagnostic tools in equine medicine.
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18
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Dhruva SS, Shah ND, Vemulapalli S, Deshmukh A, Beatty AL, Gamble GM, Freeman JV, Hummel JP, Piccini JP, Akar JG, Ervin K, Arges KL, Emanuel L, Noseworthy PA, Hu T, Bartlett V, Ross JS. Heart Watch Study: protocol for a pragmatic randomised controlled trial. BMJ Open 2021; 11:e054550. [PMID: 35234659 PMCID: PMC8719216 DOI: 10.1136/bmjopen-2021-054550] [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: 06/16/2021] [Accepted: 12/03/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Personal digital devices that provide health information, such as the Apple Watch, have developed an increasing array of cardiopulmonary tracking features which have received regulatory clearance and are directly marketed to consumers. Despite their widespread and increasing use, data about the impact of personal digital device use on patient-reported outcomes and healthcare utilisation are sparse. Among a population of patients with atrial fibrillation and/or atrial flutter undergoing cardioversion, our primary aim is to determine the impact of the heart rate measurement, irregular rhythm notification, and ECG features of the Apple Watch on quality of life and healthcare utilisation. METHODS AND ANALYSIS We are conducting a prospective, open-label multicentre pragmatic randomised clinical trial, leveraging a unique patient-centred health data sharing platform for enrolment and follow-up. A total of 150 patients undergoing cardioversion for atrial fibrillation or atrial flutter will be randomised 1:1 to receive the Apple Watch Series 6 or Withings Move at the time of cardioversion. The primary outcome is the difference in the Atrial Fibrillation Effect on QualiTy-of-life global score at 6 months postcardioversion. Secondary outcomes include inpatient and outpatient healthcare utilisation. Additional secondary outcomes include a comparison of the Apple Watch ECG and pulse oximeter features with gold-standard data obtained in routine clinical care settings. ETHICS AND DISSEMINATION The Institutional Review Boards at Yale University, Mayo Clinic, and Duke University Health System have approved the trial protocol. This trial will provide important data to policymakers, clinicians and patients about the impact of the heart rate, irregular rhythm notification, and ECG features of widely used personal digital devices on patient quality of life and healthcare utilisation. Findings will be disseminated to study participants, at professional society meetings and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04468321.
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Affiliation(s)
- Sanket S Dhruva
- Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Nilay D Shah
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, New York, USA
| | - Alexis L Beatty
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Ginger M Gamble
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - James V Freeman
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - James P Hummel
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph G Akar
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Keondae Ervin
- National Evaluation System for health Technology Coordinating Center (NESTcc), Medical Device Innovation Consortium, Arlington, Virginia, USA
| | - Kristine L Arges
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lindsay Emanuel
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter A Noseworthy
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, New York, USA
| | - Tiffany Hu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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